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Endovascular treatment of nonfunctional vascular access through retrograde arterial access: A single-center experience with midterm follow-up. JOURNAL OF SURGERY AND MEDICINE 2022. [DOI: 10.28982/josam.994217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Hobby S, Stroebel M, Yamada R, Johnson T, Uflacker A, Hannegan C, Guimaraes M. Transradial Access: A Comprehensive Review. VASCULAR AND ENDOVASCULAR REVIEW 2021. [DOI: 10.15420/ver.2020.17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Transradial access (TRA) via the left radial artery is an alternative to traditional transfemoral access for catheter-based procedures that is becoming increasingly more relevant in all types of arterial vascular interventions. First investigated in the realm of cardiology, TRA has been proven to provide many benefits (such as lower complication rates, lower cost, and improved patient comfort during and after the procedure) when compared with traditional femoral access while maintaining efficacy. This article provides an in-depth summary of the technical aspects of radial access while incorporating more recent data to explain patient preference for TRA, and the ways that TRA can improve peri-procedure workflow and compensation. It also describes potential complications, such as radial artery spasm, difficult anatomic variants and radial artery occlusion, and then gives techniques for mitigating and treating these complications. The article explains why TRA has become an important option for vascular and interventional radiology physicians, and why it is likely that this will continue to grow in relevance.
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Affiliation(s)
- Shawn Hobby
- Vascular and Interventional Radiology Division, Medical University of South Carolina, Charleston, SC, US
| | - Maxwell Stroebel
- Vascular and Interventional Radiology Division, Medical University of South Carolina, Charleston, SC, US
| | - Ricardo Yamada
- Vascular and Interventional Radiology Division, Medical University of South Carolina, Charleston, SC, US
| | - Thor Johnson
- Vascular and Interventional Radiology Division, Medical University of South Carolina, Charleston, SC, US
| | - Andre Uflacker
- Vascular and Interventional Radiology Division, Medical University of South Carolina, Charleston, SC, US
| | - Christopher Hannegan
- Vascular and Interventional Radiology Division, Medical University of South Carolina, Charleston, SC, US
| | - Marcelo Guimaraes
- Vascular and Interventional Radiology Division, Medical University of South Carolina, Charleston, SC, US
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Hepatocellular carcinoma in adult thalassemia patients: an expert opinion based on current evidence. BMC Gastroenterol 2020; 20:251. [PMID: 32746786 PMCID: PMC7398335 DOI: 10.1186/s12876-020-01391-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 07/21/2020] [Indexed: 02/07/2023] Open
Abstract
Beta-thalassemia represents a heterogeneous group of haemoglobin inherited disorders, among the most common genetic diseases in the world, frequent in the Mediterranean basin. As beta-thalassemia patients' survival has increased over time, previously unknown complications are observed with increasing frequency. Among them, an increased risk of hepatocellular carcinoma (HCC) has been registered. Our aim is to reduce inequalities in diagnosis and treatment and to offer patients univocal recommendations in any institution.The members of the panel - gastroenterologists, radiologists, surgeons and oncologists -were selected on the basis of their publication records and expertise. Thirteen clinical questions, derived from clinical needs, and an integration of all the committee members' suggestions, were formulated. Modified Delphi approach involving a detailed literature review and the collective judgement of experts, was applied to this work.Thirteen statements were derived from expert opinions' based on the current literature, on recently developed reviews and on technological advancements. Each statement is discussed in a short paragraph reporting the current key evidence. As this is an emerging issue, the number of papers on HCC in beta-thalassemia patients is limited and based on anecdotal cases rather than on randomized controlled studies. Therefore, the panel has discussed, step by step, the possible differences between beta-thalassemia and non beta-thalassemia patients. Despite the paucity of the literature, practical and concise statements were generated.This paper offers a practical guide organized by statements describing how to manage HCC in patients with beta-thalassemia.
