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Korotkikh AV, Babunashvili AM, Kazantsev AN, Annaev ZS. A narrative review of history, advantages, future developments of the distal radial access. J Vasc Access 2024; 25:745-752. [PMID: 36262018 DOI: 10.1177/11297298221129416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This article presents a historical excursus and a review of modern literature on distal radial access for interventional surgery, discussing the anatomical and physiological substantiation of the use of this access point in endovascular surgery, its advantages and disadvantages. The main considerations directly related to distal puncture, choice of instrumentation, hemostasis, possible complications, and prevention are analyzed. The major areas of interventional surgery (coronary, vascular, oncological, and neurointerventional), where the distal radial approach is actively used, are reflected and their characteristics are highlighted. In general, it has been shown that with the development of technology, improved manual skills, the widespread use of hydrophilic introducers, and modern sheathless guiding catheters, the vessel diameter, and puncture site are not decisive factors when choosing access for any type of intervention.
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Acar E, Izci S, Donmez I, Yilmaz MF, Ozgul N, Kayabası O, Gokce M, Güneş Y, Izgi IA, Kirma C. The Left D istal transradial access site co uld give a safe alter nate sit e for tra nsradial coronary in tervention (The Litaunent Study). Angiology 2024; 75:425-433. [PMID: 37345456 DOI: 10.1177/00033197231183226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
Transradial Access (TRA) is the suggested method when performing coronary procedures. TRA has several advantages over the transfemoral approach, but also some restrictions. The present study compared the efficacy and safety of the traditional proximal transradial approach (pTRA) with a newer technique known as the distal transradial approach (dTRA) for performing a coronary angiography (CAG) and percutaneous coronary intervention (PCI). Patients (n = 700) were placed into one of two categories (dTRA or pTRA) based on a random technique. The primary endpoint was RAO at follow-up. The secondary endpoints included the time required for sheath insertion, the rate of successful sheath insertion, rate of successful completion of CAG and PCI, total procedure time, total fluoroscopy time, total radiation dose, total contrast volume used, pain perception (visual analog scale 0-10), and hemostasis duration. dTRA patients had more skin punctures, failed punctures, failed wiring, overlap of access sites, sheath insertion time, and pain evaluation scale, while the pTRA group had more hemostasis time and first-time cannulation. RAO and pseudoaneurysm (PseA) were lower in the dTRA group. In this randomized study, dTRA had lower RAO and PseA than pTRA. However, multicenter, larger-patient trials are needed to provide definitive evidence.
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Affiliation(s)
- Emrah Acar
- Department of Cardiology, Abant Izzet Baysal University, Bolu, Turkey
| | - Servet Izci
- Kartal Koşuyolu Heart and Vascular Disease Research and Training Hospital, Istanbul, Turkey
| | - Ibrahim Donmez
- Department of Cardiology, Abant Izzet Baysal University, Bolu, Turkey
| | - Mehmet Fatih Yilmaz
- Department of Cardiology, Siyami Ersek Heart and Vascular Disease Research and Training Hospital, Istanbul, Turkey
| | - Neryan Ozgul
- Department of Cardiology, Kastamonu Training and Research Hospital, Kastamonu, Turkey
| | - Oguz Kayabası
- Department of Cardiology, Cankiri State Hospital, Cankiri, Turkey
| | - Mustafa Gokce
- Department of Cardiology, Karadeniz Technical University, Faculty of Medicine, Trabzon, Turkey
| | - Yilmaz Güneş
- Department of Cardiology, Abant Izzet Baysal University, Bolu, Turkey
| | - Ibrahim Akin Izgi
- Department of Cardiology, Abant Izzet Baysal University, Bolu, Turkey
| | - Cevat Kirma
- Kartal Koşuyolu Heart and Vascular Disease Research and Training Hospital, Istanbul, Turkey
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Song C, Carlson SJ. Radial Artery Access for Peripheral Vascular Interventions: A Review of the Literature. Ann Vasc Surg 2024:S0890-5096(24)00144-4. [PMID: 38582199 DOI: 10.1016/j.avsg.2023.11.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 11/23/2023] [Indexed: 04/08/2024]
Abstract
BACKGROUND Percutaneous radial artery access for lower extremity arterial interventions has increased in popularity in recent years. The purpose of this review is to summarize available data regarding its safety and efficacy. METHODS Studies related to the use of the percutaneous radial artery access for peripheral artery intervention were identified in a search of the PubMed database. Outcomes evaluated were access complications and technical success. RESULTS Thirteen studies that evaluated patients undergoing percutaneous radial artery access with peripheral interventions were reviewed. Several studies were able to demonstrate use of up to 8Fr sheath; however, the majority was 6Fr. Reported rates of asymptomatic radial artery occlusion ranged up to 16% and reported radial artery access site complication rate ranged from 0 to 15.6%. Technical success ranged from 74 to 98.7%. CONCLUSIONS Percutaneous radial artery access can effectively and safely be used in select patients.
