Guide Coronary Angiography and Intervention By the Radial Approach for Dummies.

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The radial artery is smaller, more superficial and thinner than the femoral artery. .. J. Radial versus femoral access for coronary angiography and intervention in .
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Radial artery occlusion RAO is the most common complication, affecting 1. Preserving radial artery patency is of paramount importance. It is important to remember that almost all potential complications are preventable by accurate preprocedural evaluation, meticulous technique and optimal post-procedural management.

How to do radial coronary angiogram?

Its development and procedural failure 0. Technical Recommendations for Complex Percutaneous Coronary Intervention in Acute Coronary Syndrome Challenging anatomy must be avoided to minimise the risk of complications and shorten the duration of both the procedure and radiation exposure. For this reason, a systematic preliminary angiogram of the forearm arteries through the radial introducer is recommended.

The nal choice of procedure will depend on the level of expertise of the operator, and the equipment required. In patients with cardiogenic shock, TRA procedures can be performed if the radial artery is palpable while leaving two potential femoral accesses for IABP counterpulsation or more complex cardiac-assist devices see Figures The right side is usually more ergonomic to the operator; however, the left radial approach might be more convenient in the learning phase because of similar catheter handling when compared to the femoral approach.

Even if dedicated catheter shapes are available, traditional femoral shapes accommodate the radial approach easily. Coaxial alignment with the target coronary artery is mandatory and requires different handling for the right radial versus femoral approach. The choice of guiding catheter diameter, shape, size is essential for adequate back-up.

In selected patients of large stature, larger catheters 7 or even 8 Fr or sheathless guiding catheters can be considered, allowing for large-lumen guiding catheters to be used in a small radial artery. However, these catheters, though useful in selected cases, are more difcult to handle in complex procedures due to lower back-up. RAO should be prevented during and after the procedure with systematic assessment of the arterial patency. Specic early and delayed post-procedural attention to forearm haematomas is mandatory. Conclusion Considerable evidence supports conversion to TRA for most PCI procedures in ACS, with an emphasis on decreasing access site bleeding and vascular complications without compromising procedural outcome.

Beside the development of new more selective and safe antithrombotic agents, the use of TRA remains likely the best way to significantly affect access site-related bleeding risk. A high-risk subset of patients for bleeding and vascular complications such as complex STEMI patients, women and the elderly, might particularly benefit from the TRA whenever appropriately available and performed by skilled operators.

2. Patient selection

Certain limitations to the TRA such as longer radiation exposure during the learning curve and the potential inuence on radial artery patency have slowed down acceptance of this technique. Therefore, the modern interventional cardiologist should go through a high-volume radial training programme, and after developing the optimal radial expertise, adopt 'the TRA rst' whenever possible. Adding the ulnar artery access expertise could further reduce the crossover rate to TFA, and lower the intrinsic risk of bleeding and vascular complications associated with TFA. Femoral approach will likely remain the viable alternative for patients not eligible for the wrist access and accessory access for larger devices in patients with cardiogenic shock.

Complex PCIs in patients with ACS, cardiogenic shock and left main culprit, should be performed only by experienced high-volume radialists. Finally, it is important to remember that the choice of access site is only one aspect of improving the patient's outcome. All interventions should be performed according to the highest available standards, providing the best care for each individual patient without sacricing procedural success and long-term prognosis.

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Heart Catheterization through Radial Artery

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How to do radial coronary angiogram?

Catheterization and Cardiovascular Interventions, 67, Chinese Medical Journal, , Clinical Interventions in Aging, 9, The paper is not in the journal. Transradial coronary angiography has established itself as safe alternative to transfemoral approach. The Right Radial Approach RRA has been a favorite for most of the interventional cardiologists due to the convenience in operating from the right side.

LRA does have many advantages over the right, the vascular anatomy being one of them.

3. Left or right radial access?

The aim of our study was to compare the right radial approach of diagnostic coronary angiography with left radial approach. Multipurpose TIG Tiger catheter was used in both the approaches to catheterize the right as well as left coronary artery. The access time, catheter manipulation time, procedure time, amount of contrast used, hospital stay, intensity of pain experienced, cost of the procedure and quality of coronary angiogram observed were statistically insignificant while the fluoroscopy time was slightly statistically significant which was independent to catheter manipulation time.

The neglected Left Radial Approach to coronary angiography is as efficacious, safe and cost effective with reduction in arterial spasm complications when compared to the Right Radial Approach performed by multipurpose Tiger catheter.

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Received 12 July ; accepted 16 August ; published 19 August 1. Inclusion Criteria The patients included in the study satisfied following criteria: Exclusion Criteria 1 Abnormal Allen test 2 Previous CAG by radial approach 3 Right heart catheterization 4 Simultaneous renal or aortic angiography 5 Presence of indication for ventricular angiogram 6 Any contraindication for coronary angiography 2.

Procedure All patients in the RRA had their wrists hyperextended and the operator standing on right side of the patient while in the LRA the patients had their left forearm laid on their left side. Study Limitations 1 Because of language problem it was difficult to collect data. Data Collection The data for this study was collected for a period of 9 months, by the principal researcher during the procedure and was recorded into a structure questionnaire.

Results The mean age of the patients in left radial approach group LRA was Conflicts of Interest The authors declare no conflicts of interest. Cite this paper Rajoria, P. I have subsequently performed more than consecutive ultrasound guided radial procedures in the past two and a half years. Since I can see the artery before attempting access, I also know its size as well as any anatomic variations, and can plan accordingly. The radial artery usually is large enough to accommodate a 6 Fr sheath, often a 7 Fr sheath, and occasionally an 8 Fr sheath, thereby permitting most complex coronary procedures.


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Knowing the diameter of the radial artery beforehand allows interventionalists to properly plan their complex radial procedures. It is also interesting to note that our findings with regards to the radial artery diameter using ultrasound were similar to those found by another group of researchers using angiography. These findings have also been recently published in the Journal of Invasive Cardiology. If quickly and reliably obtaining radial access has been a challenge for you, UGRAA may be the tool you need.

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