Chapter 3
Radial Artery, Alternative Arm Access, and Related Techniques
Thomas J. Ford,
Paul Bamford,
Peter Barlis,
Christian Said,
Thomas J. Ford
Search for more papers by this authorPaul Bamford
Search for more papers by this authorPeter Barlis
Search for more papers by this authorChristian Said
Search for more papers by this authorThomas J. Ford,
Paul Bamford,
Peter Barlis,
Christian Said,
Thomas J. Ford
Search for more papers by this authorPaul Bamford
Search for more papers by this authorPeter Barlis
Search for more papers by this authorChristian Said
Search for more papers by this authorBook Editor(s):George D. Dangas MD, MACC, MSCAI, FAHA, FESC,
Carlo Di Mario MD, PhD, FRCP, FACC, FSCAI, FESC,
Holger Thiele MD,
Peter Barlis MBBS, MPH, PHD, FACC, FESC, FRACP,
Tayo Addo MD, Bimmer Claessen MD, Christian Hengstenberg MD, Nicholas Kipshidze MD,
George D. Dangas MD, MACC, MSCAI, FAHA, FESC
Professor of Medicine (Cardiology) & Surgery (Vascular) Professor of Cardiology Adjunct Professor of Internal Medicine
Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, New York, NY, USA
National Kapodistrian University of Athens, Greece
Medical University of Vienna, Austria
Search for more papers by this authorCarlo Di Mario MD, PhD, FRCP, FACC, FSCAI, FESC
Professor of Cardiology Director of the Structural Interventional Cardiology Division Honorary Consultant
University of Florence
University Hospital Careggi, Florence, Italy
Cardiologist Royal Brompton Hospital, London, UK
Search for more papers by this authorHolger Thiele MD
Professor of Cardiology at University of Leipzig
Heart Center Leipzig at University of Leipzig, Leipzig, Germany
Search for more papers by this authorPeter Barlis MBBS, MPH, PHD, FACC, FESC, FRACP
Professor of Cardiology Interventional Cardiologist
University of Melbourne, Melbourne, Victoria, Australia
St Vincent's & Northern Hospitals Victoria, Australia
Search for more papers by this authorFirst published: 06 May 2022
Summary
Transradial access (TRA) for angiography and angioplasty is safe and effective with distinct advantages over alternative access sites. This chapter summarizes preprocedural considerations, radial artery puncture techniques, and common anatomical hurdles. High take-off radial artery, radial loop, and arterial tortuosity are the most common barriers to a successful transradial approach. They can usually be recognized and overcome with certain techniques and a small learning curve. Transradial access can be associated with different complications compared to the femoral approach, although vessel spasm, injury/dissection and hematomas are usually associated with less significant clinical sequelae. Catheter shapes and procedural techniques vary slightly though standard-shaped guide catheters still remain most commonly used worldwide and are appropriate in most cases. Universal radial catheters with single-catheter approaches offer further potential benefits with some caveats compared with standard shapes.
References
- Ferrante G , Rao SV , Jüni P et al . Radial Versus Femoral Access for Coronary Interventions Across the Entire Spectrum of Patients With Coronary Artery Disease . JACC: Cardiovascular Interventions 2016 ; 9 : 1419 – 1434 .
- Hamon M , Pristipino C , Di Mario C , et al . Consensus document on the radial approach in percutaneous cardiovascular interventions: position paper by the European Association of Percutaneous Cardiovascular Interventions and Working Groups on Acute Cardiac Care** and Thrombosis of the European Society of Cardiology . EuroIntervention. 2013 Mar; 8 ( 11 ): 1242 – 51 . doi: 10.4244/EIJV8I11A192.
- Mason PJ , Shah B , Tamis-Holland JE et al . An Update on Radial Artery Access and Best Practices for Transradial Coronary Angiography and Intervention in Acute Coronary Syndrome: A Scientific Statement From the American Heart Association . Circulation: Cardiovascular Interventions 2018 ; 11 : e000035 .
- Valgimigli M , Frigoli E , Leonardi S et al . Radial versus femoral access and bivalirudin versus unfractionated heparin in invasively managed patients with acute coronary syndrome (MATRIX): final 1-year results of a multicentre, randomised controlled trial . The Lancet 2018 ; 392 : 835 – 848 .