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Affiliation(s)
- Carolyn Song
- The Division of Surgery, Veterans Affairs Boston Healthcare System, West Roxbury, MA
| | - Sarah J Carlson
- The Division of Vascular Surgery, Veteran Affairs Boston Healthcare System, West Roxbury, MA.
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Achim A, Ruzsa Z. The distal radial artery: Versatile vascular access for transcatheter interventions. J Vasc Access 2024; 25:415-422. [PMID: 38477132 DOI: 10.1177/11297298221118235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024] Open
Abstract
Conventional transradial access has been established as the gold standard for invasive coronary angiography and percutaneous interventions by the current European and American guidelines. The distal or snuffbox radial artery access represents an alternative transradial access site that allows radial sheath insertion with the patient's hand pronated. Firstly described 40 years ago, it exploded in popularity only recently. Promising additional benefits, the distal radial access is increasingly being adopted in various types of percutaneous interventions, being preferred by many interventional cardiologists and radiologists for its reduced vascular complications and time to hemostasis, and improvement of patient and operator comfort. Other centers consider it a fad, waiting for solid clear evidence and benefits. The evidence is dynamic and discrepant, depending on the center, the operator, and how it was collected (randomized controlled vs observational studies). Another essential aspect raised by "skeptics" was whether distal radial access, by its smaller diameter and more angled course, can support all types of interventions. The aim of this review is to gather all the scenarios where distal radial access has been utilized and to conclude whether this vascular access is feasible across all transcatheter interventions.
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Affiliation(s)
- Alexandru Achim
- Department of Interventional Cardiology, Medicala 1 Clinic, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
- Klinik für Kardiologie, Medizinische Universitätsklinik, Kantonsspital Baselland, Liestal, Switzerland
- Department of Internal Medicine, Division of Invasive Cardiology, University of Szeged, Szeged, Hungary
| | - Zoltan Ruzsa
- Department of Internal Medicine, Division of Invasive Cardiology, University of Szeged, Szeged, Hungary
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Ju J, Mao L, Wang Y, Xie H, Zhou S. Design and application of the intraoperative protective device for patients undergoing interventional therapy via the femoral artery approach. Technol Health Care 2024; 32:831-840. [PMID: 37458055 DOI: 10.3233/thc-230254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
BACKGROUND Femoral artery puncture is still the most used surgical approach. Because the operation requires local anaesthesia, the patient may not be able to exert full self-control, and their upper and lower limbs and trunk need to be constrained by a protection device. OBJECTIVE To explore the safe application effect of a new type of anti-movement protection device for upper and lower extremities, shoulders and chest in patients undergoing interventional therapy via the femoral artery approach. METHODS This is a prospective randomised controlled study. A total of 230 patients were randomly divided into two groups: the study group (n= 115) and the control group (n= 115). The time needed to implement the restraint operation and the loosening of the restraint device in the two groups was recorded, and the satisfaction of surgeons and nurses was investigated. RESULTS The time needed to perform restraint operation in the study group was significantly less than that in the control group (4.06 ± 0.61 min vs. 7.01 ± 0.76 min, P< 0.05). The satisfaction of surgeons and nurses with the use of the new protective device was significantly better than that of the conventional restraint band (P< 0.05). CONCLUSION The new anti-movement protection device for upper and lower limbs, shoulders and chest can conveniently and quickly achieve effective protection and braking of patients, ensure the safety of surgery and improve satisfaction.
