Radial Artery Access Research Articles

Practical uses of the BENCHMARK™ BMX®81 in the road less travelled: Guide catheter comparison for radial access in neurovascular intervention.

Radial arterial access has gained interest for neurovascular procedures in recent years. Although there are no randomized control trials for neurointervention procedures using radial access, there is growing literature demonstrating its feasibility and favorable outcomes. Equipment technical improvements, like the recently introduced BENCHMARK™ BMX®81 System, have made radial navigation safer, with improved maneuverability and support for a variety of procedures. We present a multicenter case series highlighting our institutional radial access experience comparing the BMX®81 with alternative catheters. Multicenter retrospective cohort study of 80 patients who underwent neurovascular procedures through a radial approach. In half of the cases a BENCHMARK™ BMX®81 System was used. The comparison group consisted of the BENCHMARK™071 and 96, Neuron MAX®088 and BALLAST™ systems. Procedures included endovascular thrombectomy, carotid and brachiocephalic artery stenting, middle meningeal artery embolization, flow diverter stenting, vertebral artery sacrifice, aneurysm coiling, and WEB™ device deployment. In our series, the BMX®81 was successful in the navigation of the anatomy to the target location in 95% of cases. No radial access or BMX®81 related complications were identified. There was no significant difference in fluoroscopy time between the BMX81 and the comparison group. Four patients in the comparison group had catheter-related complications due to vasospasm. Eighty-six percent of BMX®81 cases had satisfactory outcomes and no technical difficulties. The remainder presented technical difficulties, but none of these were considered secondary to the puncture site or support structure. The BENCHMARK™ BMX®81 System is a recently developed guiding catheter which has design and size features supporting radial access for a variety of neurovascular interventions. Early multicenter experience highlights the ease of use and versatility of this new catheter as an alternative to transfemoral access as well as other catheters used for radial access.

Interventions for renal artery stenosis: Appraisal of novel physiological insights and procedural techniques to improve clinical outcome.

Randomized clinical trials failed to show additional benefit of renal artery stenting on top of medical therapy. Instead of writing an obituary on renal artery stenting, we try to explain these disappointing results. A transstenotic pressure gradient is needed to reduce renal perfusion and to activate the renin-angiotensin-aldosterone system. In only a minority of patients included in trials, a transstenotic pressure gradient is measured and reported. Like the coronary circulation, integration of physiological lesion assessment will allow to avoid stenting of non-significant lesions and select those patients that are most likely to benefit from renal artery stenting. Renal artery interventions are associated with peri-procedural complications. Contemporary techniques, including radial artery access, no-touch technique to engage the renal ostium and the use of embolic protection devices, will minimize procedural risk. Combining optimal patient selection and meticulous technique might lead to a netto clinical benefit when renal artery stenting is added to optimal medical therapy.

Effectiveness of Radial Artery Positioning Board (RAPB) on Radial Artery Access and Prevention of Access Site Complications among Patients Admitted in Critical Care Units at Tertiary Care Hospital, Puducherry

Background: Radial artery access is a fundamental procedure in critical care settings, yet achieving optimal wrist extension poses challenges. This study investigates the efficacy of a novel intervention, the radial artery positioning board (RAPB), in enhancing radial artery access success rates and preventing access site complications among critically ill patients.  Methods: Employing a randomized controlled trial with a two-group post-tests only control design, 160 patients were enrolled using a block random sampling method. The study, conducted at a tertiary care hospital in Puducherry, utilized both descriptive and inferential statistical analyses to assess the outcomes.  Results: Analysis revealed a significant improvement in the success rates of radial artery access (z = -11.125, p < 0.05) and a notable reduction in access site complications (z = 7.938, p < 0.05) in the RAPB group compared to the control group. Furthermore, a positive correlation was established between successful radial artery access using RAPB and the prevention of access site complications (r = 0.504, p < 0.05).  Conclusion: The findings underscore the effectiveness of RAPB in facilitating early radial artery access with heightened success rates and diminished access site complications among critically ill patients. Additionally, body mass index and comorbidities exhibited statistically significant associations with radial artery access (p < 0.05), emphasizing the need for tailored interventions in this population.

Ultrasound-guided Axillary Artery Catheter Placement and Associated Complications in Critically Ill Patients.

