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Thieme M, Krankenberg H. Transradial Access for Aortoiliac Interventions: COMFORT, But With Compromises. JACC Cardiovasc Interv 2024; 17:1902-1904. [PMID: 39197988 DOI: 10.1016/j.jcin.2024.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Accepted: 07/01/2024] [Indexed: 09/01/2024]
Affiliation(s)
- Marcus Thieme
- Department of Angiology, Cardiology, Diabetology, REGIOMED-Vascular Center, Sonneberg, Germany; Department of Internal Medicine I, Friedrich Schiller University, Jena University Hospital, Jena, Germany; School of Medicine, University of Split, Split, Croatia.
| | - Hans Krankenberg
- Department of Angiology, Cardiology, Diabetology, REGIOMED-Vascular Center, Sonneberg, Germany; School of Medicine, University of Split, Split, Croatia
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2
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Hebert CA, Rosenthal RL, Schussler JM. Transradial Renal Angioplasty and Stent Placement for Systemic Hypertension Caused by Severe Unilateral Renovascular Stenosis. Cureus 2023; 15:e34781. [PMID: 36909107 PMCID: PMC10005850 DOI: 10.7759/cureus.34781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2023] [Indexed: 02/11/2023] Open
Abstract
Percutaneous transluminal angioplasty and stent placement for renovascular hypertension is a recognized albeit seldom used therapy. We present a case of severe renovascular hypertension, due to renal artery atherosclerosis, treated successfully with stent placement via the radial artery access approach.
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Affiliation(s)
| | - Robert L Rosenthal
- Cardiology, Baylor University Medical Center, Dallas, USA.,Cardiology, Baylor Scott & White Heart and Vascular Hospital, Dallas, USA
| | - Jeffrey M Schussler
- Cardiology, Baylor University Medical Center, Dallas, USA.,Interventional Cardiology, Baylor Scott & White Heart and Vascular Hospital, Dallas, USA
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Renal Arteriography via Radial Artery Access with a 125 cm Long Angiographic Catheter. BIOMED RESEARCH INTERNATIONAL 2021; 2021:5564462. [PMID: 33977105 PMCID: PMC8087463 DOI: 10.1155/2021/5564462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/26/2021] [Accepted: 04/19/2021] [Indexed: 11/17/2022]
Abstract
A 125 cm long catheter makes it possible to perform renal arteriography via radial artery, but its feasibility and safety remain unclear. Our study recruited 1,323 patients grouped by two different vascular accesses to renal arteriography, i.e., femoral artery access and radial artery access. The success rate of angiography was 100% in both groups. Differential analysis showed that the overall complication incidence of radial artery access group was significantly lower (2.5% for radial artery access vs. 4.8% for femoral artery access, p = 0.03). From this study, we suggest that using the 125 cm angiographic catheter to perform renal arteriography via radial artery access is feasible and safe.
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Contemporary Use of Radial to Peripheral Access for Management of Peripheral Artery Disease. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2021. [DOI: 10.1007/s11936-020-00895-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Peripheral vascular intervention (PVI) improves quality of life and reduces major adverse limb events in patients with peripheral arterial disease. PVI is commonly performed via the femoral artery, and the most common adverse periprocedural event is a vascular access complication. Transradial access for PVI has the potential to reduce vascular access complications and improve patient outcomes. Further study is needed to elucidate the risks of stroke, acute kidney injury, and radiation exposure in the setting of transradial PVI. As transradial access for PVI progresses, it will be important to build the evidence base along with procedural experience.
