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Safety and Feasibility of Transradial Infrainguinal Peripheral Arterial Disease Interventions

Transradial access (TRA) has traditionally been favored for coronary interventions. Tools with up to 200 cm length now allow operators to treat infrainguinal peripheral arterial disease (PAD) using TRA. This study aims to assess the safety and feasibility of TRA infrainguinal interventions.

Alex Sher, MD
Raghuram Posham, MD
Ageliki Vouyouka, MD
Rahul Patel, MD, FSIR
Robert Lookstein, MD, FSIR
Peter L. Faries, MD
Aaron Fischman, MD, FSIR
Rami Tadros, MD

April 2020

Transradial and Transfemoral Uterine Fibroid Embolization Comparative Study: Technical and Clinical Outcomes.

To compare clinical and technical outcomes of transradial (TRA) uterine artery embolization (UAE) with those of the transfemoral (TFA) approach.

Masoud Nakhaei, MD
Alireza Mojtahedi, MD
Salomao Faintuch, MD
A. Sarwar, MD
O.R. Brook, MD

January 2020

Initial experience with transradial access for cerebrovascular procedures: is it feasible and safe?

Despite the proven benefit of transradial access over transfemoral access in cardiac procedures, the transition for cerebrovascular procedures has only been slowly enforced. Here we present our experience with transradial access in cerebral diagnostic angiographies and neurointerventional procedures.

H. Styczen, MD
V. Maus, MD
I. Tsogkas, MD
D. Meila, MD
M. Bester, MD
Jan-Hendrik Buhk, MD
Marios N. Psychogios, MD

January 2020

Single-Center Retrospective Comparative Analysis of Transradial, Transbrachial, and Transfemoral Approach for Mesenteric Arterial Procedures

To assess feasibility and safety of transradial access (TRA) compared with transfemoral access (TFA) and transbrachial access (TBA) for mesenteric arterial endovascular procedures.

LJD van Dijk, MD
D. van Noord, MD
M. van Mierlo, MD
DC Bijdevaate, MD
MJ Bruno, MD
A. Moelker, MD

January 2020

Transradial Access for Neurointerventions: Management of Access Challenges and Complications

Numerous large randomized trials have shown a significant morbidity and mortality benefit with the transradial approach (TRA) over the transfemoral approach (TFA) for endovascular procedures. However, this technique is routinely avoided or aborted due to unfamiliarity with the technique and the associated anatomical difficulties that may be faced in this approach. The objective of this review is to identify both the common and uncommon challenges that may be encountered during a transradial approach for cerebrovascular catheterization and to provide tips and tricks to overcome the transradial learning curve.

Marie-Christine Brunet, MD
Stephanie H Chen, MD
Eric C Peterson, MD

January 2020

Expedited TR Band Removal for Transradial Approach for Noncoronary Visceral Procedures: Initial Experience.

For transradial interventions, most published studies report an initial Terumo Radial (TR) band placement time of 60 minutes, with gradual deflation over 30 to 90 minutes. We aimed to determine, retrospectively, whether TR band removal time could be expedited to 45 to 60 minutes, without adverse effects via an expedited single-step deflation protocol.

M. Shahid, MD
V. Chandra, MD
E. Wajswol, MD
S. Contractor, MD
P. Shukla, MD
A. Kumar, MD

December 2019

Transitioning to Transradial Access for Cerebral Aneurysm Embolization

Despite several retrospective studies showing the safety and efficacy of transradial access for cerebral angiography, neurointerventionalists are apprehensive about implementing TRA for neurointerventions. This reluctance is mainly due to anatomic factors, technical factors, and a long learning curve (relative to transfemoral access). We present here our experience of TRA transition for cerebral aneurysm embolization. Our aim was to demonstrate the feasibility and safety of radial access for consecutive embolizations of ruptured and unruptured cerebral aneurysms.

C. Chivot, MD
R. Bouzerar, MD
T. Yzet, MD

November 2019

Feasibility of repeat transradial access for neuroendovascular procedures

Transradial artery access (TRA) for cerebrovascular angiography is increasing due to decreased access site complications and overwhelming patient preference. While interventional cardiologists have reported up to 10 successive TRA procedures via the same radial access site, this is the first study examining successive use of the same artery for repeat procedures in neurointerventional procedures.

