PMID- 31611111
OWN - NLM
STAT- MEDLINE
DCOM- 20200914
LR  - 20210819
IS  - 1097-6809 (Electronic)
IS  - 0741-5214 (Linking)
VI  - 71
IP  - 5
DP  - 2020 May
TI  - Safety and efficacy of radial access in trauma in 65 trauma endovascular cases.
PG  - 1564-1571
LID - S0741-5214(19)32168-8 [pii]
LID - 10.1016/j.jvs.2019.08.227 [doi]
AB  - OBJECTIVE: Endovascular techniques in trauma surgery are becoming increasingly 
      important in patient management, with procedures such as pelvic and splenic 
      angioembolization becoming the standard of care for certain injuries. 
      Traditionally, such interventions are performed via femoral access, although the 
      morbidity of this approach is not insignificant (3%-10%). Transradial access 
      (TRA) is an attractive alternative, pioneered by cardiologists, with low rates of 
      access site complications in patients undergoing coronary intervention. Recently, 
      this technology has extended to other interventions. The aim of this study was to 
      present the initial experience of a radial program in a busy trauma center, with 
      specific regard to safety and complications. METHODS: The medical records of 
      trauma patients undergoing endovascular procedures via TRA between March 2018 and 
      December 2018 were queried for procedural and postoperative data. Demography and 
      injury characteristics were presented for the overall cohort, followed by a 
      comparison of procedural data and complications between laterality. Continuous 
      variables were compared using a two-tailed t-test and categorical variables were 
      compared using a chi(2) test. RESULTS: Over a 9-month period, 65 patients underwent 
      81 interventions via TRA, most commonly solid organ or pelvic 
      angiography/embolization. Radial artery access was achieved in all patients, with 
      procedural success achieved in all but two patients (n = 63 [96.9%]) who had 
      hypoplastic radial artery anatomy, who underwent ulnar access. The overall 
      technique-related complication rate was 1.5% with no difference observed between 
      laterality (n = 1; P = .523). One patient with an admission Glasgow Coma Score of 
      3 and coagulopathy developed radial artery thrombosis after pelvic angiography 
      via right TRA. Mortality was seen in seven patients (10.8%) owing to hemorrhagic 
      shock (n = 3 [42.8%]) or multiorgan failure (n = 4 [57.1%]). There were no cases 
      of postprocedural access site bleeding, hematoma, pseudoaneurysm, vascular 
      injury, intraoperative arrhythmia or cerebrovascular accident, arteriovenous 
      fistula formation, or infection. CONCLUSIONS: TRA is a feasible and low-risk 
      alternative for endovascular intervention in the trauma patient. It yields good 
      technical success with low morbidity. Although larger studies are needed to 
      establish the full efficacy of TRA at the multi-institutional level, this 
      single-institution study demonstrates the legitimacy of an alternative means for 
      endovascular intervention in the trauma patient.
CI  - Copyright (c) 2019 Society for Vascular Surgery. Published by Elsevier Inc. All 
      rights reserved.
FAU - Adnan, Sakib M
AU  - Adnan SM
AD  - Department of Surgery, Einstein Healthcare Network, Philadelphia, Pa.
FAU - Romagnoli, Anna N
AU  - Romagnoli AN
AD  - R Adams Cowley Shock Trauma Center, University of Maryland Medical System, 
      Baltimore, Md.
FAU - Madurska, Marta J
AU  - Madurska MJ
AD  - R Adams Cowley Shock Trauma Center, University of Maryland Medical System, 
      Baltimore, Md.
FAU - Dubose, Joseph J
AU  - Dubose JJ
AD  - R Adams Cowley Shock Trauma Center, University of Maryland Medical System, 
      Baltimore, Md.
FAU - Scalea, Thomas M
AU  - Scalea TM
AD  - R Adams Cowley Shock Trauma Center, University of Maryland Medical System, 
      Baltimore, Md.
FAU - Morrison, Jonathan J
AU  - Morrison JJ
AD  - R Adams Cowley Shock Trauma Center, University of Maryland Medical System, 
      Baltimore, Md. Electronic address: jonathan.morrison@umm.edu.
LA  - eng
PT  - Journal Article
DEP - 20191011
PL  - United States
TA  - J Vasc Surg
JT  - Journal of vascular surgery
JID - 8407742
SB  - IM
CIN - J Vasc Surg. 2021 Feb;73(2):736-737. PMID: 33485497
CIN - J Vasc Surg. 2021 Feb;73(2):736. PMID: 33485498
CIN - J Vasc Surg. 2021 Feb;73(2):740-741. PMID: 33485503
CIN - J Vasc Surg. 2021 Feb;73(2):741-742. PMID: 33485504
MH  - Adult
MH  - *Catheterization, Peripheral/adverse effects
MH  - *Endovascular Procedures/adverse effects
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Punctures
MH  - *Radial Artery
MH  - Retrospective Studies
MH  - Risk Assessment
MH  - Risk Factors
MH  - Time Factors
MH  - Treatment Outcome
MH  - Wounds and Injuries/*therapy
OTO - NOTNLM
OT  - Endovascular intervention
OT  - Morbidity
OT  - Radial artery
OT  - Transradial access
OT  - Trauma management
EDAT- 2019/10/16 06:00
MHDA- 2020/09/15 06:00
CRDT- 2019/10/16 06:00
PHST- 2019/05/01 00:00 [received]
PHST- 2019/08/15 00:00 [accepted]
PHST- 2019/10/16 06:00 [pubmed]
PHST- 2020/09/15 06:00 [medline]
PHST- 2019/10/16 06:00 [entrez]
AID - S0741-5214(19)32168-8 [pii]
AID - 10.1016/j.jvs.2019.08.227 [doi]
PST - ppublish
SO  - J Vasc Surg. 2020 May;71(5):1564-1571. doi: 10.1016/j.jvs.2019.08.227. Epub 2019 
      Oct 11.