Traditional Femoral Approach Research Articles

Feasibility and Safety of Coronary Angiography via Radial Approach in Cardiac Transplant Recipients: A Single Center Experience.

Coronary angiography remains the gold standard post-transplant screening test for cardiac allograft vasculopathy. This procedure has traditionally been performed via femoral approach. Data on safety and efficacy of radial approach in cardiac transplant patients remains scarce. Single center retrospective study including all cardiac transplant patients who underwent coronary angiography via transradial approach (TRA) or transfemoral approach (TFA). Safety and efficacy outcomes were compared between the 2 groups. Primary end points included major bleeding, vascular complications, crossover to femoral approach, contrast use and radiation exposure. A total of 201 patients were included. 96 patients (47.8%) underwent angiography via TRA. At baseline, no significant differences with regards to age, gender, or traditional risk factors such as HTN, DM, hyperlipidemia were noted between the 2 groups. Most patients underwent intravascular ultrasound (n = 179, 89%) with no statistically significant differences between the 2 groups (TRA: 90.6% vs TFA: 87.6%, P = 0.5). Additionally, there were no statistically significant differences in radiation exposure, amount of contrast use and fluoroscopy time between the 2 groups. Although there were trends toward increased bleeding among TFA group, these were not statistically significant and were mostly driven by access site hematomas. Use of TRA increased over time and Conversion from TRA to TFA was low (n = 4, 4.2%). Coronary angiography via the radial approach in cardiac transplant recipients is feasible, safe and is associated with low a risk of bleeding with no significant increase in radiation exposure when compared to the traditional femoral approach.

Cranio‐Caudal (Transradial) Approach for Renal Artery Intervention

This report describes the technique of transradial renal angiography and interventions. We illustrate the approach using typical case images. We believe cranio-caudal approach to the renal artery for diagnostic and therapeutic catheterization offers advantages over the traditional femoral approach.

Forearm Approach for Percutaneous Coronary Procedures

This article gives contemporary review on the forearm approach for percutaneous diagnostic and interventional coronary procedures. Advantages and disadvantages as well as practical issues and current controversies regarding both radial and ulnar artery approach are discussed throughout the paper. Having in mind advantages of forearm approach in terms of safety and comfort over the traditional femoral approach, as well as the rapid development of invasive technology in the past years, it will probably become the default vascular approach for all percutaneous coronary procedures in the near future.

E-051 Putting the “Eye” in I.V. Access—unconventional approaches in head and neck intervention

Introduction/purposeUnconventional Access techniques have been documented in the literature and have the potential to provide a complimentary platform for intervention in select cases. This limited case series illustrates two such...

Insertion of Permanent Hemodialysis Catheters through the Great Saphenous Vein

In patients with end stage renal disease when there is inability for the creation of a direct arterio-venous fistula or by using a graft, the insertion of a permanent hemodialysis catheter in a central vein ensures the conduction of hemodialysis. We present a technique of placing a permanent catheter in the inferior vena cava through the great saphenous vein without the use of a guide wire. Over the study period, 12 hemodialyzed patients, with a mean age of 73 years, were referred for placement of a dialysis catheter through the great saphenous veins. The procedure was performed under local anesthesia, ECG monitoring, and fluoroscopic control. The insertion of the tunneled hemodialysis catheters was accomplished with ease, through surgical exposure of the great saphenous vein, without the need for a guidewire. The hemodialysis catheter's function was assessed intraoperatively. No intraoperative or immediate post operative complications were noted while during the study period 3 thromboses and an infection were detected (0,95 per 1000 catheter days). The primary catheter patency rates were 92%, 84%, 54% at 30, 90 and 180 days respectively, varying from 28 to 845 days (mean±SD = 294 ± 243,3). The introduction of dialysis catheters in the inferior vena cava through the great saphenous vein is technically simple with rare complications and with higher patency rates compared to the traditional femoral approach.

Unusual Complication After Left-Lobe Liver Biopsy for Diffuse Liver Disease: Severe Bleeding From the Superior Epigastric Artery

Imaging-guided parenchymal liver biopsy for diffuse liver disease is increasingly performed via an epigastric route from the left lobe, as opposed to the more traditional intercostal right-sided approach. We conducted a retrospective analysis of all liver biopsies performed at our department for 3 years (July 2007 through June 2010). A total of 1028 liver biopsies were performed during this period. Of these, 776 biopsies were performed for diffuse medical liver disease. Electronic medical records were reviewed for any documented complications. We identified six cases (0.8%) of documented significant bleeding after 776 biopsies. All bleeding complications were associated with the left-sided epigastric approach. No documented case of major bleeding from the right-sided approach was recorded during the same period. We describe four patients with severe bleeding complications in which classic imaging features were noted on CT, pointing to injury of the superior epigastric artery as the possible cause of the bleeding. It is important to recognize the subtle CT signs of superior epigastric artery bleeding because the traditional femoral approach with angiography of the hepatic and portal vessels may not reveal active bleeding. The superior epigastric artery, rather than the hepatic arteries, should be evaluated. A brachial approach for the angiogram may be the more optimal technique.

