1 / 32

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

paul2
Télécharger la présentation

Radial Access Just another artery?

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  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

More Related