Safety and Feasibility of Trans-radial Access for Non Coronary and Peripheral Vascular Interventions

Research paper by Saqib Zia, Amandeep Juneja; Sara Shams; Beenish Faheem; Masood A. Shariff; Kuldeep Singh; Jonathan Schor; Jonathan Deitch

Indexed on: 10 Jun '18Published on: 07 Jun '18Published in: Annals of Vascular Surgery


Publication date: Available online 7 June 2018 Source:Annals of Vascular Surgery Author(s): Saqib Zia, Kuldeep Singh, Amandeep Juneja, Jonathan Schor, Jonathan Deitch Purpose Transradial access (TRad) is becoming the preferred access for cardiac catheterization. The utility and safety of TRad in non-coronary and peripheral vascular interventions remains ill-defined and serves as the basis for this study. Methods Patients undergoing non-coronary and peripheral endovascular procedures via TRad from August 2010 to February 2013 at our institution were reviewed retrospectively. Demographic data, indications, interventions performed, sheath size, procedural outcomes and access site complications were evaluated. Post-procedural radial artery patency and hand ischemic symptoms were evaluated clinically and by duplex ultrasound. Results 19 patients underwent 24 procedures via TRad for both diagnostic (11/24) and therapeutic (13/24) purposes. 12 (63%) were women and 75% (18/24) were from left side. Indications included absent femoral pulses in 12 (50%), morbid obesity in 6 (25%), previous bypass originating or terminating in the groin in 4 (17%) and groin wound infection in 2 (8%) cases. A 5 French (Fr) sheath was used in 13 (54%) cases, 6 Fr in 10 (42%) cases and 7 Fr in 1 (4%) case.13 therapeutic interventions included 7 (29%) iliac angioplasties and or stent, 3 (13%) femoral anastomosis angioplasties, 2 (8%) superficial femoral artery angioplasties and 1 (4%) mesenteric angioplasty. No access site hematoma or procedure related deaths were reported. Post procedure radial artery occlusion was observed in 6 (31%) patients. All occlusions were asymptomatic except 1 (4%) patient with self-limiting forearm pain lasting for 1 day. Sheath size strongly correlated with radial artery occlusion. Conclusions TRad appears to be a safe and feasible alternative option for patients undergoing non-coronary and peripheral interventions. Radial artery occlusion, mostly asymptomatic, can occur and is directly related to the sheath size. Smaller sheath sizes, longer platform devices, better radial access kits and better closure devices could potentially eliminate some of the challenges associated with TRad.