Arterial catheter placement for hemodynamic monitoring is commonly performed in critically ill patients. The radial and femoral arteries are the two sites most frequently used; there is limited data on the use of the axillary artery for this purpose. The aim of this study was to investigate the rate of complications from ultrasound-guided axillary artery catheter placement in critically ill patients. A retrospective study at a tertiary care center of patients admitted to an intensive care unit who had ultrasound-guided axillary artery catheter placement during admission. Primary outcome of interest was catheter related complications, including bleeding, vascular complications, compartment syndrome, stroke or air embolism, catheter malfunction, and need for surgical intervention. This study identified 88 patients who had an ultrasound-guided axillary artery catheter placed during their admission. Of these 88, nine patients required multiple catheters placed, for a total of 99 axillary artery catheter placement events. The median age was 64 [IQR 48, 71], 41 (47%) were female, and median body mass index (BMI) was 26 [IQR 22, 30]. The most common complication was minor bleeding (11%), followed by catheter malfunction (2%), and vascular complications (2%). Univariate analyses did not show any association between demographics and clinical variables, and complications related to axillary arterial catheter. The most common complication found with ultrasound-guided axillary artery catheter placement was minor bleeding, followed by catheter malfunction, and vascular complications. Ultrasound-guided axillary arterial catheters are an alternative in patients in whom radial or femoral arterial access is difficult or not possible to achieve.

Current alternatives to traditional radial approach for coronary interventions: A randomized prospective study of the ulnar and distal radial approaches.

The radial artery is the standard access for coronary intervention; however, it is essential to have alternative accesses as it may be used as a conduit during coronary artery bypass grafting or for dialysis fistula. Ulnar and distal radial artery accesses have emerged as alternative accesses for traditional radial artery. To compare distal radial artery access and ulnar artery access as alternatives to traditional radial artery access regarding safety, efficacy, and success rate. Two-hundred patients were included (100 traditional radial [TRA], 50 distal radial [DRA] and 50 ulnar). Access artery follow up ultrasound was performed up to 28 days. Procedural success rate was 97%, 74%, and 92% in the TRA, DRA and ulnar groups, respectively (p < 0.001). Crossover occurred in 3 patients (3%) in TRA, 13 patients (26%) in DRA and 4 cases (8%) in ulnar group (p < 0.001). The most common cause of crossover was failure of artery cannulation. Regarding cannulation time, the mean access time in seconds was 80.19 ± 25.98, 148.4 ± 29.60, 90.5 ± 21.84 in TRA, DRA and ulnar groups, respectively (p < 0.001). Our study concluded that these new approaches proved to be potential alternatives to traditional radial approach; however, ulnar artery access proved to be superior to distal radial artery access as regards success rate and cannulation time.

Radial Artery Access for Peripheral Vascular Interventions: A Review of the Literature

ObjectivePercutaneous radial artery access for lower extremity arterial interventions has increased in popularity in recent years. The purpose of this review is to summarize available data regarding its safety and efficacy. MethodsStudies related to the use of the percutaneous radial artery access for peripheral artery intervention were identified in a search of the PubMed database. Outcomes evaluated were access complications and technical success. ResultsThirteen studies that evaluated patients undergoing percutaneous radial artery access with peripheral interventions were reviewed. Several studies were able to demonstrate use of up to 8Fr sheath; however, the majority was 6Fr. Reported rates of asymptomatic radial artery occlusion ranged up to 16% and reported radial artery access site complication rate ranged from 0-15.6%. Technical success ranged from 74%-98.7%. ConclusionsPercutaneous radial artery access can effectively and safely be used in select patients.

706 Radial Versus Femoral Access for Diagnostic Cerebral Angiography: A Systematic Review and Meta-analysis of Randomized Trials

