CIO 2022-28 Radial Access for Interventional Oncologic Interventions—A Single-Center Experience of 307 Trans-Radial Procedures

Purpose: Radial access is gaining momentum for interventional oncologic intervention due to its several advantages over femoral access, including lower access site complication rates, reduced peri-procedural pain and shorter recovery times. The purpose of this study is to evaluate a single institution’s experience with radial access for interventional oncologic interventions.

Methods: This IRB-approved single center retrospective study included 166 total patients (118 male, 48 female, age at procedure 68.9±10) who underwent 295 interventions using trans-radial access between September 2014 and March 2022.  The procedures included chemoembolization, chemoperfusion, radioembolization, bland embolization and diagnostic angiography. Medical records and imaging data were reviewed to evaluate procedural success, complications and radial artery diameter.

Results: A total of 313 trans-arterial interventions were planned in these 166 patients. Trans-radial access was attempted in 307 of these cases. Out of 307 attempts at interventions via transradial access, 295 were successful (96%). Six of the patients were deemed to not be candidates for trans-radial access secondary to Barbeau D waveform in 4 patients, occluded radial artery in 1 patient, and presence of hemodialysis fistula in 1 patient. Mean radial artery diameter was 2.52±0.51mm. During the successful 295 procedures, 3 (1%) total complications occurred: 2 subcutaneous wrist hematomas and 1 subcutaneous fluid collection at the right mid-forearm. 8 patients had a platelet count of less than 15,000/uL at the time of procedure (6.3±4.1/uL) with no associated bleeding complications. 26 patients had a radial artery diameter < 2mm which is regarded as a contraindication for radial access. This subset of patients underwent a total of 35 procedures with a technical success rate of 97% (34/35). 19 patients underwent 4 or more trans-radial procedures via the same radial artery. The median number of trans-radial access procedures performed in these patients was 8. Technical success rate was 100%.

Conclusions: Trans-radial access is a safe and effective method for performing interventional oncologic interventions. Even in extreme conditions such as severe thrombocytopenia and radial artery diameter < 2mm, it has a high technical success rate. Additionally, the same radial artery can be accessed multiple times with a high technical success rate.