Transradial interventions in contemporary vascular surgery practice

Abstract

Objectives Upper extremity arterial access is often required for endovascular procedures, especially for antegrade access to the visceral aortic branches. Radial arterial access has been shown previously to have low complication rates, and patients tolerate the procedure well and are able to recover quickly. However, transradial access remains relatively uncommon amongst vascular surgeons. Methods The radial artery was evaluated by ultrasound to evaluate for adequate caliber, and to identify any aberrant anatomy or arterial loops. A modified Barbeau test was performed to ensure sufficient collateral circulation. A cocktail of nitroglycerin, verapamil and heparin was administered intra-arterially to combat vasospasm. Sheaths up to 6 French were utilized for interventions. On completion of the procedure, a compression band was used for hemostasis in all cases. Results Twenty-five interventions were performed in 24 patients. The left radial artery was used in 23/25 cases (92.0%). Procedures included visceral and renal artery interventions; stent graft repair of a renal artery aneurysm; embolization of splenic, pancreaticoduodenal and internal mammary aneurysms; embolization of bilateral hypogastric arteries following blunt pelvic trauma; interventions for peripheral arterial disease; delivery of a renal snorkel graft during endovascular aortic aneurysm repair, and access for diagnostic catheters during thoracic endovascular aortic aneurysm repair. Technical success was 92.0%. There was one post-operative radial artery occlusion (4.3%) which led to paresthesias but resolved with anticoagulation. There were no instances of arterial rupture, hematoma, or hand ischemia requiring intervention. Conclusions Using the transradial approach, we have demonstrated a high technical success rate over a range of clinical contexts with minimal morbidity and no significant complications such as bleeding or hand ischemia. The safety profile compares favorably to historical complication rates from brachial access. Radial access is a safe and useful skill for vascular surgeons to master.

Interventional Radiology in Pelvic Trauma

“…However, radial artery access is emerging as a strategy for trauma patients, with technical success rates that are similar to the femoral approach. [23][24][25] Transradial access is obtained with the palm supinated and parallel to the floor with slight wrist hyperextension. 25 Access may be obtained by either single-or double-wall puncture technique, with the latter associated with higher first-pass success rates.…”

“…Each angiography is typically acquired with a contrast injection rate of 5 to 8 mL/second for 3 seconds, knowing that extended filming may be necessary before pelvic arterial extravasation is visualized. 9,23 In some cases, the evaluation of questionable areas of contrast extravasation may require additional imaging with selective catheterization of the anterior and posterior divisions of the internal iliac artery. This is particularly true for patients with metallic external pelvic fixation or a contrast-containing bladder, both of which may obscure the field of view.…”

“…Occlusion of a runoff vessel, such as the superficial femoral or popliteal artery, necessitates urgent revascularization with suction embolectomy of Gelfoam to avoid severe limb ischemia. 23…”

“…This decision often comes down to the patient's clinical status-in hemodynamically unstable patients, simply doing nothing is generally not an option, thus making empiric treatment a more desirable decision. 15,23…”

Safety and efficacy of radial access in trauma in 65 trauma endovascular cases

“…6,7 visceral and peripheral interventions, which is generally accomplished via the left radial artery. 8,9 The role of TRA in the endovascular management of trauma patients is unknown. The aim of this study was to present the initial experience of a radial program in a busy trauma center, with specific regard to complications and whether that is influenced by laterality.…”