Jonathan Roberts, MD
Radial artery access for cardiac cath lab procedures is becoming the preferred access site by many operators. Successfully ‘sticking’ the radial artery can be one of the most challenging parts of a radial procedure. As an ‘old dog’ accustomed to sticking a large femoral artery, I found learning the ‘new trick’ of sticking a small radial artery at times a challenge. Several cases of multiple unsuccessful puncture attempts (I could feel the artery, I just couldn’t stick it!) causing radial artery spasm, then having to switch to a different access site, led me to believe there must be a better way. A light went on when I saw a demonstration of ultrasound directed vascular access given to my colleagues, the interventional radiologists. Why not ‘see’ the radial artery, not ‘feel’ it when trying to get access? (See figures).
Learning the technique of Ultrasound Guided Radial Artery Access (UGRAA) is quite straightforward.(1) I had essentially no experience of ultrasound-guided vascular access. I found that after approximately 20 cases of UGRAA, I was very comfortable with the technique. I wanted to see if UGRAA really made a difference, so I collected data on 50 consecutive patients undergoing UGRAA, and compared it to historical controls of palpation guided radial access. These data are presented in an article recently published in the Journal of Invasive Cardiology.(2)
Using UGRAA, I was able to obtain access on the first pass in 80% of patients in this small study. I have subsequently performed more than 1200 consecutive ultrasound guided radial procedures in the past two and a half years. I now successfully obtain radial access almost 100% of time using UGRAA. 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. 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.(3)
Over the past three years, I have shifted my practice from less than 10% radial access to greater than 90%. UGRAA was the catalyst that allowed me to become a “radialist.” Quickly obtaining radial access 100% of the time is no longer an issue. If quickly and reliably obtaining radial access has been a challenge for you, UGRAA may be the tool you need. With minimal training and a quick learning curve, it allows anyone to become a master of radial artery access, including those ‘dummies’ like me that previously struggled at times with radial access.
- Roberts J, Manur R. Ultrasound-Guided Radial Artery Access in the Cath Lab: A Step by Step Guide. Cardiac Interventions Today. March/April 2013.
- Roberts J, Manur R. Ultrasound-Guided Radial Artery Access by a Non-Ultrasound-Trained Interventional Cardiologist Improved First-Attempt Success Rates and Shortened Time for Successful Radial Artery Cannulation. J INVASIVE CARDIOL. 2013;25(12):676-679.
- Okuyan H, Hzal F, Taçoy G, Timurkaynak T. Angiographic Evaluation of the Radial Artery Diameter in Patients Who Underwent Coronary Angiography or Coronary Intervention. J INVASIVE CARDIOL. 2013;25(7):353-357.
A selection of Radial Access Technique articles available at http://www.invasivecardiology.com
- Sanghvi K, Nachtigall J, Luft U. Transradial endovascular treatment of severe common femoral artery stenosis. J Invasive Cardiol. 2013 Nov;25(11):616-9.
- Zaremski L, Quesada R, Kovacs M, Schernthaner M, Uthoff H. Prospective comparison of palpation versus ultrasound-guided radial access for cardiac catheterization. J Invasive Cardiol. 2013 Oct;25(10):538-42.
- Williams PD, Eichhöfer J, Mamas MA, Arnous S, Fath-Ordoubadi F, Fraser D. Transradial intervention via large-bore guide catheters: a study of coronary bifurcation disease treatment using the crush technique. J Invasive Cardiol. 2013 Sep;25(9):455-9.
- Nazer B, Boyle A. Treatment of Recurrent Radial Artery Pseudoaneurysms by Prolonged Mechanical Compression. J Invasive Cardiol. 2013 Jul;25(7):358-9.