title: Feasibility of complex coronary and peripheral interventions by trans-radial approach using large sheaths.
abstract: BACKGROUND
  Trans-radial approach (TRA) reduces vascular access-site complications but has some technical limitations. Usually, TRA procedures are performed using 5 Fr or 6 Fr sheaths, whereas complex interventions requiring larger sheaths are approached by trans-femoral access.
  
  
  METHODS
  During 4 years, at two Institutions with high TRA use, we have attempted to perform selected complex coronary or peripheral interventions by TRA using sheaths larger than 6 Fr. Clinical and procedural data were prospectively collected. Attempt to place a 7 Fr or 8 Fr sheath (according to the planned strategy of the procedure) was performed after 5-6 Fr sheath insertion, administration of intra-arterial nitrates and radial artery angiography. Late (>3 months) patency of the radial artery was checked (by angiography in the case of repeated procedures or by palpation + reverse Allen test).
  
  
  RESULTS
  We collected 60 patients in which TRA large sheath insertion was attempted. The large sheath (87% 7 Fr, 13% 8 Fr) was successfully placed in all cases. Most of the procedures were complex coronary interventions (bifurcated or highly thrombotic or calcific chronic total occlusive lesions), whereas 8.3% were carotid interventions. Procedural success rate was 98.3% (1 failure to reopen a chronic total occlusion). No access-site related complication occurred. In 57 (95%) patients, late radial artery patency was assessed and showed patency in 90% of the cases, the remaining patients having asymptomatic collateralized occlusion.
  
  
  CONCLUSIONS
  In selected patients, complex percutaneous interventions requiring 7-8 Fr sheaths can be successfully performed by RA approach without access-site clinical consequences.
authors.affiliation: Unidad de Hemodinámica, Hospital Universitario Mutua Terrassa, Terrassa, Spain.
authors.forename: Santiago F
authors.initials: SF
authors.lastname: Coroleu
authors.forename: Francesco
authors.initials: F
authors.lastname: Burzotta
authors.forename: Carlos
authors.initials: C
authors.lastname: Fernández-Gómez
authors.forename: Antonella
authors.initials: A
authors.lastname: Tommasino
authors.forename: Maura
authors.initials: M
authors.lastname: Giammarinaro
authors.forename: Valentina
authors.initials: V
authors.lastname: Coluccia
authors.forename: Paola
authors.initials: P
authors.lastname: Di Noi
authors.forename: Giovanni
authors.initials: G
authors.lastname: Schiavoni
authors.forename: Carlo
authors.initials: C
authors.lastname: Trani
mesh_terms: D000368:Aged; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D002340:Carotid Artery Diseases / Q000628:therapy*; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D057785:Catheters; D003327:Coronary Disease / Q000628:therapy*; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D010173:Palpation; D011446:Prospective Studies; D017534:Radial Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D011859:Radiography; D013030:Spain; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency