Radial Sheath Research Articles

Association of 5 F and 6 F radial sheath with the incidence of radial artery occlusion after transradial catheterization: a systematic review, meta-analysis and meta-regression.

Association of 5 F and 6 F radial sheath with the incidence of radial artery occlusion after transradial catheterization: a systematic review, meta-analysis and meta-regression.

Balloon aortic valvuloplasty through the novel transradial technique.

Balloon aortic valvuloplasty (BAV) has been typically performed through a femoral approach thus increasing the risk of bleeding and access site-related vascular complications. The aim of this study was to describe the safety and efficacy of transradial aortic valve valvuloplasty (TRBAV). The present research is a retrospective, single-center study including patients undergoing TRBAV (October 2019-July 2020). BAV was performed using 18-25 mm balloons through an 8-10 French (F) radial sheath. Successful BAV was defined as ≥50% reduction in peak-to-peak gradient (efficacy endpoint). Procedural complications, including radial artery occlusion (RAO) at follow-up were evaluated (safety endpoint). Twenty-four patients underwent TRBAV were included, aged 81 (73-85) years, 70% males, EuroScoreII 3.1 (2.1-5.5). Aortic valve gradient was significantly reduced (pre-50±24 vs. 18.7±13 mmHg post, P<0.001), and 91% had successful BAV. Mean gradient drop was 31.4±16.8 mmHg. One patient (4%) required cross-over to femoral access for severe vasospasm and was excluded from the analysis. Most used sheaths were 8F (46%) and 9F (37%), mostly for 20 mm (50%) and 23 mm (38%) balloons. There were neither major procedural complications (neither balloon entrapment nor compartmental syndrome) nor minor complications (any access-site bleeding). RAO was observed in 2 patients (8%), both asymptomatic. TRBAV was safe, feasible, and efficacious with a small rate of conversion and RAO, suggesting reproducibility of this novel technique. TRBAV may represent an alternative to femoral access in selected patients although larger studies are warranted.

Feasibility of Distal Radial Access for Coronary Angiography and Percutaneous Coronary Intervention: A Single Center Experience

Objective: Asymptomatic radial artery occlusion remains the most common complication in transradial coronary interventional procedure. To prevent radial artery occlusion, distal transradial access (dTRA) has been suggested recently. In this article, we aim to describe our experience and to assess feasibility and safety of this new access site for routine coronary angiography (CAG) and percutaneous coronary intervention (PCI). Methods: We retrospective analyzed 1,063 consecutive patients who were assigned to undergo CAG or procedural PCI through dTRA between 1 January 2018 and 31 December 2019 at Affiliated Zhongshan Hospital of Dalian University. The size of radial sheath used was 5 or 6 French. The sheath was removed at procedure termination, and hemostasis was obtained by compression bandage with gauze. The success rate of dTRA access defined by successful radial artery cannulation on the first dTRA side attempted, the cause of access failure, the hemostasis duration, the incidence of post-catheterization radial artery occlusion, and the other access-related complications including hematoma of forearm and thumb numbness were assessed. Results: Radial artery cannulation via dTRA was successful in 953 of 1,063 patients with a success rate of 89.7%. Mean age of successful cases was 64.6 ± 11.2 years (26–94 years) with 339 (35.6%) women. A total of 363 (38.1%) cases were PCI. Among them, 95 cases (10%) underwent urgent PCI, including primary PCI in 64 patients with ST-segment elevation myocardial infarction and immediate PCI (<2 h from hospital admission) in 31 patients with very high-risk non-ST-segment elevation acute coronary syndrome. A total of 269 (28.2%) cases were via left dTRA. The 6 French sheath was used in 602 (63.2%) cases. Hemostasis was obtained within 2 h in 853 (89.5%) patients. There were 110 (10.3%) procedural failures: 59 (5.6%) cases of artery puncture failure, 49 (4.9%) cases of guide wire insertion failure, and 2 (0.2%) cases of sheath insertion failure. Complications potentially related to distal radial access included radial artery occlusion at the access site (13 cases, 1.4%), forearm radial artery occlusion (4 cases, 0.4%), hematoma of forearm (5 cases, 0.5%), and transient thumb numbness (2 cases, 0.2%). Conclusion: dTRA is a feasible and safe access and can be used as a rational alternative to traditional radial access for routine coronary interventional procedure.