INTRODUCTION: Radial artery access is the gold standard for percutaneous coronary procedures, desmonstrating benefits for patient safety and comfort, its adoption for diagnostic cerebral angiography has been limited by doctors’ concerns about achieving procedural success. METHODS: PubMed, Embase and Cochrane databases were searched through April 2023. Statistical analysis were performed using R version 4.2.3. Random-effects meta-analysis with risk ratio (RR) and 95% CI were estimated using the inverse variance and Mantel-Haenszel method for binary outcomes and DerSimonian-Laird estimator for continuous outcomes. The primary outcome was technical success, and the secondary outcomes were procedure time, radiation exposure and fluoroscopy. RESULTS: After reviewing 142 studies, were included 3 randomized trials involving 492 patients with 250 patients in radial group (50.81%) and 242 in femoral (49.19%). The total mean age of the patients was 57 years old, 249 males (50.61%) and 243 females (49.39%). There is no significant difference in technical success (RR 0.99, 95% CI 0.94 to 1.03, p = 0.555, I2 = 0%), procedure time (WMD 2.08 minutes, 95% CI -5.11 to 9.28, p = 0.570, I2 = 87%) and radiation exposure also showed no significant difference (WMD 27.87 mGy, 95% CI -21.43 to 77.17, p=0.268, I2 = 0%). Fluoroscopy time had high heterogeneity and a non-significant result (WMD 2.70 minutes, 95% CI -0.73 to 6.13, p = 0.123, I2 = 82%). The funnel plots showed roughly inverted symmetrical distributions among study points which indicated the lack of any preliminary publication bias. Leave-one-out sensitivity analysis determined that the final pooled results were unstable. CONCLUSIONS: The findings suggest that the procedures studied have similar technical success rates and radiation exposure. Studies are needed to explore the factors contributing to heterogeneity in procedure and fluoroscopy times to optimize safety and efficiency in radial or femoral access.

Distal Versus Proximal Radial Artery Access for Cardiac Catheterization: 1-Year Outcomes

Proximal radial artery (PRA) access for cardiac catheterization is safe but can jeopardize subsequent use of the artery because of occlusion. Distal radial artery (DRA) access in the anatomical snuffbox preserves the RA but safety and potential detrimental effects on hand function are unknown. We aimed to assess hand function and complications after DRA and PRA. In this single-center trial, 300 patients were randomly allocated 1:1 to cardiac catheterization through DRA or PRA. The primary end point of change in hand function from baseline to 1 year was a composite of the Quick Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, hand grip test, and thumb-forefinger pinch test. The secondary end points included access feasibility and complications. Of 216 patients with 1-year completed follow-up, 112 were randomly allocated to DRA and 104 to PRA, with balanced demographics and procedural characteristics. Both groups had similar access site bleeding rates (DRA 0% vs PRA 1.4%, p = 0.25). Radial artery occlusion occurred in 1 PRA patient versus 2 in DRA. There was no significant difference in change of hand function, median (interquartile range) hand grip (DRA 0.7 [-3 to 4.5] vs PRA 1.3 [-2 to 4.3] kg, p = 0.57), pinch grip (DRA -0.1 [-1.1 to 1] vs PRA -0.3 [-1 to 0.7] kg, p = 0.66), and Quick DASH (DRA 0 [-6.6 to 2.3] vs PRA 0 [-4.6 to 2.9] points, p = 0.58). The composite of hand function was comparable between PRA and DRA. In conclusion, DRA is a safe strategy for cardiac catheterization, with a low complication rate. Compared with PRA, there is no increased risk of hand dysfunction or radial artery occlusion at 1 year.

Distal Versus Proximal Radial Arterial Access for Percutaneous Coronary Angiography and Intervention: Updated Meta-Analysis of Randomized Controlled Trials

Radial artery occlusion (RAO) is a major impediment to reintervention in patients who underwent proximal transradial access (p-TRA) for coronary catheterization. Distal transradial access (d-TRA) at the level of snuffbox distal to the radial artery bifurcation is a novel alternative to p-TRA. We conducted an updated meta-analysis of all available randomized controlled trials (RCTs) to compare the incidence of RAO between p-TRA and d-TRA, along with access site-related complications. PubMed, Web of Science, and Google Scholar were searched for RCTs published since 2017 to October 2023 comparing d-TRA and p-TRA for coronary angiography and/or intervention. Risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals were calculated using the random-effects model for procedural and clinical outcomes for the 2 approaches. A total of 18 RCTs with 8,205 patients (d-TRA n = 4,096, p-TRA n = 4,109) were included. The risk of RAO (RR 0.31, 0.21 to 0.46, p ≤0.001) and time to hemostasis (minutes) (MD -51.18, -70.62 to -31.73, p <0.001) was significantly lower in the d-TRA group. Crossover rates (RR 2.39, 1.71 to 3.32, p <0.001), access time (minutes) (MD 0.93, 0.50 to 1.37, p <0.001), procedural pain (MD 0.46, 0.13 to 0.79, p = 0.006), and multiple puncture attempts (RR 2.13, 1.10 to 4.11, p = 0.03) were significantly higher in the d-TRA group. The use of d-TRA for coronary angiography and/or intervention is associated with a lower risk of RAO at the forearm and may preserve p-TRA site for reintervention in selective patients by reducing the incidence of RAO.