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Affiliation(s)
- Jieqin Ju
- Interventional Center, The First Hospital of Ningbo University, Ningbo, Zhejiang, China
| | - Liqing Mao
- Interventional Center, The First Hospital of Ningbo University, Ningbo, Zhejiang, China
| | - Yuejing Wang
- Interventional Center, The First Hospital of Ningbo University, Ningbo, Zhejiang, China
| | - Haofen Xie
- Department of Nursing, The First Hospital of Ningbo University, Ningbo, Zhejiang, China
| | - Shengjun Zhou
- Neurological Center, The First Hospital of Ningbo University, Ningbo, Zhejiang, China
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Murai K, Fujino M, Iwai T, Sawada K, Matama H, Miura H, Honda S, Yoneda S, Takagi K, Otsuka F, Kataoka Y, Asaumi Y, Tahara Y, Noguchi T. Distal Radial Approach in Coronary Angiography Using a Transdermal Nitroglycerin Patch: Double-Blinded Randomized Trial. Am J Cardiol 2023; 203:325-331. [PMID: 37517127 DOI: 10.1016/j.amjcard.2023.07.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 07/09/2023] [Accepted: 07/13/2023] [Indexed: 08/01/2023]
Abstract
Nitroglycerin dilates the radial artery and prevents spasm, which increases the success rate of sheath cannulation through the conventional transradial approach. However, the effects of nitroglycerin on distal radial approach (DRA) procedures are not known. The aim of this study is to elucidate whether a transdermal nitroglycerin patch improves the rate of successful DRA cannulation. A total of 92 patients scheduled for coronary angiography by means of DRA randomly received (1:1) a transdermal nitroglycerin patch preintegrated with the covering material or only the covering material on their upper arm on the side of the puncture. The diameter of the distal radial artery was evaluated with ultrasound at baseline and after application. DRA procedures were performed in a double-blind fashion. The primary outcome was the rate of successful palpation-guided distal radial artery cannulation with the first puncture. The nitroglycerin group had larger distal radial artery diameter after patch application than that of the no-treatment group (mean, 3.21 mm vs 2.71 mm, p <0.001), but not at baseline (mean, 2.64 mm vs 2.64 mm, p = 0.965).The nitroglycerin group had a significantly higher success rate of DRA cannulation with the first puncture than that of the no-treatment group (59% vs 24%, p = 0.001; odds ratio 4.5, 95% confidence interval 1.9 to 11.0). The nitroglycerin group required fewer punctures than did the no-treatment group (median, 1 vs 3, p = 0.019). There were no significant differences in the occurrence of hypotension between the 2 groups. No patients experienced radial artery occlusion. In conclusion, transdermal nitroglycerin patch application safely facilitates DRA cannulation. Trial Registration: Japan Registry of Clinical Trials, https://jrct.niph.go.jp/ (identifier: jRCTs051210128).
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Affiliation(s)
- Kota Murai
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Center, Suita, Japan
| | - Masashi Fujino
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Center, Suita, Japan.
| | - Takamasa Iwai
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Center, Suita, Japan
| | - Kenichiro Sawada
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Center, Suita, Japan
| | - Hideo Matama
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Center, Suita, Japan
| | - Hiroyuki Miura
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Center, Suita, Japan
| | - Satoshi Honda
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Center, Suita, Japan
| | - Shuichi Yoneda
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Center, Suita, Japan
| | - Kensuke Takagi
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Center, Suita, Japan
| | - Fumiyuki Otsuka
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Center, Suita, Japan
| | - Yu Kataoka
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Center, Suita, Japan
| | - Yasuhide Asaumi
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Center, Suita, Japan
| | - Yoshio Tahara
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Center, Suita, Japan
| | - Teruo Noguchi
- Department of Cardiovascular Medicine, National Cerebral & Cardiovascular Center, Suita, Japan
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Parwani D, Ahmed MA, Mahawar A, Gorantla VR. Peripheral Arterial Disease: A Narrative Review. Cureus 2023; 15:e40267. [PMID: 37448414 PMCID: PMC10336185 DOI: 10.7759/cureus.40267] [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: 06/11/2023] [Indexed: 07/15/2023] Open
Abstract
Peripheral arterial disease (PAD) describes the partial or complete occlusion of blood flow in the distal arteries of the body. A decreased arterial patency may occur due to a reduction in the elasticity or diameter of the vessel. The goal of interventions is to decrease incidence and reduce complications by identifying and minimizing the primary causes. This paper discusses PAD affecting the aortoiliac, common femoral, and femoropopliteal arteries. In a significant portion of the population, PAD may lack usual symptoms such as limb pain, claudication, and diminished pulses. Imaging techniques become crucial to ensuring timely diagnosis, monitoring treatment effectiveness, and preventing recurrence. Duplex ultrasound (DUS) is a cheap and non-invasive preliminary technique to detect atherosclerotic plaques and grade arterial stenosis. Magnetic resonance angiography (MRA) provides the added advantage of minimizing artifacts. Digital subtraction angiography (DSA) remains the gold standard for grading the degree of stenosis but is only employed second-line to DUS or MRA due to the high dose of nephrotoxic contrast. Computed tomography angiography (CTA) is able to overcome the anatomical limitations of DUS and MRA and proves to be a suitable alternative to DSA in patients with renal disease. Preventative measures involve monitoring blood pressure, cholesterol levels, and tobacco usage. First-line treatment options include endovascular procedures as well as surgical interventions in cases of significant arterial involvement. Endovascular treatments involve the use of balloon angioplasty, drug-coated balloons, and drug-coated stents, to name a few, that serve as minimally invasive techniques to manage PAD. Surgical procedures, although more complex, are considered gold-standard treatment options for long and intricate lesions. Endovascular methods are generally preferred over surgical options as the complication risk is severely reduced and the rates of reintervention are comparable to surgical options.
