Radial Artery Access Research Articles

TCTAP A-053 Preliminary Study on Recanalization of the Occluded Radial Artery Through Distal Radial Artery Access: A Single-Centre Experience

TCTAP A-053 Preliminary Study on Recanalization of the Occluded Radial Artery Through Distal Radial Artery Access: A Single-Centre Experience

Revascularization of coronary and left popliteal artery lesions from the same radial arterial access.

Aimo, Albertoa,b; Coceani, Michele Alessandrob; Ciardetti, Marcob; Teresi, Lucioa; Pastormerlo, Luigi Emiliob; Palmieri, Cataldob Author Information

Association of Radial Artery Access with Reduced Incidence of Acute Kidney Injury in Patient Undergoing Percutaneous Coronary Intervention

Introduction: Percutaneous Coronary Intervention (PCI) is a commonly performed procedure for treating coronary artery disease. However, one of the potential complications of this procedure is Acute Kidney Injury (AKI), which can result in significant morbidity and mortality for patients. Objectives of the study: The main objective of the study is to find the association of radial artery access with reduced incidence of acute kidney injury in patient undergoing percutaneous coronary intervention. Material and methods: This was a retrospective cohort study conducted at Medical Teaching Institute-Hayatabad Medical Complex, Peshawar between January 10, 2022 and June 13, 2022. The study was approved by the institutional review board. Data were collected from electronic medical records, including demographic information, medical history, procedural details, laboratory values, and outcomes. The primary outcome was the incidence of acute kidney injury (AKI), defined as an increase in serum creatinine of ≥0.3 mg/dL or ≥50% within 48 hours after the procedure. Results: Based on a study of 300 patients undergoing cardiac catheterization, there was a significant association between the use of radial artery access and reduced incidence of acute kidney injury (AKI). The odds ratio for radial artery access was 0.59 (95% CI 0.32-1.09), indicating a lower risk of AKI with this approach. This finding is consistent with the results presented in Table 3, which also showed a lower incidence of AKI in the radial artery access group. However, the p-value for radial artery access was 0.09, indicating that this association did not reach statistical significance. Conclusion: Based on the results of the study, it can be concluded that radial artery access may be associated with a lower incidence of acute kidney injury (AKI) and fewer bleeding complications compared to femoral artery access in patients undergoing cardiac procedures such as percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG).

Comparing the Efficacy and Success Rate of Radial Artery Approach under Ultrasound Guidance and Palpation Technique for Coronary Intervention at Central Chest Institute of Thailand

Background: Previous studies of ultrasound guidance for transradial artery access during coronary angiography or interventional procedures demonstrate improving success rate, number of attempts, and short-time access in radial artery cannulation. Objective: To compare the benefit of ultrasound guidance radial artery access during coronary angiography (CAG) or percutaneous coronary intervention (PCI) with palpation technique in experienced and inexperienced operators. Materials and Methods: A randomized prospective study was performed between October 2021 and April 2022. One hundred sixty-four patients were randomized into three groups. The first group, group I (55 cases), underwent radial artery puncture with ultrasound guidance by an experienced interventionist. The second group, group II (56 cases), underwent radial artery puncture using the palpation technique by another experienced interventionist. The third group, group III (53 cases), was also assigned to radial artery puncture with the palpation technique, however, performed by three interventional cardiology fellows. Results: The success rate of radial cannulation was 55 (100%) in group I, 52 (92.9%) in group II, and 48 (90.6%) in group III (p=0.060). Firstattempt success rates in the three groups were 83.6%, 75%, and 69.8%, respectively (p=0.233). The median number of attempts was not significantly different (p=0.208). Time to access the radial artery in group I was reduced significantly compared to the palpation technique in group II and group III (p<0.001). There were no significant differences in complications such as difficult access, access site crossover, radial spasm, and hematoma/ bleeding complication (p=0.135, 0.367, 0.132, and 0.700, respectively). Conclusion: In experienced operators, an ultrasound-guided technique has been shown to have beneficial advantages in reducing the time to access radial artery cannulation compared to experienced and inexperienced operators using the palpation technique. Keywords: Transradial catheterization; Ultrasound guide

Up to snuff (box): Coalescing advances in dorsal radial arterial access.