Access-site Complications of the Transradial Approach: Rare But Still There.

In the past decade, the Transradial Approach (TRA) has constantly gained ground among interventional cardiologists. TRA’s anatomical advantages, in addition to patients’ acceptance and financial benefits, due to rapid patient mobilization and shorter hospital stay, made it the default approach in most catheterization laboratories.Access-site complications of TRA are rare and usually of little clinical impact, thus, they are often overlooked and underdiagnosed. Radial Artery Occlusion (RAO) is the most common, followed by radial artery spasm, perforation, hemorrhagic complications, pseudoaneurysm, arterio-venous fistula, and even rarer complications, such as nerve injury, sterile granuloma, eversion endarterectomy or skin necrosis. Most of them are conservatively treated, but rarely, surgical treatment may be needed and late diagnosis may lead to life-threatening situations, such as hand ischemia or compartment syndrome and tissue loss. Additionally, some complications may eventually lead to TRA failure and switch to a different approach.On the other hand, it is the opinion of the authors that non-occlusive radial artery injury, commonly included in TRA’s complications in the literature, should be regarded more as an anticipated functional and anatomical cascade, following radial artery puncture and sheath insertion.

Radial Artery Access for Cerebral Angiography: 2-Dimensional Operative Video.

A number of studies have demonstrated that the radial artery is a safer access site than the femoral artery for endovascular procedures.1-4 In the prospective randomized studies comparing transradial and transfemoral approaches for cardiac procedures, there was a 60% reduction in access site complications as well as significant decreases in all-cause mortality with the transradial approach as compared to transfemoral, which has led to the adoption of a radial first strategy.5-7 Neurointerventional studies have demonstrated similar safety benefits as well as improved patient preference.8-14 In this video, a patient presented with an unruptured anterior communicating artery aneurysm and consented to a transradial artery diagnostic cerebral angiogram. This technical video demonstrates the key preprocedural preparation, room setup, patient positioning, steps for radial artery, and distal radial artery puncture and sheath placement. Distal transradial artery access is our preferred approach for diagnostic cerebral angiography because of an improved safety profile and procedural ergonomics. In cases in which a larger radial artery is advantageous such as for neurointerventions requiring larger systems, a standard transradial approach may be performed.9 In this video, a full 6-vessel cerebral angiogram is performed, followed by our arteriotomy closure technique using our standard equipment including a 10-cm 5 French Glidesheath Slender (Terumo, Japan), 100-cm hydrophilic coated 5 French Simmons 1 catheter (Merit OEM), 0.035 hydrophilic coated guidewire, and SafeGuard closure device (Merit, Salt Lake City, Utah).

Sheaths and Double Layers with Instabilities

The properties of sheaths and associated potential structures and instabilities cover a broad field which even a review cannot cover everything. Thus, the focus will be on about a dozen examples, describe their observations and focus on the basic physical explanations for the effects, while further details are found in the references. Due to familiarity the review focuses mainly on the authors work but compared and referenced related work. The topics start with a high frequency oscillations near the electron plasma frequency. Low frequency instabilities also occur at the ion plasma frequency.The injection of ions into an electron-rich sheath widens the sheath and forms a double layer. Likewise, the injection of electrons into an ion rich sheath widens and establishes a double layer which occurs in free plasma injection into vacuum. The sheath widens and forms a double layer by ionization in an electron rich sheath. When particle fluxes in "fireballs" gets out of balance the double layer performs relaxation instabilities which has been studied extensively. Fireballs inside spherical electrodes create a new instability due to the transit time of trapped electrons. On cylindrical and spherical electrodes the electron rich sheath rotates in magnetized plasmas. Electrons rotate due to $\mathbf E \times \mathbf B_0$ which excites electron drift waves with azimuthal eigenmodes. Conversely a permanent magnetic dipole has been used as a negative electrode. The impact of energetic ions produces secondary electron emission, forming a ring of plasma around the magnetic equator. Such "magnetrons" are subject to various instabilities. Finally, the current to a positively biased electrode in a uniformly magnetized plasma is unstable to relaxation oscillations, which shows an example of global effects. The sheath at the electrode raises the potential in the flux tube of the electrode thereby creating a radial sheath which moves unmagnetized ions radially. The ion motion creates a density perturbation which affects the electrode current. If the electrode draws large currents the current disruptions create large inductive voltages on the electrode, which again produce double layers. This phenomenon has been seen in reconnection currents. Many examples of sheath properties will be explained. Although the focus is on the physics some examples of applications will be suggested such as neutral gas heating and accelerating, sputtering of plasma magnetrons and rf oscillators.