Safety and Efficacy of Enoxaparin During Low-Risk Elective Percutaneous Coronary Intervention

Intravenous unfractionated heparin (UFH) is the most frequently used anticoagulant for percutaneous coronary intervention (PCI). Intravenous enoxaparin, a low-molecular weight heparin, has superior pharmacokinetic and pharmacodynamic properties compared with UFH. Multiple trials have shown enoxaparin to be safe and effective in PCI. However, there has not been a contemporary study evaluating its safety and efficacy. To assess its efficacy and safety, intravenous enoxaparin during PCI via radial artery access was evaluated in PCI patients from Jan 2015 to Dec 2019. Outcomes included procedural success, all-cause mortality, ischemic complications, and bleeding complications from the time of the procedure until hospital discharge. 1,019 consecutive eligible patients were identified. Median age was 63 years, and 70% were males. The indication for PCI was stable and unstable angina in two thirds of cases (77%). Few patients had myocardial infarction (MI) (2.2%) as the indication for intervention. The procedure was successful in 98.2% of cases. There were no deaths. Procedural MI occurred in 0.3% of patients. Acute stent thrombosis occurred in 0.4%. Urgent revascularization and stroke occurred in 0.1% each. Small wrist hematomas occurred in 0.3% and all were managed conservatively. There was one radial artery pseudoaneurysm. There were no cases of major bleeding. In conclusion, this single-center study showed that intravenous enoxaparin is a reasonable alternative anticoagulant for use in low-risk and elective non-myocardial infarction percutaneous coronary intervention via radial artery access.

Sheath Tip Radial Artery Disruption as a Mechanism for Forearm Hematoma: Insights from the Distal Radial Artery Approach

Abstract Introduction Radial artery occlusion (RAO), Forearm Hematoma (FH), and compartmental syndrome are three well-recognized complications associated with radial artery (RA) access to percutaneous coronary intervention (PCI). There are disparate ways the RA can be damaged, from multiple needling attempts to adverse interactions between the radial sheath, exchange wire, and diagnostic or guiding catheter with the artery. Case presentation We describe a 49-year-old man who had PCI through his right distal RA (dRA) with a straightforward needle puncture, followed by placement of a Terumo® 10cm 6Fr Glidesheath Slender™. After primary PCI to the right coronary artery, right FH developed, but there was neither swelling at the dRA area nor in the hand. He had staged PCI to the left circumflex artery a few days later, and a radial arteriogram was performed using the same access site. This revealed a “circumferential dissection” in the RA, which was likely to have been caused by the tip of the initial radial sheath. Conclusion Hypothetically, the radial sheath can systematically traumatize the RA. It may be the common denominator for RA disruption, RA thrombosis, RAO, FH, and compartmental syndrome in a continuum. Urgent radial arteriography, whenever post-procedural FH is detected, allows for the source of forearm bleeding to be determined and addressed. Trialing this strategy against current watchful conservative management is warranted.

Vascular Complications of Percutaneous Coronary Intervention Via Distal Radial Artery Approach in Patients With Acute Myocardial Infarction With and Without ST-Segment Elevation.

