Transradial approach for renal artery stenting

Transradial Renal Angioplasty and Stent Placement for Systemic Hypertension Caused by Severe Unilateral Renovascular Stenosis

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.

Renal Arteriography via Radial Artery Access with a 125 cm Long Angiographic Catheter

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.

Radial Access for Peripheral Interventions

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.

Efficacy and indications of transradial and transfemoral approaches for peripheral artery stent implantation

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.

Transradial versus Transfemoral Approach in Peripheral Arterial Interventions

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.

Transradial approach for challenging vascular access interventions

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.

Transradial access for renal artery intervention

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.

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

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.

Cranio-caudal (transradial) approach for renal artery intervention

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.

Renal artery intervention using a virtual 4.5-Fr guiding catheter

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.

Transradial renal stenting: why and how

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).

Transradial approach for noncoronary angiography and interventions

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.

Percutaneous Treatment of Dysfunctional Brescia-Cimino Fistulae Through a Radial Arterial Approach

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.

Transradial intervention for native fistula failure

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.

Transradial stenting of the iliac artery: A case report

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.

Impact of the Rapid-Exchange Versus Over-the-Wire Technique on Procedural Complications of Renal Artery Angioplasty

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.

Neuroendovascular Interventions for Intracranial Posterior Circulation Disease via the Transradial Approach: Technical Case Report

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.

Transradial Renal Artery Angioplasty and Stenting in a Patient With Leriche Syndrome

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.

Value, limitations, and techniques of renal artery stenting

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.