Radial Artery Access for Non-cardiac Interventions, Early Experience & Lessons Learned
James McPhee, MD, Michelle Martin, MD, Samir Shah, MD, Joseph Raffetto, MD.
VA Boston Healthcare System, West Roxbury, MA, USA.
OBJECTIVES: Radial artery access for coronary interventions has largely replaced femoral artery access when feasible due to decreased risk and extent of access-related complications. Vascular surgeons have largely relied on femoral artery and brachial artery access for peripheral diagnostic and interventional access due to inexperience with radial technique. We present our early experience with radial artery access for non-coronary interventions.
METHODS: Single site retrospective review. Consecutive patients undergoing radial access 9/8/14-6/9/17. Patients selected based on indication for intervention, prior interventions/prohibitive groin scar or presence of iliofemoral occlusive disease. Preoperative evaluation included duplex ultrasound of the radial artery and documented Doppler flow in the palmar arch with manual radial occlusion. Post-procedure compression was accomplished using the TR band™. Retrospective review of prospective database.
RESULTS: During the studied 2 year period, 12 patients underwent ultrasound guided radial access. Patients included: 2 diagnostic, 2 innominate, 3 left subclavian, 4 mesenteric and 1 external iliac interventions. Most patients were male (11/12,91.6%) and Mean age was 67.4 (range 47-85). 10 patients had left radial access and 2 had right. One patient developed a left radial hematoma treated with manual compression with no sequelae, there were no other complications with 100% technical success. Mean follow-up was 621 days [range 69-1071]. No patient has required re-intervention over follow-up period. Technical limitations included inadequate length 6F hydrophilic sheath systems (max length 25cm) for .035 mesenteric interventions necessitating comfort with guiding catheters and .014 intervention platforms. Patient height considerations and catheter/sheath lengths currently limit extent of lower extremity interventions.
CONCLUSIONS: Radial artery access for peripheral interventions is a useful skill for vascular surgeons. Supra-aortic trunk and mesenteric interventions are well-suited for radial access due to current catheter and hydrophilic sheath length limitations. Radial access should be considered prior to brachial access as complication rates are low, and may be of less clinical significance than complications at the brachial and femoral sites. Future focus on longer platforms could expand lower extremity indications.
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