Long Radial Sheath for Angiography of Femoral Artery Large Sheath Access Site with Vascular Closure Devices

Radial access combined with hemodynamic support has the limitation of not allowing adequate angiography or delivery of peripheral balloons for managing the femoral access site after removal of the large femoral sheath. We present a case series with use of a novel long 6 French guiding sheath via left radial artery access for angiography of the femoral access site after removal of a large sheath for left ventricular assist device with vascular closure devices.

Heparin-free distal radial artery approach to cardiac catheterisation and the small radial recurrent artery.

Radial artery access has transformed cardiac catheterisation, allowing it to be performed in a daycase setting, saving both hospital beds, and nursing care costs. However, there are two common and seemingly diametrically opposite complications. These are radial artery occlusion and forearm haematoma; the former could be reduced by heparin, but at the expense of precipitating the latter. These complications increase proportionally to the size of radial artery sheath used. Interestingly, by cannulating the radial artery more distally beyond its bifurcation in the hand, the distal radial approach appears to be the 'one stone, two birds' or the synchronous Chinese idiom, 'yīshí'èrniăo's' solution, reducing both complications at the same time. Extending this further and downsizing to a 4Fr catheter system, heparin use could be spared altogether, without complications, and haemostasis achieved with short manual pressure at the puncture site. Hence, further cost savings by foregoing commercial compression bands, and abolishing access site care for nurses. We illustrate the above strategy in a patient with challenging radial anatomy, made simple and easy.

Balloon Angioplasty of the Radial Artery to Solve a Challenging Radial Sheath Insertion.

The inability to advance the dedicated wire of the transradial sheath in a radial artery with a good pulsatile blood flow is a very rare event. In this case, the advancement of a high-performance 0.014 inch coronary wire is the only option to gain the vessel. Then, if the transradial sheath is stuck in the proximal radial artery wall, balloon angioplasty of the radial artery may allow successful reinsertion of the transradial sheath. This technique allows the preservation of radial artery access, avoiding a shift to an alternative arterial approach.

A Randomized Trial Comparing Short versus Prolonged Hemostasis with Rescue Recanalization by Ipsilateral Ulnar Artery Compression: Impact on Radial Artery Occlusion-The RESCUE-RAO Trial.

Background Despite the enormous benefits of radial access, this route is associated with a risk of radial artery occlusion (RAO). Objective We compared the incidence of RAO in patients undergoing transradial coronary angiography and intervention after short versus prolonged hemostasis protocol. Also we assessed the efficacy of rescue 1-hour ipsilateral ulnar artery compression if RAO was observed after hemostasis. Material and Methods. Patients referred for elective transradial coronary procedures were eligible. After 6 F radial sheath removal, patients were randomized to short (3 hours) (n = 495) or prolonged (8 hours) (n = 503) hemostasis and a simple bandage was placed over the puncture site. After hemostasis was completed, oximetry plethysmography was used to assess the patency of the radial artery. Results One thousand patients were randomized. Baseline characteristics were similar between both groups with average age 61.4 ± 9.4 years (71% male) and PCI performed on half of the patients. The RAO rate immediately after hemostasis was 3.2% in the short hemostasis group and 10.1% in the prolonged group (p < 0.001). Rescue recanalization was successful only in the short group in 56.2% (11/19); at hospital discharge, RAO rates were 1.4% in the short group and 10.1% in the prolonged group (p < 0.001). Conclusion Shorter hemostasis was associated with significantly less RAO compared to prolonged hemostasis. Rescue radial artery recanalization was effective in > 50%, but only in the short hemostasis group.

