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Friday, October 11, 2019

Distal Radial Artery Access for Noncoronary Endovascular Treatment Is a Safe and Feasible Technique

Clinical question
Is distal radial artery (DRA) access for noncoronary interventional radiology procedures feasible and safe?

Take away point
DRA access is a feasible and safe technique for abdominal interventional radiology embolization procedures. No radial artery occlusion or other major complications were observed in patients who underwent follow-up ultrasound.

van Dam, Lievay et al. Distal Radial Artery Access for Noncoronary Endovascular Treatment Is a Safe and Feasible Technique. Journal of Vascular and Interventional Radiology, Volume 30, Issue 8, 1281 - 1285

Click here for abstract

Study design
Retrospective review of 82 punctures in 56 patients.

Funding Source
No reported funding

Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands

Figure 1. 
Optimal location of distal radial artery access at the deep palmar arch superficial to the scaphoid and trapezium.

Distal radial artery access has shown to be a safe technique for interventional radiology embolization procedures. The authors performed a retrospective review of 82 DRA procedures in 56 patients. Procedural details and complications were reviewed during the admission and at follow up.

The Barbeau test was used to evaluate radioulnar collateral circulation before the procedure. The preferred puncture site was at the DRA at the anatomical snuffbox (radial fossa). A mixture of 300 μg nitroglycerin and lidocaine 2% was given for analgesia and vasodilation, access was gained with ultrasound guidance using a 21-gauge needle and radial artery sheath, and an anti-spasmolytic mixture of 200 μg nitroglycerin, 2.5 mg verapamil, and 5000 IE heparin was administered. Patent hemostasis was achieved using a Safeguard Radial Compression Device.

Procedures included transarterial chemoembolization, Y-90 pretreatment work up, Y-90 treatment, and hepatic, renal, and splenic artery embolization. The mean number of DRA accesses per patient was 1.46. There was a 97.6% technical success rate. There were 8 minor complications, including 3 hematomas and 1 case of pain without hematoma. All minor complications resolved without treatment. Follow up ultrasound was available after 54 procedures at a mean time of 55 days. Only 1 complication at the DRA was seen on ultrasound. There was 1 case of a non-flow limiting focal dissection, which had resolved on follow up procedure 38 days later.

The authors retrospectively reviewed 82 distal radial artery procedures. The results were promising and showed a 97.6% technical success rate without any major complications or cases of radial artery occlusion. Follow up ultrasound imaging provides further reassurance of the safety of DRA access. Access at the distal radial artery, distal to the superficial palmar arch shows theoretical benefit without increased complication. While the data is encouraging, larger patient populations and long term follow up would be helpful to further understand the safety and benefits.

Post Author
Maxwell R. Cretcher, DO
Resident Physician, Integrated Interventional Radiology
Dotter Department of Interventional Radiology
Oregon Health & Science University

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