Radial access “safe and well tolerated” across range of peripheral vascular interventions

Aaron Fischman

A single-centre, retrospective study published online in December 2015 in the Journal of Vascular and Interventional Radiology (JVIR), set out to review the safety and feasibility of using transradial access for non-coronary interventions.

A team from the Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, USA, retrospectively analysed data from 946 patients evaluated for 1,531 consecutive radial access procedures from over a three-year period between 2012 and 2015.

Patients were excluded from undergoing radial access if the sheath size required for the procedure was greater than 6F; if they showed Barbeau D waveform; if the radial artery diameter was less than 2mm on ultrasound; if they had a history of severe aortic tortuosity or radial artery occlusion, or they were undergoing dialysis.

“Transradial access was attempted in 936 patients (over 60% were male, with the median patient age being 62.4 years) who underwent 1,512 consecutive procedures. These procedures included nearly 500 chemoembolization procedures, 393 yttrium-90 mapping, around 300 infusion procedures, 172 renal/visceral intervention, almost 120 uterine artery embolization cases, 43 peripheral interventions, 10 endoleak repairs and two other procedures. The investigators looked at complications at the 30-day follow-up point,” the authors write. As reported in JVIR by Raghuram Posham and colleagues, the technical success was 98.2% (1,485/1,512). Major complications (0.13%) included pseudoaneurysm (n=1) and seizure (n=1). Minor complications (2.38%) included haematoma/bleeding (n=13), radial artery occlusion (n=11), arm pain (n=6), and radial artery spasm (n=6). Twenty-seven cases (1.8%) required crossover to transfemoral access.

Crossover rates were higher in female patients (p=0.0055), those who were shorter than 1.7 metre (p=0.024), renal/visceral interventions (p=0.0003), and endoleak interventions (p=0.0357). “Multivariate analysis demonstrated intervention type to be the only significant predictor of crossover to transfemoral access (renal/visceral interventions, p=0.001 and endoleak repair, p=0.042),” the authors write.

Corresponding author of the study Aaron Fischman told Interventional News: “This study shows that transradial access is feasible and safe for procedures outside the coronary circulation for a variety of visceral interventions. This is the largest series published to date on this technique with remarkably low adverse event rates. It paves the way for future studies regarding transradial access. In particular, patient satisfaction and quality of life is of paramount interest to myself and the other investigators. It is important to note, however, that these results may not be replicated in lower volume centres. Specific training in the technique is available for new operators and is encouraged.”