Peripheral Arterial Intervention Via Transradial Access:Safety And Feasibility

Part 1:Feasibility and Safety of Peripheral Vascular Intervention via Transradial AccessPurpose: To evaluate the feasibility and safety of transradial approach for peripheral arterial intervention.Materials and Methods: 408 patients undergoing 762 peripheral arterial interventions via transradial access(TRA)were retrospectively reviewed with a mean age of(57.7±10.7)years and a mean height of(168±7.3)cm.Of these interventions,610 were trans-arterial chemoembolization(TACE)for liver cancer,31 were digestive angiography(±embolization),70 were preoperative embolization of spinal tumors,15 were embolization(±arterial infusion)of bladder cancer,31 were uterine artery embolization(±arterial infusion),5 were renal artery angioplasty.The puncture and procedural success rate,postoperative complications and patients’ preference were recorded.Result: The total puncture success rate was 97.38%(742/762).Failure of left radial artery puncture occurred in 20 cases due to radial artery spasm(n=16)or radial artery stenosis after previous puncture(n=4),with cross-over to the left ulnar artery(n=7)or femoral artery(n=13).In 728 procedures,catheterization of all target vessels and following manipulations were successfully carried out,with the procedural success rate of 98.11%(728/742).Complications included radial artery spasm during catheterization(n=3),postoperative minor subcutaneous hematoma or congestion(n=9),radial artery pulsation weakness(n=9),and forearm pain(n=1).Of the 97 patients who had received previous transfemoral access procedures,95 preferred to TRA.A total of 333 TACE via TRA were performed in 131 patients with hepatocellular carcinoma(HCC),with 73 patients receiving twice and 58 patients receiving ≥3 times.The success rate of puncture in these procedures was 98.8%(329/333).One patient with HCC had undergone TACE via left TRA for 9 times,and the radial artery was still in good pulsation for next puncture.Conclusion: Transradial approach for peripheral arterial intervention is safe and feasible,which could improve patients’ preference.Part 2: Comparative Study of Operator Radiation Dose during TACE via Transradial Access in Different positions and Transfemoral AccessPurpose: To compare the operator radiation dose in transarterial chemoembolization(TACE)via transradial access(TRA)in different positions and transfemoral access(TFA).Materials and Methods: Between January and November 2019,120 consecutive patients who were going to have TACE were randomly divided into four groups with 30 patients in each group.In group A,patients were placed in foot-first position with the left upper arm abducted on the hand plate at 70-90°,and TACE was performed through the left radial artery;in group B,patients were in conventional head-first position with the left hand placed in the left groin,and TACE was performed through the left radial artery;in group C,patients were in conventional head-first position,and TACE was performed through the right radial artery;in group D,patients were in conventional head-first position,and TACE was performed via the right femoral artery.Before each procedure,radiation dose test tablets(thermoluminescent dosemeter,TLD)were taped at seven different body parts of the operator(the orbital area,neck,left anterior chest,lower abdomen,left wrist,right wrist and foot),and the radiation dose was measured after procedure.The fluoroscopy time(FT),Dose-Area Product(DAP),Air Kerma(AK),were also recorded for each procedure.The normalized radiation dose(the effective radiation dose received at each body part of the operator per second)was calculated.Comparison was performed to evaluate whether there was statistical difference among the four groups.Result: There were no statistically significant differences in patient and tumor characteristics among the four groups.The mean FT from intubation to celiac trunk was(47.5±36.1)s in group A,(53.6±21.3)s in group B,(76.0 ±45.2)s in group C,and(40.3±28.3)s in group D,respectively,and the difference was statistically significant(P < 0.01).There were no statistical differences in total FT,DAP and AK among the four groups.There were statistically significant differences in the radiation dose the operator received at pelvic cavity(P=0.03),right wrist(P < 0.01)and the total dose(P < 0.05),while there were no statistically significant differences in the radiation dose at head,thyroid,chest,left wrist and foot.There were statistical differences among the four groups in the normalized radiation dose at thyroid,chest,pelvic cavity,left wrist,right wrist and total dose(P < 0.05).The normalized radiation dose of the operator at different parts was lower in group A and higher in group C.Conclusion: In this study,a longer FT was required for intubation through the right radial artery to the celiac trunk.The normalized radiation dose received by the operater was statistically different when performing TACE via TRA in different positions or TFA.There is a trend of lower dose in group A and higher dose in group C at the thyroid,chest,pelvic cavity,left wrist and right wrist.TACE via left TRA with the patient in foot-first position and the left upper arm abducted at 70-90° may effectively reduce the operator radiation dose,and thereby reduce the risk of radiation.