Distal radial artery (DRA) access is a novel alternative to conventional radial artery access for coronary catheterization. This study investigated the incidence of vascular complications with percutaneous coronary intervention (PCI) from DRA access among patients with acute myocardial infarction (AMI) with and without ST-segment elevation. Between April 2018 and October 2019, a total of 131 consecutive patients underwent primary PCI for AMI, among whom DRA access was used in 116 (88.5%), comprising 77 with ST-segment elevation myocardial infarction (STEMI) and 39 with non-ST-segment elevation myocardial infarction. The mean patient age was 70.4 ± 12.9 years and 71.6% were male. Right DRA was used in 110 patients (94.8%). A 5 or 6 Fr sheath was used in the PCI procedure. Patient backgrounds, procedural characteristics, and procedural complications were retrospectively analyzed. Patency of the radial artery was examined using Doppler ultrasound. Minor bleeding (Bleeding Academic Research Consortium [BARC] 2) was observed in 2 patients (1.7%) while no major bleedings (BARC 3a, 3b, 3c, and 5) were observed. On the Early Discharge After Transradial Stenting of Coronary Arteries Study (EASY) hematoma scale, a grade III hematoma (≥10 cm) was observed in 1 patient (0.9%), and no patients with hematoma were > grade IV. Doppler ultrasound of the radial artery was performed on 95 patients (81.9%). The incidence of radial artery occlusion was 1.1% (n = 1). The door-to-balloon time for STEMI patients was 40.0 ± 30.8 minutes. The current study demonstrated that DRA access was associated with a low incidence of access-site complications within optimal revascularization time among patients with AMI who underwent PCI.

Exploring the correlation between radial artery access and decreased occurrence of contrast-induced nephropathy.

Objective: To Investigate the Impact of Radial Artery Access on Contrast-Induced Nephropathy (CIN) Incidence. Study Design: Retrospective study. Setting: Department of Cardiology, Hayatabad Medical Complex in Peshawar. Period: January 2021 to June 2022. Material &amp; Methods: Patients aged ≥ 30 who have undergone cardiac catheterization procedures, with a focus on those who have undergone the procedure using radial artery access. Those patients who had pre-existing renal impairments or kidney diseases, with a history of contrast allergies, were included in the study. However, those patients who were under the age of &lt; 30, had undergone cardiac catheterization procedures using femoral artery access, and with incomplete medical records were excluded. All the data were analyzed in SPSS version 26. Results: In our study involving 164 participants. Individuals who experienced CIN exhibited a considerably greater average age of 69.89 years when contrasted with the 66.86 years of those in the non-CIN category (p=0.03). Furthermore, a higher percentage of patients in the CIN group were aged 65 or older (35.1% vs. 11%, p&lt;0.001), highlighting the increased vulnerability of older individuals to CIN. The timing of reperfusion therapy, indicated by the time-to-reperfusion, was significantly longer in the CIN group (6.2 ± 3.3 hours) compared to the non-CIN group (4.9 ± 3.7 hours, p=0.001), suggesting that delayed reperfusion may be a risk factor for CIN. Conclusion: Patients with anterior infarction, delayed reperfusion, lower left ventricular ejection fraction (LVEF), and higher serum creatinine levels were also more likely to develop CIN.

The RAVI registry: prospective, multicenter study of radial access in embolization procedures – 30 days follow up

BackgroundThere is a lack of registry studies about transradial access (TRA) outcomes. This prospective registry evaluated the TRA and procedure outcomes of visceral embolizations performed via TRA with 30-day follow-up.Material & methodsProspective, multicenter registry included uterine fibroids (UFE), prostate artery (PAE), liver tumors (LT), and other hypervascular tumors (OHT) embolization performed in six US hospitals. Between February 2020 and January 2022, 99 patients underwent one radial artery visceral intervention (RAVI); 70 had UFE (70.7%), 16 PAE (16.2%), 7 LT (7.1%), and 6 OHT (6.1%). The mean age was 50.1 (±11.1) years, and 74/99 (74.7%) were females. The primary safety endpoints included hand ischemia, stroke, and death. Procedural success was defined as completing the intended procedure via radial artery (RA) access. Technical success was defined as the successful delivery of HydroPearl™ microspheres and complete embolization of the target vessel.ResultsProcedural and technical successes were 100% and 97%, respectively. There was no stroke, hand ischemia, radial-to-femoral conversion, access-related serious adverse events, or clinically evident radial artery occlusion at 30 days. There were two deaths: one respiratory failure and one progression of liver disease. Minor RA-related adverse event included arterial spasm, hematoma, and post-procedure discomfort.ConclusionThis prospective, multicenter, open-label registry confirmed the high safety profile and effectiveness of radial access in UFE, PAE, LT, and OHT embolization procedures without stroke, hand ischemia, or access-related serious adverse events at 30-day follow-up.