SH Chen, MD
MC Brunet, MD
S. Sur, MD
DR Yavagal, MD
RM Starke, MD
EC Peterson, MD

October 2019

Distal Transradial Access in the Anatomic Snuffbox for Diagnostic Cerebral Angiography

The aim of this study was to describe the feasibility, technique, and safety of distal transradial access in the anatomic snuffbox for diagnostic cerebral angiography. A retrospective review of diagnostic cerebral angiograms obtained during a 6-month period with distal transradial access was performed. Thirty-four successful procedures were performed via distal transradial access. There were 4 failed attempts. This single-center experience using distal transradial access suggests that this technique is safe and effective.

P Patel, MD
N Majmundar, MD
I Bach, MD
V Dodson, MD
F Al-Mufti, MD
L Tomycz, MD
P Khandelwal, MD

September 2019

Operator Learning Curve for Transradial Liver Cancer Embolization: Implications for the Initiation of a Transradial Access Program

We aimed to analyze transradial access (TRA) learning curve on patients undergoing hepatic chemoembolization, investigating the relationship between procedural volumes and various benchmarks of procedural success.

Roberto Iezzi, MD
Alessandro Posa, MD
Biagio Merlino, MD
Maurizio Pompili, MD
Eleonora Annicchiarico, MD
Elena Rodolfino, MD
Michele Basso, MD
Alessandra Cassano, MD
Antonio Gasbarrini, MD
Riccardo Manfredi, MD

September 2019

Distal Radial Artery Access for Noncoronary Endovascular Treatment Is a Safe and Feasible Technique

To evaluate safety and feasibility of distal radial artery (DRA) access for noncoronary interventional radiology procedures.

Lievay van Dam, MD
Tychon Geeraedts, MD
Diederick Bijdevaate, MD
Pieter Jan van Doormaal,
Ayleen The, MD
Adriaan Moelker, MD

August 2019

Radical Radial: Pearls and Pitfalls in Transradial Yttrium-90 Liver-Directed Therapy

The frequency of transradial access in interventional radiology has been steadily increasing, including for yttrium-90 (Y-90) selective internal radiation therapy to treat hepatic malignancies. The aim of this article is to detail an optimized approach to transradial Y-90 (TRY-90), showing it to be a safe and feasible first-line approach to hepatic selective internal radiation therapy. Salient preprocedural considerations to enable appropriate patient selection for TRY-90 are discussed and a detailed equipment list is provided. The article will describe our approach to TRY-90 in addition to a discussion around technical pearls and pitfalls.

John Chung, MD
Anastasia Hadjivassiliou, MD
Darren Klass, MD
David Liu, MD

June 2019

Palmar Warming for Radial Artery Vasodilation to Facilitate Transradial Access: A Randomized Controlled Trial

This research investigates the efficacy of palmar warming to induce radial artery vasodilation.

Ramsey Al-Hakim, MD
J. Cody Hedge, MD
Younes Jahangiri, MD
John A. Kaufman, MD, MS, FSIR
Roberto Galuppo, MD
Khashayar Farsad, MD, PhD, FSIR

March 2019

Prospective Study on Total Fluoroscopic Time in Patients Undergoing Uterine Artery Embolization: Comparing Transradial and Transfemoral Approaches

This study compares total fluoroscopy time (FT) to perform uterine artery embolization (UAE) with transradial approach (TRA) versus transfemoral approach (TFA). Our hypothesis was that there would be no significant procedural time penalty incurred, despite the learning curve associated with adopting a new approach.

Chloe Mortensen
John Joon Young Chung
David Y. Liu, Stephen Ho
Gerald M. Legiehn
Lindsay Machan
Darren Klass

March 2019

Patient Experience and Preference in Transradial versus Transfemoral Access during Transarterial Radioembolization: A Randomized Single-Center Trial

A study to determine patient preference for transradial access (TRA) or transfemoral access (TFA) after experiencing both.

