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Radial Access Just another artery?

Radial Access Just another artery?. Keith G Oldroyd Department of Cardiology Western Infirmary Glasgow. Brachial access Not just another artery!. Femoral access Not just another artery!. C Ilsley; personal communication. Femoral access Not just another artery!. 45 year old women

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Radial Access Just another artery?

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  1. Radial AccessJust another artery? Keith G Oldroyd Department of Cardiology Western Infirmary Glasgow

  2. Brachial accessNot just another artery!

  3. Femoral accessNot just another artery! C Ilsley; personal communication

  4. Femoral accessNot just another artery! • 45 year old women • Moderate obesity • Elective catheterisation – RFV/RFA • Major retroperitoneal haemorrhage • CT scan; 6 unit transfusion • Discharged on day 6 • Readmitted on day 9 • RCFA false aneurysm • Doppler, CT, thrombin injections • Discharged day 13

  5. Radial access: just another artery?History of transradial catheterisation • 1964 • Campeau, Montreal Heart Institute • Cut-down on proximal RRA • 1970/80’s • Percutaneous approach • Axillary > Femoral > Brachial • 1989 • Percutaneous transradial coronary angiography/PTCA

  6. Pre-Colombian Aspirin Persantin Warfarin Dextran 8-9F sheaths 1 week in hospital No closure devices 10% bleeding 5-10% SAT Post-Colombian Aspirin Clopidogrel 6F(5F) sheaths day case/23 hours Closure devices <1% bleeding <1% SAT Radial access: just another artery?Why bother?

  7. Radial access: just another artery?ACCESS Study • Randomised comparison of different access sites • Experienced operators • No difference in procedural or fluoroscopy times JACC 1997; 29: 1269-75. Amsterdam, NL

  8. Radial access: just another artery?Carafe Study • Randomised • Two experienced operators • ~50% follow-on PCI with closure devices for femoral cases • Radial groups • Reduced pain • Earlier ambulation and discharge • Lower costs CCVI 2001; 52:181-7. Massy, France

  9. Radial access: just another artery?Multiple procedures • 812 patients • 1438 procedures • 6F – 45% • 5F – 55% CCVI 2001;54: 204-8. Fukuoka, Japan

  10. Radial access: just another artery?

  11. Radial access: just another artery?Difficult radial anatomy – small vessels (1) • Randomised trial of 5Fr vs 6Fr transradial PCI in 171 patients with a +ve Allen test CCVI 2002; 57: 172-6. Greifswa, FRG

  12. Radial access: just another artery?Difficult radial anatomy – small vessels (2) • 90 patients • Randomised to hydrophilic sheath vs conventional sheath • Automatic pullback with an electronic traction guageCCVI 2001; 54: 289-94. Quebec Can

  13. Radial access: just another artery?

  14. Radial access: just another artery?

  15. Radial access: just another artery?

  16. Radial access: just another artery?

  17. Radial access: just another artery?Difficult radial anatomy • Preprocedural ultrasound in 115 patients • Anatomic variations in 11 (9.6%) • Tortuosity 6 - proceed • Stenoses 2 - proceed • Hypoplasia 2 - femoral • Radioulnar loop 1 - femoral • Success 111 (97.4%)CCVI 2000; 49: 357-62 Tokyo, Japan

  18. Radial access: just another artery?

  19. Radial access: just another artery?Difficult subclavian anatomy • Retro-oesophageal right subclavian artery • 11 patients in 3730 attempted transradial procedures • Increased failure rate (7%)CCVI 2001; 54: 202-3. Massy, France

  20. Radial access: just another artery?Difficult coronary anatomy • LIMA • LRA is access site of choice • Specific catheters to approach from RRA • RIMA • RRA is access site of choice • Anomalous origin of RCA from L sinus of valsalva • Series of case reports • RRA appears to be access site of choice • Saphenous vein grafts • Avoid during initial experience

  21. Radial access: just another artery?Comparison with closure devices (1) • Two groups of 109 consecutive PCI’s • Not randomised but matched for usual demographic parameters • Experienced operators CCVI 2000; 49: 157-9. Raleigh, NC, USA

  22. Radial access: just another artery?Comparison with closure devices (2) • 6 high volume operators in a high volume centre • Prospective non-randomised registry CCVI 2000; 51: 417-21. Massy, Fr

  23. Radial access: just another artery?GP IIb/IIIa inhibitors • 150 consecutive patients treated with GPIIb/IIIa inhibitors Eur Heart J 2000; 21: 662-7. Toulouse, Fr.

  24. Radial access: just another artery?Acute myocardial infarction • Two centre registry of 1224 patients with AMI treated by primary PCI CCVI 2002; 55: 206-11. Massy, Fr

  25. Radial access: just another artery?Non-coronary intervention • Carotid - Case report • Castriota F et al. J Endovasc Surg 1999; 6: 385-6 • Vertebral - Case report • Fessler RD et al (Buffalo, NY) Neurosurg 2000; 46: 1527-8 • Renal - 25 patients; 27 arteries; 100% success • Galli Met al (Como, It) J Inv Cardiol 2002; 14:386-90

  26. Radial access: just another artery?Potential effect on interventional activity • Elective day case PCI • Reduced costs compared to groin closure • No failed haemostasis • Convert beds to reclining chairs • In-patient PCI programme • Reduced bed utilisation • Fewer complications • Reduced LOS

  27. Radial access: just another artery? The only artery!

  28. Normal arterial anatomy in forearm

  29. Brachial tortuosity

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