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Safety and Feasibility of Transradial Access for Noncoronary and Peripheral Vascular Interventions
Saqib Zia1, Kuldeep Singh1, Amandeep Juneja1
1Division of Vascular and Endovascular surgery, Staten Island University Hospital Northwell Health, Staten Island, NY.
Insights
Transradial access (TRad) is a safe option for peripheral vascular interventions. While radial artery occlusion can occur, it is usually asymptomatic and linked to sheath size.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Endovascular Interventions
Background:
- Transradial access (TRad) is increasingly preferred for cardiac catheterization.
- The safety and efficacy of TRad for noncoronary and peripheral interventions are not well-established.
Purpose of the Study:
- To evaluate the safety and feasibility of transradial access for noncoronary and peripheral endovascular procedures.
- To assess access-site complications and postprocedural radial artery patency.
Main Methods:
- Retrospective review of patients undergoing noncoronary and peripheral endovascular procedures via TRad.
- Evaluation of demographic data, procedural outcomes, and access-site complications.
- Clinical and duplex ultrasound assessment of radial artery patency and ischemic symptoms.
Main Results:
- 24 procedures were performed on 19 patients, with 13 therapeutic interventions.
- No access-site hematomas or procedure-related deaths occurred.
- Radial artery occlusion was observed in 31% of patients, mostly asymptomatic and correlated with sheath size.
Conclusions:
- Transradial access is a safe and feasible alternative for noncoronary and peripheral interventions.
- Radial artery occlusion is a potential complication, primarily asymptomatic, and related to sheath size.
- Optimizing sheath size and access devices may mitigate TRad challenges.
Background:
Transradial access (TRad) is becoming the preferred access for cardiac catheterization. The use and safety of TRad in noncoronary and peripheral vascular interventions remains ill-defined and serves as the basis for this study.
Methods:
Patients undergoing noncoronary and peripheral endovascular procedures via TRad from August 2010 to February 2013 at our institution were reviewed retrospectively. Demographic data, indications, interventions performed, sheath size, procedural outcomes, and access-site complications were evaluated. Postprocedural radial artery patency and hand ischemic symptoms were evaluated clinically and by duplex ultrasound.
Results:
Nineteen patients underwent 24 procedures via TRad for both diagnostic (11/24) and therapeutic (13/24) purposes. Twelve (63%) were women, and 75% (18/24) were from left radial artery. Indications included absent femoral pulses in 12 (50%), morbid obesity in 6 (25%), previous bypass originating or terminating in the groin in 4 (17%), and groin wound infection in 2 (8%) cases. A 5F sheath was used in 13 (54%) cases, 6F in 10 (42%) cases, and 7F in 1 (4%) case. Thirteen therapeutic interventions included 7 (29%) iliac angioplasties and/or stent, 3 (13%) femoral anastomosis angioplasties, 2 (8%) superficial femoral artery angioplasties, and 1 (4%) mesenteric angioplasty. No access-site hematoma or procedure-related deaths were reported. Postprocedural radial artery occlusion was observed in 6 (31%) patients. All occlusions were asymptomatic, except for 1 (4%) patient with self-limiting forearm pain lasting for 1 day. Sheath size strongly correlated with radial artery occlusion.
Conclusions:
TRad appears to be a safe and feasible alternative option for patients undergoing noncoronary and peripheral interventions. Radial artery occlusion, mostly asymptomatic, can occur and is directly related to the sheath size. Smaller sheath sizes, longer platform devices, better radial access kits, and better closure devices could potentially eliminate some of the challenges associated with TRad.
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