title: Transradial Approach for Noncoronary Interventions: A Single-Center Review of Safety and Feasibility in the First 1,500 Cases.
abstract: OBJECTIVE
  To review safety and feasibility in a single center using transradial access (TRA) for noncoronary interventions.
  
  
  METHODS
  Retrospective analysis was performed of 946 patients evaluated for 1,531 consecutive TRA procedures from April 2012 to July 2015. Exclusion criteria included sheath > 6 F, Barbeau D waveform, radial artery (RA) diameter < 2 mm on ultrasound, history of severe aortic tortuosity or RA occlusion, and dialysis. TRA was attempted in 936 patients (62% men; median age, 62.4 y) who underwent 1,512 consecutive procedures (chemoembolization [n = 485], yttrium-90 mapping [n = 391] and infusion [n = 293], renal/visceral intervention [n = 172], uterine artery embolization [n = 116], peripheral intervention [n = 43], endoleak repair [n = 10], and other [n = 2]). Patients were evaluated for complications during follow-up at ~30 days.
  
  
  RESULTS
  Technical success was 98.2% (1,485/1,512). Major complications (0.13%) included pseudoaneurysm (n = 1) and seizure (n = 1). Minor complications (2.38%) included hematoma/bleeding (n = 13), RA occlusion (n = 11), arm pain (n = 6), and RA spasm (n = 6). Univariate analysis demonstrated a lower rate of adverse events in African American patients (hazard ratio [HR], 0.25; 95% confidence interval [CI], 0.07-0.86; P = .027). Twenty-seven cases (1.8%) required crossover to transfemoral access (TFA). Crossover rates were higher in female patients (P = .0055), height < 1.7 m (P = .024), renal/visceral interventions (P = .0003), and endoleak interventions (P = .0357). Multivariate analysis demonstrated intervention type to be the only significant predictor of TFA crossover (renal/visceral [HR, 4.48; 95% CI, 1.84-10.9; P = .001]; endoleak repair [HR, 9.54; 95% CI, 1.09-83.8; P = .042]).
  
  
  CONCLUSIONS
  TRA was safe and well tolerated in a heterogeneous patient population across a range of peripheral vascular interventions.
authors.affiliation: Department of Radiology, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, New York, NY 10029.
authors.forename: Raghuram
authors.initials: R
authors.lastname: Posham
authors.affiliation: Department of Radiology, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, New York, NY 10029.
authors.forename: Derek M
authors.initials: DM
authors.lastname: Biederman
authors.affiliation: Department of Radiology, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, New York, NY 10029.
authors.forename: Rahul S
authors.initials: RS
authors.lastname: Patel
authors.affiliation: Department of Radiology, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, New York, NY 10029.
authors.forename: Edward
authors.initials: E
authors.lastname: Kim
authors.affiliation: Department of Radiology, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, New York, NY 10029.
authors.forename: Nora E
authors.initials: NE
authors.lastname: Tabori
authors.affiliation: Department of Radiology, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, New York, NY 10029.
authors.forename: F Scott
authors.initials: FS
authors.lastname: Nowakowski
authors.affiliation: Department of Radiology, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, New York, NY 10029.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Lookstein
authors.affiliation: Department of Radiology, Icahn School of Medicine at Mount Sinai, 1 Gustave Levy Place, New York, NY 10029. Electronic address: aaron.fischman@mountsinai.org.
authors.forename: Aaron M
authors.initials: AM
authors.lastname: Fischman
mesh_terms: D000368:Aged; D002404:Catheterization / Q000379:methods*; D016461:Chemoembolization, Therapeutic; D057867:Endoleak / Q000601:surgery; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007261:Infusions, Intra-Arterial; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D017534:Radial Artery; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D055357:Uterine Artery Embolization