Radial Access in the Setting of Angiography and Embolization for Trauma: Our Experience

Sunday, March 5, 2023

3:18 PM – 3:27 PM

Location: Phoenix Convention Center, 222C

Presenting Author(s)

Julia Ding, BS

Medical Student
Emory University School of Medicine

Disclosure(s): No financial relationships to disclose

Author/Co-author(s)

Hanzhou (Hanssen) Li, MD

IR/DR Resident Physician
Emory University School of Medicine
ZZ

Zachary Zaiman, n/a

Research Assistant
Emory University School of Medicine
HT

Hari Trivedi, MD

Assistant Professor
Emory University
Peter J. Park, MD

Assistant Professor
Emory University
Neil J. Resnick, MD

Interim Division Director of Interventional Radiology
Emory University
JN

Jonathan Nguyen, DO, FACS, FACOS

Associate Professor
Morehouse School of Medicine
Zachary L. Bercu, MD RPVI (he/him/his)

Assistant Division Director, Innovation and Strategy; Associate Professor
Emory University School of Medicine
Janice Newsome, MD, FSIR

Associate Professor
Emory School of Medicine
JG

Judy Gichowa, MD, MS

Assistant Professor
Emory University School of Medicine

Disclosure(s):

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

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

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

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:

Traditionally, transradial artery access (TRA) has been secondary to transfemoral artery access (TFA) for interventional radiology (IR) procedures, especially in the setting of trauma. As interventionists have demonstrated increasing confidence in TRA in emergent settings such as in cardiac and stroke cases, the use of TRA in the setting of trauma has gained increasing traction. We aim to describe our experience with TRA for IR angiography and embolization in the setting of trauma.

Materials and Methods:

We performed a retrospective review of all arterial angiography and possible embolization cases in the setting of trauma performed by IRs at our level 1 trauma center from 2015 to 2022. Cases were extracted from our institutional database using the search terms “trauma”, “gunshot”, “gsw”, and “mvc”. We manually reviewed and excluded the non-trauma cases.

Results:

630 trauma patients (mean age 41, 30.4% female) underwent 685 arterial angiography with possible embolization. 91.7% (628/685) of cases underwent TFA; 6.9% (47/685) underwent TRA; 0.1% (1/685) underwent brachial artery access; 0.1% (1/685) underwent subclavian artery access; and 0.4% (3/685) underwent TFA first but transitioned to TRA. There was no significant difference in age (mean 40.9 TFA , mean 39.1 TRA, p = 0.42) or sex (p = 0.87) between those who underwent TFA vs TRA. TRA were successfully performed for 23 pelvic, 1 splenic, 2 renal, 10 hepatic, 1 mesenteric, 2 intercostal artery, and 8 combination cases. Reasons for TFA to TRA transition include difficulty accessing the femoral artery or the bleeding target artery. Reasons given for attempting TRA before TFA include groin hematomas and pelvic binder. 87.2% (41/47) had a pre-procedural CT/CTA demonstrating hemorrhage or pseudoaneurysm. 72.3% (34/47) had a post-procedure CT/CTA for follow-up. The average contrast usage for TRA cases was 106.4 cc with mean fluoro time of 17.5 min. The reintervention rate was 14.9% (7/47) due to rebleeding or no active bleeding seen on the initial angiogram. There were no reported radial access site complications.

Conclusion:

Although IRs traditionally have relied on TFA for trauma angiography and embolization, TRA can be an alternative, safe option for a variety of emergent cases. TRA may be the route of choice in trauma patients with groin hematomas or pelvic binders.