Update on Transradial Access for Percutaneous Transcatheter Visceral Artery Embolization

Abstract

Transfemoral access (TFA) is a widely used first-line approach for most peripheral vascular interventions. Since its introduction in cardiologic and neurointerventional procedures, several advantages of transradial access (TRA) over TFA have been demonstrated, such as patient preference, lower complication rates, early ambulation, and shorter hospital stay. However, studies reporting the safety and efficacy of this approach for peripheral vascular interventions performed by interventional radiologists are relatively few. This review aimed to summarize the technique and clinical applications of TRA in percutaneous transcatheter visceral artery embolization and the management of complications.

Keywords: Review; TFA; TRA; Visceral artery embolization.

Fig. 1. Barbeau test and four types of Barbeau waveforms.

Fig. 2. Position of left arm for TRA.

A. Arm positioned at 75–90°, almost perpendicular to table for easier vessel access with ultrasound. Proper positioning of left wrist was achieved by using long arm board and left radial artery was punctured. B. Arm was then repositioned against patient's side. Arm positioned at patient's side in position similar to that of patient's groin, which allows catheters/wires to be positioned over patient's draped body in way similar to that in traditional transfemoral access.

Fig. 3. Radial artery puncture.

A. Diameter of radial artery (arrow) is measured at 3.2 mm on ultrasound image. Radial artery is punctured with 21-gauge needle following single-wall technique under ultrasound guidance. B, C. 0.018-inch wire is advanced into radial artery.

Fig. 4. Snuffbox radial artery access technique.

Fig. 5. Catheter selection for TRA.

A. Four types of ultimate catheters. B. 125-cm 5-Fr ultimate 1 radial catheter (Merit Medical Systems) and standard 0.035-inch hydrophilic guide wire (Radifocus, Terumo) are used to navigate subclavian region and engage descending aorta.

Fig. 6. PreludeSYNC (Merit Medical Systems) and nonocclusive patent hemostasis technique.

Note that center of “crosshairs” is placed over arteriotomy site (location where sheath entered artery, approximately 1–2 mm proximal to skin puncture site).

Fig. 7. Clinical applications of TRA on TACE for hepatic malignancy.

A. Coronal contrast-enhanced CT shows 5-cm hepatocellular carcinoma (arrow) in segment 6 of liver. B. Hepatic arteriography showing multiple hypervascular tumors in both lobes of liver. C. After selection of tumor feeder using microcatheter, drug-eluting bead loaded with doxorubicin/nonionic contrast suspension is slowly injected until near stasis. D. Post-embolization hepatic arteriography showing complete devascularization of tumor in liver. E. Coronal contrast-enhanced CT image 1 month after TACE showing complete response (arrow). TRA = transradial access, TACE = transarterial chemoembolization

Fig. 8. Clinical applications of TRA on embolization of renal angiomyolipoma.

A. Left renal arteriography showing hypervascular tumor in right kidney upper pole (arrow). B. After selection of tumor feeder using microcatheter, permanent embolic agents (polyvinyl alcohol particle) are slowly injected until near stasis. C. Super-selective embolization of tumor feeder with microcoil (arrow). D. Post-embolization left renal arteriography showing complete devascularization of tumor and preserved perfusion in renal parenchyma.

Fig. 9. Clinical applications of TRA on prostate artery embolization.

A. Left internal iliac arteriography showing enlarged prostate with prominent vascularity (arrow). B. Selective left prostate artery angiography showing hypertrophied vasculature within prostate gland (arrow). C. After selection of prostate artery using microcatheter, permanent embolic agents (polyvinyl alcohol particle) are slowly injected until near stasis. D. Post-embolization left prostate artery angiogram shows complete devascularization of hypertrophied vasculature within prostate gland.