Description of Technique and Short-Term Outcomes of Radial Artery Access for Vascular Disease

Abstract

Objectives: Radial artery access is widely utilized in coronary angiography with reported lower rates of vascular complications and better patient comfort. There is limited data in the literature regarding radial access in peripheral endovascular procedures. We hypothesize that radial access is safe and feasible for peripheral endovascular procedures. Methods: A retrospective chart review was performed for all patients who underwent angiography using radial artery access between August 2013 and December 2017. Patient demographics and perioperative data were recorded and analyzed. Patient Selection: The operating surgeon screened patients presenting for elective angiography for possible radial artery access. Ultrasound guidance was used in all cases. Upon cannulation, the sheath was infused with an antispasmodic cocktail, and the patients were systemically anticoagulated. Results: Forty-seven out of 52 patients successfully completed their procedure (90% success rate). The patients were mostly female (60%), elderly (mean age of 71 years), and had several comorbidities. Preoperative diagnoses were variable. Procedures were both diagnostic (58%) and interventional (42%) with maximum sheath size used being 7F and median fluoroscopy time of 7.5 minutes. Only 2 patients experienced perioperative complications, and both of these were minor hematomas that resolved with manual pressure. Conclusions: Transradial arterial access for peripheral vascular angiography and interventions is safe and feasible. With low complication rates and increased patient comfort, transradial access serves as an excellent alternative to transfemoral access for a variety of endovascular procedures.

Acute Limb Ischemia after Radial Artery Access for Uterine Fibroid Embolization

“…A commonly utilized technique describes preference for the left radial artery due to its shorter distance from abdominal vasculature and avoidance of brachiocephalic tortuosity. 3 The radial artery is measured under ultrasound to determine vessel caliber. If the diameter measures less than 2 mm, the radial access is aborted and the femoral is commonly utilized instead.…”

“…If the diameter measures less than 2 mm, the radial access is aborted and the femoral is commonly utilized instead. 3 Micropuncture access is then obtained and a sheath placed within the radial artery. Once sheath access has been established, an intra-arterial vasodilator "cocktail" is often administered to help reduce arterial spasm and incidence of radial artery thrombosis.…”

“…1,4 A second dose may be administered as needed depending on procedure length or before sheath removal at the conclusion of the procedure. 3 Radial artery spasm (RAS) is a frequently described complication of radial arterial access and is often associated with RAO. It may manifest as discomfort in the forearm following difficult arterial access.…”

“…Several options for this “cocktail” exist, with one common mixture being 3,000 U heparin, 2.5 mg verapamil, and 200 μg of nitroglycerin. 3 Other cocktails include alternate dosing of different calcium channel blockers, including verapamil, diltiazem, and nicardipine. 1 4 A second dose may be administered as needed depending on procedure length or before sheath removal at the conclusion of the procedure.…”

Utilisation of Image Guidance to Enhance Safety of Deployment of the Mynx Control Vascular Closure Device

“…While there is a growing trend amongst cardiologists, interventional radiologists and vascular surgeons alike towards radial access, 1 with increased availability of equipment such as long shaft balloons and stents to facilitate this, femoral artery access remains a routine technique employed on a daily basis in most endovascular suites. The use of femoral artery closure devices following percutaneous arterial access allows for earlier mobilisation, reduced staff burden and improved comfort for patients as compared with manual compression and reduces the risk of puncture site complications.…”