Transradial Vascular Access Research Articles

Sheathless radial approach in contemporary coronary rotational atherectomy: data from two high-volume centers

Aim: To analyze the feasibility and procedural outcome of percutaneous coronary intervention (PCI) using rotational atherectomy (RA), performed via transradial sheathless guiding catheter, as compared to a standard radial and femoral vascular approach. Methods: All consecutive patients undergoing RA at two high-volume PCI centers from May 2011 to May 2023 were included. Comparisons were made between the two transradial approaches and between the three types of vascular access. Results: Two hundred twenty-three patients were enrolled. Baseline characteristics were similar, with the exception of gender. We observed, in percentages, fewer cases of failure for sheathless than standard transradial attempts (7.5% vs. 11.5%, respectively), whereas all trans-femoral attempts were successful. Transfemoral procedures were longer and more frequently performed under mechanical circulatory support. There was no difference in procedural success between the three vascular approaches. A trend towards a higher rate of vascular and bleeding complications was found in the femoral group. Conclusion: Sheathless transradial vascular access is a viable option when performing RA during complex PCI procedures, tending to result in fewer failures than the standard transradial approach and reduced bleeding and vascular complications compared to the femoral method.

Application of transradial and transfemoral accesses during hepatic artery chemoembolization in the treatment of patients with malignant liver neoplasms

Introduction Malignant neoplasms of the liver are one of the most common pathologies in oncology. Chemoembolization of the hepatic artery is currently widely used in the treatment of unresectable liver tumors. Transradial vascular access is actively used in interventional cardiology due to fewer local vascular complications. At the same time, until recently, chemoembolization of the hepatic artery was more often performed via transfemoral vascular access.The aim of the work is a comparative analysis of the results of transradial and transfemoral vascular accesses for the purpose of hepatic artery chemoembolization.Material and methods The data of 69 patients who underwent 212 hepatic artery chemoembolization procedures for malignant neoplasms in the liver were analyzed. The group of transradial access included 107 (50.5 %) interventions, the group of transfemoral access – 105 (49.5 %). The groups were comparable in terms of the main initial clinical and anamnestic data.Results Chemoembolization of the hepatic artery was successfully performed in 98.1 % in the transradial access group and 99 % in the transfemoral access group (p = 1.0). The total duration of intervention, time spent on catheterization of the target artery and radiation exposure were significantly shorter in the transradial access group than in the opposite group. The incidence of local vascular complications was not significantly different between the groups: 11 (10.3 %) and 12 (11.4 %) cases, respectively (p = 0.79). According to the results of patient interviews, the use of transradial access was accompanied by significantly less discomfort associated with the procedure.Discussion Traditionally, embolization of peripheral arteries is performed via transfemoral access, and the total incidence of local vascular complications (large subcutaneous hematomas, false aneurysms, arterovenous fistulas, etc.) is relatively high. According to the results of studies, it is possible to reduce the incidence of local vascular complications without increasing the cost of the procedure by performing the same interventions using transradial access.Conclusion Transradial vascular access has a number of significant advantages over transfemoral access, and therefore can be recommended as a priority for performing hepatic artery chemoembolization.

Cardiac catheterisation: avoiding common pitfalls with transradial vascular access.

Cardiac catheterisation is a common invasive procedure. Transradial vascular access is the default approach due to a reduced risk of vascular and bleeding complications. Although transradial vascular access complications are infrequent it is important to identify, mitigate and manage them appropriately when they arise. Several techniques have been identified to try to reduce their occurrence pre- and post- procedurally, as well as manage any complication sequalae. This review article summarises the incidence, type, prevention and management of complications encountered in transradial vascular access.

Percutaneous coronary intervention in octogenarians: 10-year experience from a primary percutaneous coronary intervention centre with off-site cardiothoracic support.

