Clinical experience with distal transradial access for endovascular treatment of various noncoronary interventions in a multicenter study

Comparison of Distal Transradial and Femoral Access in Endovascular Treatment of Non-coronary Arterial Disease

This study compared the efficacy and safety of distal transradial access (dTRA) and common femoral artery access (CFA) for endovascular treatment of non-coronary arterial disease. 102 interventions were divided into dTRA (n = 51) and CFA (n = 51) groups; the puncture success rate was 100% in both groups. The mean number of punctures and puncture time were greater in the dTRA than CFA group (1.86 vs 1.04 and 3.96 vs ≤1.00 min, p < .001 for both), whereas the access-related complication rate was comparable. The surgical success rate was higher in the CFA than dTRA group (98.0 vs 84.3, p = .036), and the operative time was longer in the dTRA than CFA group (99.09 vs 84.10 min, p = .017). The postoperative adverse event rate was not different between the dTRA and CFA groups. dTRA is a safe and feasible access for non-coronary arterial disease and is comparable to CFA in terms of puncture success, access-related complications, and major adverse events. The dTRA is inferior to CFA in the treatment of lower extremity arterial disease. Due to the increase in the operation time and the contrast medium volume in the dTRA, it is necessary to be vigilant about contrast nephropathy and late radiological random side effects.

Efficacy and Safety of Distal Radial Access for Transcatheter Arterial Chemoembolization (TACE) of the Liver

BACKGROUND

The distal radial artery has emerged as an alternative vascular-access site to conventional transfemoral and transradial approaches. The main advantage over the conventional transradial route is the reduced risk of radial artery occlusion, especially in those patients who, for various clinical reasons, have to undergo repeated endovascular procedures. This study aims to assess the efficacy and safety of distal radial access for transcatheter arterial chemoembolization of the liver.

METHODS

This investigation is a single-center retrospective analysis of 42 consecutive patients who had undergone, from January 2018 to December 2022, transcatheter arterial chemoembolization of the liver with distal radial access for intermediate-stage hepatocellular carcinoma. Outcome data were compared with a retrospectively constituted control group of 40 patients undergoing drug-eluting beads-transcatheter arterial chemoembolization with femoral access.

RESULTS

Technical success was achieved in all cases, with a 2.4% conversion rate for distal radial access. A superselective chemoembolization was performed in 35 (83.3%) cases of distal radial access. No episode of radial artery spasm or radial artery occlusion occurred. No significant differences in efficacy and safety were observed between the distal radial access group and the femoral access group.

CONCLUSIONS

Distal radial access is effective, safe, and comparable to femoral access in patients undergoing transcatheter arterial chemoembolization of the liver.

Distal radial artery access in noncoronary procedures

Since the beginning of interventional cardiology and for decades, the femoral artery has been the access of choice for both diagnostic and interventional endovascular procedures. Due to an extensive evidence base accumulated over the last 20 years, the majority of interventional cardiologists around the world prefer classical radial artery access for both elective and emergency procedures. A similar trend has been observed for distal radial artery access over the last five years. Noncoronary endovascular surgery undergoes the same stages of improvement and optimization of access, but in a more accelerated way. The goal of this review is to analyze the literature on distal radial artery access in noncoronary procedures.

Distal radial artery approach for endovascular therapy

It has been reported that the distal transradial approach (dTRA) is safe and useful for percutaneous coronary intervention (PCI). In this study we evaluated the safety and efficacy of the dTRA for endovascular therapy (EVT). The dTRA for EVT was performed in 43 lesions from 35 patients. Approach site was determined at the discretion of the operator. Clinical data were analyzed retrospectively. Average patient age was 74.0 ± 6.5 years; 30 (86%) were male; average height was 161.1 ± 8.4 cm. Diabetes mellitus, hypertension, dyslipidemia, and smoking habit were present in 19 (54.3%), 31 (88.6%), 29 (82.9%), and 29 (82.9%) patients, respectively. Target lesions were iliac artery in 38 (88.4%) patients, superficial femoral artery in 4 (9.3%) and renal artery in the remaining patient (2.3%). Eight lesions (18.6%) were chronic total occlusions. Thirteen (30.2%), 2 (4.7%), and 28 (65.1%) lesions were treated using 4.5, 6, and 7 French long guiding systems, respectively. All lesions were successfully treated without any procedural or access site-related complications. No additional puncture sites were required. Ankle brachial index significantly improved from 0.62 ± 0.20 to 0.92 ± 0.17 (p < 0.0001) post-treatment for the lower limbs. There were no radial artery occlusions, target lesion revascularization, or complications 1 month later. Similar to PCI, the dTRA for EVT is safe and feasible without any specific complications in carefully selected patients.

