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

Raghuram Posham, Derek M. Biederman, Rahul S. Patel, Edward Kim, Nora E. Tabori, F. Scott Nowakowski, Robert A. Lookstein, Aaron M. Fischman

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119 Scopus citations

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.

Original languageEnglish
Pages (from-to)159-166
Number of pages8
JournalJournal of Vascular and Interventional Radiology
Volume27
Issue number2
DOIs
StatePublished - 1 Feb 2016

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