OBJECTIVETo examine the trends in patient characteristics and clinical outcomes over a ten-year period and to analyse the predictors of mortality in octogenarians undergoing percutaneous coronary intervention (PCI) in our centre.METHODSA total of 782 consecutive octogenarians (aged 80 and above) were identified from a prospectively collected PCI database within our non-surgical, medium volume centre between 1st January 2007 and 31st December 2016. This represented 10.9% of all PCI procedures performed in our centre during this period. We evaluated the demographic and procedural characteristics of the cohort with respect to clinical outcomes (all-cause in-hospital and 1-year mortality, in-hospital complication rates, duration of hospital admission, coronary disease angiographic complexity and major co-morbidities). The cohort was further stratified into three chronological tertiles (January 2007 to July 2012, 261 cases; August 2012 to May 2015, 261 cases; June 2015 to December 2016, 260 cases) to assess for differences over time. Predictors of mortality were identified through a multivariate regression analysis.RESULTSThe number of octogenarians undergoing PCI increased nearly ten-fold over the studied period. Despite this, there were no significant differences in clinical outcomes or patient characteristics, except for the increased use of trans-radial vascular access [11.9% in first tertile vs. 73.2% in third tertile (P < 0.0001)]. The all-cause in-hospital (5.8% vs. 4.6% vs. 3.8%, P = 0.578) and 1-year mortality (12.4% vs. 12.5% vs. 14.4%, P = 0.746) remained constant in all three tertiles respectively. Six independent predictors of mortality were identified - increasing age [HR = 1.12 (1.03−1.22), P = 0.008], cardiogenic shock [HR = 16.40 (4.04–66.65), P < 0.0001], severe left ventricular impairment [HR = 3.52 (1.69−7.33), P = 0.001], peripheral vascular disease [HR = 2.73 (1.22−6.13), P = 0.015], diabetes [HR = 2.59 (1.30−5.17), P = 0.007] and low creatinine clearance [HR = 0.98 (0.96−1.00), P = 0.031]. CONCLUSIONThis contemporary observational study provides a useful insight into the real-world practice of PCI in octogenarians.

Interventional treatment of acute myocardial infarction-related cardiogenic shock.

Acute revascularization is with some evidence the only intervention proven to improve the prognosis in myocardial infarction-related cardiogenic shock but several interventions are continuously being investigated in order to increase survival among these patients. In this review, several aspects related to the interventional treatment of cardiogenic shock are discussed chronologically from symptom debut to leaving the cardiac catheterization laboratory. In the randomized CULPRIT-SHOCK trial, a culprit-only revascularization strategy was reported superior to immediate complete revascularization among patients with multivessel disease. Recent large-scale observational data underline the marked prognostic importance of time from medical contact to revascularization in acute myocardial infarction-related cardiogenic shock. Moreover, studies suggest a potential beneficial effect of a transradial vascular access as well as early initialization of mechanical circulatory support in carefully selected patients. This, however, needs further validation. Acute revascularization remains a crucial part of the initial management of acute myocardial infarction-related cardiogenic shock. Among cardiogenic shock patients presenting with multivessel disease, a culprit-only approach should be the routine strategy. Time to revascularization plays a crucial role in the setting of cardiogenic shock, why prehospital optimization and triaging may be the most important factors in order to improve prognosis in AMI-related cardiogenic shock.

Use of the Left Radial Artery as Vascular Access for Coronary Angiography and as a Bypass Conduit: A Clinical Dilemma?

PurposeInternational coronary revascularization guidelines recommend both, transradial vascular access for coronary angiography/intervention and use of the radial artery as a conduit for coronary artery bypass grafting (CABG). These recommendations may pose a clinical dilemma, as transradial access exposes these arteries to vascular trauma which makes them potentially unsuitable as future grafts. In this study, we investigated the awareness and views of cardiologists on these guideline recommendations. MethodsWe performed semi-structured interviews with 50 cardiologists from 19 centers, who regularly perform coronary angiographies or interventions, and outlined clinical scenarios to evaluate their preference of vascular access. In addition, we assessed whether preference was related to sub-specialization. ResultsThe interviewed cardiologists had 16 ± 9.3 years of professional experience. There were 23 (46%) cardiologists from 7 centers without percutaneous coronary intervention facilities, and 27 (56%) cardiologists from 12 interventional centers. All 50 (100%) cardiologists indicated familiarity with the guidelines, yet 28 (56%) said not to be familiar with the aforementioned dilemma, and 9 (18%) stated there was no dilemma at all. Responses did not differ significantly between interventional (n = 28) and non-interventional (n = 22) cardiologists; however, if the right radial artery was unavailable (e.g., occluded), interventional cardiologists more often said to prefer access via the left radial artery (18/28 (64%) vs. 5/22 (23%), p = 0.001). ConclusionMore than half of the interviewed cardiologists indicated that they had not realized that left transradial access preceding CABG may preclude later use of this artery as a conduit. Notably, in case of unavailability of the right radial artery, interventional cardiologists preferred left transradial access more often than non-interventional cardiologists.