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Iezzi R, Posa A, Merlino B, Pompili M, Annicchiarico E, Rodolfino E, Basso M, Cassano A, Gasbarrini A, Manfredi R. Operator learning curve for transradial liver cancer embolization: implications for the initiation of a transradial access program. ACTA ACUST UNITED AC 2020; 25:368-374. [PMID: 31348005 DOI: 10.5152/dir.2019.18437] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE We aimed to analyze transradial access (TRA) learning curve on patients undergoing hepatic chemoembolization, investigating the relationship between procedural volumes and various benchmarks of procedural success. METHODS We enrolled 60 consecutive patients who received two unilobar hepatic chemoembolizations within a 4-week interval performed by a single interventional radiologist, highly-trained in conventional transfemoral access (TFA) procedures, but without any previous practical experience in TRA procedures and with a preliminary 2-day theoretical training only. Consecutive patients were prospectively enrolled and analyzed in 3 groups: A (cases 1 to 20), B (cases 21 to 40), and C (cases 41 to 60). All patients underwent one hepatic chemoembolization using TRA and the other one using TFA in random order. All TFA procedures performed by the same operator in the same series of patients were considered as the control group. Primary endpoint was to analyze the relationship between TRA procedure operator experience and benchmarks of procedural success, to define the optimal procedural learning curve. RESULTS Technical success was obtained in all patients, with a crossover rate (radial to femoral access) of 0%. An association between incremental TRA operator experience (in terms of performed procedures) and decrease of preparation, puncture, fluoroscopy, and total examination times was observed. Similarly, inverse associations between incremental TRA operator experience and contrast medium (CM) volumes (P < 0.001) and radiation dose (RD) values (in terms of RAK - Reference Air Kerma) (P < 0.001) were also observed. Compared with TFA, CM volumes and RD values were significantly higher only in group A (cases 1-20). Procedure success remained high in all TRA groups and no significant association between TRA incremental experience and postprocedural outcomes was found. Higher postprocedural complaints at the access route and more limitations in performing basic activities were recorded after TFA vs. TRA (P < 0.001). CONCLUSION TRA catheterizations can be safely performed in patients treated for liver cancer embolization after a relatively short training in controlled conditions and with a better performance in comparison with TFA. Operator proficiency improves with greater TRA experience, with a threshold needed to overcome the learning curve represented by about 20 procedures.
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Affiliation(s)
- Roberto Iezzi
- Department of Bioimaging and Radiological Sciences, Candiolo Cancer Institute-IRCCS, Rome, Italy; Department of Radiological Sciences, Catholic University School of Medicine, Rome, Italy
| | - Alessandro Posa
- Department of Radiology, IRCCS Fatebenefratelli Hospital Foundation for Health Research and Education, Rome, Italy
| | - Biagio Merlino
- Department of Bioimaging and Radiological Sciences, Candiolo Cancer Institute-IRCCS, Rome, Italy; Department of Radiological Sciences, Catholic University School of Medicine, Rome, Italy
| | - Maurizio Pompili
- Department of Internal Medicine, Catholic University School of Medicine, Rome, Italy
| | | | - Elena Rodolfino
- Department of Bioimaging and Radiological Sciences, Candiolo Cancer Institute-IRCCS, Rome, Italy
| | - Michele Basso
- Department of Oncology, Catholic University School of Medicine, Rome, Italy
| | - Alessandra Cassano
- Department of Oncology, Catholic University School of Medicine, Rome, Italy
| | - Antonio Gasbarrini
- Department of Internal Medicine, Catholic University School of Medicine, Rome, Italy
| | - Riccardo Manfredi
- Department of Bioimaging and Radiological Sciences, Candiolo Cancer Institute-IRCCS, Rome, Italy; Department of Radiological Sciences, Catholic University School of Medicine, Rome, Italy
