Ipsilateral Transradial Approach for Shoulder Embolization: Safety, Feasibility, and Technical Approach

Purpose: This study evaluates the safety and feasibility for ipsilateral transradial access (TRA) for shoulder and humeral embolization as well as important factors related to the technical approach.

Materials and Methods: Retrospective review was performed of all upper extremity interventions via ipsilateral transradial access at a single institution. In all cases, a Barbeau test was performed using a pulse oximeter to confirm dual circulation of the palmar arch. A hydrophilic Glidesheath (Terumo, Somerset, NJ) was placed in the radial artery using ultrasound guidance. After sheath placement, heparin (3000 units), verapamil (2.5 mg), and nitroglycerin (200 mcg) were administered intraarterially. Variable 4- or 5-Fr diagnostic catheters and coaxial microcatheters were used in all cases to cannulate the shoulder and upper extremity arteries. Technical success, major and minor adverse events (AEs), fluoroscopy time(FT), procedural details, and imaging were recorded.

Results: In this study, ipsilateral TRA was attempted in 12 patients (8 male, 4 female; mean age, 57.8 years) from April 2007 to March 2019. The procedure was performed for preoperative embolization for osseous metastases resection (n = 9), arteriovenous malformation embolization (n = 2), and traumatic vascular injury (n = 1). TRA guiding catheters included 4- and 5-Fr Berenstein (Merit, South Jordan, UT), 5-Fr SOS (AngioDynamics, Latham, New York), 5-Fr MPA (Cordis, Warren, NJ), 5-Fr Sarah Radial (Terumo, Japan), 4-Fr Cobra (Merit, South Jordan, UT), 5-Fr Rim (Merit, South Jordan, UT), and 5-Fr FH3 (Merit, South Jordan, UT) catheters. Technical success was 100% (12 of 12). There were no major periprocedural AEs and one minor AE (access site hematoma), and average FT was 16.2 minutes. The procedural details varied on each case relative to the arterial upper extremity anatomy, patient positioning, and embolic material.

Conclusions: Ipsilateral TRA is a safe and technical feasible method for upper extremity and shoulder arterial embolization.