Key Points Publications concerning the dorsal radial approach have proliferated providing an opportunity to evaluate the present state of knowledge with meta‐analysis. Advantage to the dorsal radial compared to conventional radial access include less radial artery occlusion, quicker hemostasis time and less bleeding. Disadvantages to dorsal radial continue to be an increased access time and greater risk of cross‐over, both characteristics that may be attenuated by experience.

Fertility after Transcatheter Arterial Embolization for Obstetric Hemorrhage: An Urban Health Care System Observational Study.

This study aimed to investigate pregnancy rate, pregnancy outcomes, and resumption of menses after transcatheter arterial embolization (TAE) for obstetric hemorrhage (OH). Sixty-seven patients who underwent TAE for OH from 2006 to 2020 within an urban, multihospital health care system were identified retrospectively. Selected patients were interviewed by phone to complete a survey with a primary outcome of self-reported pregnancy in those seeking pregnancy. Secondary outcomes included pregnancy outcomes and resumption of menses. Univariate testing of association of pregnancy and miscarriage rate with embolic agent was performed using Fisher's exact test. Thirty-three of 50 patients (66%) meeting the inclusion criteria completed the survey on fertility, a median of 47 (range, 13-123) months after TAE for OH. Of the 13 patients who attempted pregnancy, there was a pregnancy rate of 77% and miscarriage rate of 38%. Those who delivered live newborns conceived spontaneously, carried to term, and delivered a healthy newborn via cesarean section at a weight appropriate for gestational age. Thirty (91%) patients resumed menstruation, and the majority with unchanged frequency. Most patients underwent bilateral uterine artery embolization with radial artery access (54%). The most common embolic agents used were gelfoam only (30%) and glue only (24%). There was no statistically significant association between embolic agent and pregnancy or miscarriage rate. Spontaneous pregnancy with live birth and resumption of menses can occur in a majority of patients after TAE for OH. · Most patients who attempted pregnancy after TAE for OH achieved pregnancy.. · Most patients who became pregnant conceived spontaneously and delivered healthy newborns at term.. · Most patients resumed menstruation after TAE for OH.. · There was no significant association between type of embolic and pregnancy or miscarriage rate..

Head and neck angiography in the pediatric population: single-center experience with indications, safety, feasibility, and technical differences among infants, childhood, and adolescents.

Pediatric patients are candidates for head and neck endovascular procedures less frequently than adults. Data on utilization, feasibility, safety, and technical details of head and neck angiography in the pediatric population are scarce. The authors performed a retrospective review of their center's endovascular database to identify all patients ≤ 18 years of age who underwent diagnostic or interventional catheter-based angiography of the head and neck. Procedure-related variables for identified patients were compared across infancy (birth to 2 years), childhood (> 2-11 years), and adolescence (> 11-18 years). One hundred twenty-one pediatric patients who underwent 274 angiogram procedures were included in this study. Of these angiograms, 197 were diagnostic and 118 were interventional (including 41 of the diagnostic angiogram procedures that were performed concurrently with the intervention). The most common indications for diagnostic angiograms were suspected vascular malformations in 52 cases (26.4%) and aneurysms in 23 (11.7%). The rate of positive findings on diagnostic angiograms ranged from 27.3% to 80% according to the indication. Access site-related complications were observed after 2 punctures (0.7%). Procedure-related complications occurred in 3 patients (1.1%). In adolescents, the rates of general anesthesia use and sheathless access were significantly lower (each p < 0.001), and the rates of radial artery access (p < 0.001); 5-French (5F) (p = 0.01), 6F (p < 0.001), and 8F (p = 0.03) access; and closure device usage (p < 0.001) were significantly higher. In infants, the rates of ultrasound guidance, 4F access, and failure of the primary puncture site were significantly higher (each p < 0.001). Head and neck angiograms in the pediatric population were feasible and safe in the authors' overall experience. Technical differences were observed across the infant, childhood, and adolescent groups, but safe outcomes were similar throughout these age ranges.