Lisa B. Liu, MD
Mario A. Cedillo, MD
Vivian Bishay, MD
Mona Ranade, MD
Rahul S. Patel, MD, FSIR
Edward Kim, MD, FSIR
Scott F. Nowakowski, MD, FSIR
Robert A. Lookstein, MD, FSIR
Aaron M. Fischman, MD, FSIR

March 2019

Distal transradial artery access in the anatomical snuffbox for coronary angiography as an alternative access site for faster hemostasis

This study investigated the feasibility, safety, and the potential benefit of faster hemostasis with the distal transradial artery access (TRA).

Shunsuke Aoi, MD
Wah Wah Htun, MD
Stephanie Freeo, NP
Samuel Lee, BS
Htoo Kyaw, MD
Victor Alfaro, MD
John Coppola, MD
Samir Pancholy, MD
Tak Kwan, MD

February 2019

Radial Access for Lower Extremity Peripheral Arterial Interventions: Do We Have the Tools?

This article provides an up-to-date review of the literature and devices currently available for operators wishing to treat lower extremity PAD via TRA and the limitations they may face.

Raghuram Posham, MD
Lindsay B. Young, MD
Robert A. Lookstein, MD
Constantino Pena, MD
Rahul S. Patel, MD
Aaron M. Fischman, MD

February 2019

A Novel Approach to Reduce Radial Artery Occlusion After Transradial Catheterization: Postprocedural/Prehemostasis Intra-arterial Nitroglycerin

This research evaluates whether administration of nitroglycerin through the sheath at the end of a transradial procedure might preserve the patency of the radial artery.

Surya Dharma, MD, PhD, FIHA, FICA, FAPSIC, FESC, FSCAI
Sasko Kedev, MD, PhD, FESC, FACC
Tejas Patel, MD, FESC, FACC, FSCAI
Ferdinand Kiemeneij, MD, PhD, FESC
Ian C. Gilchrist MD, FACC, FSCAI

February 2019

Transradial Versus Transfemoral Access for Anterior Circulation Mechanical Thrombectomy: Comparison of Technical and Clinical Outcomes

This study compares outcomes in patients who underwent MT via TRA versus TFA.

Stephanie H Chen, MD
Brian M. Snelling, MD
Samir Sur, MD
Sumedh Subodh Shah, MD
David J. McCarthy, MD
Evan Luther, MD
Dileep R. Yavagal, MD
Eric C. Peterson, MD
Robert M. Starke, MD

January 2019

Patient Radiation Exposure in Transradial versus Transfemoral Yttrium-90 Radioembolization: A Retrospective Propensity Score-Matched Analysis

This study compares differences in patient radiation exposure (PRE) during transarterial yttrium-90 (90Y) radioembolization (TARE) between transradial access (TRA) and transfemoral access (TFA).

Joshua Loewenstern, BS
Colton Welch, BS
Safet Lekperic, MD
Vivian Bishay, MD
Mona Ranade, MD
Rahul S. Patel, MD
Edward Kim, MD
F. Scott Nowakowski, MD
Robert A. Lookstein, MD
Aaron M. Fischman, MD

May 2018

Transradial Versus Transfemoral Arterial Access in Liver Cancer Embolization: Randomized Trial to Assess Patient Satisfaction

This study set out to determine whether transradial access (TRA) or transfemoral access (TFA) provides better patient satisfaction during intra-arterial therapy (IAT) for liver cancer.

Ricardo Yamada, MD
Stephen Bracewell, MD
Beatriz Bassaco, BS
Juan Camacho, MD
M. Bret Anderson, MD
Andrew Conrad, MD
Corie Lynn, BS
Paul Burns, BS
Heather Collins, PhD
Marcelo Guimaraes, MD, FSIR

January 2018

Safety and Outcomes of Transradial Access in Patients with International Normalized Ratio 1.5 or Above

Article examines the safety and outcomes for patients undergoing transradial noncoronary interventions with international normalized ratio (INR) greater than or equal to 1.5.

