Radial Access Intervention: Application in Complex Oncological Procedures

Background: Radial access for vascular intervention has been a firmly established as a default access route in our institution and is now routinely used for complex oncological procedures. We present our experience as Europe’s largest single site cancer center, share tips to deal with potential complications and tricks that would facilitate a safer, technically easier procedure. Method(s): Over the last 3 years, we have performed over 60 interventional oncological procedures ranging from intra-hepatic treatments including trans-arterial chemoembolization (TACE), selective internal radiation therapy (SIRT), pelvic intervention including fibroid and prostate embolization as well as acute vascular treatments. Result(s): Our procedural outcomes have demonstrated that radial access is a safe, viable access route with reduced morbidity and improved patient experience. Potential complications would include radial artery spasm for which a combination of Glyceryl Trinatrate (GTN), Heprin and Verapamil work well. Reduced torquability when accessing distant treatment sites can be overcome by using appropriate types and lengths of catheters. Further challenges such as limb ischemia and procedural failure will be discussed with specific clinical cases. Repeat radial artery punctures and poor haemostats can result in radial artery occlusion, we have devised a deflation protocol to reduce the incidence of this. Conclusion(s): Radial access is safe and technically feasible in complex oncological intervention. Once user familiarity is established, it can be safely used for a range of procedures ranging from diagnostic angiograms to complex and acute vascular treatments.