Renal Arteriography via Radial Artery Access with a 125 cm Long Angiographic Catheter

A 125 cm long catheter makes it possible to perform renal arteriography via radial artery, but its feasibility and safety remain unclear. Our study recruited 1,323 patients grouped by two different vascular accesses to renal arteriography, i.e., femoral artery access and radial artery access. The success rate of angiography was 100% in both groups. Differential analysis showed that the overall complication incidence of radial artery access group was significantly lower (2.5% for radial artery access vs. 4.8% for femoral artery access, p = 0.03). From this study, we suggest that using the 125 cm angiographic catheter to perform renal arteriography via radial artery access is feasible and safe.

Distal snuffbox versus conventional radial artery access: An updated systematic review and meta-analysis

BACKGROUND

A comprehensive comparison of available data in terms of vascular complications between distal and conventional transradial access is still partial and a net benefit of such approach has not yet been clearly demonstrated.

OBJECTIVE

To provide an updated comparison of complications between distal and conventional transradial access used to perform coronary angiography and/or percutaneous coronary intervention performing a systematic review and meta-analysis.

DATA SOURCES

Data were obtained searching MEDLINE, Scopus, and Web of Science for all investigations published any time to December 22, 2020 reporting a comparison between distal and conventional transradial access. The occurrence of radial artery occlusion was chosen as the primary outcome while the hematoma at access site and spasm as secondary and tertiary outcome, respectively.

STUDY ELIGIBILITY CRITERIA

Case-control studies comparing distal and conventional transradial access for coronary angiography and/or percutaneous coronary intervention. All studies included adult patients aged at least 18 years.

STUDY APPRAISAL AND SYNTHESIS METHODS

Overall, 7073 patients (mean age 57.9 and 58.4 years for distal and conventional transradial access, respectively), were analyzed. The rate of radial artery occlusion was significantly lower in the distal compared with the conventional group (2.1% vs 4.6%, p < 0.001). The pooled analysis, based on a fixed effect model confirmed a lower relative risk of occlusion when distal access is used (RR: 0.46, 95% CI: 0.31-069, p = 0.002, I² = 0%). Conversely, no differences in the risk of developing a hematoma at the access site or in the occurrence of a radial artery spasms were observed comparing the two groups (RR: 0.65, 95% CI: 0.37-1.13, p = 0.12, I² = 0% and RR: 0.88, 95% CI: 0.48-1.63, p = 0.001, I² = 0%, respectively).

LIMITATIONS

Only eight case-control studies met inclusion criteria.

CONCLUSION

This metanalysis confirmed a lower risk of radial artery occlusion using distal access and comparable performance in terms of hematoma, and radial artery spam risk.

Distal Transradial Access for Diagnostic Cerebral Angiography and Neurointervention: Systematic Review and Meta-analysis

BACKGROUND

Radial artery access for cerebral angiography is traditionally performed in the wrist. Distal transradial access in the anatomic snuffbox is an alternative with several advantages.

PURPOSE

Our aim was to review the safety and efficacy of distal transradial access for diagnostic cerebral angiography and neurointerventions.

DATA SOURCES

We performed a comprehensive search of the literature using PubMed, Scopus, and EMBASE.

STUDY SELECTION

The study included all case series of at least 10 patients describing outcomes associated with distal transradial access for diagnostic cerebral angiography or a neurointervention.

DATA ANALYSIS

Random-effects models were used to obtain pooled rates of procedural success and complications.

DATA SYNTHESIS

A total of 7 studies comprising 348 (75.8%) diagnostic cerebral angiograms and 111 (24.2%) interventions met the inclusion criteria. The pooled success rate was 95% (95% CI, 91%-98%; I² = 74.33). The pooled minor complication rate was 2% (95% CI, 1%-4%; I² = 0. No major complications were reported. For diagnostic procedures, the combined mean fluoroscopy time was 13.53 [SD, 8.82] minutes and the mean contrast dose was 74.9 [SD, 35.6] mL.

LIMITATIONS

A small number of studies met the inclusion criteria, all of them were retrospective, and none compared outcomes with proximal transradial or femoral access.

CONCLUSIONS

Early experience with distal transradial access suggests that it is a safe and effective alternative to proximal radial and femoral access for performing diagnostic cerebral angiography and interventions. Additional studies are needed to establish its efficacy and compare it with other access sites.