Distal Transradial Approach - NVHVV CarVasZ 2018/Presentatie... · Access-Site Complications:...

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Distal Transradial Approach Dr. Giovanni Amoroso OLVG Amsterdam A new way of puncture!

Transcript of Distal Transradial Approach - NVHVV CarVasZ 2018/Presentatie... · Access-Site Complications:...

Page 1: Distal Transradial Approach - NVHVV CarVasZ 2018/Presentatie... · Access-Site Complications: Postprocedural and 1-month Follow-Up. 60 Learning Curve with Distal Transradial Access

Distal Transradial ApproachA new way of puncture?

Dr. Giovanni Amoroso

OLVG Amsterdam

A new way of puncture!

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(potentiële)

belangenverstrengelingGeen / Zie hieronder

Voor bijeenkomst mogelijk

relevante relaties met

bedrijven

Bedrijfsnamen

Sponsoring of

onderzoeksgeld

Medikit

Cordis

Svelte

Abbott

Biotronik

Medtronic

Disclosure belangen spreker

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Superficial palmarBranch

Radial ArteryUlnar Artery

Deep PalmarArch

Dorsal viewVolar view

SnuffBox

True DTRARadial Artery

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Distal Right Radial

Sheathless 5F Medikit

Footage taken at OLVG with permission

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https://www.slideshare.net/theradialist/11-aimradial2016-thu-babunashvili-a

Dr A Babunashvili – Moscow

First description of distal radial puncture

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Dr F Kiemeneij – Blaricum

First publication on distal radial approach (Eurointervention 2017)

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8Capodanno D EuroIntervention 2018

#radialfirst#ldtra

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Rationale for DTRA

• Comfort for the patient

• Comfort for the operator

• Secondary clinical outcomes

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Comfort for the patient

• No wrist immobilisation after procedure

• Shorter hemostasis (day-care!)

• Only for Left DTRA: dominant hand (mostly right) unaffected

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Comfort for the operator(only for Left DTRA)

• Stand at the Right side of table

• Less anatomical abnormalities/easier coronary cannulation (?)

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Secondary Clinical Outcomes

• Preservation of RA in case of distal occlusion

– A-V Shunts (dialysis)

– arterial Grafts (CABG)

–Repeated Interventions

• Lower rates of occlusions

• Less complaints/incidence of Upper Extremity Dysfunction (UED)?

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In case of right approach put the arm on its sideIn case of left approach put the hand palm down on the crotch

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My first case – May 29th 2017

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Keep it simple!

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1. a. Position left hand on the crotchb. Position right hand on the side

2. Hyperextend the wrist3. Give Lidocaine (3-5 cc)4. Use needle-cannula (transfixion kit)

and hydrophilic wire5. Extend the elbow before crossing6. Be gentle and patient!

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Thumb

Pink

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Pitfalls

• Low puncture

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Radial Artery

Palmar Arch

Cannula

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0.014” wire to Radial Artery

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Pitfalls

• Arterial bends

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Conventional Puncture Site

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knot in the Distal Radial Artery

Cannula

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330.014” Wire in Radial Artery

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Echo-guided puncture

Kiemeneij, Eurointervention 2017

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Advantages

• Bail out in case of failed conventional approach

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Dissection after conventional TRA

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Advantages

• Recanalisation of RAO

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Cannula

Radial Artery Occlusion

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Straight Terumo 0.021” through the cannula

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Angiography once 5F Glidesheath Slender inserted

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Advancement of 0.014” coronary wire up to upper arm

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Advancement of 5F Guiding Catheter (BAT Technique)

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Radial artery successfully recanalised

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Risks?

Avascular Necrosis of the Scaphoid Bone

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SafeGuard Radial 5-6 cc

+/- StatSeal DIsc

Remove after one hour

My Hemostatic Technique (1)

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5F Sheathless PCI Medikit

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Compression with SafeGuard Radial

6 cc, one hour

Footage taken at OLVG with permission

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TR Band XL 10 cc

Remove the hard support

Remove after one hour

My Hemostatic Technique (2)

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5F Sheathless PCI

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• 70 patients• 61% Angio 39% PCI/FFR

• 11% failure• 0% major bleedings• 1.5% dRAO

Kiemeneij F, EuroIntervention 2017

Are there scientific evidences?

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59Jun-Won Lee et al, EuroIntervention 2018

Access-Site Complications: Postprocedural and 1-month Follow-Up

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Learning Curve with Distal Transradial Access

Jun-Won Lee et al, EuroIntervention 2018

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Conclusions• Distal TRA seems a valid alternative to

conventional transradial approach, with the additional advantages of:• Increased comfort for both patient and

operator (in case of left distal approach)• Reduced incidence/impact of RAO

• Distal TRA seems a feasible approach for treating RAO

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Back – up slides

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