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Affiliation(s)
| | - Sunil V Rao
- Division of Cardiology, Duke Clinical Research Institute, Duke University, 200 Morris Street, Durham, NC 27701, USA
| | - Rajesh V Swaminathan
- Division of Cardiology, Duke Clinical Research Institute, Duke University, 200 Morris Street, Durham, NC 27701, USA
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Chen P, Li H, Zeng C, Fang Y, Shi W, Zhang X, Yang C. Efficacy and indications of transradial and transfemoral approaches for peripheral artery stent implantation. Exp Ther Med 2017; 13:2975-2982. [PMID: 28587369 DOI: 10.3892/etm.2017.4307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 02/10/2017] [Indexed: 11/06/2022] Open
Abstract
The transradial approach (TRA) has become an attractive alternative to the transfemoral approach (TFA) in percutaneous coronary intervention. To date, however, these two approaches have not been systematically compared in various percutaneous peripheral artery interventions (PPAIs). In the present study 258 patients with peripheral artery disease that underwent PPAI via the TRA (n=75) or the TFA (n=183) were analyzed. Clinical factors and outcomes in these two groups were compared. The puncture time was significantly longer (P<0.05) and the prevalence of artery vasospasm significantly higher (P<0.05) in patients who underwent PPAI via the TRA rather than via the TFA. However, the complication rate was significantly lower (P<0.05) and the artery compression time (P<0.05) and time bedridden (P<0.05) were significantly shorter via the TRA than via the TFA. These results suggest that PPAI via the TRA was associated with a lower complication rate, and shorter artery compression time and bedridden time than PPAI via the TFA. The TRA may be preferable for bilateral vertebral artery stenosis, whereas the TFA may be preferable for interventional treatment of carotid and subclavian artery stenosis. Therefore, the catheter length, artery support and push force should be comprehensively considered before choosing the TRA or TFA in the interventional treatment of renal artery stenosis.
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Affiliation(s)
- Peng Chen
- Department of Cardiology, Daping Hospital, Third Military Medical University, Chongqing 400042, P.R. China
| | - Huijie Li
- Department of Cardiology, Daping Hospital, Third Military Medical University, Chongqing 400042, P.R. China
| | - Chunyu Zeng
- Department of Cardiology, Daping Hospital, Third Military Medical University, Chongqing 400042, P.R. China
| | - Yuqiang Fang
- Department of Cardiology, Daping Hospital, Third Military Medical University, Chongqing 400042, P.R. China
| | - Weibin Shi
- Department of Cardiology, Daping Hospital, Third Military Medical University, Chongqing 400042, P.R. China
| | - Xiaoqun Zhang
- Department of Cardiology, Daping Hospital, Third Military Medical University, Chongqing 400042, P.R. China
| | - Chengming Yang
- Department of Cardiology, Daping Hospital, Third Military Medical University, Chongqing 400042, P.R. China
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Alternative access for endovascular treatment of cerebrovascular diseases. Clin Neurol Neurosurg 2016; 145:89-95. [DOI: 10.1016/j.clineuro.2016.04.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 03/22/2016] [Accepted: 04/15/2016] [Indexed: 12/25/2022]
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8
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Oren O, Oren M, Turgeman Y. Transradial versus Transfemoral Approach in Peripheral Arterial Interventions. Int J Angiol 2015; 25:148-52. [PMID: 27574380 DOI: 10.1055/s-0035-1563607] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
This study aims to compare the clinical and procedural characteristics, including iatrogenic complications, of transradial versus transfemoral approach in patients who underwent peripheral arterial interventions. We retrospectively analyzed data of 72 patients who had undergone interventions of peripheral arteries in the preceding 3 years. Of all the procedures, 39 were performed using the transfemoral approach and 33 using the transradial approach. We assessed baseline clinical factors as well as procedure-related parameters (volume of contrast media, the amount of radiation, and duration of radiation exposure), rates of primary success, and acute vascular, access-site, or neurological complications. Patients whose interventions were done via transradial access had similar demographic characteristics to those who had transfemoral angioplasties. The presence of cardiovascular risk factors was similar in the two groups, but patients in the transradial subset were significantly more likely to have dyslipidemia (90.9 vs.71.7%, p value = 0.04) and less likely to have baseline chronic kidney disease (3.0 vs. 23.0%, p value = 0.01). The length of admission was shorter for patients who underwent transradial interventions compared with the transfemoral approach (1.1 vs. 1.3 days, p value = 0.04). Fluoroscopy time, the amount of radiation, and the volume of contrast media were similar between the two groups. Rates of primary success and periprocedural complications did not differ between the two groups. The transradial route appears to be a viable, safe, and noninferior alternative to the transfemoral approach for treatment of atherosclerotic stenosis in peripheral arterial territories. Prospective studies are needed.
