title: Transradial approach for challenging vascular access interventions.
abstract: BACKGROUND
  Percutaneous interventional procedures for vascular access are usually performed using the draining cephalic or basilic vein. The transradial approach, which has been extensively investigated for coronary angiography and intervention, could be an attractive new technique for peri-anastomotic arteriovenous fistula stenosis.
  
  
  METHODS
  From June 2012 to February 2013, 30 patients with end-stage renal failure were evaluated for transradial vascular access intervention. A 4-French (Fr) micropuncture kit was used to access the radial artery and then subsequently upgraded to a 5-Fr sheath. Fourteen patients required an upgrade to a 6-Fr sheath for the final intervention.
  
  
  RESULTS
  Primary technical success (residual stenosis <30%) was achieved in all cases where angioplasty was performed. Technical success regarding access was achieved in all patients. There were no peri-procedural complications. The post-interventional primary patency was calculated as 100%, 100%, 88.4% and 32.8% at 1, 6, 9 and 12 months, respectively. The post-interventional primary assisted patency was calculated as 100%, 100%, 100% and 63.3% at 1, 6, 9 and 12 months, respectively. Based on colour-coded Duplex scan and/or photoelectric plethysmography, all access-site arteries showed normal perfusion; however, the freedom from significant radial artery restenosis was 92.4% at 12-month follow-up.
  
  
  CONCLUSIONS
  The transradial approach for vascular access endovascular interventions is technically feasible and safe. It allows simultaneous treatment of peri-anastomotic lesions in fistulas with complex venous anatomy as well as lesions in the arterial inflow and central outflow.
authors.affiliation: Department of Vascular Surgery, Royal Perth Hospital, Perth, Australia.
authors.forename: Mitra
authors.initials: M
authors.lastname: Rahmatzadeh
authors.affiliation: Department of Vascular Surgery, Royal Perth Hospital, Perth, Australia.
authors.forename: Vikram
authors.initials: V
authors.lastname: Vijayan
authors.affiliation: Department of Vascular Surgery, Royal Perth Hospital, Perth, Australia.
authors.forename: Carsten J
authors.initials: CJ
authors.lastname: Ritter
authors.affiliation: Department of Vascular Surgery, Royal Perth Hospital, Perth, Australia.
authors.forename: Joseph
authors.initials: J
authors.lastname: Hockley
authors.affiliation: Department of Vascular Surgery, Royal Perth Hospital, Perth, Australia.
authors.forename: Benjamin Dk
authors.initials: BD
authors.lastname: Leong
authors.affiliation: Department of Vascular Surgery, Royal Perth Hospital, Perth, Australia Renal Access Unit, Royal Perth Hospital, Perth, Australia.
authors.forename: Monique
authors.initials: M
authors.lastname: Sandford
authors.affiliation: Department of Vascular Surgery, Royal Perth Hospital, Perth, Australia Renal Access Unit, Royal Perth Hospital, Perth, Australia School of Surgery, University of Western Australia, Australia bibombe@iinet.net.au.
authors.forename: Bibombe P
authors.initials: BP
authors.lastname: Mwipatayi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty / Q000295:instrumentation / Q000379:methods*; D001157:Arterial Occlusive Diseases / Q000209:etiology / Q000503:physiopathology; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D002406:Catheterization, Peripheral / Q000295:instrumentation / Q000379:methods*; D003251:Constriction, Pathologic; D004867:Equipment Design; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010991:Plethysmography; D011677:Punctures; D017534:Radial Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D011859:Radiography; D006435:Renal Dialysis; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color; D062666:Vascular Access Devices; D014654:Vascular Patency; D014904:Western Australia
keywords: Transradial; access; arteriovenous; fistula; stenosis