- Neumann FJ , Sousa-Uva M , Ahlsson A et al . 2018 ESC/EACTS Guidelines on myocardial revascularization . Eur Heart J 2019 ; 40 : 87 – 165 .
- Jolly SS , Yusuf S , Cairns J et al . Radial versus femoral access for coronary angiography and intervention in patients with acute coronary syndromes (RIVAL): a randomised, parallel group, multicentre trial . The Lancet 2011 ; 377 : 1409 – 1420 .
- Romagnoli E , Biondi-Zoccai G , Sciahbasi A et al . Radial versus femoral randomized investigation in ST-segment elevation acute coronary syndrome: the RIFLE-STEACS (Radial Versus Femoral Randomized Investigation in ST-Elevation Acute Coronary Syndrome) study . J Am Coll Cardiol 2012 ; 60 : 2481 – 9 .
- Mason PJ , Shah B , Tamis-Holland JE et al . An Update on Radial Artery Access and Best Practices for Transradial Coronary Angiography and Intervention in Acute Coronary Syndrome: A Scientific Statement From the American Heart Association . Circ Cardiovasc Interv 2018 ; 11 : e000035 .
- Lascarrou JB , Merdji H , Le Gouge A et al . Targeted Temperature Management for Cardiac Arrest with Nonshockable Rhythm . N Engl J Med 2019 ; 381 : 2327 – 2337 .
- Kotowycz MA , Dzavik V . Radial artery patency after transradial catheterization . Circ Cardiovasc Interv 2012 ; 5 : 127 – 33 .
- Sciahbasi A , Frigoli E , Sarandrea A et al . Radiation Exposure and Vascular Access in Acute Coronary Syndromes: The RAD-Matrix Trial . J Am Coll Cardiol 2017 ; 69 : 2530 – 2537 .
- Dandekar VK , Vidovich MI , Shroff AR . Complications of transradial catheterization . Cardiovasc Revasc Med 2012 ; 13 : 39 – 50 .
- Shroff AR , Gulati R , Drachman DE et al . SCAI expert consensus statement update on best practices for transradial angiography and intervention . Catheterization and Cardiovascular Interventions 2020 ; 95 : 245 – 252 .
- Fernandez R , Zaky F , Ekmejian A , Curtis E , Lee A . Safety and efficacy of ulnar artery approach for percutaneous cardiac catheterization: Systematic review and meta-analysis . Catheter Cardiovasc Interv 2018 ; 91 : 1273 – 1280 .
- Shah RM , Patel D , Abbate A , Cowley MJ , Jovin IS . Comparison of transradial coronary procedures via right radial versus left radial artery approach: A meta-analysis . Catheter Cardiovasc Interv 2016 ; 88 : 1027 – 1033 .
- Kiemeneij F. Left distal transradial access in the anatomical snuffbox for coronary angiography (ldTRA) and interventions (ldTRI) . EuroIntervention 2017 ; 13 : 851 – 857 .
- Michael TT , Alomar M , Papayannis A et al . A randomized comparison of the transradial and transfemoral approaches for coronary artery bypass graft angiography and intervention: the RADIAL-CABG Trial (RADIAL Versus Femoral Access for Coronary Artery Bypass Graft Angiography and Intervention) . JACC Cardiovasc Interv 2013 ; 6 : 1138 – 44 .
- Tsigkas G , Makris A , Tsiafoutis I et al . The L-RECORD Study . JACC Cardiovasc Interv 2020 ; 13 : 1014 – 1016 .
- Vefali V , Saricam E . The comparison of traditional radial access and novel distal radial access for cardiac catheterization . Cardiovasc Revasc Med 2019 .
- Liontou C , Kontopodis E , Oikonomidis N et al . Distal radial access: a review article . Cardiovasc Revasc Med 2019 .
- Abdelaal E , Brousseau-Provencher C , Montminy S et al . Risk score, causes, and clinical impact of failure of transradial approach for percutaneous coronary interventions . JACC Cardiovasc Interv 2013 ; 6 : 1129 – 37 .
- Shroff AR , Gulati R , Drachman DE et al . SCAI expert consensus statement update on best practices for transradial angiography and intervention . Catheter Cardiovasc Interv 2020 ; 95 : 245 – 252 .
- Nguyen P , Makris A , Hennessy A et al . Standard versus ultrasound-guided radial and femoral access in coronary angiography and intervention (SURF): a randomised controlled trial . EuroIntervention 2019 ; 15 : e522 – e530 .
- Pancholy SB , Sanghvi KA , Patel TM . Radial artery access technique evaluation trial: randomized comparison of Seldinger versus modified Seldinger technique for arterial access for transradial catheterization . Catheter Cardiovasc Interv 2012 ; 80 : 288 – 91 .
- Lo TS , Nolan J , Fountzopoulos E et al . Radial artery anomaly and its influence on transradial coronary procedural outcome . Heart 2008 ; 95 : 410 – 415 .
- Rodriguez-Niedenfuhr M , Vazquez T , Nearn L , Ferreira B , Parkin I , Sanudo JR . Variations of the arterial pattern in the upper limb revisited: a morphological and statistical study, with a review of the literature . J Anat 2001 ; 199 : 547 – 66 .
- Louvard Y , Lefevre T . Loops and transradial approach in coronary diagnosis and intervention . Catheter Cardiovasc Interv 2000 ; 51 : 250 – 2 .
- Patel T , Shah S , Pancholy S et al . Working through complexities of radial and brachial vasculature during transradial approach . Catheter Cardiovasc Interv 2014 ; 83 : 1074 – 88 .
- Patel T , Shah S , Pancholy S , Rao S , Bertrand OF , Kwan T . Balloon-assisted tracking: a must-know technique to overcome difficult anatomy during transradial approach . Catheter Cardiovasc Interv 2014 ; 83 : 211 – 20 .
- Cha KS , Kim MH , Kim HJ . Prevalence and clinical predictors of severe tortuosity of right subclavian artery in patients undergoing transradial coronary angiography . Am J Cardiol 2003 ; 92 : 1220 – 2 .
- Abhaichand RK , Louvard Y , Gobeil JF , Loubeyre C , Lefevre T , Morice MC . The problem of arteria lusoria in right transradial coronary angiography and angioplasty . Catheter Cardiovasc Interv 2001 ; 54 : 196 – 201 .
- Ferrante G , Rao SV , Jüni P et al . Radial Versus Femoral Access for Coronary Interventions Across the Entire Spectrum of Patients With Coronary Artery Disease: A Meta-Analysis of Randomized Trials . JACC: Cardiovascular Interventions 2016 ; 9 : 1419 – 1434 .
- Hadjivassiliou A , Cardarelli-Leite L , Jalal S et al . Left Distal Transradial Access (ldTRA): A Comparative Assessment of Conventional and Distal Radial Artery Size . Cardiovasc Intervent Radiol 2020 .
- Rosencher J , Chaib A , Barbou F et al . How to limit radial artery spasm during percutaneous coronary interventions: The spasmolytic agents to avoid spasm during transradial percutaneous coronary interventions (SPASM3) study . Catheterization and cardiovascular interventions: Official Journal of the Society for Cardiac Angiography & Interventions 2014 ; 84 : 766 – 71 .
- Rathore S , Stables RH , Pauriah M et al . Impact of length and hydrophilic coating of the introducer sheath on radial artery spasm during transradial coronary intervention: a randomized study . JACC Cardiovascular interventions 2010 ; 3 : 475 – 83 .
-
Abe S
,
Meguro T
,
Endoh N
et al
.
Response of the radial artery to three vasodilatory agents
.
Catheter Cardiovasc Interv
2000
;
49
:
253
–
6
.
10.1002/(SICI)1522-726X(200003)49:3<253::AID-CCD5>3.0.CO;2-5 CAS PubMed Web of Science® Google Scholar
- Varenne O , Jegou A , Cohen R et al . Prevention of arterial spasm during percutaneous coronary interventions through radial artery: the SPASM study . Catheter Cardiovasc Interv 2006 ; 68 : 231 – 5 .
- Curtis E , Fernandez R , Lee A . The effect of vasodilatory medications on radial artery spasm in patients undergoing transradial coronary artery procedures: a systematic review . JBI Database of Systematic Reviews and Implementation Reports 2017 ; 15 : 1952 – 1967 .
- Deftereos S , Giannopoulos G , Raisakis K et al . Moderate procedural sedation and opioid analgesia during transradial coronary interventions to prevent spasm: a prospective randomized study . JACC Cardiovasc Interv 2013 ; 6 : 267 – 73 .
