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J Vasc Interv Radiol. 2016 Feb;27(2):159-66. doi: 10.1016/j.jvir.2015.10.026. Epub 2015 Dec 22.

Transradial Approach for Noncoronary Interventions: A Single-Center Review of Safety and Feasibility in the First 1,500 Cases.

Author information

1
Department of Radiology, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, New York, NY 10029.
2
Department of Radiology, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, New York, NY 10029. Electronic address: aaron.fischman@mountsinai.org.

Abstract

PURPOSE:

To review safety and feasibility in a single center using transradial access (TRA) for noncoronary interventions.

MATERIALS AND METHODS:

Retrospective analysis was performed of 946 patients evaluated for 1,531 consecutive TRA procedures from April 2012 to July 2015. Exclusion criteria included sheath > 6 F, Barbeau D waveform, radial artery (RA) diameter < 2 mm on ultrasound, history of severe aortic tortuosity or RA occlusion, and dialysis. TRA was attempted in 936 patients (62% men; median age, 62.4 y) who underwent 1,512 consecutive procedures (chemoembolization [n = 485], yttrium-90 mapping [n = 391] and infusion [n = 293], renal/visceral intervention [n = 172], uterine artery embolization [n = 116], peripheral intervention [n = 43], endoleak repair [n = 10], and other [n = 2]). Patients were evaluated for complications during follow-up at ~30 days.

RESULTS:

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 hematoma/bleeding (n = 13), RA occlusion (n = 11), arm pain (n = 6), and RA spasm (n = 6). Univariate analysis demonstrated a lower rate of adverse events in African American patients (hazard ratio [HR], 0.25; 95% confidence interval [CI], 0.07-0.86; P = .027). Twenty-seven cases (1.8%) required crossover to transfemoral access (TFA). Crossover rates were higher in female patients (P = .0055), height < 1.7 m (P = .024), renal/visceral interventions (P = .0003), and endoleak interventions (P = .0357). Multivariate analysis demonstrated intervention type to be the only significant predictor of TFA crossover (renal/visceral [HR, 4.48; 95% CI, 1.84-10.9; P = .001]; endoleak repair [HR, 9.54; 95% CI, 1.09-83.8; P = .042]).

CONCLUSIONS:

TRA was safe and well tolerated in a heterogeneous patient population across a range of peripheral vascular interventions.

PMID:
26706186
DOI:
10.1016/j.jvir.2015.10.026
[Indexed for MEDLINE]

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