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Affiliation(s)
- Divya Parwani
- Anatomical Sciences, St. George's University School of Medicine, St.George's, GRD
| | - Mohamed A Ahmed
- Anatomical Sciences, St. George's University School of Medicine, St. George's, GRD
| | - Anmol Mahawar
- Anatomical Sciences, St. George's University School of Medicine, St.George's, GRD
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Csavajda Á, Nardai S, Bertrand OF, Ruzsa Z. Superficial temporal artery access for carotid artery stenting: A case report. Clin Case Rep 2023; 11:e6947. [PMID: 36794037 PMCID: PMC9923472 DOI: 10.1002/ccr3.6947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/19/2023] [Accepted: 01/27/2023] [Indexed: 02/15/2023] Open
Abstract
Percutaneous intervention of patients who suffer from generalized vascular disease is often a great challenge due to the limited accessibility of the access gates. We discuss the case of a 66-year-old man who presented with critical right internal carotid artery (ICA) stenosis after previous hospitalization due to stroke. In addition to arteria lusoria, the patient had known bilateral femoral amputation, occlusion of the left ICA and significant three-vessel coronary artery disease. After unsuccessful common carotid artery (CCA) cannulation from the right distal radial artery access, we successfully performed the diagnostic angiography and the planned right ICA-CCA intervention using superficial temporal artery (STA) puncture. We showed that STA access can be used as an alternative and additional access site for diagnostic carotid artery angiography and intervention when standard access sites alone are insufficient.
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Affiliation(s)
- Ádám Csavajda
- Invasive Cardiology, Bács‐Kiskun County Hospital, Teaching Hospital of the Albert Szent‐Györgyi Medical SchoolUniversity of SzegedKecskemétHungary
| | - Sándor Nardai
- Semmelweis University Heart and Vascular CentreBudapestHungary
| | | | - Zoltán Ruzsa
- Semmelweis University Heart and Vascular CentreBudapestHungary,Department of Internal Medicine, Invasive CardiologyAlbert Szent‐Györgyi Medical School, University of SzegedSzegedHungary
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9
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Lorenzo Górriz A, Rodríguez Paz C, Aguilar Tejedor Y, Fandiño E, García MJ, López-Jurado ALF, Tomás Muñoz P, Paolillo R, Seguel Ravest V, Barranco-Pons R. Early exploration of the economic impact of transradial access (TRA) versus transfemoral access (TFA) for neurovascular procedures in Spain. J Med Econ 2023; 26:1445-1454. [PMID: 37814553 DOI: 10.1080/13696998.2023.2266956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 10/02/2023] [Indexed: 10/11/2023]
Abstract
INTRODUCTION Transfemoral access (TFA) is the primary access approach for neurointerventional procedures. Transradial access (TRA) is established in cardiology due to its lower complications, yet, it is at its early stages in neuroprocedures. This study performs an early exploration of the economic impact associated with the introduction of TRA in diagnostic and therapeutic neuroprocedures from the Spanish NHS perspective. METHODS An economic model was developed to estimate the cost and clinical implications of using TRA compared to TFA. Costs considered access-related, complications and recovery time costs obtained from local databases and experts' inputs. Clinical inputs were sourced from the literature. A panel of eight experts from different Spanish hospitals, validated or adjusted the values based on local experience. Hypothetical cohorts of 10,000 and 1000 patients were considered for diagnostic and therapeutic neuroprocedures respectively. Deterministic sensitivity analysis was performed. RESULTS TRA in diagnostic procedures was associated with lower costs with savings ranging between €486 and €157 depending on the TFA recovery time considered. TRA is estimated to lead to 158 fewer access-site complications. In therapeutic procedures, TRA resulted in 76.4 fewer complications and was estimated to be cost-neutral with an incremental cost of €21.56 per patient despite recovery times were not included for this group. Variation of the parameters in the sensitivity analysis did not change the direction of the results. LIMITATIONS Clinical data was obtained from literature validated by experts therefore results generalizability is limited. In therapeutic neuroprocedures, there is an experience imbalance between approaches and recovery times were not included hence the total impact is not fully captured. CONCLUSIONS The early economic model suggests that implementing TRA is associated with reduced costs and complications in diagnostic procedures. In therapeutic procedures, TRA lead to fewer complications and it is estimated to be cost-neutral, however its full potential still needs to be quantified.
