Safety and Outcomes of Transradial Access in Patients with International Normalized Ratio 1.5 or above

Titano, J.; Biederman, D.; Zech, John R.; Korff, R.; Ranade, M.; Patel, Rahul; Kim, Edward; Nowakowski, F.; Lookstein, R.; Fischman, A.

doi:10.1016/j.jvir.2017.11.010

Cited by 16 publications

(10 citation statements)

References 23 publications

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“…The benefits of TRA have been extensively described in the literature. Among the greatest benefits include significantly reduced access site and major complications, 4,5,7,11 ability to treat fully anticoagulated patients with low bleeding risk, 12 faster mobilization, 10,40 and cost-effectiveness. 9 TRA also allows operators opportunity for bilateral lower extremity treatment during the same procedure, and alternative access for treatment in cases where TFA may not be suitable such as in patients with severely calcified femoral arteries, tortuous iliac arteries preventing retrograde access, or having pros-thetic endografts.…”

Section: Resultsmentioning

confidence: 99%

“…10,11 Furthermore, TRA has allowed for operators to perform procedures on fully anticoagulated patients, without significant added bleeding risk. 12,13 Despite the growing body of literature highlighting the benefits of TRA and the clear shift in operator access site preference to TRA during coronary 14 and more recently visceral interventions, 7,15,16 TFA remains the predominant access site choice in the management of PAD. This article aims to highlight recent literature evaluating TRA in PAD interventions, currently available tools to treat PAD via TRA, their limitations, and future needs to successfully implement the published benefits of TRA in the management of PAD.…”

mentioning

confidence: 99%

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Radial Access for Lower Extremity Peripheral Arterial Interventions: Do We Have the Tools?

Posham

Young

Lookstein

et al. 2018

Semin intervent Radiol

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The benefits of transradial arterial access (TRA) versus transfemoral arterial access (TFA) have been extensively described in the literature; however, TFA remains the predominant access site choice in the management of peripheral arterial disease (PAD). There are still significant unmet needs for operators wishing to provide the same effective interventions for lower extremity PAD via TRA as with TFA. This article provides an up-to-date review of the literature and devices currently available for operators wishing to treat lower extremity PAD via TRA and the limitations they may face.

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Section: Resultsmentioning

confidence: 99%

mentioning

confidence: 99%

Radial Access for Lower Extremity Peripheral Arterial Interventions: Do We Have the Tools?

Posham

Young

Lookstein

et al. 2018

Semin intervent Radiol

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“…TRA is ideal in this setting owing to its low bleeding risk profile with minor grade access site hematomas occurring in only 5.7% of cases with a preprocedural INR of greater than 1.5. 17 , 18 Transfemoral access site complications in noncoagulopathic patients is quoted at 3% for clinically significant hematoma and 2% risk of thrombotic complication. 19 Moreover, patients with elevated INR (>1.6) undergoing vascular interventions via transfemoral access have demonstrated significant retroperitoneal hematoma, requiring open surgical intervention in 2.4% of such patients.…”

Section: Discussionmentioning

confidence: 99%

Giant visceral artery pseudoaneurysm treated with endovascular transradial coil embolization

Shan

Trương

Tarabey

et al. 2020

Journal of Vascular Surgery Cases, Innovations and Techniques

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Visceral artery pseudoaneurysms (PSAs) are relatively rare, and cases associated with distal vasculature of the superior mesenteric artery are largely unreported. Visceral artery PSAs, without intervention, can lead to morbidity or mortality from rupture or mesenteric ischemia. Historically, open aneurysmectomy is the gold standard; however, endovascular modalities have emerged as the first-line treatment in patients who are poor surgical candidates and/or have unfavorable anatomy. Herein, we describe a case of a symptomatic PSA of the distal superior mesenteric artery treated via the transradial approach with endovascular coil embolization, showing successful aneurysmal exclusion and preservation of enteric collateral flow.

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“…These studies have shown that in patients where a TRA approach was taken, technical success was high with no access site-related complications. 1,[5][6][7][8][9] However, practitioners may avoid a TRA for various reasons. The inexperienced operator may fear risk of increased procedure times or technical success with TRA.…”

Section: Discussionmentioning

confidence: 99%

“…4 Following this trend, the TRA has been attempted for various noncoronary interventions as well and similarly demonstrated both safety and feasibility with technical success in multiple studies. 1,[5][6][7][8][9] In a large single-center study by Posham et al, 1512 noncoronary procedures using TRA were evaluated and found to be both safe and effective. 8 Various other retrospective studies have compared the TRA to TFA in noncoronary interventions and found that the TRA demonstrates decreased local vascular complications associated with femoral access, but it has an overall lower success rate due to the lack of adequate tools (ie, size of catheters).…”

Section: Introductionmentioning

confidence: 99%

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

Patel

Sare

Shahid

et al. 2020

Vasc Endovascular Surg

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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.

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Safety and Outcomes of Transradial Access in Patients with International Normalized Ratio 1.5 or above

Cited by 16 publications

References 23 publications

Radial Access for Lower Extremity Peripheral Arterial Interventions: Do We Have the Tools?

Radial Access for Lower Extremity Peripheral Arterial Interventions: Do We Have the Tools?

Giant visceral artery pseudoaneurysm treated with endovascular transradial coil embolization

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

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