Chapter 40: The Radial Approach for Renal and Mesenteric Intervention

The benefits of the transradial approach for coronary angiography and intervention are well recognized. Decreased major bleeding, reduction in vascular complications, decreased patient length of stay, enhanced patient comfort and overall decreased costs have all been well established with a possible mortality benefit linked to the use of transradial approach for primary percutaneous coronary intervention in ST-elevation myocardial infarction. Use of transradial approach for percutaneous intervention in the renal and mesenteric beds remains less studied. While several large, randomized control trials exist for its use in coronary intervention, studies for the use of a transradial approach in the mesenteric and renal vascular beds are limited to observational studies, retrospective or feasibility studies, technical reports and case reports/ case series. Despite this lack of prospective, randomized data, it is likely that the benefits seen with the transradial approach in the coronary space would translate into additional procedural arenas.

Many early case accounts of alternative access for renal and mesenteric intervention were adopted mainly as bailout strategies when femoral access was limited by either significant peripheral vascular disease, Leriche syndrome at its most extreme, substantial ilio-femoral tortuosity, or severe angulation of the target vessel from the aorta. However, given initial equipment size requirements for peripheral intervention, radial access was thought to be prohibitive, and brachial, axillary and even subclavian access sites were used alternatively in these circumstances. Since that time, the bulky 8 Fr sheaths required to deliver equipment to these vascular territories have been largely replaced by 6 Fr systems, allowing for the reevaluation of the transradial approach as a feasible and potentially safer alternative to the above-mentioned access sites.

Author: 
Elizabeth M. Retzer, MD and Sandeep Nathan, MD, MSc