Transradial approach for diagnostic cerebral angiograms in the elderly: a comparative observational study

Abstract

BackgroundThe transradial approach (TRA) reduces mortality, morbidity, access site complications, hospital cost, and length of stay while maximizing patient satisfaction. We aimed to assess the technical success and safety of TRA for elderly patients (aged ≥75 years).MethodsA retrospective chart review and comparative analysis was performed for elderly patients undergoing a diagnostic cerebral angiogram performed via TRA versus transfemoral approach (TFA). Also, a second comparative analysis was performed among the TRA cohort between elderly patients and their younger counterparts.ResultsComparative analysis in the elderly (TRA vs TFA) showed no significant differences for contrast dose per vessel (43.7 vs 34.6 mL, P=0.106), fluoroscopy time per vessel (5.7 vs 5.2 min, P=0.849), procedure duration (59.8 vs 65.2 min, P=0.057), conversion rate (5.8% vs 2.9%, P=0.650), and access site complications (2.3% vs 2.9%, P=1.00). Radiation exposure per vessel (18.9 vs 51.9 Gy cm2, P=0.001) was significantly lower in the elderly TRA group.The second comparison (TRA in elderly vs TRA in the young) showed no significant differences for contrast dose per vessel (43.7 vs 37.8 mL, P=0.185), radiation exposure per vessel (18.9 vs 16.5 Gy cm2, P=0.507), procedure duration (59.8 vs 58.3 min, P=0.788), access site complication (2.3% vs 1.7%, P=0.55), and conversation rate (5.8% vs 1.8%, P=0.092). A trend for prolonged fluoroscopy time per vessel (5.7 vs 4.7 min, P=0.050) was observed in the elderly TRA group.ConclusionsTRA is a technically feasible and safe option for diagnostic neurointerventional procedures in the elderly. Our small elderly cohort was not powered enough to show a significant difference in terms of access site complications between TRA and TFA.

Comparison of radiation exposure and clinical outcomes between transradial and transfemoral diagnostic cerebral approaches: a retrospective study

“…We chose to use the 10-item Patient-Reported Outcomes measurement Information System GHS because it is a well-known valid and reliable scale used in assessing and tracking the impact of healthcare interventions in health and functional disability over time. This novel finding from our 30-day postprocedural PRO adds to previous literature [1][2][3][4][5] that only reported immediate QOL outcome with the TRA approach during the postoperative phase. These studies demonstrated a higher satisfaction rate with the radial approach mainly because of a shorter recovery time likely related to postprocedural comfort and reduced hospital stay.…”

Trans-radial cerebral angiography-safety, efficacy and patient comfort: review of literature

“…In a comparative analysis of patients aged >75 years, Sweid et al noticed that radiation exposure per vessel was significantly lower in the elderly TRA group than the elderly TFA group (p=0.001). 32 However, there were no significant differences between TRA and TFA groups for contrast dose, fluoroscopy time, procedure duration, crossover rate, or access site complications. A second comparison (TRA in elderly versus TRA in the young) showed no significant differences for contrast dose, radiation exposure, procedure duration, access site complication or cross-over rate.…”

“…[9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]33,34 This prompted numerous other studies which were directed explicitly towards cerebral angiography and neuro-intervention, albeit on a smaller scale. 8,29,32 In the study by Osbun et al intraoperative cerebral angiography from a TRA was technically feasible for a variety of cerebrovascular pathologies without any access site complications or postoperative hand ischemia. 8 Moreover, they demonstrated its applicability in different patient positions and improved the work-flow ergonomics.…”

“…32 Causes of failure and technical difficulties that might necessitate a cross-over to the femoral access include severe vasospasm (prohibiting the advancement of the catheter despite adequate vasolytic medication), inadvertent entry into the venous system, radial artery loop, radial artery extravasation, radial artery tortuosity, Arteria Lusoria, left common carotid artery tortuosity, bovine aortic arch, spinal angiogram, large body habitus (prevents adequate visualisation of the major vessels) and failure to form the Simmons catheter. 8,32 COMPLICATIONS Some of the observed complications include excessive bleeding, large hematoma formation, pseudoaneurysm needing additional closure, arteriovenous fistula, arterial dissection, ischemic limb needing surgery, radial artery extravasation, abscess, retroperitoneal hemorrhage, stroke and/or death. 8,9,32…”

“…8,32 COMPLICATIONS Some of the observed complications include excessive bleeding, large hematoma formation, pseudoaneurysm needing additional closure, arteriovenous fistula, arterial dissection, ischemic limb needing surgery, radial artery extravasation, abscess, retroperitoneal hemorrhage, stroke and/or death. 8,9,32…”