A Review of “Patel’s Atlas of Transradial Intervention: The Basics and Beyond”

On October 30, 1958, Mason Sones accidentally pioneered coronary angiograpy at the Cleveland Clinic, directly injecting contrast medium into the right coronary artery. The catheter was threaded into the aorta through a cutdown of the brachial artery. Later, in the 1960’s, Melvin Judkins introduced the percutaneous transfemoral approach, which is the currently the most widely used catheterization technique. The Sones technique exploded our understanding of coronary anatomy and disease. The Judkins technique became the gateway for non-surgical treatment of atherosclerotic disease. Today, transradial (TR) coronary angiography and intervention seems to be everywhere. Pick up a cardiac journal, visit various cath-related websites, and you cannot escape being inundated with industry ads, articles on technique, and workshops offered at various conferences. We have gone from arm to leg and back again.

I am a total advocate of TR. If I was the patient, I would be much more comfortable with a needle to my wrist than to my groin. However, old habits die hard. A couple of examples that come to mind from over the years are chilled injectate for thermodilution cardiac output and one-hour bed rest per sheath French size after manual hemostasis. Femoral artery first for vascular access during catheterization procedures is another one of those habits. The major roadblocks to TR include both operator and cath lab team learning curves. Issues to overcome include new patient prep and set up, resistance to change, unfamiliarity with equipment, limited ability to use larger interventional devices, new technique increasing procedural time, and fear of failure. Dr. Patel addresses all of these issues and more in his textbook, “Patel’s Atlas of Transradial Intervention: the Basics and Beyond.”

The textbook is an incredible work, covering all aspects of TR catheterization and intervention in 242 pages. Chapter one begins where it should: patient selection, cath lab setup, and patient preparation. Beautiful color photographs and illustrations walk us through performing and interpreting an Allen’s Test, equipment and hardware, and site preparation. Chapters two and three continue with radial access through hemostasis. Subsequent chapters discuss identifying and managing complications which may occur with TR, anatomical issues such as a radial loop, coronary cannulation with standard femoral and radial-specific catheter curves, sheathless access for both angiography and intervention, and TR techniques for coronary interventions. This relatively short textbook contains a multitude of angiographic examples addressing every imaginable challenge that may be encountered.

Today, vascular complications of the transfemoral approach continue to be a significant concern. The transradial approach offers real advantages in patient comfort and nearly eliminates major vascular complications. “There is little justification to ignore one of the main developments in interventional cardiology and stubbornly refuse to embrace a technique likely to reduce minor adverse events and improve patients’ comfort.”¹ If you work in an invasive cardiovascular laboratory, “Patel’s Atlas of Transradial Intervention: the Basics and Beyond” is a reference book that needs to be part of  your library.

Reference

1. Di Mario C, Viceconte N. Radial angioplasty: Worthy RIVAL, not undisputed winner. Lancet 2011; doi:10.1016/S0140-6736(11)60469-8. Available at: https://www.thelancet.com.

More information is available online at: patelsatlas-basicsandbeyond.com/