Transradial Approach for Coronary Angiography and Interventions: Results of the First International Transradial Practice Survey

The aim of this study was to evaluate practice of transradial approach (TRA). TRA has been adopted as an alternative access site for coronary procedures. A questionnaire was distributed worldwide with Internet-based software. The survey was conducted from August 2009 to January 2010 among 1,107 interventional cardiologists in 75 countries. Although pre-TRA dual hand circulation testing is not uniform in the world, >85% in the U.S. perform Allen or oximetry testing. Right radial artery is used in almost 90%. Judkins catheters are the most popular for left coronary artery angiographies (66.5%) and right coronary artery angiographies (58.8%). For percutaneous coronary intervention (PCI), 6-F is now standard. For PCI of left coronary artery, operators use standard extra back-up guiding catheters in >65% and, for right coronary artery 70.4% use right Judkins catheters. Although heparin remains the routine antithrombotic agent in the world, bivalirudin is frequently used in the U.S. for PCI. The incidence of radial artery occlusion before hospital discharge is not assessed in >50%. Overall, approximately 50% responded that their TRA practice will increase in the future (68.4% in the U.S.). TRA is already widely used across the world. Diagnostic and guiding-catheters used for TRA remain similar to those used for traditional femoral approach, suggesting that specialized radial catheters are not frequently used. However, there is substantial variation in practice as it relates to specific aspects of TRA, suggesting that more data are needed to determine the optimal strategy to facilitate TRA and optimize radial artery patency after catheterization.

Alternative Approach for Endovascular Treatment of Aortic Aneurysms

Endovascular treatment of thoracic aortic aneurysms is limited in patients with small or calcified femoral arteries, with the most serious complication being rupture at the insertion site or distal sections of the artery. To overcome this, an iliac conduit is normally created by surgical exposure. We used an original access in a patient with a thoracoabdominal aortic aneurysm and narrow femoral artery to introduce the endovascular prosthesis directly into the surgically exposed iliac artery by a small laparotomy and abdominal wall tunnel without iliac conduit. The endoprosthesis was easily implanted, and complete hemostasis was achieved with minimal blood loss.

Transradial right and left heart catheterizations: A comparison to traditional femoral approach

This study compares the transradial versus transfemoral approach to combined right- and left-heart catheterization. Central venous access from peripheral veins has been a historically useful technique. Although the need for right-heart catheterization has been considered an exclusion for transradial catheterization, we have combined a peripheral approach to the central venous system with radial arterial access which permits bilateral heart catheterization using a transradial approach. Over an 18-month period all right-heart catheterizations done in conjunction with arterial access were reviewed. Salvage procedures, mixed site access, and biopsy procedures were excluded. Radial procedures were performed using radial artery access and a forearm vein. Femoral procedures used femoral artery/vein. Demographics, procedural information, and postprocedural complications including those requiring vascular ultrasound or transfusion were recorded and used for comparison between groups. Total of 175 femoral/105 radial cases done by 4 operators met criteria for comparison. Both groups had similar procedural indications and age. Procedural durations were shorter (P < .01) with radial 70 +/- 5.0 min (+/-95% CI) vs. femoral 75 +/- 5.4 min (+/-95% CI). Crossover was noted in several patients from both groups; radial procedures (n = 2) failed due to previous shoulder trauma. Femoral crossover to radial involved difficult arterial access. Complications related to access site occurred in 12 femoral and 0 radial patients. Using the forearm for central venous access appears safer than using the femoral vessels. Transradial catheterizations can be done in combination with forearm venous access procedures with excellent results and enhanced patient safety.

Intra-aortic balloon pump: nursing implications for patients with an iliac artery approach

Long-term use of an intra-aortic balloon pump is often necessary for patients with severe left ventricular dysfunction who are awaiting cardiac transplantation. Complications caused by prolonged bed rest and immobility can occur when the traditional femoral approach is used for insertion of the balloon catheter. Insertion of the intra-aortic balloon catheter through the iliac artery is an alternative technique that allows patients to sit, stand, and walk while receiving counterpulsation. This approach is now being used to prevent the complications of immobility in patients awaiting cardiac transplantation. In this article, the special considerations, potential complications, and nursing interventions unique to the iliac artery approach are delineated.

Cardiac catheterization and coronary angiography using 5 french preformed (Judkins) catheters from the percutaneous right brachial approach: A comparative analysis with the femoral approach

This study describes a method for the performance of cardiac catheterization using 5 French preformed Judkins catheters from a percutaneous right brachial approach, and compares that technique to the more traditional percutaneous right femoral approach with 6 French catheters. One hundred consecutive patients requiring diagnostic left heart catheterization and selective coronary angiography were randomized according to femoral versus brachial arterial technique. Procedural efficiency, radiation exposure, and diagnostic film quality favored the femoral approach, while patient comfort, hemostasis time, time to ambulation, and decreased need for post-procedure nursing care favored the brachial approach. No differences were identified in complications. Cardiac catheterization from a right brachial artery percutaneous approach with 5 French preformed catheters has both advantages and disadvantages when compared with a more traditional femoral approach with 6 French catheters. Multiple factors should be considered before selecting an approach to diagnostic cardiac catheterization and each patient should be individually evaluated for determination of the optimal technique.