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Radial access for coronary procedures

Radial access for coronary procedures. Giuseppe Biondi-Zoccai , MD Sapienza University of Rome, Latina, Italy giuseppe.biondizoccai@uniroma1.it gbiondizoccai@gmail.com. Why should you like radial access?. BLEEDING. THROMBOSIS. Why should you listen to me?. Why should you listen to me?.

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Radial access for coronary procedures

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  1. Radial access for coronary procedures Giuseppe Biondi-Zoccai, MD Sapienza University of Rome, Latina, Italy giuseppe.biondizoccai@uniroma1.it gbiondizoccai@gmail.com

  2. Why should you like radial access? BLEEDING THROMBOSIS

  3. Why should you listen to me?

  4. Why should you listen to me? Biondi-Zoccaiet al, Catheter Cardiovasc Interven 2011

  5. Learningmilestones • Basics • Indications and contraindications • Advantages and disadvantages • Potential complications

  6. Google searchfor “radialaccessppt”

  7. Google searchfor “radialaccessppt”

  8. Radial, ulnar and interosseusarteries

  9. Femoral and radialdiameters

  10. Oxymetry Allen test

  11. Oxymetry Allen test

  12. Choiceofaccesskits

  13. Right versus leftradialartery PROCEDURAL FAILURE PROCEDURAL TIME Biondi-Zoccaiet al, Int J Cardiol 2013

  14. Patent or meanBP-targetedhemostasis Cuberoet al, Catheter Cardiovasc Interven 2009

  15. Radialimplementation Romagnoli et al, Int J Cardiol 2013

  16. Learningmilestones • Basics • Indications and contraindications • Advantages and disadvantages • Potential complications

  17. Morbidly obese

  18. Oralanticoagulants

  19. Peripheralarterydisease

  20. Aorticdissection

  21. Loops, spasm, abnormalorigin, or tortuosity

  22. Arteria lusoria

  23. Upper limbatherosclerosis

  24. Leftinternalmammaryartery PCI

  25. Large sheath procedures

  26. RIMA vs radialartery vs RGEA vs SVG: functionalocclusion Benedetto et al, Eur J CardiothoracSurg 2014

  27. Indications • Morbidly obese • Peripheral artery disease • Aortic dissection • Oral anticoagulants (eg INR>2) • … • … • … • … • … • … • …

  28. Contraindications • Extremely low height • Anatomic anomalies (including arterialusoria) • Ulnar occlusion • Upper limb atherosclerosis • Vasculitis • Know disease of brachial, axillary, subclavian or innominate arteries • Prior radial grafting • Need for radial grafts during CABG • Chronic renal failure with potential need for AV fistula • LIMA PCI • Large sheath procedures

  29. Learningmilestones • Basics • Indications and contraindications • Advantages and disadvantages • Potential complications

  30. Patient and personnel comfort

  31. Flexibilityofradialaccess Biondi-Zoccaiet al, J Cardiovasc DisDiagn 2013

  32. Reducedriskof entry site complications Agostoni et al, J Am Coll Cardiol 2004

  33. Reduced risk of major bleeding Komocsiet al, ArchMed Sci 2014

  34. Reducingriskofbleeding, evenwithbivalirudin Marsoet al, American College ofCardiology 2010

  35. Reduced incidence of CIAKI Cortese et al, Am J Cardiol 2014

  36. Reduced risk of MACE Komocsiet al, ArchMed Sci 2014

  37. Reducedriskof NACE in cardiogenic shock requiring IABP Romagnoli et al, Am Heart J 2013

  38. Reduced risk of death Komocsiet al, ArchMed Sci 2014

  39. Meta-regression in STEMI Biondi-Zoccaiet al, Int J Cardiol 2013

  40. More skills (or ultrasound) are required for puncture Guet al, Crit Care 2014

  41. Door-to-balloon time Weaver et al, Catheter Cardiovasc Interven 2010

  42. Learning curve Spaulding et al, Catheter Cardiovasc Diagnosis 1996

  43. Radiation exposure Lange et al, Catheter Cardiovasc Interven 2006

  44. Lower catheter support Tobitaet al, J Invasive Cardiol 2013

  45. Advantages • Increased patient comfort • Reduced personnel burden • Same day discharge possible and safe • Reduced hospital stay • Reduced costs • Reduced risk of entry site complications • Reduced risk of bleeding • Reduced risk of DVT • Reduced risk of CIAKI • Reduced risk of MACE • Reduced risk of death

  46. Disadvantages • Ability to maintain arm position is required • Less comfort for operator • Anatomy highly variable • Longer learning curve • Increased radiation exposure, procedural duration, and contrast volume • Limitation to sheath and catheter size (and no room for IABP) • Less support for catheters and devices • More difficult access to specific vessels (SVG, LIMA) • Right heart cath possible but more difficult • Dedicated materials required • Repeat procedure may increase risk of complications

  47. Learningmilestones • Basics • Indications and contraindications • Advantages and disadvantages • Potential complications

  48. Stroke

  49. Hematoma

  50. Radialperforation Sanmartinet al, RevEsp Cardiol 2004

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