Access, Radial Artery

With the introduction of various catheters designed for radial access, the radial artery access has been gaining popularity recently. The Simmons catheters are typically the go-to choice for selecting target arteries.


Tips and Tricks

Medicine

Avoiding Complications


Cases

1

Ultrasound-Guided Radial Artery Puncture

A: Frequently, there is an accompanying vein (red arrow) running alongside the radial artery (yellow arrowhead).
B: Applying gentle pressure on the wrist will cause the vein to collapse, while the artery remains full with pulsations. Observe the slight "upward shift" of both the collapsed vein and the artery (closer to the skin).


2


The local anesthetic infiltrated area (white diamond) can be seen above the right radial artery (red star).


3

CTA Neck

The aberrant right subclavian artery/lusorian artery (red arrow) which can be easily ascertained on CTA neck, is considered a relative contraindication for radial access.[1] Yellow arrow: right CCA. Blue arrow: left CCA. Green arrow: left subclavian artery. Orange arrow: right VA. Pink star: esophagus. White diamond: trachea. (Unfortunately, this is not an ideal study due to the suboptimal timing and contrast contamination in the adjacent veins.)


CTA Chest

This patient presented after a chest trauma. There is also an aberrant right subclavian artery (red arrow). Also, please note the right pulmonary contusion and the chest tube.



This is an MRA neck of another patient who has an aberrant right subclavian artery.


4


This angiography revealed a tortuous right radial artery origin with adjacent two U-turns. The Glidewire was too stiff to safely navigate through these two turns (red arrow). Consequently, the decision was made to abandon radial access and switch to a femoral access. In cases where the right radial artery remains the only viable option for access, one could consider using a microwire to guide the selection of the brachial artery, followed by a microcatheter to straighten the radial artery origin.


5


The right VA (pink arrow) is typically the first artery to catheterize in diagnostic cerebral angiography via the radial access.

(A): In this pre-operative CTA neck 3D reconstruction view, the right VA origin (green arrow) can be clearly recognized with its relative location to the tip of the distal right subclavian curve (white arrow).
(B): Advance the catheter tip (orange arrow) to the estimated VA origin and obtain a roadmap to assist in artery catheterization.

An alternative method to localize the right VA origin would be to advance the catheter tip more distally and then retract it while puffing contrast to opacify it.


  1. Radial Access via Aberrant Right Subclavian Artery | neuroangio.org ↩︎