Dialysis Interventions and Transplant Interventions

Session: Educational Exhibit Presentations - Station 2: Dialysis Interventions and Transplant Interventions

Transradial Approach for Dialysis Access Interventions

Monday, March 6, 2023

5:05 PM – 5:10 PM

Location: Phoenix Convention Center, North Ballroom 120ABC, Poster Hall

Abstract Presenter(s)

TM

Tej I. Mehta, MD

Interventional Radiology Resident
Johns Hopkins Hospital

Disclosure(s): No financial relationships to disclose

Author/Co-author(s)

BH

Brian Holly, MD

Program Director
Johns Hopkins Hospital
ML

Mark L. Lessne, MD

Vascular and Interventional Radiologist
Vascular & Interventional Specialists, Charlotte Radiology

Disclosure(s):

Tej I. Mehta, MD: No financial relationships to disclose

Mark L. Lessne, MD: ABBOTT, ANGIODYNAMICS, ANGIOSAFE, BD BARD, BOSTON SCIENTIFIC, CSI – FRONTIER, INTACT VASCULAR, ABBOTT, MEDTRONIC, MICRO MEDICAL SOLUTIONS, PLURISTEM, LTD SURMODICS, VERYAN, VESPER MEDICAL: Consultant (Ongoing), Speaking and Teaching (Ongoing); Baylis Medical Technologies: Speaking and Teaching (Ongoing); CARDIOVASCUAR SYSTEMS (CSI), CORDIS/CARDINAL HEALTH, INARI MEDICAL INC., INTACT VASCULAR, MEDTRONIC, PHILIPS, VESPER: Consultant (Ongoing); Merit Medical: Contracted Research (Ongoing); phillips/volcano/Spectranetics: Speaking and Teaching (Ongoing); Terumo: Speaking and Teaching (Ongoing)

Learning Objectives:

-Review transradial artery access (TRA) for upper extremity arteriovenous fistula and graft (AVF/AVG) interventions.

-Provide case-based techniques for TRA hemodialysis (HD) access interventions.

-Identify advantages, disadvantages, pitfalls, and tips of TRA access for HD access interventions.

Background:

HD is preferably performed via an upper extremity AVF or AVG. HD access failure is a major cause of morbidity in patients with end-stage renal disease [1] and p</span>ercutaneous interventions are a mainstay of access repair. Traditionally, endovascular interventions of HD access are performed via direct puncture of the AVF or AVG, though other techniques have been described. TRA for HD access interventions is an increasingly recognized option that may improve ergonomics, procedure time, and access site complications. This abstract will review techniques of TRA for HD access interventions through various case-based examples.

Clinical Findings/Procedure Details:

Technique:

-Techniques of TRA access unique to HD interventions will be described, including patient selection and pre-procedure ultrasound to ensure TRA will be feasible and effective.

-Guidelines regarding radial sheath sizing and dual access techniques for larger bore devices will be discussed.

-Operator and patient positioning to improve ergonomics and decrease radiation dose during HD interventions will be illustrated.

Advantages of TRA:

- TRA enables evaluation and treatment of the entire HD circuit from arterial inflow to right atrium without need for multiple access sites [2].

- Mechanical thrombectomy may be performed with single TR sheath with potential for improved mechanical advantage and optimal evaluation of completion flow dynamics to predict immediate success [3].

-Decreased access site complications relative to other upper extremity access sites i.e. brachial access [4].

Disadvantages of TRA and alternative strategies:

- Sheath size options for radial access are more limited.

- Circuit configuration must be well delineated prior to TRA.

- Complications associated with TRA including hand ischemia.

Case illustrations will be provided, including:

-Thrombectomy

-Percutaneous AVF interventions.

-Central venous outflow obstruction.

-Inflow insufficiency.

Conclusion and/or Teaching Points:

TRA for HD access interventions is a technique that may identify and treat lesions from a single puncture site, predict procedural success with intra-procedural monitoring, improve ergonomics and reduce radiation. Techniques and pitfalls unique to TRA must be understood by the interventionalist to ensure safe and effective therapies.