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Interventional Radiology
Procedures
Arterial Procedures
General Considerations
Arterial Access
Arterial Access
Chad Davis, MD; Brandt C. Wible, MD
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KEY FACTS

  • Terminology

    • Procedure

      • Post Procedure

        TERMINOLOGY

        • Definitions

          • Arterial access: Needle puncture, guidewire, and subsequent sheath/catheter introduction, providing arterial access for angiography/vascular intervention
            • Common femoral artery (CFA) access
              • Most frequent access site
              • Majority of punctures retrograde; antegrade can be done for leg interventions
            • Radial artery access
              • Alternative to CFA access
              • Transradial access (TRA) vs. CFA
                • Consider in patients on anticoagulation
                • Reduced complications in obese patients
                • Reduced recovery time
              • No closure devices necessary: Reduced procedural cost, no foreign body deployed
              • Requires preprocedure Barbeau test
            • Brachial artery access
              • Alternative access for anticipated upper extremity intervention or CFA/radial access not feasible
              • Low brachial artery access preferred vs. high access
              • Axillary artery access has higher complication rate than femoral or radial access
                • Hematoma may track within medial brachial fascial compartment and compress brachial plexus
                • High brachial artery access risks similar to axillary
            • Popliteal
              • Nontraditional access, usually for leg intervention
            • Tibiopedal
              • Treatment of chronic limb ischemia; limb salvage
              • Retrograde access; typically following failed antegrade recanalization of infrapopliteal occlusions in ischemic angiosome
            • Aortic access
              • Direct needle puncture of abdominal aorta with subsequent sheath/catheter placement
                • Selective arterial catheterization difficult
                • Often used for translumbar endoleak repair

        PREPROCEDURE

        • Indications

          • Contraindications

            • Preprocedure Imaging

              • Getting Started

                PROCEDURE

                • Patient Position/Location

                  • Equipment Preparation

                    • Procedure Steps

                      • Alternative Procedures/Therapies

                        POST PROCEDURE

                        • Things to Do

                          OUTCOMES

                          • Complications

                            Selected References

                            1. Gayed A et al: Society of Interventional Radiology quality improvement standards on radial artery access. J Vasc Interv Radiol. 32(5):761.e1-21, 2021
                            2. Tsigkas G et al: Transradial access through the anatomical snuffbox: results of a feasibility study. Hellenic J Cardiol. 62(3):201-5, 2021
                            3. Adnan SM et al: Radial versus femoral arterial access for trauma endovascular interventions: a noninferiority study. J Trauma Acute Care Surg. 89(3):458-63, 2020
                            4. Parikh A et al: Distal radial and ulnar arteries: the alternative forearm access. Curr Treat Options Cardiovasc Med. 22(1):1, 2020
                            5. Patel IJ et al: Society of Interventional Radiology consensus guidelines for the periprocedural management of thrombotic and bleeding risk in patients undergoing percutaneous image-guided interventions-part II: recommendations: endorsed by the Canadian Association for Interventional Radiology and the Cardiovascular and Interventional Radiological Society of Europe. J Vasc Interv Radiol. 30(8):1168-84.e1, 2019
                            6. Posham R et al: Transradial approach for noncoronary interventions: a single-center review of safety and feasibility in the first 1,500 cases. J Vasc Interv Radiol. 27(2):159-66, 2016
                            7. Dobrow EM et al: Retrograde tibiopedal access for the treatment of critical limb ischemia. Tech Vasc Interv Radiol. 18(2):66-75, 2015
                            8. Fischman AM et al: A technical guide describing the use of transradial access technique for endovascular interventions. Tech Vasc Interv Radiol. 18(2):58-65, 2015
                            9. Steve Lee K et al: Brachial artery access. Tech Vasc Interv Radiol. 18(2):87-92, 2015
                            10. Resnick NJ et al: Uterine artery embolization using a transradial approach: initial experience and technique. J Vasc Interv Radiol. 25(3):443-7, 2014
                            11. Patel IJ et al: Addendum of newer anticoagulants to the SIR Consensus Guideline. J Vasc Interv Radiol. 24(5):641-5, 2013
                            12. Patel IJ et al: Consensus guidelines for periprocedural management of coagulation status and hemostasis risk in percutaneous image-guided interventions. J Vasc Interv Radiol. 23(6):727-36, 2012
                            13. Haude M et al: Femoral artery puncture. EuroIntervention. 5(6):751, 2010
                            14. Alvarez-Tostado JA et al: The brachial artery: a critical access for endovascular procedures. J Vasc Surg. 49(2):378-85; discussion 385, 2009
                            15. Turi ZG: Fluoroscopy guided vascular access: asking the right question, but getting the wrong answer? Catheter Cardiovasc Interv. 74(4):540-2, 2009
                            16. Montero-Baker M et al: Retrograde approach for complex popliteal and tibioperoneal occlusions. J Endovasc Ther. 15(5):594-604, 2008
                            17. Taha MM et al: Access site complications with carotid angioplasty and stenting. Surg Neurol. 68(4):431-7, 2007
                            18. Yilmaz S et al: Ultrasound-guided retrograde popliteal artery catheterization: experience in 174 consecutive patients. J Endovasc Ther. 12(6):714-22, 2005
                            19. Barbeau GR et al: Evaluation of the ulnopalmar arterial arches with pulse oximetry and plethysmography: comparison with the Allen's test in 1010 patients. Am Heart J. 147(3):489-93, 2004
                            20. Chan TY et al: Position of skin puncture in translumbar aortography. Acta Radiol. 34(6):631-2, 1993
                            21. Rupp SB et al: Relationship of the inguinal ligament to pelvic radiographic landmarks: anatomic correlation and its role in femoral arteriography. J Vasc Interv Radiol. 4(3):409-13, 1993
                            22. Bakal CW et al: Translumbar arch aortography: a retrospective controlled study of usefulness, technique, and safety. Radiology. 178(1):225-8, 1991
                            23. Smith DC et al: Medial brachial fascial compartment syndrome: anatomic basis of neuropathy after transaxillary arteriography. Radiology. 173(1):149-54, 1989
                            24. Maurer HJ: Translumbar aortography. Br J Radiol. 60(720):1237-8, 1987
                            25. Lipchik EO et al: Percutaneous brachial artery catheterization. Radiology. 160(3):842-3, 1986
                            Related Anatomy
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                            Related Differential Diagnoses
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                            References
                            Tables