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Affiliation(s)
- Antonio Lorenzo Górriz
- Interventional Neuroradiology, Hospital General Universitari de Castelló, Castellon de la Plana, Spain
| | - Carlos Rodríguez Paz
- Neuroradiology Unit, Department of Radiology, Hospital Álvaro Cunqueiro, Vigo, Spain
| | - Yeray Aguilar Tejedor
- Radiology Department, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Canarias, Spain
| | - Eduardo Fandiño
- Radiology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - María Jesús García
- Neuroradiology Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | | | - Pablo Tomás Muñoz
- Neuroradiology Unit, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Rosa Paolillo
- Study & Scientific Solutions, Medtronic Italia SpA, Milano, Italy
| | | | - Roger Barranco-Pons
- Interventional Neuroradiology Department, Hospital Universitari de Bellvitge, Barcelona, Spain
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Korotkikh AV, Babunashvili AM, Kazantsev AN, Tarasyuk ES, Annaev ZS. Distal radial artery access in noncoronary procedures. Curr Probl Cardiol 2022:101207. [PMID: 35460683 DOI: 10.1016/j.cpcardiol.2022.101207] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 04/13/2022] [Indexed: 11/28/2022]
Abstract
Since the beginning of interventional cardiology and for decades, the femoral artery has been the access of choice for both diagnostic and interventional endovascular procedures. Due to an extensive evidence base accumulated over the last 20 years, the majority of interventional cardiologists around the world prefer classical radial artery access for both elective and emergency procedures. A similar trend has been observed for distal radial artery access over the last five years. Noncoronary endovascular surgery undergoes the same stages of improvement and optimization of access, but in a more accelerated way. The goal of this review is to analyze the literature on distal radial artery access in noncoronary procedures.
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Affiliation(s)
- A V Korotkikh
- Cardiac Surgery Clinic, Amur State Medical Academy, Blagoveshchensk, Russia.
| | | | | | - E S Tarasyuk
- Amur Regional Clinical Hospital, Blagoveshchensk, Russia
| | - Z S Annaev
- Novyy Urengoy Central Hospital, Novyy Urengoy, Russia
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11
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Chen SX, Zhang B, Hao YX, Xiao H. Percutaneous mechanical thrombectomy for acute superior mesenteric artery embolism via left distal transradial access in the anatomical snuffbox. Quant Imaging Med Surg 2022; 12:1641-1646. [PMID: 35111655 DOI: 10.21037/qims-21-357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 10/28/2021] [Indexed: 11/06/2022]
Affiliation(s)
- Shang-Xiong Chen
- Department of Vascular Surgery, Southwest Hospital, Army Medical University, Chongqing, China
| | - Bin Zhang
- Department of Vascular Surgery, Southwest Hospital, Army Medical University, Chongqing, China
| | - Ying-Xue Hao
- Department of Vascular Surgery, Southwest Hospital, Army Medical University, Chongqing, China
| | - Hang Xiao
- Department of Vascular Surgery, Southwest Hospital, Army Medical University, Chongqing, China
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12
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Shi G, Li F, Zhang L, Gong C, Xue S, Song Y, Cai G. Retrograde Recanalization of Occluded Radial Artery: A Single-Centre Experience and Literature Review. J Endovasc Ther 2022; 29:755-762. [PMID: 35001676 DOI: 10.1177/15266028211067732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Radial artery occlusion (RAO) is one of the common complications after coronary intervention via the conventional radial artery approach. The purpose of the study was to explore the safety and feasibility of retrograde recanalization of the occluded radial artery via a distal radial artery (DRA) approach. METHODS Combined with the practice of our centre and a literature review, we summarized the procedure of retrograde recanalization of RAO, success rate, and complications. RESULTS A total of 14 of 15 patients with 15 pieces of occluded radial arteries were successfully recanalized via the DRA in our centre. In the 15 occluded vessels, 11 vessels (73.3%) had total occlusion and 4 vessels (26.7%) had functional occlusion. Four of 15 occluded vessels were acute