Repeat Transradial Access in Interventional Radiology: Our institutional experience

Tuesday, March 7, 2023

3:27 PM – 3:36 PM

Location: Phoenix Convention Center, 222C

Presenting Author(s)

Kaesha Thomas, MBBS (she/her/hers)

Research Assistant
Emory University School of Medicine

Disclosure(s): No financial relationships to disclose

Author/Co-author(s)

JG

Judy Gichoya, MD

Assistant Professor In Radiology
Emory University
Julia Ding, BS

Medical Student
Emory University School of Medicine
HS

Hifza Sakhi, BS

Medical Student
PCOM Georgia
ZZ

Zachary Zaiman, n/a

Research Assistant
Emory University School of Medicine
Hanzhou (Hanssen) Li, MD

IR/DR Resident Physician
Emory University School of Medicine
HT

Hari Trivedi, MD

Assistant Professor
Emory University
Peter J. Park, MD

Assistant Professor
Emory University
Zachary L. Bercu, MD RPVI (he/him/his)

Assistant Division Director, Innovation and Strategy; Associate Professor
Emory University School of Medicine
Neil J. Resnick, MD

Interim Division Director of Interventional Radiology
Emory University
Janice Newsome, MD, FSIR

Associate Professor
Emory School of Medicine

Disclosure(s):

Kaesha Thomas, MBBS: No financial relationships to disclose

Judy Gichoya, MD: No financial relationships to disclose

Julia Ding, BS: No financial relationships to disclose

Hanzhou (Hanssen) Li, MD: No financial relationships to disclose

Peter J. Park, MD: No financial relationships to disclose

Zachary L. Bercu, MD RPVI: Terumo Medical Corporation: Speaking and Teaching (Ongoing); XAct Robotics: Advisory Committee or Review Panel Member (Ongoing)

Neil J. Resnick, MD: No relevant disclosure to display

Janice Newsome, MD, FSIR: Boston Scientific: Advisory Committee or Review Panel Member (Ongoing); CARESTREAM: Research Grant Recipient (Ongoing); Cook Inc: Consultant (Ongoing); Medtronic: Research Grant Recipient (Ongoing); TVIR: Co Editor (Ongoing)

Purpose: Transradial Access (TRA) is a popular technique among interventionalists for arterial vascular access. Compared to the transfemoral approach, TRA has fewer bleeding-related complications, lesser myocardial infarctions, and is associated with a shorter hospital stay.{1} It is not uncommon for a patient in interventional radiology to have multiple procedures over the course of their treatment timeline; however, there is a dearth of data surrounding the feasibility, efficacy and timing of repeat TRA.{2,3,4}

Materials and Methods: We performed a retrospective analysis of 402 patients who had undergone repeat ( ≥ 2) procedures at our academic tertiary center between 2010 and 2022.

Results:

A total of 1104 interventional procedures using transradial access were performed in 397 patients. The cohort was 71% (282/397) male and 29% (115/397) female with a mean age of 65.2 years (range of 24-88). All patients underwent ≥2 procedures; 105 patients underwent more than 3 procedures; 35 patients underwent more than 4 procedures; 18 patients underwent more than 5 procedures; 13 patients underwent ≥ 6; and 5 patients underwent 7-9 procedures. The TRA procedures performed include Y-90 radioembolization (411/1104), MAA mapping (351/1104), chemoembolization (143/1104), and varied combinations of particle, coil and gelfoam embolizations (151/1104).

The median [IQR] and mode of the time between a patient’s first and last TRA was 63 [31-100] days and 35 days respectively. Repeat catheterization by TRA was performed twice in 56% of patients (221/397). Of these patients, 42% (93/221) had their repeat catheterization within 30 days. The mean time between catheterizations was 15 days with a median of 17 [5-24] days. The average time interval for patients with repeat catheterization after 30 days (128/221, 58%) was 93 days with a median of 49 [37-83] days.

The procedural technical success rate was 98.6% (1088/1104). The most common reason for a unsuccessful TRA was due to artery occlusion (31.3%, 5/16) vasospasm (25%, 4/16), thrombosis (12.5%, 2/16), small caliber artery (12.5%, 2/16), and hematoma (6.25%, 1/16).

Conclusion: Repeat TRA is technically feasible, safe and can be successfully performed within 7 days of the first intervention.