Safety and Feasibility of Transradial Access in Patients Presenting With Traumatic Injuries: A Single Urban Center Experience

Abstract

Purpose: To evaluate the efficacy, safety, and feasibility of transradial approach (TRA) for endovascular management of traumatic bleeding. Materials and Methods: A retrospective review was performed at a single level 1 trauma institution from August 2018 to July 2019. Patients presented to the interventional radiology department who were intended to be treating using TRA for the management of trauma-induced bleeding were selected. Demographics, indication for embolization, embolization site, preprocedural labs, hemodynamic stability, technical success, and complications were recorded. Results: Transradial approach was attempted in 29 (74.4%) of the 39 patients identified by operators who prefer TRA. Four patients received treatment using TRA on 2 separate occasions, for a total of 33 procedures completed with a technical success of 97% (32/33). Transradial approach was safely completed in 9 patients (27.3%) with preprocedural hemodynamically unstable status. For the 10 patients who received treatment via a transfemoral approach (TFA), traumatic disfiguration of the left upper extremity, preexisting arterial lines placed by the trauma team, and external iliac artery injuries requiring covered stent placement were the most common indications for TFA over TRA. There were no procedural or access site–related complications. Conclusion: Transradial approach for the endovascular management of bleeding in a trauma setting is safe and effective with a high technical success rate and no complications.

Interventional Management for Pelvic Trauma

“…또한 REBOA, A-line 등의 기존에 거치된 sheath가 있다면, 그 경로를 사용할 수 있다. 광범위한 골반 연조직 외상 또는 대퇴동맥 접근을 불가능하게 만드는 손상이 있는 경우 일반적으로 겨드랑동맥 또는 상완동맥 접근방법을 사용했지만, 최근에는 요골동맥 접근법이 응급 외상환자에게 있어 대퇴동맥 접근법과 유사한 기술적 성공률을 보이고 있다( 28 ). 접근 방식에 관계없이 sheath의 삽입은 환자의 혈관조영 및 시술을 위해 최대한 빠르고 안전하게 이루어져야 하며, 6F sheath를 삽입할 경우, 5F 카테터로 시술을 하는 동안 sheath를 A-line으로 사용할 수 있어 유용하다.…”