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Du N, Yang MJ, Ma JQ, Luo JJ, Zhang ZH, Yu TZ, Zheng ZY, Zhang W, Yan ZP. Transradial access chemoembolization for hepatocellular carcinoma in comparation with transfemoral access. Transl Cancer Res 2019; 8:1795-1805. [PMID: 35116930 PMCID: PMC8799211 DOI: 10.21037/tcr.2019.08.40] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 08/12/2019] [Indexed: 11/23/2022]
Abstract
Background This study aimed to compare the safety and efficacy of transradial access (TRA) with transfemoral access (TFA) chemoembolization in treatment of hepatocellular carcinoma (HCC). Methods HCC patients who were late for curative treatment on initial diagnosis or HCC patients who had undergone one or several rounds of transarterial chemoembolization (TACE) were enrolled. The clinical and angiographic characteristics, the procedure related details, and the follow-up data from patients who underwent TRA and TFA were analyzed and compared. Results In total, 112 patients undergoing 160 TRA-TACE and 107 patients undergoing 163 TFA-TACE were included. The technical success rate of TRA was 95.0% and that of TFA was 98.8% (P=0.102). In the TFA-TACE group, 5.5% of cases suffered access site-related complications, including 6 with minor bleeding and 3 with severe bleeding or pseudoaneurysm. In the TRA-TACE group, 1.9% of cases underwent crossover to femoral access for selective cannulation failure. The rate of radial artery occlusion (RAO) was 2.7% (3 of 112 patients), and none of the RAO patients suffered paresthesia, pain at the site of occlusion, hand function loss or distal ischemia. Comparing patients with/without access site-related complications in the TFA-TACE group, there was a statistical difference in patient age and in the percentage of patient with a PT time >15 s (72.6% vs. 57.1%, P<0.001; 44.4% vs. 11.7%, P=0.022). Conclusions TRA is a safe and effective method for patients undergoing TACE. Compared with TFA, TRA may reduce the occurrence of access site-related bleeding and vascular complications. TRA-TACE may especially benefit older patients or those with a longer prothrombin time (PT).
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Affiliation(s)
- Nan Du
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China.,Shanghai Institute of Medical Imaging, Shanghai 200041, China
| | - Min-Jie Yang
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China.,Shanghai Institute of Medical Imaging, Shanghai 200041, China
| | - Jing-Qin Ma
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China.,Shanghai Institute of Medical Imaging, Shanghai 200041, China
| | - Jian-Jun Luo
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China.,Shanghai Institute of Medical Imaging, Shanghai 200041, China
| | - Zi-Han Zhang
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Tian-Zhu Yu
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Zhi-Yuan Zheng
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China.,Shanghai Institute of Medical Imaging, Shanghai 200041, China
| | - Wen Zhang
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China.,Shanghai Institute of Medical Imaging, Shanghai 200041, China
| | - Zhi-Ping Yan
- Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China.,Shanghai Institute of Medical Imaging, Shanghai 200041, China
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Iezzi R, Pompili M, Posa A, Annicchiarico E, Garcovich M, Merlino B, Rodolfino E, Di Noia V, Basso M, Cassano A, Barone C, Gasbarrini A, Manfredi R, Colosimo C. Transradial versus Transfemoral Access for Hepatic Chemoembolization: Intrapatient Prospective Single-Center Study. J Vasc Interv Radiol 2017; 28:1234-1239. [PMID: 28757286 DOI: 10.1016/j.jvir.2017.06.022] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 06/09/2017] [Accepted: 06/16/2017] [Indexed: 11/30/2022] Open
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Lu Z, Liu S, Yi Y, Ni X, Wang J, Huang J, Fu Y, Cao Y, Zhou J, Fan J, Qiu S. Serum gamma-glutamyl transferase levels affect the prognosis of patients with intrahepatic cholangiocarcinoma who receive postoperative adjuvant transcatheter arterial chemoembolization: A propensity score matching study. Int J Surg 2017; 37:24-28. [DOI: 10.1016/j.ijsu.2016.10.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 10/12/2016] [Indexed: 02/08/2023]
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