Abstract Number ‐ 135: Surpass Evolve® Flow Diversion for Embolization of Unruptured Anterior Circulation Aneurysms: 6‐month Obliteration Rates

Introduction The Surpass Evolve flow diverter (FD) is a 64‐wire cobalt‐chromium device with improved ease of deployment and conformability, compared to its predecessor. Data on procedural outcomes and aneurysm obliteration rate remain limited. The objective of this study was to describe the procedural outcomes, including 6‐month obliteration rates, for patients who underwent Surpass Evolve FD embolization of an unruptured anterior circulation aneurysm. Methods All consecutive patients with an unruptured anterior circulation aneurysm who were treated with the Surpass Evolve FD between Aug 2020 and May 2022 were included. Patients with a ruptured or posterior circulation aneurysm were excluded. Demographic and clinical features, aneurysm morphology, arterial access, and procedural factors and outcome were extracted from our departmental neurointerventional database. Summary statistics included frequencies, and measures of central tendency and dispersion as appropriate. Results Sixty patients (82% female, mean age 57.9 years ± 15.5) underwent elective Surpass Evolve flow diversion for an unruptured anterior circulation aneurysm. In 47 (78%) patients, a native aneurysm was flow‐diverted, and in 13 (22%) patients, FD was performed for a recurrent aneurysm. Distribution of aneurysm location was: supraclinoid ICA (65%), cavernous ICA (12%), cervical ICA (10%) and anterior cerebral artery (13%). Thirty‐nine (65%) patients underwent left‐sided intervention. Mean aneurysm maximal diameter was 8.7 ± 5.7 mm. The majority of patients (49, 82%) underwent radial arterial access. Balloon angioplasty or J‐wire manipulation was used to enhance apposition in 37 (62%) cases. To date, thirty‐five (58%) patients have had a follow up angiogram (mean 0.65 years ± 0.2 from intervention); in 5 patients, there was mild non‐flow‐limiting stenosis. Based on the Raymond‐Roy Occlusion Classification, 25 (71%) had complete occlusion, 1 (2%) had a residual neck, and 9 (26%) had residual aneurysm. Conclusions The Surpass Evolve FD is safe and associated with favorable occlusion rates at six months. In our early experience, complication rates are well within the acceptable limits.

A tale of two registries: Trends and outcomes of percutaneous coronary intervention in two transatlantic populations.

Key Points Patients undergoing percutaneous coronary intervention (PCI) in the state of Michigan have more comorbidities compared to patients undergoing PCI in the United Kingdom. While the adoption of radial artery access for PCI has increased steadily over time in both Michigan and the United Kingdom, the use of radial access was significantly greater in the UK at all time points compared to Michigan for all PCI indications. The use of mechanical support during PCI has increased over time in Michigan but decreased over time in the United Kingdom.

Evaluation of Peripheral Vascular Function After Distal Radial Artery Access for Invasive Percutaneous Coronary Procedures

Abstract Objective: The aim of this study is to investigate the difference in impact between distal transradial access (dTRA) and classical transradial access (TRA) on vascular function using flow-mediated vasodilation (FMD) following coronary diagnostic and therapeutic catheterizations. Methods: The analysis involves a non-randomized inclusion of patients undergoing either diagnostic or elective percutaneous coronary intervention, using a dTRA access or a conventional standard TRA. Two hours after the procedure ended, the endothelium-dependent flow-mediated dilation of the brachial artery was measured by ultrasound. Results: A total number of 50 patients were included. There was no statistically significant difference between the two groups (7.20% vs 6.99%, p &lt; 0.09 for non-inferiority). Additionally, there were higher baseline values observed for BA diameters in the conventional approach group. Regarding the other secondary endpoints, there were no major access site complications, radial occlusion, in-hospital major bleeding or severe arterial spasm recorded in both groups. Conclusion: Compared to conventional TRA, accessing distal radial artery for diagnostic and therapeutic coronary interventions has the same impact on short-term vascular endothelial function and was safely performed without any major vascular complications.

Comparison of Outcome of Traditional Radial Artery versus Distal Artery Approach in Patients undergoing Coronary Intervention

