Prone Transradial Catheterization for Combined Single-Session Transarterial Embolization and Percutaneous Posterior Approach Cryoablation of Solid Neoplasms

Abstract

Transradial access (TRA) has been associated with improved post-procedure hemostasis and patient satisfaction, and decreased hemorrhagic complications, sedation requirements, recovery times, and procedure-related costs when compared with traditional transfemoral catheterization. Supine TRA has been described for the treatment of myocardial infarctions, aortoiliac and femoropopliteal stenoses, and a variety of neoplasms. This original research describes prone transradial catheterization to facilitate combined single-session transarterial embolization and percutaneous cryoablation of solid neoplasms from a posterior approach without repositioning. Prone TRA access, transarterial embolization, and percutaneous cryoablation were successful in all cases described. Mean procedure time was 210 min (range: 140-250 min). One minor complication, transient bacteremia which responded to antibiotics, was reported. No major complications occurred.

Prone transradial catheterization for combined single-session endovascular and percutaneous interventions: approach, technical success, safety, and outcomes in 15 patients

“…The combination of transarterial embolization with radiofrequency ablation has been shown to have greater efficacy in the treatment of solid renal neoplasms than either therapy alone (18)(19)(20)(21). Oncologic interventions such as combined transarterial embolization and radiofrequen-cy ablation, have been shown to be successful using the PTRA approach with posterior percutaneous access to directly target the lesion (13). In such cases, if supine transradial or transfemoral access were used for endovascular intervention, the patient would need mid-procedure repositioning and re-preparation for subsequent percutaneous intervention.…”

“…All patients undergoing PTRA for combined endovascular and percutaneous posterior-approach interventions (n=15) were identified via retrospective review of the electronic medical record (EPIC; Epic Systems Corporation) in conjunction with the department's prospectively maintained database (Microsoft Access 2017). Three (21%) patients were included in a prior report describing the prone transradial technique for simultaneous embolization and cryoablation of solid neoplasms (13).…”

“…TRA access and PTRA have been previously described (13,14). All patients were evaluated by an attending interventional radiologist in the hospital, emergency department, or clinic before the procedure.…”

“…In such cases, repositioning the patient mid-procedure from supine to prone or vice versa is cumbersome and time consuming and may place the patient at greater risk for procedural complications. Prone transradial access (PTRA) with combined posterior-approach percutaneous ablation has been previously described for these instances (13).…”