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Evaluation of Transradial Subclavian Artery Embolization
Steven D. Abramowitz, MD, Tareq M. Massimi, MD, Misaki M. Kiguchi, MD, Rajesh K. Malik, Edward Y. Woo, MD.
MedStar Washington Hospital Center, Washington, DC, USA.

Objective(s):
The purpose of this study is to review the safety and feasibility of utilizing transradial access in performing subclavian artery embolization. Traditional delayed subclavian embolization in TEVAR has been performed by higher risk percutaneous brachial access or invasive brachial artery exposure.
Methods:
A prospectively maintained, single-center retrospective database was queried for those patients who had undergone carotid-subclavian bypass prior to TEVAR for aortic aneurysms and dissections. Twenty-five patients were identified that had undergone transradial subclavian artery embolization at the time of TEVAR between 2014-2016. Transradial access was performed via a 5F transradial appropriate sheath using ultrasound guidance for access in all cases. Patients were given 3000 units of heparin, 2.5 miligrams of verapamil and 200 mircograms of nitroglycerin through the sheath upon insertion. Transradial access was not performed in those patients with Barbeau D waveforms or patients with a radial artery diameter of <2mm on ultrasound evaluation. Hemostasis was achieved with a radial access closure device. Patients were evaluated immediately post-operatively, on the first post-operative day and at one month follow up for complications.
Results:
Technical success in transradial subclavian embolization was achieved in all 25 patients when defined as cessation of retrograde flow on completion angiography with preservation of the vertebral artery. The average procedure time from puncture to sheath withdrawal was less than 9 minutes with an average of 2.6 coils used per case. Immediate post-operative follow-up revealed no major or minor complications including stroke, hematoma, radial artery occlusion, carotid-subclavian graft disruption, pseuodoaneurysm formation, embolization, and arm pain. On 30 day follow-up, there was a 100% success rate with no evidence of endoleak and 100% of patients had palpable radial pulses without evidence of occlusion.
Conclusions:
Transradial embolization may represent a safer and more efficient means of performing subclavian artery embolization after carotid-subclavian bypass during TEVAR than traditional transbrachial access options.


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