Although most interventional cardiologists favor radial artery (RA) access because to its ergonomic practicality, data on distal artery (DRA) access with relation to RA patency has not been compared in major trials. Objective: To compare the access feasibility of distal radial artery vs Forearm radial artery for cardiac catheterization operations. Methods: A cross sectional study of total of 198 patients undergoing radial coronary operations were monitored for radial artery occlusion (RAO) and other local problems with DRA and FRA access. Purposive sampling was performed. The inclusion criteria include all participants who had a palpable distal or proximal radial pulse. The patient was free to choose between the two approaches. Patients having an inappropriate radial pulse were eliminated. Results: The main objective was fulfilled by 11.7% in the FRA and 10.4% in the DRA group (p-value=0.24). Cannulation time was greater in the DRA group compared to the FRA group; however, this had no effect on hemostasis time (254 20 vs. 254 17; p-value=0.72). Hematoma (26.4% vs. 12.5%; OR (95% CI): 3.18 (1.09–5.63); p-value 0.001) was more prevalent with FRA, while radial artery spasm (18.6 % vs. 22.9 %; OR (95 % CI): 0.53 (0.03 – 0.95); p-value=0.01). Conclusions: When compared to Forearm Radial Artery access, Distal Radial Artery access is linked with poorer cannulation success rates and greater RAO rates. It is, however, linked to the production of lower hematomas

Transradial Access Failures During Neuroangiography for Patients With Moyamoya.

Despite studies continuing to demonstrate the utility of transradial access (TRA) in neuroangiography, minimal data exist regarding predictors of TRA failure. Furthermore, although many patients with moyamoya disease/syndrome will require life-long angiographic evaluation, even less has been reported on the usage of TRA in this population. To perform a matched analysis at our high-volume moyamoya center to determine predictors of TRA failure in these patients. A total of 636 patients undergoing TRA for neuroangiography were identified from 2018 to 2020. Demographic and angiographic characteristics including radial artery spasm (RAS), radial anomalies, and access site conversion were compared between patients with moyamoya and the rest of the cohort. A 4:1 matched analysis, based on age and sex, was also performed to eliminate confounding variables. Patients with moyamoya were younger (40 vs 57 years, P < .0001), had smaller radial diameters (1.9 vs 2.6 mm, P < .0001), more commonly had a high brachial bifurcation (25.9% vs 8.5%, P = .008), more frequently experienced clinically significant RAS (40% vs 8.4%, P < .0001), and more often required access site conversion (26.7% vs 7.8%, P = .002). Increasing age was associated with less TRA failures in patients with moyamoya (odds ratio = 0.918) but more failures in the rest of the cohort (odds ratio = 1.034). In the matched analysis, patients with moyamoya continued to experience more radial anomalies, RAS, and access site conversions. Patients with moyamoya, when controlling for age and sex, have higher rates of TRA failure during neuroangiography. Increasing age in Moyamoya is inversely correlated with TRA failures suggesting that younger patients with moyamoya are at higher risk of extracranial arteriopathy.

Distal versus conventional radial artery access for coronary catheterization: A systematic review and meta-analysis.

The distal radial artery (DRA) access is an alternative to the conventional radial artery (CRA) access for coronary angiography and interventions and appears to be associated with reduced incidence of certain outcomes. A systematic review was performed to evaluate differences between DRA versus CRA access for coronary angiography and/or interventions. Following preferredreporting items for systematic review and meta-analysis-protocols guidelines, two reviewers independently selected studies published in the electronic databases (MEDLINE, EMBASE, SCOPUS, CENTRAL) from inception to October 10, 2022, followed by data extraction, meta-analysis, and quality assessment. The final review included 28 studies with (total: 9151 patients [DRA:4474; CRA: 4677]). Compared with CRA, DRA access was found to be associated with a shorter time to achieve hemostasis (mean difference,MD: -32.49 [95% confidence interval, CI:-65.53, -2.46], p < 0.00001), and reduced incidence of radial artery occlusion (RAO)(risk ratio,RR: 0.38 [95% CI: 0.25, 0.57], p < 0.00001), any bleeding (RR: 0.44 [95% CI: 0.22, 0.86], p = 0.02), and pseudoaneurysm (RR: 0.41 [95% CI: 0.18, 0.99], p = 0.05). However, DRA access has increased access time (MD: 0.31 [95% CI: -0.09, 0.71], p < 0.00001) and crossover rates (RR: 2.75 [95% CI: 1.70, 4.44], p < 0.00001). There were no statistically significant differences in other technical aspects and complications. DRA access is a safe and feasible approach for coronary angiography and interventions. Compared to CRA, DRA provides a shorter hemostasis time, lower incidence of RAO, any bleeding, and pseudoaneurysm, and is associated with increased access time and crossover rates.

