Transradial access for peripheral vascular interventions

Staniloae, Cezar; Korabathina, Ravikiran; Coppola, John

doi:10.1002/ccd.24608

Cited by 28 publications

(28 citation statements)

References 20 publications

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“…There are no RCTs examining bleeding rates for TRA vs FA, so one must rely on data from this and other observational studies. Staniloae et al, 3 in a small observational study of 27 TRA vs 41 FA patients undergoing aortoiliac interventions, reported no transfusions for either group, but 7.3% had access site access, showing an 8.7% (2102 patients) rate of periprocedural blood or blood product transfusions. Given the associations between procedure-related transfusion and increased mortality, 1,[26][27][28][29] findings in such a large population warrant concern, justifying the need for RCT comparisons.…”

Section: Bleeding Complicationsmentioning

confidence: 99%

Comparison of Transradial vs Transfemoral Access for Aortoiliac and Femoropopliteal Interventions

et al. 2016

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Purpose: To compare the procedure and safety outcomes of the transradial approach (TRA) with the femoral approach (FA) for treating aortoiliac and femoropopliteal stenoses and occlusions. Methods: A single-center retrospective study was conducted involving 188 patients (mean age 66.4±10.8 years; 116 men) with lower limb claudication or critical limb ischemia who underwent aortoiliac (131, 62.4%) or femoropopliteal (79, 37.6%) interventions on 210 lesions over a 3-year period. Operator discretion determined TRA suitability; exclusions included Raynaud’s disease, upper limb occlusive disease, previous TRA difficulties, or planned hemodialysis. Lesion characteristics, clinical endpoints, and access site complications were compared. Results: FA was used primarily in 123 patients and the TRA (12 left and 53 right radial arteries) in 65 procedures. Eleven (16.9%) TRAs failed vs 9 (7.3%) FAs (p=0.42). Crossover to FA was due to occlusive lesions requiring alternative equipment in 9 cases and to tortuosity of the aortic arch vessels in 2 patients. The 134 FA interventions (balloon angioplasty, stents) were retrograde (112, 83.6%) or antegrade (22, 16.4%). There were significantly more TASC C/D lesions in the FA group (p=0.02). Sheath sizes (5-F to 8-F) did not differ between groups, and no significant differences were found between FA vs TRA in terms of procedure time (50.0±28.9 vs 46.8±25.1 minutes, p=0.50) or length of stay (2.2±0.6 vs 2.1±0.3 days, p=0.24). While there were no strokes, access site complications occurred in 6.0% of the FA patients vs 3.7% of the TRA patients (p=0.12). Conclusion: The transradial approach for aortoiliac and femoropopliteal interventions is safe and efficacious compared with the transfemoral approach for a range of lesion subtypes. Nevertheless, there remains a need for improvements in peripheral device and catheter technology to decrease transradial failure rates.

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Section: Bleeding Complicationsmentioning

confidence: 99%

Comparison of Transradial vs Transfemoral Access for Aortoiliac and Femoropopliteal Interventions

et al. 2016

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“…The radial artery (RA) is the preferred access site for percutaneous coronary interventions (PCI), and it is also gaining popularity for peripheral interventions . Percutaneous iliac artery interventions (PIAI) are usually performed using the femoral or brachial artery (BA) , but limited data exists for iliac artery (IA) angioplasty performed through transradial (TR) approaches .…”

Section: Introductionmentioning

confidence: 99%

Transradial and transulnar access for iliac artery interventions using sheathless guiding systems: A feasibility study

Ruzsa

Tóth

Nemes

et al. 2016

Cathet Cardio Intervent

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PurposeOur aim was to evaluate the acute success and complication rates of the transradial and transulnar access for iliac artery stenting using sheathless guiding systems.MethodsClinical and angiographic data from 156 consecutive patients with symptomatic iliac artery stenosis who were treated with transradial or transulnar access were evaluated. All patients underwent Duplex ultrasound before and after the intervention. The primary endpoints were the procedural success rate, major adverse events, and access site complication rates. The secondary endpoints were the angiographic result of the iliac artery intervention, fluoroscopy time, X‐ray dose, procedure length, crossover rate to another puncture site and hospitalization duration. The impact of the learning curve was also investigated, along with right or left radial access.ResultsThe indication for the intervention was intermittent claudication in 109 patients (69.9%), critical limb ischemia in 44 (28.2%) subjects and acute limb ischemia in three individuals (1.9%). Technical success was achieved in 155 patients (99.4%), with a crossover rate of 3.8%. Radial and ulnar artery access was used in 151 (96.8%) and 7 (4.5%) patients, respectively. The Ankle‐brachial index increased from 0.69 [0.65–0.72] to 0.91 [0.88–0.95] as a result of the procedures (P < 0.001). The cumulative incidence of major adverse events was 3.8% at the 2‐month follow‐up (0% in patients with intermittent claudication and 13.8% in patients with critical limb ischemia). Radial artery access site complications were encountered in eight patients (5.1%). We documented decreased X‐ray doses (1742.0 [783.9–2701] vs. 1435 [991.1–1879] vs. 692.8 [275.3–1110] Gy cm−2 P < 0.05) over time; however, the fluoroscopy time, procedure time, and contrast consumption were not significantly different. Left hand access was not associated with significantly better results than right radial artery access.ConclusionsIliac artery stenting can be safely and effectively performed using radial or ulnar artery access and sheathless guiding catheters, with acceptable complication rates and high levels of technical success. The physician learning curve plays an important role in decreasing the X‐ray dose. © 2016 The Authors. Catheterization and Cardiovascular Interventions Published by Wiley Periodicals, Inc.

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“…Upper limb access including the brachial or radial artery has several advantages compared to conventional femoral access in terms of anatomical reasons, fewer bleeding complications, and/or patient preference [5]. In common iliac artery disease, the contralateral femoral artery approach may encounter difficulty when crossing the contralateral common iliac artery lesion.…”

Section: Antegrade Upper Limb Accessmentioning

confidence: 99%

Angiography and Endovascular Therapy for Aortoiliac Artery Disease

Fukuda¹

2017

Angiography and Endovascular Therapy for Peripheral Artery Disease

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The treatment of aortoiliac occlusive disease has shifted to endovascular therapy. Even in complex lesion, precise angiography enables successful treatment in endovascular work. However, complications-related endovascular intervention of these lesions is catastrophic. Accurate angiographic assessment is mandatory to complete the procedure. This article reviews angiographic approach for aortoiliac artery disease in diagnosis, endovascular intervention, and complications.

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Transradial access for peripheral vascular interventions

Cited by 28 publications

References 20 publications

Comparison of Transradial vs Transfemoral Access for Aortoiliac and Femoropopliteal Interventions

Comparison of Transradial vs Transfemoral Access for Aortoiliac and Femoropopliteal Interventions

Transradial and transulnar access for iliac artery interventions using sheathless guiding systems: A feasibility study

Angiography and Endovascular Therapy for Aortoiliac Artery Disease

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