Transradial Iliac and Femoral Angiography and Intervention: Initial Results and Technique
Sean P. Wengerter, MD, William E. Beckerman, MD, Rami O. Tadros, MD, Rahul Patel, MD, Aaron Fischman, MD, Marin L. Michael, MD, Peter L. Faries, MD, Ageliki G. Vouyouka, MD.
Mount Sinai, ny, NY, USA.
Transradial access (TRA) has been widely adopted for coronary and visceral interventions. Applying TRA to lower extremity interventions has become a reality with the development of longer and lower profile endovascular devices. TRA may be preferable in certain patients with difficult femoral site access. This study evaluates the safety and feasibility of iliofemoral interventions via TRA. Methods:
Retrospective review of all diagnostic and therapeutic iliofemoral TRA procedures was performed utilizing a prospectively maintained database. The radial artery was assessed with the Barbeau test to confirm collateralization. In all cases, access was achieved under ultrasound guidance. Heparin (3000 units), verapamil (2.5 mg), and nitroglycerin (200 mcg) were administered intra-arterially. Patient demographics, imaging, technical success, and adverse events (AEs) were reviewed. Results:
From 04/2013 to 3/2017, 29 TRA iliofemoral procedures were performed in 29 patients (16 M;13 F), (mean age 67, range 44-81). Of the 29 procedures, 16 were planned diagnostic procedures and 13 were interventions. Access site was left radial in 89.7% of cases. Sheath size was 20.7 % 4 Fr, 48.3% 5 Fr and 31% 6 Fr. The distal most site of intervention was CFA in 3 cases, EIA in 4 cases, PFA in 1 case, and CIA in 4 cases. Technical success was 96.6%. There was one failed radial access, which necessitated femoral access. There was one brachial artery pseudoaneurysm. Conclusions:
TRA for iliofemoral procedures is a feasible and safe alternative to TFA. TRA allows for both diagnostic imaging of the iliofemoral arteries and intervention, while avoiding TFA sites and minimizing femoral access-related complications. The application of TRA in the iliofemoral vessels will likely expand as newer devices are developed.
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