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Objective: Transradial access (Trad) is being used on a widespread basis for cardiac catheterization procedures with good success. It's utility and safety in non-coronary vascular interventions remains ill-defined and serves as the basis for this study.
METHODS: Between August 2010 and February 2011, all patients who underwent peripheral angiograms via Trad for diagnostic or therapeutic purposes were retrospectively evaluated. Demographic data, indication for Trad, type of intervention, procedural outcomes, sheath size and morbidity, related to the procedure and access site, were evaluated. Radial artery suitability for access was determined pre-procedurally based on the Allen’s test. All patients except 1 received intra-arterial spasmolytic cocktail mixture of 5 mg verapamil, 200 ug of nitroglycerine and 5ml of 1% lidocaine. Post-procedural radial artery patency and hand ischemic symptoms were evaluated by duplex ultrasound and physical examination.
RESULTS: A total of 19 patients underwent 24 procedures via Trad for both diagnostic and therapeutic purposes (13;11) The cohort of patients undergoing Trad included 12 (63%) women and 7 (37%) men. Trad was performed preferentially on the left side (76%). Indication for Trad was absent femoral pulses 12 (63%), previous bypass originating or terminating in the groin 4 (21%), groin wound infection 2 (10%) and morbid obesity 6 (31%). Interventions included iliac angioplasty/stenting 7/24 (29%), anastomotic femoral angioplasty 12%, proximal SFA angioplasty 8%, mesenteric angioplasty 4%. None of the patients suffered from hand ischemia, access site hematoma, or any major morbidity related to the procedure. Only one patient complained of forearm pain lasting 1 week; this patient did not receive the spasmolytic cocktail. A 7 French (F) sheath was used in 12%, 6 F in 75% and 5 F in 23%. Post procedure radial artery occlusion was observed in 30% of the patients however none were symptomatic. Sheath size strongly correlated with arterial occlusion.
CONCLUSIONS: Trad is a safe and feasible option for patients who are in need of peripheral angiography or intervention and deemed to be too high risk for femoral access. Limitations are the length of available sheaths, balloon length and stent platform lengths. Asymptomatic radial artery occlusion is common and is directly related to sheath size.