Association of Radial Artery Access with Reduced Incidence of Acute Kidney Injury

Introduction: Acute kidney injury (AKI) is a common complication that can occur after invasive cardiac procedures. This condition can cause significant morbidity and mortality, especially in high-risk patients, such as those with preexisting renal dysfunction. Objectives: The main objective of the study is to find the association of radial artery access with reduced incidence of acute kidney injury. Material and methods: The study is conducted at the Department of Cardiology, Hayatabad Medical Complex, Peshawar. This is a tertiary care center that provides cardiac care services to a large population of the Khyber Pakhtunkhwa province of Pakistan. The center has state-of-the-art facilities and a team of experienced cardiologists and cardiac surgeons who perform a variety of cardiac procedures, including PCI and CABG. Results: Based on a study of 300 patients undergoing cardiac catheterization, there was a significant association between the use of radial artery access and reduced incidence of acute kidney injury (AKI). The study found that 20% of patients who underwent femoral artery access developed AKI, compared to only 10% of patients who underwent radial artery access. This indicates that radial artery access may be a safer option for cardiac catheterization procedures, as it may help reduce the risk of AKI in patients. Conclusion: In conclusion, the present study provides evidence that radial artery access is associated with a lower incidence of acute kidney injury (AKI) in patients undergoing percutaneous coronary intervention (PCI).

Association of Radial Artery Access with Reduced Incidence of Acute Kidney Injury.

To determine if radial artery (RA) access compared with femoral artery (FA) access for percutaneous coronary intervention (PCI) is associated with a lower incidence of acute kidney injury (AKI). AKI results in substantial morbidity and cost following PCI. Prior studies comparing the occurrence of AKI associated with radial artery (RA) versus femoral artery (FA) access have mixed results. Using a large state-wide database, 14,077 patients (8,539 with RA and 5,538 patents with FA access) were retrospectively compared to assess the occurrence of AKI following PCI. To reduce selection bias and balance clinical data across the two groups, a novel machine learning method called a Generalized Boosted Model was conducted on the arterial access site generating a weighted propensity score for each variable. A logistic regression analysis was then performed on the occurrence of AKI following PCI using the weighted propensity scores from the Generalized Boosted Model. As shown in other studies, multiple variables were associated with an increase in AKI after PCI. Only RA access (OR 0.82; 95% CI 0.74-0.91) and male gender (OR 0.80; 95% CI 0.72-0.89) were associated with a lower occurrence of AKI. Based on the calculated Mehran scores, patients were stratified into groups with an increasing risk of AKI. RA access was consistently found to have a lower risk of AKI compared with FA access across these groups of increasing risk. Compared with FA access, RA access is associated with an 18% lower rate of AKI following PCI. This effect was observed among different levels of risk for developing AKI. Although developed from a retrospective analysis, this study supports the use of RA access when technically possible in a diverse group of patients.

Technical Success and Safety of Transradial Uterine Artery Embolisation for Symptomatic Fibroids at a Single Centre in South Africa

Abstract Background The femoral artery has remained the primary means of vascular access for uterine artery embolisation in the treatment of uterine fibroids. Transradial access for coronary artery catheterization is gaining wider acceptance, with studies in the cardiac literature demonstrating key advantages. The primary objective of this study was to compare the technical success and safety of the transradial approach for uterine artery embolization performed at a single centre in South Africa. Methods Data was obtained from consecutive patients undergoing uterine artery embolisation for the treatment of symptomatic fibroids over a 30-month period. Specifically technical success and patient safety were analysed. Results A total of 496 patients were included in the study. Of these 27 patients had primary contraindications to radial access. The remaining 469 patients who underwent radial artery access, technical success was achieved in 459 cases (97.9%). The primary cause of technical failure was radial artery spasm (9.9%). Mean procedure times were 53.5 minutes ± 15.2 minutes with total screening times of 9.6 ± 9.1 minutes. The mean radiation dose area product was 6321.7 ± 3449.8 cGy.cm2. Complications were recorded in 40 (8.5%) patients, of which 7 (1.5%) were major complications. Conclusions This study corroborates evidence that this approach is a safe and effective alternative to the traditional transfemoral route for the treatment of uterine fibroids.