Joseph J. Titano, MD
Derek M. Biederman, MD
John Zech, MA
Ricki Korff, BE
Mona Ranade, MD
Rahul Patel, MD
Edward Kim, MD
Francis Nowakowski, MD
Robert Lookstein, MD
Aaron M. Fischman, MD

November 2017

Transradial versus Transfemoral Access for Hepatic Chemoembolization: Intrapatient Prospective Single-Center Study

This article compares the transfemoral approach (TFA) and transradial approach (TRA) in patients undergoing hepatic chemoembolization in terms of safety, feasibility, and procedural variables, including fluoroscopy time, radiation dose (reference air kerma [RAK]), and patient preference.

Roberto Iezzi, MD
Maurizio Pompili, MD
Alessandro Posa, MD
Eleonora Annicchiarico, MD
Matteo Garcovich, MD
Biagio Merlino, MD
Elena Rodolfino, MD
Vincenzo Di Noia, MD
Michele Basso, MD
Alessandra Cassano, MD
Carlo Barone, MD
Antonio Gasbarrini, MD
Riccardo Manfredi, MD
Cesare Colosimo, MD

September 2017

Cone-beam CT Acquisition During Transradial TACE Made Easy: Use of the Swivel Arm Board

Having recently introduced a swivel arm board to allow seamless repositioning of the access arm during and after CBCT acquisition, this study details the technique and feasibility of this useful adjunct to transradial TACE.

Uei Pua, FRCR, FAMS
Chia Chia Teo
Pe Thet U
Lawrence Han Hwee Quek, FRCR, FAMS

August 2017

“Snuffbox” Distal Radial Access

This article discusses an alternative transradial access site. The distal radial artery is accessed under ultrasound (US) guidance over the trapezium.

Uei Pua, MBBS, MMed, FRCR, FAMS
Lawrence Han Hwee Quek, BMBS, FRCR, MMed, FRANZCR, FAMS

July 2017

Prostate Artery Embolization via Transradial or Transulnar versus Transfemoral Arterial Access: Technical Results

Compares safety and feasibility of prostate artery embolization (PAE) via transradial/transulnar access (TR/UA) and transfemoral access (TFA).

Shivank Bhatia, MD
Sardis H. Harward, MPH
Vishal K. Sinha, BS
Govindarajan Narayanan, MD

June 2017

Transradial Approach for Mechanical Thrombectomy in Anterior Circulation Large-vessel Occlusion

This study describes the authors’ recent institutional experience with the transradial approach to anterior circulation large-vessel occlusions (LVOs) in acute ischemic stroke patients and to report its technical feasibility.

Samir Sur, MD
Brian Snelling, MD
Priyank Khandelwal, MD
Justin M. Caplan, MD
Eric C. Peterson, MD
Robert M. Starke, MD
Dileep R. Yavagal, MD

April 2017

Transulnar Approach as an Alternative to Transradial Approach in Non-coronary Intervention: Safety, Feasibility and Technical Factors

This study evaluates the safety and efficacy of TUA in patients undergoing visceral interventions in the setting of contraindication to TRA.

Adam Zybulewski
Martin Edwards, Edward Kim Francis S. Nowakowski
Rahul Patel, Nora Tabori
Robert Lookstein
Aaron M. Fischman

January 2017

Prone Transradial Catheterization for Combined Single-Session Transarterial Embolization and Percutaneous Posterior Approach Cryoablation of Solid Neoplasms

A tutorial on how to optimize transradial success by avoiding obstacles.

Jeffrey Forris Beecham Chick
Casey Branach
Bill Saliba Majdalany
J. Matthew Meadows
Douglas A. Murrey
Wael A. Saad
Minhaj S. Khaja
Kyle J. Cooper
Matthew L. Osher
Ravi Nara Srinivasa

December 2016

Transradial Approach for Hepatic Radioembolization: Initial Results and Technique

Selective internal radiation therapy (SIRT) performed via the TRA can enhance patient comfort, compared with the traditional transfemoral approach (TFA), by allowing immediate ambulation and precluding potential complications associated with the TFA, such as closure device injury or retroperitoneal hematoma. This report shares initial experience with and technique for using the TRA for SIRT.