                            Tables

                            KEY FACTS

                            • Terminology

                              • Procedure

                                • Post Procedure

                                  TERMINOLOGY

                                  • Definitions

                                    • Arterial access: Needle puncture, guidewire, and subsequent sheath/catheter introduction, providing arterial access for angiography/vascular intervention
                                      • Common femoral artery (CFA) access
                                        • Most frequent access site
                                        • Majority of punctures retrograde; antegrade can be done for leg interventions
                                      • Radial artery access
                                        • Alternative to CFA access
                                        • Transradial access (TRA) vs. CFA
                                          • Consider in patients on anticoagulation
                                          • Reduced complications in obese patients
                                          • Reduced recovery time
                                        • No closure devices necessary: Reduced procedural cost, no foreign body deployed
                                        • Requires preprocedure Barbeau test
                                      • Brachial artery access
                                        • Alternative access for anticipated upper extremity intervention or CFA/radial access not feasible
                                        • Low brachial artery access preferred vs. high access
                                        • Axillary artery access has higher complication rate than femoral or radial access
                                          • Hematoma may track within medial brachial fascial compartment and compress brachial plexus
                                          • High brachial artery access risks similar to axillary
                                      • Popliteal
                                        • Nontraditional access, usually for leg intervention
                                      • Tibiopedal
                                        • Treatment of chronic limb ischemia; limb salvage
                                        • Retrograde access; typically following failed antegrade recanalization of infrapopliteal occlusions in ischemic angiosome
                                      • Aortic access
                                        • Direct needle puncture of abdominal aorta with subsequent sheath/catheter placement
                                          • Selective arterial catheterization difficult
                                          • Often used for translumbar endoleak repair