Safety and Feasibility of Transradial Access for Neurointervention Procedures in Patients With Radial Artery Occlusion

Background Transradial access (TRA) has proven advantages in interventional cardiology and neurointervention. There is limited literature detailing radial artery occlusion (RAO) recanalization, and generally, RAO necessitates alternate access. The purpose of this study was to evaluate the safety and feasibility of TRA in patients with RAO, allowing successful completion of the intended neurointervention procedure. Methods and Results Prospectively maintained databases at 2 Australian high‐volume neurointervention centers between January 2019 and February 2022 were reviewed. All consecutive patients with RAO who underwent attempted TRA for diagnostic neuroangiography or neurointervention procedures were included. Sixty‐one attempts at TRA through RAO for neurointervention procedures were performed in 42 patients. The mean age was 54.9 years, and 65.6% were women. Fifty‐three cases (86%) successfully completed the intended neurointervention procedure following RAO recanalization: 33 cases of diagnostic cerebral angiography, 9 cases of cerebral vasospasms, 6 cases of aneurysm repairs, 3 cases of endovascular thrombectomies, 1 case of carotid artery stenting/angioplasty, and 1 case of intracranial dural arteriovenous fistula embolization. Six cases (9.8%) required conversion to alternate access to complete the procedure because of failed TRA or anatomical challenges to select the target vessel. Two cases (3.2%) experienced transient minor radial artery extravasation without clinical sequelae. No major complications were encountered. Conclusions TRA in patients with RAO for neurointervention procedures is both safe and feasible, with no significant additional equipment or cost. RAO is not a contraindication to radial artery access in neurointervention.

The Role of Ultrasound in Accessing the Distal Radial Artery at the Anatomical Snuffbox for Cardiovascular Interventions.

In an effort to refine transcatheter vascular interventions, radial artery access has moved more distally at the anatomical snuffbox. Here, more challenges appear as the artery is smaller, more angulated, and more difficult to palpate. Including ultrasound guidance as a mandatory step during puncture may encourage more operators to switch to this approach. In the femoral approach, ultrasound guidance is strongly recommended because of bleeding complications, whereas in the proximal (conventional) radial approach, the role of ultrasound remains optional, and in current practice, almost all cases are performed by palpation of the pulse only. However, in distal radial access, the situation is different because the artery differs in caliber and position, and imaging can help the operator for a clean puncture, especially since repeated punctures are not only painful but also any hematoma formation leads to the complete compression of the artery and failure of access. The aim of this review is to investigate the rationale of vascular ultrasound during distal radial access and to establish some techniques and anatomical landmarks for the ultrasonographic exploration of the dorsal area of the hand.

Retrospective Comparative Study to Assess the Safety and Efficacy of Transradial Arterial Access for Hepatic Tumor Embolizations: A Single Operator Experience

Abstract Objectives To assess the efficacy and safety of transradial arterial access (TRA) for hepatic tumor embolizations and compare the outcomes between the TRA and transfemoral arterial access (TFA). Materials and Methods A retrospective analysis of all consecutive hepatic tumor embolization procedures done through TFA or TRA by a single operator from November 2017 to April 2019 was performed. The procedural variables, including fluoroscopy time, radiation dose (reference air kerma [RAK]), conversion and complication rates, and patient preferences were recorded. The primary endpoint was technical success, which was defined as the successful completion of the embolization procedure. Procedural variables including radiation exposure and patient preferences, and complications were analyzed as secondary endpoints. Results Out of 102 procedures in 90 patients, 44 were performed through TFA and the rest by TRA. A technical success rate of 98.2% and a crossover rate of 1.7% were recorded for TRA. There were no major vascular complications and similar rates of minor complications (8.6% for TRA, 2.3% for TFA; P = 0.055), without any clinical sequelae. After the initial learning curve, no significant differences for other procedural variables were noted between the two access sites. Faster ambulation were achieved following TRA (P &lt; 0.055). All 12 patients who underwent repeat TACE after initial TRA chose this again over TFA. Conclusions TRA is safe and effective for hepatic tumor embolization. Its safety and efficacy profile is comparable to that of TFA, with added improved patient comfort and faster ambulation. Advances in Knowledge New catheter options and modifications of the existing techniques as explained in this article proved radial arterial access as a safe and effective alternative in hepatic arterial embolization.

Retrospective single centre experience in distal radial puncture from Gleneagles Kota Kinabalu

Distal radial artery access for coronary angiogram has been introduced since 2017. It is known to have good success rate and low risk of complication. There are few advantages for this procedure compared to the conventional radial puncture.