Vivian L. Bishay
Derek M. Biederman
Thomas J. Ward
Imramsjah Martijn J. van der Bom
Rahul S. Patel
Edward Kim
Francis S. Nowakowski
Robert A. Lookstein
Aaron M. Fischman

November 2016

Embolization of a Chest Wall Arterial Venous Malformation Using a Transradial Approach

This article reports on the usefulness of TRA in embolization of a chest wall AVM with inferior coursing, intercostal “feeder” arteries forming obtuse angles with the descending thoracic aorta, more readily cannulated by a superior TRA.

Safet Lekperic, MD
Aaron M. Fischman, MD
Derek Biederman, MD

October 2016

Transradial Access for Interventional Radiology: Single-Centre Procedural and Clinical Outcome Analysis

This study sought to describe a single centre’s technical approach to transradial intervention and report on clinical outcomes and safety.

Avnesh S. Thakor, MB BChir, MD, PhD
Mohammed T. Alshammari, MD
David M. Liu, MD
John Chung, MD
Stephen G.F. Ho, MD
Gerald M. Legiehn, MD
Lindsay Machan, MD
Aaron M. Fischman, MD
Rahul S. Patel, MD
Darren Klass, MBChB, MD

September 2016

Radial Access in Patients on Anticoagulation

Is transradial access safe in anticoagulated or coagulapathic patients undergoing noncoronary endovascular interventions?

Mona Ranade, MD
Aaron M. Fischman, MD

September 2016

Upper Extremity Tumor Embolization Using a Transradial Artery Approach: Technical Note

This article reports the technique of using transradial access to perform preoperative embolization of a humeral renal cell carcinoma metastasis and pathologic fracture.

Taryar Zaw, MD
Jason C. Ni, MS
Jonathan K. Park, MD
Matthew Walsworth, MD

June 2016

Technical Feasibility of Prostatic Artery Embolization From a Transradial Approach

This study evaluates the technical feasibility of performing prostatic artery embolization (PAE) with a transradial approach (TRA). Nineteen consecutive PAEs performed using a TRA were reviewed to determine the technical success of the procedure, which was defined as bilateral embolization.

Ari J. Isaacson
Aaron M. Fischman
Charles T. Burke

February 2016

Safety and Feasibility of Transradial Access for Visceral Interventions in Patients with Thrombocytopenia

This study evaluates the safety and feasibility of TRA in thrombocytopenic patients undergoing visceral interventions.

J. J. Titano
D. M. Biederman
B. S. Marinelli
R. S. Patel
E. Kim
N. E. Tabori
F. S. Nowakowski
R. A. Lookstein
A. M. Fischman

December 2015

Transradial Approach for Noncoronary Interventions: A Single-Center Review of Safety and Feasibility in the First 1,500 Cases

Reviews safety and feasibility in a single center using transradial access (TRA) for noncoronary interventions.

Raghuram Posham, MPA
Derek M. Biederman, MD
Rahul S. Patel, MD
Edward Kim, MD
Nora E. Tabori, MD
F. Scott Nowakowski, MD
Robert A. Lookstein, MD
Aaron M. Fischman, MD

October 2015

A Technical Guide Describing the Use of Transradial Access Technique for Endovascular Interventions

This review describes the technique of TRA for noncoronary interventions, including below-diaphragm interventions such as hepatic embolization, and the issues surrounding its usage.

Aaron M. Fischman, MD
Nathaniel C. Swinburne, MD
Rahul S. Patel, MD

April 2015

Radial Versus Femoral Access in Patients with Acute Coronary Syndromes Undergoing Invasive Management: A Randomised Multicentre Trial

Article that explores whether radial compared with femoral access improves outcomes in unselected patients with acute coronary syndromes undergoing invasive management.

Marco Valgimigli et al
for the MATRIX Investigators

March 2015

Percutaneous Radial Access for Peripheral Transluminal Angioplasty

The radial approach is currently gaining popularity in the setting of coronary percutaneous transluminal angioplasty (PTA) because it decreases the incidence of vascular complications. This study reports the initial results with radial access for peripheral PTA.

Raphaël Coscas, MD
Romain de Blic, MD
Clément Capdevila, MD
Isabelle Javerliat, MD
Olivier Goëau-Brissonniere, MD, PhD
Marc Coggia, MD

February 2015

Transradial Access: When to Lay Down Arms and Fall Back to Femoral

A tutorial on how to optimize transradial success by avoiding obstacles.

