1:46 PM Abstract No. 198 - Transradial approach for hepatic arterial embolization: initial results and technique

Abstract

Purpose Extensive experience exists in the interventional cardiology community on transradial approach (TRA) for cardiac catheterization. Benefits of this technique over transfemoral approach (TFA) include lower morbidity and mortality including significant bleeding complications [1], increased patient comfort, decreased costs compared to femoral closure devices and immediate ambulation in an outpatient setting. We describe our initial experience with TRA for hepatic arterial embolization (HAE). Materials and Methods Over a 7 month period, 30 procedures were performed in 26 patients (21 male, 5 female; mean age 67) using a TRA for HAE. Procedures included: chemoembolization (TACE) (n = 14), Y90 (n = 14), and bland embolization (n = 2). Tumor pathology included: HCC (n = 21) and metastatic disease (n = 5). A Barbeau test [2] was performed using a pulse oximeter on the left thumb to confirm presence of dual circulation and patency of the palmar arch. A 5F Glidesheath [3] was placed in the left radial artery (RA) using US guidance. A solution of 3000 U heparin, 2 mg verapamil, and 200 mcg nitroglycerin was administered interarterially following sheath placement. A 5F 110 cm Optitorque Sarah Radial catheter [3] was used to catheterize the visceral arteries. At completion, a TR band [3] was placed for radial compression and removed after 2 hours. Technical success, 30-day major and minor adverse events, and patient preference were evaluated. Results Technical success was obtained in all procedures (100%). There were no major adverse events at 30 days. Mild pain and weakness in the left hand was observed in 1 case (3.3%) 3 days post Y90 which resolved with NSAIDs. One asymptomatic RA thrombosis was observed post TACE (3.3%) which was successfully cannulated for access during a 2nd TACE 28 days later. A minor hematoma was observed in 1 procedure (3.3%) which resolved spontaneously. 11/26 patients (42.3%) had prior TFA and in this group, 11/11 (100%) preferred TRA. Conclusion TRA for HAE is feasible, safe and well tolerated. In patients that previously had TFA, TRA was preferred.