Is catheterization via distal transradial access feasible in children? From vessel diameter perspective.

Distal radial artery (DRA) access is an infrequent alternative access for pediatric catheterization. The feasibility of using the DRA for arterial catheterization in children depends on the vessel's size. This study aims to provide a reference for pediatric catheterization via DRA access by evaluating the diameter of the DRA in the anatomic snuffbox (AS). We conducted a retrospective review of clinical and vascular ultrasound data of 412 children (ages 3-12) who were scheduled for arterial blood gas analysis via the DRA due to serious respiratory diseases between June 2023 and October 2023. The corrected DRA diameter in the AS was 1.97 ± 0.37 mm overall, with no significant difference between males (1.98 ± 0.38 mm) and females (1.95 ± 0.35 mm) (p = 0.457). The anteroposterior, transverse, and corrected DRA diameters increased significantly with age (p < 0.05). The DRA diameter was significantly smaller than the proximal radial artery (PRA) diameter (1.97 ± 0.37 mm vs. 2.05 ± 0.33 mm, p < 0.001) but larger than the ulnar artery (UA) diameter (1.97 ± 0.37 mm vs. 1.88 ± 0.33 mm, p < 0.001). The proportions of patients with a DRA diameter greater than 2.0 mm and 1.5 mm were 38.83% and 86.89%, respectively. The proportions of patients with DRA diameters >2.0 mm and >1.5 mm increased significantly with age (p < 0.01). The percentages of individuals with a DRA/PRA ratio ≥1.0 were 55.10% overall, 52.12% in males, and 58.60% in females. DRA diameter showed significant correlations with age (r = 0.275, p < 0.01), height (r = 0.319, p < 0.01), weight (r = 0.319, p < 0.01), BMI (r = 0.241, p < 0.01), wrist circumference (r = 0.354, p < 0.01), PRA diameter (r = 0.521, p < 0.01), and UA diameter (r = 0.272, p < 0.01). The DRA diameter in children increases with age and size, making cardiac catheterization is theoretically feasible. Preoperative evaluation of the vessel diameter and intraoperative ultrasound-guided intervention are recommended for paediatric catheterization via the DRA access.

Application of 5% lignocaine patch following radial artery access for the prevention of radial artery occlusion: A novel use

Application of 5% lignocaine patch following radial artery access for the prevention of radial artery occlusion: A novel use

Comparison of GRACE Score and SYNTAX Score in Predicting Complexity of Coronary Artery Disease in Patients with NST-ACS

Objective: To compare the GRACE score and SYNTAX score in predicting Coronary Artery Disease (CAD) severity and the variation of GRACE score with respect to SYNTAX score to assess severity of CAD. Study Design: Analytical, Cross-sectional study. Place and Duration of Study: Armed Forces Institute of Cardiology/National Institute of Heart Diseases, Rawalpindi Pakistan, from Jan 2023 to Jun 2023. Methodology: Data was gathered from n=139 participants by using consecutive sampling technique on a data collection tool.Study variables such as demographics, comorbids, clinical characteristics and SYNTAX and GRACE score were noted to asses their role in determining CAD severity. An experienced cardiologist was assigned to analyze the coronary angiogram findings, performed by using conventional techniques through radial artery, ulnar or femoral artery access. SPSS version-24.00 was used for data management and analysis. Chi square test and Pearson correlation was applied to find the association and correlation respectively. Results: Mean age of study participants was 62.09±9.74 years and males were more in number 114(82.0%). Ninety three (66.9%) patients had NSTEMI. Gender (p=0.011,0.007), was significantly associated with SYNTAX score as well as GRACE score respectively and diabetic status (p=0.003) with GRACE score. There was a strong and positive correlation between GRACE score and SYNTAX score (r=0.64; p&lt;0.001). Both scores showed significant association with CAD severity (p&lt;0.05). Conclusion: There exists a statistically significant and positive correlation between GRACE score and SYNTAX score in non-ACS (NSTEMI and UA) patients who had confirmed diagnosis of CAD on coroangiogram. The greater the GRACE score, the greater was........

Anatomical Distribution Patterns of Peripheral Arterial Disease in the Upper Extremities According to Patient Characteristics: A Retrospective Cohort Study.