Amish Patel, MD
Kevin “Chaim” Herman, MD
Vivek V. Patil, MD
Aaron M. Fischman, MD

January 2015

Uterine Artery Embolization Using a Transradial Approach: Initial Experience and Technique

This study investigates the feasibility of performing uterine artery embolization (UAE) via transradial access (TRA).

Neil J. Resnick, MD
Edward Kim, MD
Rahul S. Patel, MD
Robert A. Lookstein, MD
F. Scott Nowakowski, MD
Aaron M. Fischman, MD

November 2013

Transradial Bilateral Iliac Artery Stenting

A step-by-step instructional ‘how to’ case of transradial bilateral iliac stenting using a 5-Fr guide sheath in a symptomatic patient to illustrate an alternative to common femoral artery access.

Shayibu Harruna
Evan S. Jacobs
Christopher J. White

July 2013

The Time is now for Transradial Intervention

A technical guide describing the uses of this technique in interventional radiology and oncology procedures.

Aaron M. Fischman, MD
Rahul S. Patel, MD

April 2013

Transradial Access for Renal Artery Intervention is Feasible and Safe

Article evaluates the feasibility of transradial renal intervention and compares safety parameters with a matched group of transfemoral controls.

Oluseun Alli, MD
Verghese Mathew, MD
Aaron M. From, MD
Gregory Barsness, MD
Sanjay Misra, MD
Rajiv Gulati, MD, PhD

September 2011

Outcomes of Interventions via a Transradial Approach for Dysfunctional Brescia-Cimino Fistulas

The transradial artery approach to angioplasty has rarely been reported as a method for treating dysfunctional Brescia-Cimino fistulas. This study evaluated the feasibility, safety, and 1-year efficacy of this method for treating dysfunctional Brescia-Cimino fistulas.

Shyh-Ming Chen
Chi-Ling Hang
Hon-Kan Yip
Chi-Yuan Fang
Chiung-Jen Wu
Cheng-Hsu Yang
Yuan-Kai Hsieh
Gary Bih-Fang Guo

June 2009

Percutaneous Trans-Radial Intervention for Acute Thrombosis of Upper Arm Grafts: An Outpatient-Based, Effective, and Feasible Option

Article evaluates the efficacy, safety, and feasibility of an outpatient-based transradial intervention for acute thrombosis of upper arm graft.

Lung-Sheng Wu
Yu-Shen Lin
Chang-Min Chung
Jen-Te Hsu
Shih-Tai Chang
Teng-Yao Yang
Hui-Wen Chen
Chi-Tai Kuo
Pi-Chi Lin

June 2008

Evaluation of the Ulnopalmar Arterial Arches with Pulse Oximetry and Plethysmography: Comparison with the Allen’s Test in 1010 Patients

Study that evaluated the patency of the hand collateral arteries and to compare MAT with combined plethysmography (PL) and pulse oximetry (OX) tests before the percutaneous transradial approach.

Gerald R. Barbeau, MD, FACC
Francois Arsenault, BSc
Louise Dugas, RN
Serge Simard, MSc
Marie Mai Lariviere, RN
Sainte-Foy, Quebec, Canada

March 2004

Transradial Approach for Transcatheter Arterial Chemoembolization in Patients With Hepatocellular Carcinoma

Article evaluates the clinical usefulness and safety of transradial approach for transcatheter arterial chemoembolization (TACE) in patients with hepatocellular carcinoma (HCC) compared with that of conventional transfemoral approach.

Shunichi Shiozawa, MD
Akira Tsuchiya, MD
Shungo Endo, MD
Hiroyuki Kato, MD
Takao Katsube, MD
Kenichi Kumazawa, MD
Yoshihiko Naritaka, MD
Kenji Ogawa, MD

December 2003

Transradial Cerebral Angiography: Technique and Outcomes

Limited data exists regarding transradial cerebral angiography. This report offers detailed procedural methods for transradial cerebral angiography to facilitate adoption of the technique.

Alison M. Nohara
David F. Kallmes

July 2003

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