A Safe and Simple Method for Ambulatory Iabp Placement Using Left Axillary-radial Technique

In patients with severe heart failure, a percutaneous axillary intra-aortic balloon pump (axIABP) may permit ambulation while awaiting destination therapy. Traditionally, an “axillary-femoral” approach has been used with femoral access for axillary angiography during insertion. Here we describe an “axillary-radial” technique for axIABP insertion and removal using left radial artery for second access. Insertion: Draping is performed to allow access to left axillary and radial arteries. A 5 Fr sheath is placed in the radial artery. Heparin is withheld until axillary access is obtained. Left distal subclavian angiography is performed via 4 French Pigtail to identify optimal IABP sheath insertion site avoiding major branches (Fig 1). A 0.018” wire via the radial sheath aids target artery identification with US (Fig 2A and B). A 5 Fr sheath is inserted into the axillary artery and the J-tipped 0.032” IABP guidewire is then advanced into the descending aorta using a JR4 diagnostic catheter to navigate the aortic arch. Sequential dilations allow easy insertion of the 8 Fr sheath. The proximal tip of the axIABP is placed near the level of the carina (Fig 4); a lower position may be considered if significant subclavian tortuosity is present. The external device is stabilized to the forearm with mild slack allowed to limit displacement during restricted arm movement. Anticoagulation is started after radial hemostasis is achieved. Removal: The axIABP is manually removed through the sheath, which remains in place, to simplify site sterilization. A 6 Fr sheath is placed in the left radial artery and an uninflated 7 mm x 40 mm balloon is positioned proximal to axillary sheath. If required, the balloon is repositioned over the arteriotomy and low-pressure inflation performed, assisting hemostasis should standard techniques fail. A Perclose device is deployed, and if successful, no balloon inflation is required. Final angiography through the balloon wire lumen is needed to confirm hemostasis without vascular complication. Generally, A 50cc Maquet Sensation Plus IABP is removable through the 8 Fr sheath. However, the 40cc IABP requires insertion of an 0.018” guidewire to maintain arterial access because the IABP cannot be easily removed through the 7.5 Fr sheath and they are often removed as a unit. Prior wire placement allows insertion of an 8 Fr sheath prior to suture closure. Periprocedural antibiotics are recommended in this instance. Conclusion: The left “axillary-radial” technique described here simplifies axIABP placement, post procedure hemostasis, overall procedural ergonomics and facilitates immediate ambulation.

Feasibility and Safety of Distal Radial Artery Access in Anatomical Snuffbox for Coronary Angiography and Coronary Intervention.

There is limited data on feasibility and safety of coronary interventions performed using radial artery at anatomical snuffbox as vascular access point in South Asian region. Our study attempts to evaluate the feasibility and safety of coronary angiography and percutaneous coronary intervention using transradial access at anatomical snuffbox. Transradial access at anatomical snuffbox was attempted in 128 consecutive patients, who were planned for coronary angiography and/or percutaneous coronary intervention. Success in vascular access, completion of planned procedure and complications encountered, including patency of radial artery after the procedure, were investigated. A total of 128 patients (76 males [59.4%]; 52 females [40.6%]) between 44-78 years of age (mean age, 59.0 +/- 10.2 years) were included in the study. Distal radial artery puncture and sheath placement was successful in all patients however planned procedure was completed in 126 (98.4%) patients. Total 90 coronary angiographies and 36 percutaneous coronary interventions were performed of which five were primary percutaneous coronary intervention. We encountered brachial artery spasm among two patient (1.5%) and significant pain and swelling among three patients (2.3%). No bleeding complication, numbness or parasthesia were observed on follow-up. Patients had average pain rating of 2.4+/- 1.1 in visual analogue pain rating scale. There were no instances of radial artery occlusion after the procedure. Distal radial artery, at anatomical snuffbox, is a safe and feasible alternative vascular access site for coronary angiography and percutaneous coronary intervention.