Transradial Vascular Access as an Optimal Way for Chemoembolization of Liver Arteries

Transradial Vascular Access as an Optimal Way for Chemoembolization of Liver Arteries

Benefits of pressure-controlled hemostasis for transradial vascular access: a randomized controlled trial.

Transradial vascular access is widely used due to advantages such as facile hemostasis and reduced bed rest time. Accordingly, several hemostatic devices have been introduced for transradial vascular access. However, the pain caused by hemostatic compression has not yet been resolved. The objective of this study was to determine the optimal compression pressure to minimize pain at the hemostasis site without increasing complications after transradial catheterization. A total of 86 patients who underwent transradial catheterization from November 2014 to March 2015 were prospectively enrolled in this study. In group I (N.=42), the radial arteries were compressed by adjusting the air volume to reach systolic blood pressure plus 20 mmHg. For group II (N.=44), "conventional hemostasis" was performed by injecting a fixed volume (15 mL) of air into the air bag of the TR band. Complications, including pain, rebleeding, hematoma, and radial artery occlusion, were compared between the two groups. In addition, the pain level at the hemostasis site was assessed using a visual analog scale. The visual analog scale of group I was significantly lower than that of group II (1.548±1.549 vs. 2.466±1.682, P=0.01 at application; 1.202±1.700 vs. 2.818±2.060, P<0.001 at removal). The other complications were not significantly different between the two groups. Compared to conventional hemostasis, pressure-controlled hemostasis with systolic blood pressure plus 20 mmHg significantly reduced pain at the hemostasis site after transradial vascular access without increasing the incidence of other complications.

Percutaneous coronary intervention through transradial vascular access in different anatomies of the aortic arch

Percutaneous coronary intervention through transradial vascular access in different anatomies of the aortic arch

THE ADVANTAGE OF THE TRANSRADIAL APPROACH FOR PROSTATE ARTERY EMBOLIZATION

Treatment of benign prostatic hyperplasia is an important and challenging problem of modern medicine. One of the most modern methods of the treatment of this disease is prostatic artery embolization. This procedure is most often done through transfemoral approach. Transradial vascular access has many advantages over the transfemoral access. Our study presents a comparative analysis of the use of transradial and transfemoral approach in this type of interventions. Transradial access was used in 13 patients, and transfemoral access - in 12 patients. The success of the procedure was 100% in both groups. The total duration of the procedure, the time needed for catheterization of internal iliac and prostatic arteries and the radiation exposure were significantly lower in the transradial approach group. There were no significant differences in the incidence of complications between two groups. The use of the transradial access was associated with a significant reduction of the frequency and severity of the discomfort associated with the procedure. Transradial approach has numerous advantages over the transfemoral approach and may have great clinical significance.

The advantages of transradial vascular access in epistaxis embolization

Treatment of patients with severe or recurrent epistaxis that is refractory to therapy is an important and relevant problem of the present-day medicine. One of the most advanced methods of this pathology treatment is endovascular embolization procedure which is usually performed through transfemoral access. Transradial vascular access has a lot advantages over the transfemoral one. The authors provided a randomized study, comparing transradial and transfemoral approaches during epistaxis embolization. Transradial access group included 12 patients, and transfemoral access group – 13 patients. The success of the procedure was 100% in both groups. The total duration of the procedure, the time needed for bleeding point catheterization, the radiation exposure and the rate of complications were comparable between the two groups. The use of the transradial access was accompanied with significant reduction of the frequency and severity of the discomfort associated with the procedure.

Institutional Switch from Transfemoral to Transradial Vascular Access for Percutaneous Coronary Intervention was Associated with a Reduction in Bleeding Events: A Singlecenter Experience of >10,000 Consecutive Cases.

Transradial (TR) access for percutaneous coronary intervention (PCI) reduces bleeding compared with transfemoral (TF) access, and may reduce mortality in specific patient subsets. However, switching from TF to TR access is associated with a learning curve and it is unclear whether benefits observed in randomized trials translate into practice. We sought to characterize the trends in bleeding and mortality rates at our institution, as we changed from being a TF to predominantly TR center over a 5-year period. 10,213 consecutive patients presenting for PCI were included (mean age 65.0 ± 11.6 years, 76.1% male, 48.0% PCI for acute coronary syndrome) over 5 years at a single center with PCI volume >2,000 cases per annum. Patients were stratified by initial arterial access site (TR or TF) and outcome measures included temporal trends in TR procedural failure, 30-day bleeding complications and all-cause 1-year mortality. TR procedural failure fell to a consistently low rate within 1 year (11.8% in 2008 to 2.9% in 2009, P < 0.001). As TR volume increased, the annual 30-day bleeding rate fell (1.64% in 2008 to 0.68% in 2012, P = 0.006). TR access predicted reduced 30-day bleeding (OR 0.17 [95%CI 0.07-0.38], P < 0.001), but was not a predictor of 1-year survival (HR 0.78 [95%CI 0.58-1.05], P = 0.10). Successful transition from TF to TR PCI at our institution was rapid and associated with a reduction in 30-day bleeding. These data should encourage other centers considering the adoption of TR access.

