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• Transradial_catheterization abstract "Transradial catheterization is an endovascular procedure or catherization procedure performed to diagnose and treat arterial disease (e.g., coronary artery disease, peripheral artery disease, etc.). Endovascular procedure can be performed achieving access in to body’s arterial system from either femoral artery (in groin), brachial artery (in elbow) or radial artery in the wrist. Transfemoral (through groin) approach to perform cardiac catheterization has dominated the explosive growth[citation needed] of invasive cardiology in past three decades. In recent past radial access has gained popularity.In 1948, Radner published one of the first descriptions of transradial central arterial catheterization and attempts at coronary artery imaging using radial artery cut-down. Transradial access to perform diagnostic cardiac catheterization procedures, was introduced by Campeau and was later adapted for therapeutic procedures of coronary angioplasty by Kiemeneij and Laarman.In past few years, transradial access for coronary intervention has been increasingly becoming popular because of the various reasons. The most advantage is very low access site bleeding complication even with aggressive use of anticoagulation and antiplatelet therapies. During the angioplasty and stent procedures patient's are given therapeutic (high) doses of anticoagulation (blood thinners) and platelet inhibiting medications.With transfemoral access the bleeding complication are still up to 3% or more. Occasionally the patient can develop retroperitoneal bleeding (bleeding into the pelvic cavity), and up to 1% of the patient requires blood transfusion to treat the bleeding complication after transfemoral catheterizations. Patients may develop painful hematoma, A-V fistula or pseudoaneurysm. In modern interventional cardiology the procedural success rates are high and ischemic complications are relatively rare. However the bleeding complications associated with transfemoral catheterization have not significantly reduced even after trying new pharmacological strategies. There are strong evidence suggesting that post PCI bleeding is associated with an adverse prognosis. Postprocedural blood transfusion is also associated with poor prognosis. Bleeding complication, pseudoaneurysm, hematoma formation are nearly 0% with transradial catheterization. Possibility of blood transfusion requirement is extremely rare after trans-radial catheterization .The other reason for the increased use of radial access is the technological advances in the sheath and catheter design, and improved physician experience with this approach. With improvement in the physician's experience, radial artery access is now being used with equal efficacy to treat almost every complex coronary artery disease, including acute myocardial infarction, chronic total occlusion, bifurcation coronary artery disease and rotablation. Radial access has also been usedsuccessfully to treat peripheral artery disease including bilateral iliac artery stenosis, renal artery stenosis and for carotid interventions.Due to rapid ambulation post procedure the radial interventions became particularly attractive for patients with back pain, chronic obstructive lung disease, prostatic hypertrophy and elderly patients. As after catheterization through femoral approach patient is generally required to lay flat with immobilization of the leg for 4– 6 hours. Early ambulation and early discharge after transradial catheterization improves quality of life and reduces morbidity. Patients can literally walk off the catheterization table. For the same reasons, both patients and hospital staff overwhelmingly prefer the transradial approach as opposed to femoral access.More importantly, in era of cost control, the savings in closure devices (which are used to allow earlier ambulation after transfemoral catheterization), and early discharge had made this a cost-saving approach. Most of these advantages are upset by a relatively long learning curve for physicians, which probably prevented the procedure to become popular sooner.Although transradial procedures are extremely safe for the patient's, they have some shortcomings. The procedure is technically more difficult requiring a longer learning curve, and has potential for unsuccessful completion of procedure. Some of the high volume transradial catheterization laboratories perform 95% of the cardiac catheterization and peripheral procedures through radial access. In clinical trials before crossing the learning curve there is up to 5% failure in completing the catheterization successfully from radial approach. Technical difficulties are because of loops and tortuosity of the radial and the subclavian artery, anatomical variations in radial artery, and radial spasm.Major complication associated with a transradial interventions include early and late radial artery occlusion. Most of the radial artery occlusions are asymptomatic. Post PCI radial artery occlusion can be reduced by using smaller diameter catheters and anticoagulation. Also by avoiding prolonged compression of the radial artery and applying just enough pressure to achieve hemostasis reduces this complication of asymptomatic radial occlusion significantly. Implying this approaches the radial artery occlusion rate has come down to 1.1-1.8%.The transradial technique is the true minimally invasive “Drive-through” approach to perform coronary and peripheral angiograms and interventions. Transradial catheterization is an elegant safer, cost-effective and patient friendly procedure with only a few limitations and very low complication rate.".
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• Transradial_catheterization comment "Transradial catheterization is an endovascular procedure or catherization procedure performed to diagnose and treat arterial disease (e.g., coronary artery disease, peripheral artery disease, etc.). Endovascular procedure can be performed achieving access in to body’s arterial system from either femoral artery (in groin), brachial artery (in elbow) or radial artery in the wrist.".
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