- Bertrand OF . Acute forearm muscle swelling post transradial catheterization and compartment syndrome: prevention is better than treatment! Catheter Cardiovasc Interv 2010 ; 75 : 366 – 8 .
- Bertrand OF , Larose E , Rodés-Cabau J et al . Incidence, predictors, and clinical impact of bleeding after transradial coronary stenting and maximal antiplatelet therapy . American heart journal 2009 ; 157 : 164 – 9 .
- Sandoval Y , Bell MR , Gulati R . Transradial Artery Access Complications . Circulation: Cardiovascular Interventions 2019 ; 12 : e007386 .
- Tizon-Marcos H , Barbeau GR . Incidence of Compartment Syndrome of the Arm in a Large Series of Transradial Approach for Coronary Procedures . Journal of interventional cardiology 2008 ; 21 : 380 – 384 .
- Sallam MM , Ali M , Al-Sekaiti R . Management of radial artery perforation complicating coronary intervention: a stepwise approach . Journal of Interventional Cardiology 2011 ; 24 : 401 – 6 .
- Calviño-Santos RA , Vázquez-Rodríguez JM , Salgado-Fernández J et al . Management of iatrogenic radial artery perforation . Catheterization and Cardiovascular Interventions: Official Journal of the Society for Cardiac Angiography & Interventions 2004 ; 61 : 74 – 8 .
- van Leeuwen MAH , Hollander MR , van der Heijden DJ et al . The ACRA Anatomy Study (Assessment of Disability After Coronary Procedures Using Radial Access): A Comprehensive Anatomic and Functional Assessment of the Vasculature of the Hand and Relation to Outcome After Transradial Catheterization . Circulation Cardiovascular Interventions 2017 ; 10 .
- Pancholy SB , Bernat I , Bertrand OF , Patel TM . Prevention of Radial Artery Occlusion After Transradial Catheterization: The PROPHET-II Randomized Trial . JACC Cardiovascular interventions 2016 ; 9 : 1992 – 1999 .
- Sanmartin M , Gomez M , Rumoroso JR et al . Interruption of blood flow during compression and radial artery occlusion after transradial catheterization . Catheter Cardiovasc Interv 2007 ; 70 : 185 – 9 .
- Ben-Dor I , Rogers T , Satler LF , Waksman R . Reduction of catheter kinks and knots via radial approach . Catheterization and Cardiovascular Interventions: Official Journal of the Society for Cardiac Angiography & Interventions 2018 ; 92 : 1141 – 1146 .
- Cubero JM , Lombardo J , Pedrosa C et al . Radial compression guided by mean artery pressure versus standard compression with a pneumatic device (RACOMAP) . Catheter Cardiovasc Interv 2009 ; 73 : 467 – 72 .
- Ferdinand K , Fuminobo Y , Takashi M et al . Focus on maximal miniaturisation of transradial coronary access materials and techniques by the Slender Club Japan and Europe: an overview and classification . EuroIntervention: Journal of EuroPCR in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology 2015 ; 10 : 1178 – 1186 .
- Tonomura D , Shimada Y , Yano K et al . Feasibility and safety of a virtual 3 – Fr sheathless-guiding system for percutaneous coronary intervention . Catheterization and Cardiovascular Interventions: Official Journal of the Society for Cardiac Angiography & Interventions 2014 ; 84 : 426 – 435 .
- Cortese B , Rigattieri S , Aranzulla TC et al . Transradial versus transfemoral ancillary approach in complex structural, coronary, and peripheral interventions. Results from the multicenter ancillary registry: A study of the Italian Radial Club . Catheter Cardiovasc Interv 2018 ; 91 : 97 – 102 .
- Krause DJ , Elias G , Moazez C , Zeitjian V , Saririan M . Bleeding And Vascular Complications During Cardiac Catheterization Using Conventional Radial Access Versus “Safe” Femoral Access . Journal of the American College of Cardiology 2019 ; 73 : 1389 .
- Roussanov O , Wilson SJ , Henley K et al . Cost-effectiveness of the radial versus femoral artery approach to diagnostic cardiac catheterization . The Journal of Invasive Cardiology 2007 ; 19 : 349 – 53 .