occlusions. Two acute RAOs were only treated with aspiration via sheath, 11 RAOs with balloon angioplasty, and 2 RAOs with both, respectively. In 6 patients, cardiac catheterization was carried out via the DRA after recanalizing the RAO. A total of 10 studies reporting the results of recanalization of RAO via the DRA were systematically retrieved in the present study. In 3 case series, the number of cases was more than 5, and the success rate of recanalization was more than 85.7%. Two studies reported complications, including dissection in one case, hematoma in 2 cases, and pain in the forearm during angioplasty. CONCLUSIONS Recanalization of the occluded radial artery via the DRA was safe and effective. When repeat cardiac catheterization was required, recanalization of the RAO and subsequent coronary angiography or intervention through the ipsilateral radial artery approach was feasible.
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Affiliation(s)
- Ganwei Shi
- Department of Cardiology, Wujin Hospital Affiliated with Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, Changzhou, China
| | - Feng Li
- Department of Cardiology, Wujin Hospital Affiliated with Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, Changzhou, China
| | - Liuyan Zhang
- Department of Cardiology, Wujin Hospital Affiliated with Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, Changzhou, China
| | - Chun Gong
- Department of Cardiology, Wujin Hospital Affiliated with Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, Changzhou, China
| | - Sheliang Xue
- Department of Cardiology, Wujin Hospital Affiliated with Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, Changzhou, China
| | - Yanbin Song
- Department of Cardiology, Wujin Hospital Affiliated with Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, Changzhou, China
| | - Gaojun Cai
- Department of Cardiology, Wujin Hospital Affiliated with Jiangsu University, The Wujin Clinical College of Xuzhou Medical University, Changzhou, China
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Distal Radial Artery Access for Coronary and Peripheral Procedures: A Multicenter Experience. J Clin Med 2021; 10:jcm10245974. [PMID: 34945269 PMCID: PMC8707635 DOI: 10.3390/jcm10245974] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/07/2021] [Accepted: 12/17/2021] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Distal radial access (dRA) has recently gained global popularity as an alternative access route for vascular procedures. Among the benefits of dRA are the low risk of entry site bleeding complications, the low rate of radial artery occlusion, and improved patient and operator comfort. The aim of this large multicenter registry was to demonstrate the feasibility and safety of dRA in a wide variety of routine procedures in the catheterization laboratory, ranging from coronary angiography and percutaneous coronary intervention to peripheral procedures. METHODS The study comprised 1240 patients who underwent coronary angiography, PCI or noncoronary procedures through dRA in two Hungarian centers from January 2019 to April 2021. Baseline patient characteristics, number and duration of arterial punctures, procedural success rate, crossover rate, postoperative compression time, complications, hospitalization duration, and different learning curves were analyzed. RESULTS The average patient age was 66.4 years, with 66.8% of patients being male. The majority of patients (74.04%) underwent a coronary procedure, whereas 25.96% were involved in noncoronary interventions. dRA was successfully punctured in 97% of all patients, in all cases with ultrasound guidance. Access site crossover was performed in 2.58% of the patients, mainly via the contralateral dRA. After experiencing 150 cases, the dRA success rate plateaued at >96%. Our dedicated dRA step-by step protocol resulted in high open radial artery (RA) rates: distal and proximal RA pulses were palpable in 99.68% of all patients at hospital discharge. The rate of minor vascular complications was low (1.5%). A threshold of 50 cases was sufficient for already skilled radial operators to establish a reliable procedural method of dRA access. CONCLUSION The implementation of distal radial artery access in the everyday routine of a catheterization laboratory for coronary and noncoronary interventions is feasible and safe with an acceptable learning curve.