Implementation of a radial long sheath protocol for radial artery spasm reduces access site conversions in neurointerventions

BackgroundMany neurointerventionalists have transitioned to transradial access (TRA) as the preferred approach for neurointerventions as studies continue to demonstrate fewer access site complications than transfemoral access. However, radial artery spasm...

Effect of Vasodilatory Medications on Blood Pressure in Patients Undergoing Transradial Coronary Angiography: A Comparative Study.

Background:In patients undergoing coronary intervention, different vasodilators are used to prevent the radial artery spasm (RAS). To date, no studies investigated the effect of these vasodilators in blood pressure (BP) reduction.Aim:The study aimed to investigate and compare the effect of vasodilatory medications on BP reduction in patients undergoing transradial coronary angiography procedure.Methods:We consecutively included 300 patients undergoing transradial coronary angiography procedures and randomly assigned them into three equal groups to compare the effect of verapamil (2.5 mg), nitroglycerin (200 μg), and combination (verapamil 2.5 mg with nitroglycerin 200 (μg) was diluted in 5 ml of normal saline and given through radial sheath. Changes in the BP, heart rate (HR), and other clinical parameters were assessed and presented as standardized mean differences (SMD) with 95% confidence intervals (CIs). ANOVA test was performed to analyze the differences in the BP and other clinical parameters between the three groups.Results:Overall, the mean age of the study population was 53.26 years (standard deviation: 9.27), male patients (84%), with dyslipidemia (62.6%), and diabetes (45%). At baseline, the mean systolic BP (SBP) was 150.91 ± 31.66 mmHg, HR (72.34 ± 12.71 beats/min). After the administration of vasodilators, the combination group reduced SBP significantly (SMD: −33.35 [95% CI]: −40.27–−26.42, P < 0.001). There was a statistically significant difference between groups for the SBP (F [2,296] =3.38, P = 0.035). Verapamil alone showed a significant decrease in the SBP by −27.23 mmHg and diastolic BP by −4.980 mmHg.Conclusion:Intra-arterial administration of verapamil alone showed lower BP reduction compared to the combination of vasodilators. Verapamil could be a safer and effective alternative to prevent RAS with no deleterious effect on BP and HR in patients undergoing transradial coronary angiography.

798 Case of a Percutaneous Balloon Aortic Valvuloplasty Via the Radial Approach

Symptomatic severe aortic stenosis (AS) is common in the elderly with a prevalence of 10% in the age group>than 80. Aortic valve replacement (AVR) is the recommended treatment for patients with symptomatic severe AS. In certain cases, bridging to AVR with a balloon aortic valvuloplasty (BAV) may be needed to stablise the patient. We present a trans-radial BAV case. A frail 76 year-old female with severe AS (mean gradient 70mmHg) admitted with congestive cardiac failure was being considered for trans-catheter aortic valve implantation (TAVI). Due to complex access, anatomical issues and frailty, she was planned for a BAV to assess her symptomatic improvement prior to undertaking an alternate access TAVI. A trans-femoral route was initially attempted. Under conscious sedation, a 5-French sheath was inserted into the right common femoral artery (left common femoral was occluded) under ultrasound guidance with the use of a micro-puncture needle. A slippery wire and a BMW wire were unsuccessful in crossing a severely stenosed external iliac artery. With repeated attempts a retrograde dissection resulted, and this strategy was abandoned. A 6-French radial sheath was inserted and upgraded to a 7-French. The aortic valve was crossed with an AL 0.75 and a straight wire. BAV was undertaken with a 16 mm TYSHAK II (7French compatible). Trans-aortic Peak to Peak gradient went from 80mmHg to 50mmHG. Haemostasis achieved with a TR Band and manual pressure. To our knowledge, this is the first case of a successful BAV via the radial approach.