Transradial approach for challenging vascular access interventions.

Percutaneous interventional procedures for vascular access are usually performed using the draining cephalic or basilic vein. The transradial approach, which has been extensively investigated for coronary angiography and intervention, could be an attractive new technique for peri-anastomotic arteriovenous fistula stenosis. From June 2012 to February 2013, 30 patients with end-stage renal failure were evaluated for transradial vascular access intervention. A 4-French (Fr) micropuncture kit was used to access the radial artery and then subsequently upgraded to a 5-Fr sheath. Fourteen patients required an upgrade to a 6-Fr sheath for the final intervention. Primary technical success (residual stenosis <30%) was achieved in all cases where angioplasty was performed. Technical success regarding access was achieved in all patients. There were no peri-procedural complications. The post-interventional primary patency was calculated as 100%, 100%, 88.4% and 32.8% at 1, 6, 9 and 12 months, respectively. The post-interventional primary assisted patency was calculated as 100%, 100%, 100% and 63.3% at 1, 6, 9 and 12 months, respectively. Based on colour-coded Duplex scan and/or photoelectric plethysmography, all access-site arteries showed normal perfusion; however, the freedom from significant radial artery restenosis was 92.4% at 12-month follow-up. The transradial approach for vascular access endovascular interventions is technically feasible and safe. It allows simultaneous treatment of peri-anastomotic lesions in fistulas with complex venous anatomy as well as lesions in the arterial inflow and central outflow.

Transradial vascular access: a growing trend.

The transradial route for coronary angiography is a growing trend in the United States. Nurse practitioners (NPs) are an essential part of the preprocedural assessment and management of patients. This article will outline the benefits and risks of transradial access as well as methods for NPs to assess arterial hand circulation.

Successful transradial retrieval of an embolized guidewire during transradial vascular access

Transradial catheterization is associated with lower complication rates; however limited information is available regarding techniques to overcome unusual complications. We present a case of a 58-year-old male with suspected non-ST-elevated myocardial infarction who underwent transradial coronary angiography complicated by guidewire embolization into the radial artery and subsequent access loss. Successful retrieval of the embolized guidewire was achieved by re-accessing the same radial artery and the use of a 2 mm gooseneck microsnare. This technique was safe and prevented the need for surgical intervention or femoral access for retrieval, which are commonly described in the literature and can result in additional complications.

Pushing the limits forward: Transradial superficial femoral artery stenting

Percutaneous revascularization of superficial femoral artery (SFA) is increasingly carried out to treat patients with peripheral vascular disease and either intermittent claudication or critical limb ischemia. Transradial vascular access is increasingly adopted for invasive procedures due to reduced access-site complications and improved patient's comfort, compared with transfemoral. However, compared with coronary interventions, the adoption of transradial access in peripheral procedures is limited. Concerning SFA interventions, transradial access is usually prevented by the distance between the vascular access and the target lesion, which extends over the length of the currently available devices. Thanks to technical improvements, resulting in specifically dedicated low-profile equipment with adequate shaft length availability, transradial access is now feasible for the treatment of selected SFA lesions. We report the first two cases of SFA stenting performed by transradial access with a new specifically developed self-expanding nitinol stent with extended delivery system length. This report suggests that, with proper technique and specifically dedicated equipment, transradial SFA stenting is feasible. Treatment of SFA disease by transradial route, allowing for immediate post-procedure walking and simultaneous bilateral interventions, may represent an alternative for effective treatment of selected patients with SFA lesions.

Transradial renal stenting: Why and how

Transradial vascular access for invasive procedures is gaining increasingly acceptance due to reduced access-site complications and improved patient's comfort compared with transfemoral. However, the adoption of transradial access in peripheral vascular procedures is actually limited by anatomical and technical considerations. Yet, among all the peripheral vascular districts, the renal one seems to be particularly suitable for transradial approach. In this article, we discuss the rationale for preferring the radial approach instead of femoral and review the specific technical issues related to transradial renal artery stenting (RAS).