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Affiliation(s)
- Ohad Oren
- Technion-Israel Institute of Technology, Haifa, Israel
| | - Michal Oren
- Sackler Faculty of Medicine, Tel Aviv University-Medicine, Tel Aviv, Israel
| | - Yoav Turgeman
- Department of Cardiology, Heart Institute, Ha'Emek Medical Center, Afula, Israel
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Truesdell AG, Delgado GA, Blakeley SW, Bachinsky WB. Transradial peripheral vascular intervention: challenges and opportunities. Interv Cardiol 2015. [DOI: 10.2217/ica.14.67] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Rahmatzadeh M, Vijayan V, Ritter CJ, Hockley J, Leong BD, Sandford M, Mwipatayi BP. Transradial approach for challenging vascular access interventions. Vascular 2014; 23:374-81. [PMID: 25248384 DOI: 10.1177/1708538114546882] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Percutaneous interventional procedures for vascular access are usually performed using the draining cephalic or basilic vein. The transradial approach, which has been extensively investigated for coronary angiography and intervention, could be an attractive new technique for peri-anastomotic arteriovenous fistula stenosis. METHOD From June 2012 to February 2013, 30 patients with end-stage renal failure were evaluated for transradial vascular access intervention. A 4-French (Fr) micropuncture kit was used to access the radial artery and then subsequently upgraded to a 5-Fr sheath. Fourteen patients required an upgrade to a 6-Fr sheath for the final intervention. RESULTS Primary technical success (residual stenosis <30%) was achieved in all cases where angioplasty was performed. Technical success regarding access was achieved in all patients. There were no peri-procedural complications. The post-interventional primary patency was calculated as 100%, 100%, 88.4% and 32.8% at 1, 6, 9 and 12 months, respectively. The post-interventional primary assisted patency was calculated as 100%, 100%, 100% and 63.3% at 1, 6, 9 and 12 months, respectively. Based on colour-coded Duplex scan and/or photoelectric plethysmography, all access-site arteries showed normal perfusion; however, the freedom from significant radial artery restenosis was 92.4% at 12-month follow-up. CONCLUSION The transradial approach for vascular access endovascular interventions is technically feasible and safe. It allows simultaneous treatment of peri-anastomotic lesions in fistulas with complex venous anatomy as well as lesions in the arterial inflow and central outflow.
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Affiliation(s)
- Mitra Rahmatzadeh
- Department of Vascular Surgery, Royal Perth Hospital, Perth, Australia
| | - Vikram Vijayan
- Department of Vascular Surgery, Royal Perth Hospital, Perth, Australia
| | - Carsten J Ritter
- Department of Vascular Surgery, Royal Perth Hospital, Perth, Australia
| | - Joseph Hockley
- Department of Vascular Surgery, Royal Perth Hospital, Perth, Australia
| | - Benjamin Dk Leong
- Department of Vascular Surgery, Royal Perth Hospital, Perth, Australia
| | - Monique Sandford
- Department of Vascular Surgery, Royal Perth Hospital, Perth, Australia Renal Access Unit, Royal Perth Hospital, Perth, Australia
| | - Bibombe P Mwipatayi
- Department of Vascular Surgery, Royal Perth Hospital, Perth, Australia Renal Access Unit, Royal Perth Hospital, Perth, Australia School of Surgery, University of Western Australia, Australia
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Ruzsa Z, Tóth K, Jambrik Z, Kovács N, Nardai S, Nemes B, Hüttl K, Merkely B. Transradial access for renal artery intervention. Interv Med Appl Sci 2014; 6:97-103. [PMID: 25243074 DOI: 10.1556/imas.6.2014.3.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Revised: 06/02/2014] [Accepted: 06/02/2014] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION Percutaneous interventional procedures in the renal arteries are usually performed using a femoral or brachial vascular access. The transradial approach is becoming more popular for peripheral interventions, but limited data exists for renal artery angioplasty and stenting. METHODS We have analyzed the clinical, angiographic and technical results of renal artery stenting performed from radial artery access between 2012 and 2013. The radial artery anatomy was identified with aortography using 100 cm pig tail catheter. After engagement of the renal artery ostium with a 6F Multipurpose or 6F JR5 guiding catheter, the stenosis was passed with a 0.014" guidewire followed by angioplasty and stent implantation. RESULTS In 27 patients (mean age: 65.4 ± 9.17) with hemodynamically relevant renal artery stenosis (mean diameter stenosis: 77.7 ± 10.6%; right, n = 7; left, n = 20), interventional treatment with angioplasty and stenting was performed using a left (n = 3) or right (n = 24) radial artery access. Direct stenting was successfully performed in 13 (48%) cases, and predilatations were required in ten cases 10 (37%). Primary technical success (residual stenosis <30%) could be achieved in all cases. The mean contrast consumption was 119 ± 65 ml and the mean procedure time was 30 ± 8.2 min. There were no major periprocedural vascular complications and in one patient transient creatinine level elevation was observed (3.7%). In one patient asymptomatic radial artery occlusion was detected (3.7%). CONCLUSION Transradial renal artery angioplasty and stenting is technically feasible and safe procedure.
