Interventional Radiology technique for accessing radial artery.

1. Transradial Access: Dos and
Donts
Dr Ganesh S Deogaonkar
MBBS DMRD DNB PDCC FDFM FRCR EBIR
Consultant Vascular & Interventional Radiologist
Nanavati Max Superspeciality Hospital, Mumbai

2. Why?
•Safety- ACCESS, RIVAL,
MATRIX, RIFLE-STEACS, etc
• Convenience
•Reduced exposure

3. Essentials
Appropriate patient selection
Appropriate access technique
Appropriate hardware
Appropriate closure

4. Appropriate patient
selection

5. Barbeau test
‘no pulse return’ at 2
minutes - -ve test
Accessing collateral palmar circulation

6. Adequate vessel
size
Newer sheaths
5F- 1.6 mm
6F- 2 mm

7. Caution!
• Radial artery loop/ tortuosity
• Heavily calcified aortic arch
• History of stroke

8. Appropriate technique

9. Setup

10. Arm positioning
• Left arm
• Abducted and supinated
• Towel roll under the forearm
• Plethysmography to thumb

11. Radial access points

12. Obtaining
access:
technical bits
• USG-guided access- MUST
• Skin entry site- 1-2cm proximal to wrist
crease
• 3ml of 1% Lidocaine +/- 200Mcg of NTG
• 21G access needle at 30-45 deg (shallow)
• Single wall puncture

13. Radial
cocktail
• Slender sheath
• Aspirate
• Dilute cocktail

14. Additional
bits
• Angiograms
• Bentson wire/ J wire
• Deep inspiration –
crossing arch

15. dTRA
• Arm by patient’s side
• Neutral hand position
• Hold roller gauze to make fist

16. dTRA
• Anatomical snuff box - over trapezium
and scaphoid.
• Puncture distal to origin of superficial
palmar arch – chances of hand
ischemia very minimal.
• Neutral hand position- regular setup
can be used

17. Appropriate Hardware

18. Radial
access kit
• 21G needle
• 0.018 wire
• Slender sheaths

19. GlidecathVI
*R.A.V.I: Radial Access for Visceral Intervention

20. Glidecath RAVI

21. R.A.V.I. MG1 R.A.V.I. MG2
Effective length 125 cm 135 cm/150 cm
Effective french size 4Fr
Construction Double-braided stainless steel
Outer materials Polyurethane
Inner materials Nylon-polyurethane
Inner diameter Dital Tip: 0.041"/1.03 mm, Proximal Shaft: 0.041"/1.05 mm
Guidewire compatibility 0.038“/0.97 mm
Maximum injection pressure 750 psi
Hydrophilic coating Distal 150 mm Distal 400 mm

22. Trans radial shape configuration
MG1
For RAVI
MG2
For UFE/PAE

24. Trans radial shape configuration
MG1
For RAVI
 MG2
For UFE/PAE

25. Appropriate
Haemostasis

26. “Patent”
haemostasis
GTN 200Mcg before sheath removal
Use TR-Band
Inflate slightly more when bleeding stops
Check plethysmograph after manual ulnar
occlusion
Reduce pressure till graph seen
Gradual deflation after 60-90 min
Observe for 30 minutes

27. Dealing with
complications

32. Conclusions
Radial access- A must have skill
for modern IRs.
Safe and convenient
Initial learning curve
#radialfirst - not a religion!

33. Thank
You