Cone-beam CT acquisition during transradial TACE made easy; use of the swivel arm board.

Abstract

Transradial access for peripheral intervention often requires certain modification from its coronary counterparts. One of the challenges during transradial transarterial chemoembolization (TACE) is the need for the access arm to be repositioned during cone-beam CT (CBCT) acquisition to allow for C-arm rotation. We recently introduced a swivel arm board to allow seamless repositioning of the access arm during and after CBCT acquisition. The purpose of this study is to detail the technique and feasibility of this useful adjunct to transradial TACE. We performed a retrospective study of consecutive cases of transradial TACE between November 2015 and March 2016, which represented the period where we introduced the swivel arm board to our transradial procedure. A total of 20 transradial TACE using the swivel arm board was performed in 17 patients. There were 13 males and 4 females. The mean age was 69.5 years old (range 48-82 years). Indications for TACE included hepatocellular carcinoma (n = 14) and metastatic liver disease (n = 3). Transradial TACE was successful in all cases. A total of 40 successful arm repositioning using the swivel arm board for CBCT acquisitions were performed (100% success rate). There was no catheter or sheath dislodgement associated with the arm movements. No change in the microcatheter tip position was detected as a result of the arm repositioning. Hemostasis was successfully achieved in all the patients. There was no access related complication. The swivel arm board is a useful adjunct to enable CBCT acquisition during transradial TACE. Advances in knowledge: Transradial TACE is a novel technique, and adaptation to allow for CBCT acquisition is currently challenging. This manuscript illustrates how to overcome the positioning difficulties with the use of the swivel arm board.