BackTable / VI / Podcast / Episode #26

Radial vs. Femoral Access in IO Procedures

with Dr. Jason Iannuccilli

Dr. Christopher Beck and Dr. Jason Iannuccilli discuss radial vs femoral access in IO procedures, including the pros and cons of both, and a very informative "how I do it" for radial access by Dr. Iannuccilli.

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TriSalus Life Sciences
Radial vs. Femoral Access in IO Procedures with Dr. Jason Iannuccilli on the BackTable VI Podcast)
Ep 26 Radial vs. Femoral Access in IO Procedures with Dr. Jason Iannuccilli
00:00 / 01:04

BackTable, LLC (Producer). (2018, April 4). Ep. 26 – Radial vs. Femoral Access in IO Procedures [Audio podcast]. Retrieved from https://www.backtable.com

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Podcast Contributors

Dr. Jason Iannuccilli discusses Radial vs. Femoral Access in IO Procedures on the BackTable 26 Podcast

Dr. Jason Iannuccilli

Dr. Jason Iannuccilli is a practicing interventional radiologist with Rhode Island Medical Imaging.

Dr. Christopher Beck discusses Radial vs. Femoral Access in IO Procedures on the BackTable 26 Podcast

Dr. Christopher Beck

Dr. Chris Beck is a practicing interventional radiologist with Regional Radiology Group in New Orleans.

Dr. Michael Barraza discusses Radial vs. Femoral Access in IO Procedures on the BackTable 26 Podcast

Dr. Michael Barraza

Dr. Michael Barraza is a practicing interventional radiologist (and all around great guy) with Radiology Associates in Baton Rouge, LA.

Transcript Preview

[Jason Iannuccilli]
In general, when we're talking about the technical aspects [of radial access] we always start off with an ultrasound to the forearm while the patient is in recovery. We'll check to make sure that the radial artery is sufficient diameter. I would set the threshold at two millimeters for a minimum diameter just based on the sheath size that we're putting in there, which we'll talk about. But in general there's also data to support that the complication rates are higher when the radial artery diameter is less than two millimeters. So we measure the artery, we do an ultrasound, we kind of follow the vessel up the forearm, make sure that we can't see any sort of radial loop or extreme tortuosity that might make it a difficult procedure. Even if you see a radial loop there are ways to overcome it, but again, it may sway you toward using a femoral access if it's a complete loop, for example.

So once we do the anatomic assessment with ultrasound we usually - you don't have to but we do - assess the completeness of the palmar arch by doing a Barbeau test. So the Barbeau test, I'm sure you guys are familiar with it, but it's basically an Allen's test used with a pulse oximeter that we place on either the thumb or the index finger or the hand. We compress the radial artery and observe the pulse ox's waveform. In general, the degree of depression of that waveform is going to tell you how well the ulnar artery is perfusing that superficial palmar arch. And there are various types of waveforms just based on the change. Type A or a type B is preferred. We have done a couple type Cs and haven't had any major issues with that yet but I would say that it's just a handful of patients that we run that risk with.

So that's sort of the overall assessment. If you've got a Barbeau type A or type B and the radial artery is two millimeters and the ultrasound at least to the forearm looks pretty good I'd say it's a go. And then we prep the patient up, bring him into the room.

Disclaimer: The Materials available on BackTable.com are for informational and educational purposes only and are not a substitute for the professional judgment of a healthcare professional in diagnosing and treating patients. The opinions expressed by participants of the BackTable Podcast belong solely to the participants, and do not necessarily reflect the views of BackTable.

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