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Achim A, Szűcsborus T, Sasi V, Nagy F, Jambrik Z, Nemes A, Varga A, Bertrand OF, Ruzsa Z. Distal radial secondary access for transcatheter aortic valve implantation: The minimalistic approach. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 40:152-157. [PMID: 34848177 DOI: 10.1016/j.carrev.2021.11.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/16/2021] [Accepted: 11/17/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although not yet recommended by the guidelines, distal radial access, a new site for cardiovascular interventions, has been rapidly acknowledged and adopted by many centers due to its high rate of success, safety and fewer complications. We present our experience using secondary distal radial access during transcatheter aortic valve implantation (TAVI), proposing a new, even more minimal approach. METHODS As of November 2020, a systematic distal radial approach as secondary access site for TAVI was adopted in our center. Primary endpoints were technical success and major adverse events (MAEs). Secondary endpoints: the access site complication rate, hemodynamic and clinical results of the intervention, procedural related factors, crossover rate to the femoral access site, and hospitalization duration (in days). RESULTS From November 2020, 41 patients underwent TAVI using this strategy. Patients had a mean age of 76 ± 11.2 years, 41% were male. Six (14.63%) patients received a balloon-expandable valve and 35 (85.37%) received a self-expandable valve. TAVI was successful in all cases. No complications occurred due to transradial access. Puncture success, defined as completed sheath placement was maximum (N = 41/41,100%) and emergent transfemoral secondary access was not required in any case. Primary transfemoral vascular access site complications occurred in 7 cases (17%) of which 4 (13.63%) were resolved through distal radial access: one occlusion, two flow-limiting stenoses and four perforations of the common femoral artery. There were no additional major vascular complications at 30 days. Overall MACE rate was 2.4%. CONCLUSION The use of the distal radial approach for secondary access in TAVI is safe, feasible and has several advantages over old access sites.
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Affiliation(s)
- Alexandru Achim
- 2(nd) Department of Internal Medicine, Division of Invasive Cardiology, University of Szeged, Szeged, Hungary; Medicala 1 Invasive Cardiology Department, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania
| | - Tamás Szűcsborus
- 2(nd) Department of Internal Medicine, Division of Invasive Cardiology, University of Szeged, Szeged, Hungary
| | - Viktor Sasi
- 2(nd) Department of Internal Medicine, Division of Invasive Cardiology, University of Szeged, Szeged, Hungary
| | - Ferenc Nagy
- 2(nd) Department of Internal Medicine, Division of Invasive Cardiology, University of Szeged, Szeged, Hungary
| | - Zoltán Jambrik
- 2(nd) Department of Internal Medicine, Division of Invasive Cardiology, University of Szeged, Szeged, Hungary
| | - Attila Nemes
- 2(nd) Department of Internal Medicine, Division of Invasive Cardiology, University of Szeged, Szeged, Hungary
| | - Albert Varga
- 2(nd) Department of Internal Medicine, Division of Invasive Cardiology, University of Szeged, Szeged, Hungary
| | | | - Zoltán Ruzsa
- 2(nd) Department of Internal Medicine, Division of Invasive Cardiology, University of Szeged, Szeged, Hungary.
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Ruzsa Z, Csavajda Á, Hizoh I, Deák M, Sótonyi P, Bertrand OF, Kwan T, Merkely B, Nemes B. TRIACCESS Study: Randomized Comparison Between Radial, Femoral, and Pedal Access for Percutaneous Femoro-popliteal Artery Angioplasty. J Endovasc Ther 2021; 29:215-225. [PMID: 34427137 DOI: 10.1177/15266028211038599] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The aim of this randomized study was to compare the success and complication rates of different access sites for the treatment of superficial artery stenosis. METHODS AND RESULTS A total of 180 consecutive patients were randomized in a prospective study to treat symptomatic superficial femoral artery stenosis via radial (RA), femoral (FA), or pedal artery (PA) access. Technical success was achieved in 96.7%, 100%, and 100% of the patients in the RA, FA, and PA groups, respectively (p=0.33). Secondary access sites were used in 30%, 3.3%, and 30% of the patients in the RA, FA, and PA access groups, respectively (p=0.0002). Recanalization for chronic total occlusion was performed in 34/36 (94.4%), 30/30 (100%), and 46/46 (100%) patients in the RA, FA, and PA groups, respectively (p=0.17). The X-ray dose was significantly lower in the PA group than that in the RA and FA access groups (63.1 vs 162 vs 153 Dyn, p=0.0004). The cumulative rates of access site complications in the RA, FA, and PA groups were 3.3% (0% major and 3.3% minor), 16.7% (3.3% major and 13.3% minor), and 3.3% (3.3% major and 0% minor) (p=0.0085), respectively. The cumulative incidence of MACEs at 6 months in the RA, FA, and PA groups was 5%, 6.7%, and 1.7%, respectively. The cumulative incidence of MALEs at 6 months in the RA, FA, and PA groups was 20%, 16.7%, and 9.2%, respectively (p=0.54). CONCLUSION Femoral artery intervention can be safely and effectively performed using radial, femoral, and pedal access, but radial and pedal access is associated with a lower access site complication rate and hospitalization. Pedal access is associated with a lower X-ray dose than that with radial and femoral access.