Peripheral arterial disease (PAD) greatly affects the patients' quality of life. We aimed to investigate the affected anatomical sites and distribution patterns in upper extremity PAD using computed tomography angiography (CTA). Furthermore, we sought to identify the correlations between patient characteristics and the identified patterns. This was a retrospective chart review of upper limb CTA findings from patients with symptomatic PAD aged >18 years. Significant variables from univariate logistic regression analysis were further tested using multivariate logistic regression analysis. Statistical significance was set at p < 0.05, with confidence intervals of 95%. The mean age of the 102 included patients with upper extremity PAD was 55.45 years. Laterality analysis revealed that the upper left limb segments were more affected than the upper right limb segments (42 vs 63; left-to-right ratio, 3:2). The forearm was the segment most affected by stenotic PAD (62 segments, 3.37%). The arm was the segment most affected by occlusive PAD (14 segments, 0.76%). Diabetes mellitus (DM) and hypertension (HTN) were significant predictors of PAD (p = 0.046). In patients with DM, the occlusive form of PAD was dominant in the arm (18.18%); however, the stenotic form prevailed in the forearm (72.72%). In patients with HTN, the occlusive form of PAD was predominant in the arm (45.45%); however, the stenotic form tended to occur in the arm and forearm (90.90%). The distribution patterns of upper extremity PAD are linked to its underlying pathophysiology. HTN and DM are the most frequent comorbidities in patients with upper extremity PAD. Angiographically, PAD in these patients is likely to present as stenosis rather than as occlusion. This is vital for interventionists who deviate from radial arterial access in patients with PAD. Therefore, targeted screening standards are required, and further studies on PAD are warranted.

Radial artery spasms impair invasive cardiological procedures' performance: a pharmacological approach to prevention and treatment.

The radial artery (RA) access is currently the gold standard to perform cardiovascular interventions. One of the more common limitations is radial artery spasm which is an often complication interrupting the procedure. Common risk factors associated with spasm include female gender, periprocedural anxiety, multiple puncture attempts, distal radial access, diabetes, hypertension, and smoking. The mechanism of spasm is complex and includes calmodulin and rho-kinase pathways leading to the smooth muscle contraction. Proper hydration, anxiety management, and adequate local anesthesia should be applied to decrease the risk of spasms. Radial cocktail is often used to prevent spasm. Its composition differs between catheterization laboratories and the effect is attributed either to the verapamil or nitroglycerin, with contradictory results of different studies. Balbay maneuver is also an effective mean of prevention. Hydrophilic-coated devices can be used both to avoid spasms or reverse them. Radial angiography can be used to differentiate spasm from a tortuosity and choose proper method of management. Fasudil, a Rho-kinase inhibitor, has been reported as a pharmacological method to prevent spasm and reverse radial artery spasm.

Prospective evaluation of efficacy and safety of distal radial and radial artery access using a novel articulating-tip guidewire.

Guidewire-facilitated access to peripheral vessels is commonplace in vascular access, but guidewire insertion into small vessels, such as the radial and distal radial arteries, can still be challenging. Failure to gain access on the first attempt may contribute to increased risks of procedural complications, such as vessel dissection, spasm, and occlusion. This research assessed the safety and efficacy of radial and distal radial artery access using a novel, FDA-cleared, small-core-diameter guidewire with an articulating tip, under ultrasound guidance. This was a prospective, single-arm, single-center trial. Patients in need of vascular access were screened for participation and enrolled in the study. Guidewire insertion was attempted by four physicians (three interventional radiologists and an interventional nephrologist) at 162 arterial sites-65 radial and 97 distal radial, having a mean diameter of 2.0 mm. First-attempt successful placement of the guidewire in the artery occurred at 87.6% of access sites (142/162) and differences in the success rate between the radial and distal radial arteries or between vessels with diameter smaller or larger than 2 mm were not observed (62/68 and 67/77, respectively; p = 0.6). Four of the five reported adverse events were unrelated to the study device or procedure. Two of the three distal radial artery spasms occurred before the guidewire was used. The other two events were a radial artery spasm, and a distal radial artery site hematoma. All adverse events resolved spontaneously. First-attempt placement of a novel articulating tip guidewire in the radial and distal radial arteries occurred at a high rate in our study and was not associated with safety concerns.