Book Excerpts

Chapter 11: Radial Artery Access Techniques
Samir B. Pancholy, MD; Sanjay Shah, MD; Tejas M. Patel, MD

Radial artery access is the first step in performing an endovascular procedure using the radial artery. Despite its intuitive similarities to other access sites, there are several important unique aspects of obtaining and managing radial access that merit mention.

Radial Artery Puncture

Chapter 12: The Cocktail
Daniel Feldman, MD and Adhir Shroff, MD, MPH

Radial artery spasm (RAS) represents a common complication of transradial cardiac catheterization that can occur at any time during the procedure. As a vessel in the distal extremity, the radial artery has a relatively high propensity to spasm in response to mechanical stimulation and circulating humoral factors, such as catecholamines.

Chapter 13: Ideal Vascular Access Introducer Sheath for Transradial Procedures
Sudhir Rathore, MD, MRCP (UK), MD (Res), FESC, FACC

Transradial coronary artery access has been employed for diagnostic and interventional procedures since it was first described by Campeau in 1989 and its improvement described by Kiemeneij and Laarman in 1993. Improvement in the technique and the equipment has led to the use of the radial approach for diagnostic and interventional procedures in varied coronary syndromes.

Chapter 14: Must-Have Diagnostic Catheters
Amer K. Ardati, MD, MSc, FACC

The goal of diagnostic cardiac catheterization is to obtain high-quality hemodynamic and angiographic data in an expeditious and safe manner. Radial access provides the operator and patient with a margin of comfort, convenience, and safety that is not offered by the femoral approach.

Chapter 15: Normal Anatomy and Vascular Anomalies of the Upper Extremity
Isida Byku, MD and Sandeep Nathan, MD, MSc

The transradial approach for percutaneous coronary interventions has seen steady increases in global adoption since the first reports of transradial coronary angiography by Lucian Campeau in 1989 and transradial percutaneous coronary intervention (PCI) by Ferdinand Kiemeneij in 1992. A thorough understanding of upper extremity vascular anatomy, along with the commonly encountered vascular anoma

Chapter 16: Saphenous Vein Graft Diagnostic
Jennifer A. Tremmel, MD, MS

Less experienced radial operators often shy away from the radial approach in patients who have had coronary artery bypass grafting (CABG). This is likely due to concerns about increased difficulty in performing these procedures.

Chapter 17: Left Ventriculography from the Radial Approach
Mladen I. Vidovich, MD, FACC, FSCAI

Left ventriculography is performed during diagnostic cardiac catheterization for evaluation of left ventricular structure and function. Additionally, ventriculography is very helpful to assess wall motion abnormalities and to evaluate for presence of a ventricular septal defect or mitral regurgitation during an emergency procedure (e.g., STEMI).

Chapter 18: Radial Hemostasis
Samir B. Pancholy, MD, FACP, FACC, FSCAI; Sanjay Shah, MD, DM; Tejas M. Patel, MD, DM

Radial access has gained popularity largely due to the predictable and efficient hemostasis. Radial artery compression is easy to perform because of the anatomic advantage provided by the isolation of the radial artery with no large neurovascular structures in the immediate vicinity.

Chapter 19: Guide Catheters: Selection and Use
Srinivas Yallapragada, MD and Rajiv Gulati, MD, PhD

Guiding catheter cannulation requires additional skills and expertise when performing percutaneous coronary intervention (PCI) via the radial approach. Understanding features that can lead to inadequate guide fit/support is important to appreciate guide catheter selection and manipulation.

Chapter 20: Ulnar Arterial Access for Catheterization and Interventional Procedures
Sasko Kedev, MD, PhD

The ulnar artery is the continuation of the brachial artery and was the initial access site used by Zimmerman in 1949 for retrograde catheterization of the left ventricle. It is often larger and has a straighter course compared with the radial artery and rarely has anomalies.