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Affiliation(s)
- Zoltán Ruzsa
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary.,Invasive Cardiology, Cardiology Division, Bács-Kiskun County Hospital, Kecskemét, Hungary
| | - Ádám Csavajda
- Invasive Cardiology, Cardiology Division, Bács-Kiskun County Hospital, Kecskemét, Hungary
| | - István Hizoh
- Invasive Cardiology, Cardiology Division, Bács-Kiskun County Hospital, Kecskemét, Hungary
| | - Mónika Deák
- Invasive Cardiology, Cardiology Division, Bács-Kiskun County Hospital, Kecskemét, Hungary
| | - Péter Sótonyi
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | | | - Tak Kwan
- Mount Sinai Beth Israel, New York, NY, USA.,Chinatown Cardiology, PC, New York, NY, USA
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Balázs Nemes
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
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Rigatelli G, Zuin M, Daggubati R, Vassilev D, Zuliani G, Nguyen T, Roncon L. Distal snuffbox versus conventional radial artery access: An updated systematic review and meta-analysis. J Vasc Access 2021; 23:653-659. [PMID: 33789519 DOI: 10.1177/11297298211005256] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND A comprehensive comparison of available data in terms of vascular complications between distal and conventional transradial access is still partial and a net benefit of such approach has not yet been clearly demonstrated. OBJECTIVE To provide an updated comparison of complications between distal and conventional transradial access used to perform coronary angiography and/or percutaneous coronary intervention performing a systematic review and meta-analysis. DATA SOURCES Data were obtained searching MEDLINE, Scopus, and Web of Science for all investigations published any time to December 22, 2020 reporting a comparison between distal and conventional transradial access. The occurrence of radial artery occlusion was chosen as the primary outcome while the hematoma at access site and spasm as secondary and tertiary outcome, respectively. STUDY ELIGIBILITY CRITERIA Case-control studies comparing distal and conventional transradial access for coronary angiography and/or percutaneous coronary intervention. All studies included adult patients aged at least 18 years. STUDY APPRAISAL AND SYNTHESIS METHODS Overall, 7073 patients (mean age 57.9 and 58.4 years for distal and conventional transradial access, respectively), were analyzed. The rate of radial artery occlusion was significantly lower in the distal compared with the conventional group (2.1% vs 4.6%, p < 0.001). The pooled analysis, based on a fixed effect model confirmed a lower relative risk of occlusion when distal access is used (RR: 0.46, 95% CI: 0.31-069, p = 0.002, I2 = 0%). Conversely, no differences in the risk of developing a hematoma at the access site or in the occurrence of a radial artery spasms were observed comparing the two groups (RR: 0.65, 95% CI: 0.37-1.13, p = 0.12, I2 = 0% and RR: 0.88, 95% CI: 0.48-1.63, p = 0.001, I2 = 0%, respectively). LIMITATIONS Only eight case-control studies met inclusion criteria. CONCLUSION This metanalysis confirmed a lower risk of radial artery occlusion using distal access and comparable performance in terms of hematoma, and radial artery spam risk.
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Affiliation(s)
- Gianluca Rigatelli
- Cardiovascular Diagnosis and Endoluminal Interventions Unit, Rovigo General Hospital, Rovigo, Italy
| | - Marco Zuin
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy.,Section of Internal and Cardiopulmonary Medicine, University of Ferrara, Ferrara, Italy
| | | | - Dobrin Vassilev
- Alexandrovska Hospital University School of Medicine, Sofia, Bulgaria
| | - Giovanni Zuliani
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Thach Nguyen
- Department of Cardiovascular Research, Merrilville, MI, USA
| | - Loris Roncon
- Department of Cardiology, Rovigo General Hospital, Rovigo, Italy
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