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Hamon M, Pristipino C, Di Mario C, Nolan J, Ludwig J, Tubaro M, Sabate M, Mauri-Ferré J, Huber K, Niemelä K, Haude M, Wijns W, Dudek D, Fajadet J, Kiemeneij F. Consensus document on the radial approach in percutaneous cardiovascular interventions: position paper by the European Association of Percutaneous Cardiovascular Interventions and Working Groups on Acute Cardiac Care** and Thrombosis of the European Society of Cardiology. EUROINTERVENTION 2013; 8:1242-51. [PMID: 23354100 DOI: 10.4244/eijv8i11a192] [Citation(s) in RCA: 273] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Radial access use has been growing steadily but, despite encouraging results, still varies greatly among operators, hospitals, countries and continents. Twenty years from its introduction, it was felt that the time had come to develop a common evidence-based view on the technical, clinical and organisational implications of using the radial approach for coronary angiography and interventions. The European Association of Percutaneous Cardiovascular Interventions (EAPCI) has, therefore, appointed a core group of European and non-European experts, including pioneers of radial angioplasty and operators with different practices in vascular access supported by experts nominated by the Working Groups on Acute Cardiac Care and Thrombosis of the European Society of Cardiology (ESC). Their goal was to define the role of the radial approach in modern interventional practice and give advice on technique, training needs, and optimal clinical indications.
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Affiliation(s)
- Martial Hamon
- Recherche Clinique, Bureau 364, Centre Hospitalier Universitaire de Caen, Avenue Côte de Nacre, 14033 Caen, Normandie, France.
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Sanghvi K, Coppola J, Patel T. Cranio-caudal (transradial) approach for renal artery intervention. J Interv Cardiol 2013; 26:530-5. [PMID: 24033772 DOI: 10.1111/joic.12053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
This report describes the technique of transradial renal angiography and interventions. We illustrate the approach using typical case images. We believe cranio-caudal approach to the renal artery for diagnostic and therapeutic catheterization offers advantages over the traditional femoral approach.