Floating potential calculation for a Langmuir probe in electronegative plasmas and experimental validation in a glow discharge

A radial Langmuir probe sheath model is used to make a prediction of the floating potential of a Langmuir probe immersed in an electronegative plasma. The new electronegative plasma sheath model takes into account the positive ion and the negative ion thermal energies and is valid for any ion temperature value. The values predicted can be used for diagnosing and controlling an electronegative plasma, and we compare them with measurements of the floating potential in an Argon plasma and in a Neon plasma with with two distinct electron populations at different temperatures. We have found that the agreement is very good in a wide range of plasma pressure and discharge current values, and thus the model is applicable for electronegative plasmas. Moreover, the model can be used to measure the energy with which the ions will collide with the surface of the probe.

THREE INFLUENCING FACTORS FOR THE ACCURATE MEASUREMENT OF NON-INVASIVE CENTRAL BLOOD PRESSURE AS COMPARED TO INVASIVE MEASUREMENT

Objective: To verify the influence of 3 potential factors on the accuracy of non-invasive central BP measurement, namely the calibration peripheral BP (brachial or radial), calibration methods (systolic/diastolic BP or mean/diastolic BP), and devices. Design and method: 50 participants (aged 62.4 ± 8.9 years) without overt heart diseases were recruited from December 2017 to July 2018. Invasive aortic BP were measured with 5F Pigtail (Cordis, U.S.) and invasive radial BP were measured with 6F Radial sheath (Cordis, U.S.) after connection to the recorder (St. Jude Medical, U.S.). Brachial BP were measured non-invasively (HEM-8102A, Omron, Japan). At the same time, non-invasive central BP were measured with 3 devices, namely SphygmorCor (AtCormedical, Australia), Mobil-O-Graph (IEM, Germany), and PulsePen (DiaTecne, Italy). Non-invasive central BP were calibrated with different peripheral BP or methods manually when available.Results: Of all participants, 23 were men and 31 were hypertensive patients. The mean invasive aortic BP was 127 ± 19/95 ± 14 mmHg. Correlation analysis showed that invasive central SBP (cSBP) significantly correlated with all non-invasive cSBP (P < 0.001), no matter which device or calibration strategy was. In ANOVA analyses, recordings from Mobil-O-Graph device were significantly lower than invasive measurements (P = 0.04), while other recordings were similar to invasive measurements (P>=0.89). Next, all recordings were aggregated and re-classified based on their calibration peripheral BP, calibration methods, and devices, respectively. Taking invasive measurements as the reference, it was shown that calibration with non-invasive brachial BP were significantly lower than the reference (P = 0.01), and calibration with invasive radial BP was not different from the reference (P = 0.10). Calibration method, either SBP/DBP or mean BP/DBP, did not significantly influence the non-invasive cSBP values (P> = 0.24). Though Mobil-O-Graph had significantly lower recordings of cSBP than the reference, it was not significantly different from the SphygmorCor Device (P = 0.13). Multiple regression analysis (including age and gender as confounders) showed that, gender and calibration peripheral BP could significantly influence the accuracy of non-invasive cSBP measurement. Conclusions: The use of radial BP rather than brachial BP might be better in non-invasive cSBP measurement, and the Mobil-O-Graph device is not recommended. Calibration methods have little influence on cSBP measurement.

Effect of six-weeks high intensity interval training under simulated microgravity condition on morphology of radial nerve myelin sheet in male rats

The purpose of this study is to investigate the effect of six weeks of HIIT under simulated microgravity conditions on morphological changes of radial nerve myelin sheath in male rats. In the present study, 24 male wistar rats were randomly selected and divided into four groups including: TS (training during suspension: n=6), CS (suspension: n=6), T (training: n=6), C (control: n=6). The training groups run on treadmill for six weeks (five days a week). 24 hours after the last training session, animals were prepared for tissue samples. At the end of the experiment, changes in myelin sheath were measured by Luxol fast blue. obtaining results showed that the percentage of changes in myelin sheath in HIIT group under simulated microgravity (p≤0.001) was higher than other groups, significantly (30/27+5/27). Based on the results, HIIT under simulated microgravity conditions affected on changes in myelin sheath. Therefore, it can play an effective role in the improvement of clinical status of neurological patients and decrease side effects in Astronauts.

