Safety and Feasibility of Transradial Access for Visceral Interventions in Patients with Thrombocytopenia

Abstract

Purpose Transradial access (TRA) has shown lower morbidity and decreased bleeding complications compared with transfemoral access (TFA). This study evaluates the safety and feasibility of TRA in patients with a platelet count of [lte] 50,000/µL for visceral interventions. Material and Methods Patients who underwent visceral interventions via the radial artery with a platelet count [lte] 50,000/µL on the day of procedure were retrospectively reviewed. In all cases, a Barbeau test was performed. A 5F Glidesheath (Terumo Medical Corporation, Somerset, New Jersey) was placed in the left radial artery using ultrasound guidance. Following sheath placement, a combination of 3000 U heparin, 2.5 mg verapamil, and 200 mcg nitroglycerin was administered intra-arterially. A TR band (Terumo Medical Corporation, Somerset, New Jersey) was used for hemostasis upon completion of each procedure. Technical success, major and minor adverse events, and procedural details were recorded. Results From 1 July 1 2012 to 1 September 2014, a total of 960 peripheral interventions via TRA were performed, of which 51 procedures were performed in 44 patients (Age: 63.8 ± 10.2 years, 11 female, 33 male) with a platelet count [lte] 50,000/µL (median [interquartile range]: 39 [34 to 44.5]/µL). Interventions included chemoembolization (n = 30), radioembolization mapping (n = 15), radioembolization (n = 2), splenic embolization (n = 3), and renal embolization (n = 1). Technical success was achieved in 50/51 (98%) cases. There was 1 case of severe vessel spasm requiring ipsilateral femoral crossover. There were no major adverse events at 30 days. Minor access site bruising occurred in 3 patients (6%) and was treated conservatively in all cases. Conclusions Transradial visceral interventions in patients with thrombocytopenia are both feasible and safe.