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Affiliation(s)
- Kintur Sanghvi
- Deborah Heart and Lung Institute, Browns Mills, New Jersey
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An Experimental Study to Determine the Optimal Access Route for Renal Artery Interventions. Eur J Vasc Endovasc Surg 2013; 46:236-41. [DOI: 10.1016/j.ejvs.2013.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Accepted: 05/02/2013] [Indexed: 11/19/2022]
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Romagnoli E, Mann T, Sciahbasi A, Pendenza G, Biondi-Zoccai GGL, Sangiorgi GM. Transradial approach in the catheterization laboratory: Pros/cons and suggestions for successful implementation. Int J Cardiol 2013; 163:116-24. [PMID: 22137451 DOI: 10.1016/j.ijcard.2011.11.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2011] [Revised: 09/07/2011] [Accepted: 11/01/2011] [Indexed: 02/05/2023]
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Takeshita S, Matsumi J, Saito S. Renal artery intervention using a virtual 4.5-Fr guiding catheter. Catheter Cardiovasc Interv 2012; 81:1043-6. [PMID: 22581581 DOI: 10.1002/ccd.24484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Revised: 04/13/2012] [Accepted: 05/05/2012] [Indexed: 11/08/2022]
Abstract
A 6.5-Fr guiding catheter (Parent Plus 45, Medikit, Tokyo, Japan), composed of a hydrophilic sheathless guiding catheter and a dilator, has recently been developed for the treatment of renal artery stenosis. Because of its unique sheathless configuration, its outer diameter is comparable to that of a conventional 4.5-Fr introducer sheath, with the inner diameter being close in size to a 6.5-Fr guiding catheter. These features allow this sheathless system to be used as the sole guiding catheter while the arterial damage at the puncture site remains equivalent to that of a 4.5-Fr introducer sheath. We thus call this novel sheathless guiding catheter a virtual 4.5-Fr system. To demonstrate the potential of this virtual 4.5-Fr system, we report a case of renal artery stenosis successfully treated via the transradial route. This virtual 4.5-Fr system may become a viable alternative to conventional guiding catheters, and provide a favorable impact upon vascular access complications and patient morbidity.
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Affiliation(s)
- Satoshi Takeshita
- Department of Cardiology and Catheterization Laboratory, Shonan Kamakura General Hospital, Kamakura, Japan.
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Sengottuvelu G. Current Status of Radial Interventions. APOLLO MEDICINE 2011. [DOI: 10.1016/s0976-0016(11)60069-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Wilson SR, Grunstein I, Hirvela ER, Price DD. Ultrasound-Guided Radial Artery Catheterization and the Modified Allen's Test. J Emerg Med 2010; 38:354-8. [DOI: 10.1016/j.jemermed.2008.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2005] [Revised: 10/04/2007] [Accepted: 11/07/2007] [Indexed: 10/21/2022]
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Abstract
Transradial vascular access for invasive procedures is gaining increasingly acceptance due to reduced access-site complications and improved patient's comfort compared with transfemoral. However, the adoption of transradial access in peripheral vascular procedures is actually limited by anatomical and technical considerations. Yet, among all the peripheral vascular districts, the renal one seems to be particularly suitable for transradial approach. In this article, we discuss the rationale for preferring the radial approach instead of femoral and review the specific technical issues related to transradial renal artery stenting (RAS).
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Affiliation(s)
- Carlo Trani
- Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy.
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21
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Trani C, Burzotta F, Tommasino A, Giammarinaro M. Transradial approach to treat superficial femoral artery in-stent restenosis. Catheter Cardiovasc Interv 2009; 74:494-8. [DOI: 10.1002/ccd.22091] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Lee SH, Park HS, Jang SY, Kim JH, Park SH, Ryu HM, Jang GL. A Case of Peripheral Revascularization Via the Radial Artery Using Devices Designed for Percutaneous Coronary Intervention. Korean Circ J 2008. [DOI: 10.4070/kcj.2008.38.12.671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Sang Hyuk Lee
- Division of Cardiology, Department of Internal Medicine, Kyungpook National University Medical School, Daegu, Korea
| | - Hun Sik Park
- Division of Cardiology, Department of Internal Medicine, Kyungpook National University Medical School, Daegu, Korea
| | - Se Yong Jang
- Division of Cardiology, Department of Internal Medicine, Kyungpook National University Medical School, Daegu, Korea
