4:03 PM Abstract No. 189 Transradial arterial access vasodilation cocktail: is the calcium channel blocker needed?

Abstract

Transradial access (TRA) for arterial procedures in interventional radiology (IR) continues to grow in popularity. During IR radial arterial access it is standard to give a cocktail of Heparin, Nitrates, and a calcium channel blocker (Verapamil) through the vascular sheath to prevent arterial vasospasm. However, data within Interventional Cardiology radial access literature questions the need of Verapamil. This study was completed to evaluate the safety, efficacy, and cost of TRA without the use of Verapamil in the vasodilation cocktail at a single institution. Retrospective review of all TRA cases completed in the department of IR at a single institution were reviewed from September 2014 to July 2019. A total of 244 TRA cases were identified. Verapamil was used in the TRA vasodilation cocktail for 32 patients until May 14, 2015. No Verapamil was used for the remaining 212 TRA cases through July 2019. Electronic medical record chart review was completed on all procedures to evaluate complication rates and technical success rates. In addition, the average wholesale price of Verapamil was obtained via the vendor. Technical success rates for TRA completed with and without Verapamil in the vasodilation cocktail were 100% and 98%, respectively. The technical failures that occurred in TRA cases without Verapamil were secondary to an anatomical variant of the left radial artery and an inability to cannulate a superselective hepatic artery branch. Neither failure was impacted by the lack of Verapamil. The complication rate from TRA intervention without Verapamil was 0.8%. Both the technical success and complication rates of TRA without Verapamil compare favorably to current literature. The average wholesale price of Verapamil is $12.60 per 5 mg vial, for a total savings of $2,671.20 over the time period. Elimination of Verapamil from the TRA vasodilation cocktail showed similar safety, efficacy, and decreased hospital costs for TRA arterial IR interventions.