Abstract No. 36 Radial Access in the Setting of Angiography and Embolization for Trauma: Our Experience

Abstract

Traditionally, transradial artery access (TRA) has been secondary to transfemoral artery access (TFA) for interventional radiology (IR) procedures, especially in the setting of trauma. As interventionists have demonstrated increasing confidence in TRA in emergent settings such as in cardiac and stroke cases, the use of TRA in the setting of trauma has gained increasing traction. We aim to describe our experience with TRA for IR angiography and embolization in the setting of trauma. We performed a retrospective review of all arterial angiography and possible embolization cases in the setting of trauma performed by IRs at our level 1 trauma center from 2015 to 2022. Cases were extracted from our institutional database using the search terms “trauma,” “gunshot,” “gsw,” and “mvc.” We manually reviewed and excluded the non-trauma cases. 630 trauma patients (mean age, 41 years; 30.4% female) underwent 685 arterial angiography with possible embolization. 91.7% (628/685) of cases underwent TFA; 6.9% (47/685) underwent TRA; 0.1% (1/685) underwent brachial artery access; 0.1% (1/685) underwent subclavian artery access; and 0.4% (3/685) underwent TFA first but transitioned to TRA. There was no significant difference in age (mean, 40.9 TFA; mean, 39.1 TRA; P = 0.42) or sex (P = 0.87) between those who underwent TFA vs TRA. TRA were successfully performed for 23 pelvic, 1 splenic, 2 renal, 10 hepatic, 1 mesenteric, 2 intercostal artery, and 8 combination cases. Reasons for TFA to TRA transition include difficulty accessing the femoral artery or the bleeding target artery. Reasons given for attempting TRA before TFA include groin hematomas and pelvic binder. 87.2% (41/47) had a pre-procedural CT/CTA demonstrating hemorrhage or pseudoaneurysm. 72.3% (34/47) had a post-procedure CT/CTA for follow-up. The average contrast usage for TRA cases was 106.4 cc with mean fluoro time of 17.5 min. The reintervention rate was 14.9% (7/47) due to rebleeding or no active bleeding seen on the initial angiogram. There were no reported radial access site complications. Although IRs traditionally have relied on TFA for trauma angiography and embolization, TRA can be an alternative, safe option for a variety of emergent cases. TRA may be the route of choice in trauma patients with groin hematomas or pelvic binders.