| | - Jae Hee Kim
- Division of Cardiology, Department of Internal Medicine, Kyungpook National University Medical School, Daegu, Korea
| | - Seon Hee Park
- Division of Cardiology, Department of Internal Medicine, Kyungpook National University Medical School, Daegu, Korea
| | - Hyeon Min Ryu
- Division of Cardiology, Department of Internal Medicine, Kyungpook National University Medical School, Daegu, Korea
| | - Gui Lyen Jang
- Division of Cardiology, Department of Internal Medicine, Cheongju Medical Center, Cheongju, Korea
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Yamashita T, Imai S, Tamada T, Yamamoto A, Egashira N, Watanabe S, Higashi H, Gyoten M. Transradial approach for noncoronary angiography and interventions. Catheter Cardiovasc Interv 2007; 70:303-8. [PMID: 17630676 DOI: 10.1002/ccd.21169] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
PURPOSE The purpose of this study was to retrospectively evaluate the feasibility and safety of a transradial approach for non-coronary angiography and interventions. BACKGROUND Generally, the transradial approach is used for coronary angiography and intervention around the world, and experiences have been widely reported. However, few large studies have examined the transradial approach for vessels other than the coronary or cerebral artery. METHODS Subjects comprised 329 patients who underwent a total of 400 procedures (285 abdomens, 68 pelvises, and 47 lower limbs) with transradial angiography and interventions between January 1999 and June 2006. Normal Allen test results were confirmed before all procedures. A 130- or 150-cm long 4F catheter modified to our own design was used for angiography and interventions such as transarterial embolization or transarterial chemotherapy. RESULTS Radial artery access was unachievable in 19 of the 400 procedures (4.8%). The radial artery was injured during 1 procedure (0.2%). In the remaining 380 procedures, sufficient angiography was obtained to grasp the condition of indispensable vessels for diagnosis and interventions scheduled in advance succeeded. Total transradial technical success rate in the series was 95%. Frequency of complications such as radial injury or radial spasm was 1.8%. No cases of local hematoma, hand ischemia, or cerebral infarction were encountered. CONCLUSION The transradial approach was useful for non-coronary angiography and interventions and offers the advantages of low risk and reduced stress on patients.
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Affiliation(s)
- Takenori Yamashita
- Department of Diagnostic Radiology, Kawasaki Medical School, Okayama, Japan.
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Wang HJ, Yang YF. Percutaneous Treatment of Dysfunctional Brescia-Cimino Fistulae Through a Radial Arterial Approach. Am J Kidney Dis 2006; 48:652-8. [PMID: 16997062 DOI: 10.1053/j.ajkd.2006.07.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2006] [Accepted: 07/17/2006] [Indexed: 11/11/2022]
Abstract
BACKGROUND Dysfunctional Brescia-Cimino fistulae contribute to significant morbidity in hemodialysis patients. These fistulae normally are treated through a retrograde venous approach. There are no data regarding a transradial approach. Furthermore, measurement of pressure reduction in the radial artery appears to be useful. METHODS We retrospectively examined 50 interventions to treat 49 patients (17 men, 32 women; mean age, 61.8 +/- 10.6 years) with Brescia-Cimino fistulae. Inclusion criteria were patients with palpable radial arteries and dysfunctional end-to-side Brescia-Cimino fistulae. Patients with infected fistulae, contrast allergy, upper-arm/synthetic graft/central-vein stenosis, and end-to-end Brescia-Cimino fistulae were excluded from the study. Radial arterial pressures before and after angioplasty were compared as a surrogate of stenosis relief. Anatomic and clinical success rates were calculated. RESULTS Sixty-five stenoses and 4 total occlusions were treated through radial access. All radial punctures were successful, except in 1 patient. Most lesions were located in the cephalic vein (87%). Mean length of treated lesions was 4.1 +/- 2.8 cm. Mean pretreatment diameter of lesion stenoses was 76.7% +/- 12.1%. Mean posttreatment diameter stenosis was 22.6% +/- 8.2% (P < 0.001). Systolic, diastolic, and mean blood pressures recorded from the radial artery decreased from 130 +/- 40, 60 +/- 18, and 87 +/- 27 to 88 +/- 40, 43 +/- 18, and 60 +/- 26 mm Hg (P < 0.001, P < 0.001, and P < 0.001), respectively. The anatomic success rate of the transradial approach was 91.3%. The clinical success rate of the transradial approach was 96%. CONCLUSION The transradial approach is a feasible and highly effective approach to treat dysfunctional Brescia-Cimino fistulae. Measuring blood pressure reduction through the radial artery appears promising as a hemodynamic evaluation method.