                                  PREPROCEDURE

                                  • Indications

                                    • Contraindications

                                      • Preprocedure Imaging

                                        • Getting Started

                                          PROCEDURE

                                          • Patient Position/Location

                                            • Equipment Preparation

                                              • Procedure Steps

                                                • Alternative Procedures/Therapies

                                                  POST PROCEDURE

                                                  • Things to Do

                                                    OUTCOMES

                                                    • Complications

                                                      Selected References

                                                      1. Gayed A et al: Society of Interventional Radiology quality improvement standards on radial artery access. J Vasc Interv Radiol. 32(5):761.e1-21, 2021
                                                      2. Tsigkas G et al: Transradial access through the anatomical snuffbox: results of a feasibility study. Hellenic J Cardiol. 62(3):201-5, 2021
                                                      3. Adnan SM et al: Radial versus femoral arterial access for trauma endovascular interventions: a noninferiority study. J Trauma Acute Care Surg. 89(3):458-63, 2020
                                                      4. Parikh A et al: Distal radial and ulnar arteries: the alternative forearm access. Curr Treat Options Cardiovasc Med. 22(1):1, 2020
                                                      5. Patel IJ et al: Society of Interventional Radiology consensus guidelines for the periprocedural management of thrombotic and bleeding risk in patients undergoing percutaneous image-guided interventions-part II: recommendations: endorsed by the Canadian Association for Interventional Radiology and the Cardiovascular and Interventional Radiological Society of Europe. J Vasc Interv Radiol. 30(8):1168-84.e1, 2019
                                                      6. Posham R et al: Transradial approach for noncoronary interventions: a single-center review of safety and feasibility in the first 1,500 cases. J Vasc Interv Radiol. 27(2):159-66, 2016
                                                      7. Dobrow EM et al: Retrograde tibiopedal access for the treatment of critical limb ischemia. Tech Vasc Interv Radiol. 18(2):66-75, 2015
                                                      8. Fischman AM et al: A technical guide describing the use of transradial access technique for endovascular interventions. Tech Vasc Interv Radiol. 18(2):58-65, 2015
                                                      9. Steve Lee K et al: Brachial artery access. Tech Vasc Interv Radiol. 18(2):87-92, 2015
                                                      10. Resnick NJ et al: Uterine artery embolization using a transradial approach: initial experience and technique. J Vasc Interv Radiol. 25(3):443-7, 2014
                                                      11. Patel IJ et al: Addendum of newer anticoagulants to the SIR Consensus Guideline. J Vasc Interv Radiol. 24(5):641-5, 2013
                                                      12. Patel IJ et al: Consensus guidelines for periprocedural management of coagulation status and hemostasis risk in percutaneous image-guided interventions. J Vasc Interv Radiol. 23(6):727-36, 2012
                                                      13. Haude M et al: Femoral artery puncture. EuroIntervention. 5(6):751, 2010
                                                      14. Alvarez-Tostado JA et al: The brachial artery: a critical access for endovascular procedures. J Vasc Surg. 49(2):378-85; discussion 385, 2009
                                                      15. Turi ZG: Fluoroscopy guided vascular access: asking the right question, but getting the wrong answer? Catheter Cardiovasc Interv. 74(4):540-2, 2009
                                                      16. Montero-Baker M et al: Retrograde approach for complex popliteal and tibioperoneal occlusions. J Endovasc Ther. 15(5):594-604, 2008
                                                      17. Taha MM et al: Access site complications with carotid angioplasty and stenting. Surg Neurol. 68(4):431-7, 2007
                                                      18. Yilmaz S et al: Ultrasound-guided retrograde popliteal artery catheterization: experience in 174 consecutive patients. J Endovasc Ther. 12(6):714-22, 2005
                                                      19. Barbeau GR et al: Evaluation of the ulnopalmar arterial arches with pulse oximetry and plethysmography: comparison with the Allen's test in 1010 patients. Am Heart J. 147(3):489-93, 2004
                                                      20. Chan TY et al: Position of skin puncture in translumbar aortography. Acta Radiol. 34(6):631-2, 1993
                                                      21. Rupp SB et al: Relationship of the inguinal ligament to pelvic radiographic landmarks: anatomic correlation and its role in femoral arteriography. J Vasc Interv Radiol. 4(3):409-13, 1993
                                                      22. Bakal CW et al: Translumbar arch aortography: a retrospective controlled study of usefulness, technique, and safety. Radiology. 178(1):225-8, 1991
                                                      23. Smith DC et al: Medial brachial fascial compartment syndrome: anatomic basis of neuropathy after transaxillary arteriography. Radiology. 173(1):149-54, 1989
                                                      24. Maurer HJ: Translumbar aortography. Br J Radiol. 60(720):1237-8, 1987
                                                      25. Lipchik EO et al: Percutaneous brachial artery catheterization. Radiology. 160(3):842-3, 1986