Endothelial Insulin Resistance of Freshly Isolated Arterial Endothelial Cells From Radial Sheaths in Patients With Suspected Coronary Artery Disease

BackgroundEndothelial insulin resistance is insulin‐insensitivity in the vascular endothelium and can be observed in experimental models. This study aimed to investigate endothelial insulin resistance in patients with suspected coronary artery disease. To this end, a novel method of obtaining freshly isolated arterial endothelial cells from a radial catheter sheath was developed.Methods and ResultsFreshly isolated arterial endothelial cells were retrieved from catheter sheaths placed in radial arteries for coronary angiography (n=69, patient age 64±12 years). The endothelial cells were divided into groups for incubation with or without insulin, vascular endothelial growth factor, or acetylcholine. The intensity of phosphorylated endothelial nitric oxide synthase at Ser1177 (p‐eNOS) was quantified by immunofluorescence microscopy. The percentage increase of insulin‐induced phosphorylated endothelial nitric oxide synthase correlated negatively with derivatives of reactive oxygen metabolites, an oxidative stress test (r=−0.348, n=53, P=0.011), E/E′, an index of left ventricular diastolic dysfunction in Doppler echocardiography (ρ=−0.374, n=49, P=0.008), and log‐transformed brain natriuretic peptide (r=−0.266, n=62, P=0.037). Furthermore, percentage increase of insulin‐induced p‐eNOS was an independent factor for the cardio‐ankle vascular index (standardized coefficient β=−0.293, n=42, P=0.021) in the multivariate regression analysis of adaptive least absolute shrinkage and selection operator.ConclusionsOur results suggested that endothelial insulin resistance is associated with oxidative stress, left ventricular diastolic dysfunction, heart failure, and arterial stiffness.

Abstract No. 459 Technical success and safety of transradial approach for embolization in the setting of obstetrical and gynecological hemorrhage: a single-center experience

To retrospectively evaluate the efficacy and safety of using a transradial approach (TRA) for embolization in the setting of emergent obstetrical (OB) and gynecological (GYN) hemorrhage. TRA for management of pelvic hemorrhage may minimize patient discomfort and enhance ease of access relative to traditional femoral access in the presence of lithotomy positioning and recent pelvic surgery. All patients who underwent TRA embolization of refractory postpartum OB or GYN hemorrhage with significant hemodynamic compromise between 1/2013 and 12/2018 were retrospectively reviewed. Patient demographics, procedural details, technical success (defined as absence of extravasation on post-embolization angiography), adverse events (AEs) and clinical success (defined as hemodynamic stabilization) were reviewed. A total of 20 women (mean age 32, range 23-65) with acute uterine or vaginal hemorrhage were embolized using TRA. Indications for embolization included: post-partum hemorrhage (n=18), post gynecological surgery hemorrhage (1) and spontaneous bleeding from malignancy (1). A 4F 125cm VERT catheter was used in all cases to cannulate the internal iliac artery. Technical success was achieved in all patients. Clinical success was achieved in 95% of patients; 1 patient required repeat embolization for continued hemorrhage at 1 day. All patients received 3000 U intra-arterial heparin, 200ug nitroglycerin and 2.5 mg verapamil via radial sheath as per standard TRA technique. Patients were embolized with n-BCA liquid embolic (8), particles (8) or Gelfoam slurry (4). Embolized vessels included: unilateral uterine (4), bilateral uterine (13), hypogastric (4), internal pudendal (2) and vaginal (1). AEs included: minor radial arteritis (1) which resolved with conservative management. No major access site bleeding or ischemic AEs were noted. TRA for embolization of acute OBGYN hemorrhage, particularly in the setting of recent pelvic intervention is safe and effective.