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Affiliation(s)
- Huang-Joe Wang
- Department of Internal Medicine, Division of Cardiology, China Medical University Hospital, Taichung, Taiwan.
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Kawarada O, Yokoi Y, Nakata S, Morioka N, Takemoto K. Transradial intervention for native fistula failure. Catheter Cardiovasc Interv 2006; 68:513-20. [PMID: 16969841 DOI: 10.1002/ccd.20751] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The native radiocephalic (Brescia-Cimino) fistula is usually constructed with an anastomosis of the cephalic vein and radial artery. Catheter interventions for native fistula failure have until now been performed via the transcephalic or transbrachial approach. Transradial intervention for native fistula failure was prospectively evaluated for a selected consecutive 11 patients. Six patients had a single lesion and 5 patients had double lesions. Twelve lesions were stenotic and 4 were occlusive with thrombus. Balloon angioplasty alone was successful in 10 lesions. In thrombosed fistulas, 2 lesions underwent manual catheter-directed thrombo-aspiration and 2 further lesions underwent a combination of catheter-directed thrombo-aspiration and mechanical thrombectomy. Cutting Balloon angioplasty was performed for 3 resistant venous stenoses and for 1 radial artery stenosis. Technical and clinical success were achieved in all patients. No vessel rupture or perforation was observed in this study, nor was distal embolization in the radial artery or symptomatic pulmonary embolism. No radial artery occlusion or fistula infection was seen during the follow-up. The primary patency rates were 82% at 3 months and 64% at 6 months. Transradial intervention for native fistula failure is considered safe and feasible in a selected population; yet requires further validation.
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Affiliation(s)
- Osami Kawarada
- Department of Cardiology, Kishiwada Tokushukai Hospital, Kishiwada City, Osaka, Japan.
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Flachskampf FA, Wolf T, Daniel WG, Ludwig J. Transradial stenting of the iliac artery: A case report. Catheter Cardiovasc Interv 2005; 65:193-5. [PMID: 15895404 DOI: 10.1002/ccd.20351] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In this case report, stenting of the common iliac artery via the radial access route with 6 Fr equipment, including an extra long multipurpose catheter, is presented. Radial access avoids bleeding and ischemia that may complicate retrograde or crossover access to the iliac artery.
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Amighi J, Sabeti S, Dick P, Schlager O, Ahmadi R, Minar E, Schillinger M. Impact of the Rapid-Exchange Versus Over-the-Wire Technique on Procedural Complications of Renal Artery Angioplasty. J Endovasc Ther 2005; 12:233-9. [PMID: 15823071 DOI: 10.1583/04-1467.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To investigate whether the use of rapid-exchange (RX) systems adds to the safety of percutaneous renal artery procedures compared to the conventional over-the-wire (OTW) technique. METHODS The interventional registry in our department was interrogated to identify patients who underwent plain balloon angioplasty and/or stent implantation for >60% renal artery stenosis and intractable hypertension or decreasing renal function between 1998 and 2004. In this time period, 63 consecutive patients (36 men; mean age 67 years, range 57-80) underwent 78 renal artery angioplasty procedures. The first 46 procedures were done using a transfemoral OTW technique via 7-F sheaths; the following 32 procedures were performed with an RX system via a transfemoral 6-F access. Duration of fluoroscopy, amount of contrast agent, course of serum creatinine, and complications were compared between OTW and RX approaches. RESULTS Duration of fluoroscopy (median 13.1 versus 11.1 minutes, p=0.099) and primary technical success (94% versus 97%, p=0.64) were not significantly different between the OTW and RX approaches, but significantly less contrast agent was needed with the RX system (median 215 versus 140 mL, p<0.001). Complications, all minor, occurred significantly more often with the OTW (11/46, 24%) compared to the RX system (2/32, 6%; p=0.040) and included misplaced stents, prolonged severe hyper/hypotension, transient renal impairment, and puncture site complications. In particular, the rates of increased serum creatinine within 24 hours were higher in the OTW patients compared to the RX group (20% versus 3%, respectively, for >25% increase [p=0.041] and 9% versus 0% for >50% increase [p=0.087]). CONCLUSIONS Rapid exchange systems seem to add to the safety of percutaneous renal artery interventions. This likely may be due to a variety of causes, including lower doses of contrast medium, shorter duration of fluoroscopy, and smaller device diameters.
