title: Transradial Approach for Hepatic Radioembolization: Initial Results and Technique.
abstract: OBJECTIVE
  The transradial approach (TRA) has been shown to reduce the morbidity and mortality associated with arterial coronary interventions. Selective internal radiation therapy (SIRT) performed via the TRA can enhance patient comfort, compared with the traditional transfemoral approach (TFA), by allowing immediate ambulation and precluding potential complications associated with the TFA, such as closure device injury or retroperitoneal hematoma. We report our initial experience with and technique for using the TRA for SIRT.
  
  
  METHODS
  Between May 1, 2012, and April 30, 2015, a total of 574 procedures, including planning angiograms (n = 329) and infusions of90Y (n = 245), were performed for 318 patients (mean age, 64.5 years). Of the 245 patients who received90Y infusions, 52 had SIRT performed with the use of a permanent single-use implant of90Y resin microspheres and 193 had SIRT performed with the use of millions of small glass microspheres containing radioactive90Y. Procedural details, technical success, the radial artery (RA) occlusion rate noted at 30 days (as assessed via pulse examination), and the major and minor adverse events noted at 30 days were evaluated.
  
  
  RESULTS
  Technical success was achieved in 561 of 574 cases (97.7%). The reasons for crossover to use of the TFA included an RA loop (n = 2), RA occlusion (n = 9), and type D response as determined by use of a Barbeau test (n = 2). Patients had undergone between zero and six previous TRA procedures. The mortality rate at 30 days was 0%. Superficial bruising occurred in 13 of 574 cases (2.3%). A grade 2 hematoma that required a second nonocclusive hemostasis cuff occurred in one case. Transient forearm numbness or pain occurred in two of 574 cases. One patient had a transient convulsive event occur after receiving intraarterial infusion of verapamil. RA occlusion occurred in nine of 574 cases (1.6%).
  
  
  CONCLUSIONS
  Use of the TRA for SIRT is safe, feasible, and well tolerated and is associated with high rates of technical success and rare complications.
authors: 1 Department of Interventional Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Pl, New York, NY 10029.
authors: Vivian L
authors: VL
authors: Bishay
authors: 1 Department of Interventional Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Pl, New York, NY 10029.
authors: Derek M
authors: DM
authors: Biederman
authors: 1 Department of Interventional Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Pl, New York, NY 10029.
authors: Thomas J
authors: TJ
authors: Ward
authors: 2 Image-Guided Therapy Systems, Philips Healthcare, Best, The Netherlands.
authors: Imramsjah Martijn J
authors: IM
authors: van der Bom
authors: 1 Department of Interventional Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Pl, New York, NY 10029.
authors: Rahul S
authors: RS
authors: Patel
authors: 1 Department of Interventional Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Pl, New York, NY 10029.
authors: Edward
authors: E
authors: Kim
authors: 1 Department of Interventional Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Pl, New York, NY 10029.
authors: Francis S
authors: FS
authors: Nowakowski
authors: 1 Department of Interventional Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Pl, New York, NY 10029.
authors: Robert A
authors: RA
authors: Lookstein
authors: 1 Department of Interventional Radiology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Pl, New York, NY 10029.
authors: Aaron M
authors: AM
authors: Fischman
mesh_terms: D000368:Aged; D000792:Angiography; D006528:Carcinoma, Hepatocellular / Q000532:radiotherapy*; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D017534:Radial Artery; D016896:Treatment Outcome; D015021:Yttrium Radioisotopes / Q000627:therapeutic use*
chemical_list: D015021:Yttrium Radioisotopes
keywords: hepatocellular carcinoma; interventional oncology; selective internal radiation therapy; transradial access; yttrium-90