Massachusetts Chapter of the American College of Surgeons

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Radial Artery Access for Peripheral Vascular Interventions Is a Safe Alternative for Upper Extremity Access
Scott R. Levin1, Sarah J. Carlson2, Alik Farber1, Jeffrey Kalish1, Elizabeth G. King1, Michelle Martin3, James McPhee2, Denis Rybin1, Jeffrey J. Siracuse1
1Boston Medical Center, Boston University School of Medicine, Boston, MA; 2Veteran Affairs Boston Healthcare System, West Roxbury, MA, Boston University School of Medicine, Boston, MA; 3Veteran Affairs Boston Healthcare System, West Roxbury, MA, Harvard Medical School, Boston, MA

Background:
Radial artery access is increasingly being used for peripheral vascular interventions (PVI). Our goal was to characterize practice patterns and perioperative outcomes among PVI performed via radial artery access.

Methods:
The Vascular Quality Initiative (2016-2020) was queried for PVI performed via radial artery access. Univariable and multivariable analyses determined factors associated with peri-procedural outcomes of radial artery access cases. A separate sample of brachial artery access cases was used as a comparator.

Results:
There were 524 radial artery access cases. Interventions were aorto-iliac (55.5%), femoral-popliteal (55.3%), and infrapopliteal (8.6%). Sheath sizes were ? 5 Fr (9.7%), 6 Fr (78.1%), and 7 Fr (12.2%). Stenting and atherectomy were performed in 55.5% and 18.9% of cases, respectively, and more often with 7 Fr sheaths. Protamine was used in 17.2% of cases. Access site complications were hematomas (4.8%), including hematomas requiring intervention (0.8%); pseudoaneurysms (1%); and access stenosis/occlusion (0.8%). On multivariable analysis, sheath size was not associated with access site complications, but 7 vs. ? 5 Fr sheath size was associated with increased likelihood of length of stay >1 day (OR 5.16, 95% 1.0226, P=.047). Radial compared with brachial artery access was independently associated with fewer overall hematomas (OR .57, 95% CI .350.93, P=.026), but not with hematomas requiring intervention.

Conclusion:
PVI via radial artery access exhibit a low prevalence of post-procedure access site complications and are associated with fewer minor hematoma complications than PVI via brachial access. Radial artery access remains a viable upper extremity access alternative for PVI.


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