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Affiliation(s)
- Jasmin Amighi
- Department of Angiology, Medical University Vienna, Austria
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Bendok BR, Przybylo JH, Parkinson R, Hu Y, Awad IA, Batjer HH. Neuroendovascular Interventions for Intracranial Posterior Circulation Disease via the Transradial Approach: Technical Case Report. Neurosurgery 2005; 56:E626. [DOI: 10.1227/01.neu.0000154820.28342.38] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2004] [Accepted: 08/09/2004] [Indexed: 11/19/2022] Open
Abstract
Abstract
OBJECTIVE AND IMPORTANCE:
To describe our experience with the transradial approach for posterior circulation neurointerventional procedures. To the best of our knowledge, this approach has not been described previously for intracranial neuroendovascular procedures.
CLINICAL PRESENTATION:
The clinical and imaging characteristics as well as periprocedural outcomes of patients treated for intracranial posterior circulation disease via the transradial approach were analyzed retrospectively.
INTERVENTION:
Between January 1 and October 21, 2003, four patients with posterior circulation disease (aneurysm, n = 1, and atherosclerotic stenosis, n = 3) were treated via the transradial approach because of tortuous brachiocephalic anatomy. Procedural success was 100%, and there were no procedural complications. No technical difficulties were encountered.
CONCLUSION:
The transradial approach is an alternative to the femoral approach for posterior circulation neuroendovascular intervention. This approach has several advantages over other approaches, and the vasculature can be less tortuous than that encountered during the femoral approach. These factors can result in increased device trackability and procedural ease.
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Affiliation(s)
- Bernard R. Bendok
- Departments of Neurological Surgery and Radiology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Jason H. Przybylo
- Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Richard Parkinson
- Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Yin Hu
- Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Issam A. Awad
- Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - H Hunt Batjer
- Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
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Shiraishi J, Higaki Y, Oguni A, Inoue M, Tatsumi T, Azuma A, Matsubara H. Transradial Renal Artery Angioplasty and Stenting in a Patient With Leriche Syndrome. Int Heart J 2005; 46:557-62. [PMID: 16043951 DOI: 10.1536/ihj.46.557] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Percutaneous interventional procedures in the renal arteries are usually performed employing a femoral or brachial vascular access. In contrast, the transradial approach has been established for coronary angiography and angioplasty. We encountered a patient with Leriche syndrome who had renovascular hypertension ascribed to a severe left renal artery stenosis. To stabilize his blood pressure, we made an attempt to relieve the renal artery stenosis with Leriche syndrome by transradial renal artery angioplasty and stenting, using devices for coronary intervention. The procedure was successful without complications or residual stenosis. His hypertension improved with less antihypertensive medications. This case suggests that the radial approach might become an alternative entry site for renal artery interventions.
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Affiliation(s)
- Jun Shiraishi
- Department of Cardiology, Kyoto Prefectural Rakuto Hospital, Kyoto, Japan
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Bohannon WT, Silva MB. Value, limitations, and techniques of renal artery stenting. Semin Vasc Surg 2003; 16:300-10. [PMID: 14691772 DOI: 10.1053/j.semvascsurg.2003.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Percutaneous therapy for renovascular occlusive disease has become the preferred alternative to open renal artery revascularization. Angioplasty and stenting of renal artery stenoses has been shown to be a safe and effective option for severe hypertension and ischemic nephropathy. Catheter-based treatment, especially when performed with lower-profile systems can be performed with minimal morbidity and a reliably high degree of initial technical success. The long-term beneficial effects on blood pressure control and renal function, while debated, appear to be valid. In this article, data supporting the value and limitations of renal artery stenting are reviewed, and our technique for renal artery stenting using a lower-profile platform of balloons and stents is described.
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Affiliation(s)
- W Todd Bohannon
- Division of Vascular Surgery, Texas Tech University Health Sciences Center, Lubbock 79430-8312, USA
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