Marcelo Guimaraes

Benign central venous occlusions are frequently associated with long-term central venous access. Most of these occlusions can be recanalized with conventional endovascular technique. When conventional technique fails, sharp recanalization techniques (SRTs) can increase technical success. The SRTs include single low-profile needles, needle coaxial systems, re-entry catheter, the back end of stiff guidewires, and systems that can deliver radiofrequency energy or laser. This review on SRTs presents technical details and outcomes of the most common techniques used in central venous recanalization.

Background: There is a lack of registry studies about transradial access (TRA) outcomes. This prospective registry evaluated the TRA and procedure outcomes of visceral embolizations performed via TRA with 30-day follow-up. Material & methods: Prospective, multicenter registry included uterine fibroids (UFE), prostate artery (PAE), liver tumors (LT), and other hypervascular tumors (OHT) embolization performed in six US hospitals. Between February 2020 and January 2022, 99 patients underwent one radial artery visceral intervention (RAVI); 70 had UFE (70.7%), 16 PAE (16.2%), 7 LT (7.1%), and 6 OHT (6.1%). The mean age was 50.1 (±11.1) years, and 74/99 (74.7%) were females. The primary safety endpoints included hand ischemia, stroke, and death. Procedural success was defined as completing the intended procedure via radial artery (RA) access. Technical success was defined as the successful delivery of HydroPearl™ microspheres and complete embolization of the target vessel. Results: Procedural and technical successes were 100% and 97%, respectively. There was no stroke, hand ischemia, radial-to-femoral conversion, access-related serious adverse events, or clinically evident radial artery occlusion at 30 days. There were two deaths: one respiratory failure and one progression of liver disease. Minor RA-related adverse event included arterial spasm, hematoma, and post-procedure discomfort. Conclusion: This prospective, multicenter, open-label registry confirmed the high safety profile and effectiveness of radial access in UFE, PAE, LT, and OHT embolization procedures without stroke, hand ischemia, or access-related serious adverse events at 30-day follow-up.

Background: There is a lack of registry studies about Transradial access (TRA) outcomes. This prospective registry focused on evaluating the TRA and procedure outcomes of visceral embolizations performed via TRA with 30-day follow-up. Material & Methods: Prospective, multicenter registry included uterine fibroids (UFE), prostate artery (PAE), liver tumors (LT), and other hypervascular tumors (OHT) embolization performed in six US hospitals. Between February 2020 and January 2022,99 patients underwent one RAVI; 70 had UFE (70.7%), 16 PAE (16.2%), 7 LT (7.1%), and 6 OHT (6.1%). The mean age was 50.1 (±11.1) years and 74/99 (74.7%) were females. The primary safety endpoints included hand ischemia, stroke, and death. Procedural success was defined as the completion of the intended procedure using RA. Technical success was defined as the successful delivery of HydroPearl™ microspheres and complete embolization of the target vessel. Results: Procedural and technical successes were 100% and 97%, respectfully. There was no stroke, hand ischemia, radial-to-femoral conversion, access-related serious adverse events, or clinically evident radial artery occlusion at 30 days. There were two deaths: one respiratory failure and one progression of liver disease. Minor RA-related adverse event included arterial spasm, hematoma, and post-procedure discomfort. Conclusion: This prospective, multicenter, open-label registry confirmed the high safety profile and effectiveness of radial access in UFE, PAE, LT, and OHT embolization procedures without stroke, hand ischemia or access-related serious adverse events at 30 days follow-up.

PURPOSE We aimed to assess the use of transradial approach (TRA) among interventional radiologists (IRs) and its perceived advantages and disadvantages that have driven the decision to select or refuse this endovascular approach. METHODS A multicountry survey of 20 multiple- choice questions was conducted among interventional radiologists in Europe and the United States. Questions assessed demographic information of the participants and whether they performed TRA routinely, pre-procedural screening modalities for TRA, TRA technique, complications, reasons for adopting TRA and reasons for not adopting TRA. A total of 187 IRs completed the survey. RESULTS One hundred respondents (53.5%) performed TRA routinely. TRA was chosen based on the procedure (90%, mostly embolization) and physical examination (75%). Patient preference (79%) and faster patient ambulation/discharge (73%) were the main drivers for TRA. Long learning curve (45%), lack of training (32%), prolonged procedural time (31%), potential risk for neurological complications (31%), and increase in radiation exposure (28%) were the most frequent detractors. TRA use was significantly higher in the US than in Europe (p < 0.001) and among male IRs than female IRs (p < 0.01). There was a declining trend in use of TRA with advanced age and more years of experience of IRs. CONCLUSION TRA usage among IRs is limited by issues that can easily be addressed. This survey could help IRs to better understand the real advantages of TRA and how it can offer higher value in patient care.