Speciality Medical Dialogues
    • facebook
    • twitter
    Login Register
    • facebook
    • twitter
    Login Register
    • Medical Dialogues
    • Education Dialogues
    • Business Dialogues
    • Medical Jobs
    • Medical Matrimony
    • MD Brand Connect
    Speciality Medical Dialogues
    • Editorial
    • News
        • Anesthesiology
        • Cancer
        • Cardiac Sciences
        • Critical Care
        • Dentistry
        • Dermatology
        • Diabetes and Endo
        • Diagnostics
        • ENT
        • Featured Research
        • Gastroenterology
        • Geriatrics
        • Medicine
        • Nephrology
        • Neurosciences
        • Nursing
        • Obs and Gynae
        • Ophthalmology
        • Orthopaedics
        • Paediatrics
        • Parmedics
        • Pharmacy
        • Psychiatry
        • Pulmonology
        • Radiology
        • Surgery
        • Urology
    • Practice Guidelines
        • Anesthesiology Guidelines
        • Cancer Guidelines
        • Cardiac Sciences Guidelines
        • Critical Care Guidelines
        • Dentistry Guidelines
        • Dermatology Guidelines
        • Diabetes and Endo Guidelines
        • Diagnostics Guidelines
        • ENT Guidelines
        • Featured Practice Guidelines
        • Gastroenterology Guidelines
        • Geriatrics Guidelines
        • Medicine Guidelines
        • Nephrology Guidelines
        • Neurosciences Guidelines
        • Obs and Gynae Guidelines
        • Ophthalmology Guidelines
        • Orthopaedics Guidelines
        • Paediatrics Guidelines
        • Psychiatry Guidelines
        • Pulmonology Guidelines
        • Radiology Guidelines
        • Surgery Guidelines
        • Urology Guidelines
    LoginRegister
    Speciality Medical Dialogues
    LoginRegister
    • Home
    • Editorial
    • News
      • Anesthesiology
      • Cancer
      • Cardiac Sciences
      • Critical Care
      • Dentistry
      • Dermatology
      • Diabetes and Endo
      • Diagnostics
      • ENT
      • Featured Research
      • Gastroenterology
      • Geriatrics
      • Medicine
      • Nephrology
      • Neurosciences
      • Nursing
      • Obs and Gynae
      • Ophthalmology
      • Orthopaedics
      • Paediatrics
      • Parmedics
      • Pharmacy
      • Psychiatry
      • Pulmonology
      • Radiology
      • Surgery
      • Urology
    • Practice Guidelines
      • Anesthesiology Guidelines
      • Cancer Guidelines
      • Cardiac Sciences Guidelines
      • Critical Care Guidelines
      • Dentistry Guidelines
      • Dermatology Guidelines
      • Diabetes and Endo Guidelines
      • Diagnostics Guidelines
      • ENT Guidelines
      • Featured Practice Guidelines
      • Gastroenterology Guidelines
      • Geriatrics Guidelines
      • Medicine Guidelines
      • Nephrology Guidelines
      • Neurosciences Guidelines
      • Obs and Gynae Guidelines
      • Ophthalmology Guidelines
      • Orthopaedics Guidelines
      • Paediatrics Guidelines
      • Psychiatry Guidelines
      • Pulmonology Guidelines
      • Radiology Guidelines
      • Surgery Guidelines
      • Urology Guidelines
    • Home
    • News
    • Cardiac Sciences
    • Traversing through...

    Traversing through Radial and Brachial Region- Dr RK Jaswal

    Written by Medical Dialogues Bureau Published On 2018-02-28T15:23:12+05:30  |  Updated On 28 Feb 2018 3:23 PM IST
    Traversing through Radial and Brachial Region- Dr RK Jaswal

    Selective coronary angiography was first performed by the brachial artery. It then evolved to transfemoral access(TFA) with the Judkins technique and now TRA is frequently utilised for cardiac catherization and PCI. Just as TFA gradually replaced the brachial artery cutdown, TRA is becoming the standard practice worldwide.


    These advancements have reduced vascular complications while increasing patient satisfaction. TRA has a clear qualitative benefit to patients and a higher proportion of patients prefer TRA to TFA. Well-designed clinical studies and randomised clinical trials soon followed, which began to quantify the clinical benefits (including mortality benefits) of radial access.


    Clinical trials (SCAAR, RIFLESTEACS and RIVAL) have clearly documented the superiority of T.R.I. over T.F.I. in patients who come for primary PCI especially in a high volume trans-radialcentre or performed by high volume trans-radial operator. MATRIX trial also evaluated the effects of TRA in patients undergoing PCI for acute coronary syndrome and found that TRA decreased the net composite end point of death, myocardial infarction, stroke or bleeding academic research consortium (BARC) major bleeding. Inparticular patients treated with TRA had a lower risk of death and bleeding. In the sites with the highest proportion of patients undergoing TRA, the effects of TRA on mortality and bleeding were the greatest. Hulme et al add further observational evidence in support of both TRA and the relationship between TRA volume and outcomes.


    TRA has been recommended as default access site for primary PCI. " 2015 ESC guideline for the management of acute coronary syndrome in patient presenting without persistent ST segment elevation", radial access for coronary angiography and PCI is recommended over femoral one with highest degree of recommendation (1A). ESC recommends that in centres experienced with radial access, a radial approach is recommended for coronary angiography and PCI . It is recommended that centre treating ACS patients implement a transition from trans femoral to trans radial access and at the same time they need to maintain proficiency in T.F.A. as well.


    Despite such strong clinical evidence and recommendations, radial access remains a road less often travelled. The reason is technical difficulties encountered by the trans radial operators leading to long and steep learning curve. Majority of technical challenges are related to the success of transradial puncture and the challenges while traversing the radial, brachial and axillary artery for example; radial tortuosity, radial spasm, radial artery hypoplasia (congenital and acquired), diffuse atherosclerosis of radial artery, radio-cubital trunk, 360 degree loops of radial artery, anatomical variations of the arteries, non elastic compartments of forearm&several branches which originates from the system and can be damaged/dissected by the guidewire. All these challenges need special care and specific technique to make the procedure easy for the operator and also to make T.R.I. even more comfortable and safe for the patient. The purpose of discussing clinical challenges faced and their solutions while traversing radial and brachial artery would be discussed by me so as to help new operators shorten this learning curve and achieve proficiency in transradial intervention.


    The author Dr RK Jaswal is the Director Cardiology at Fortis Hospital, Mohali In his more than 22 yrs in the field of Interventional Cardiology has done>27000 transradial invasive procedures and >12000 transradial interventions including complex transradial coronary interventions. He is presenting on the Traversing through Radial and Brachial Region at IndiaLive 2018

    bleeding academic research consortiumbrachial arteryBrachial RegionDr Rakesh JaswalPCItransfemoral accesstransradial interventionvascular complications

    Disclaimer: This site is primarily intended for healthcare professionals. Any content/information on this website does not replace the advice of medical and/or health professionals and should not be construed as medical/diagnostic advice/endorsement or prescription. Use of this site is subject to our terms of use, privacy policy, advertisement policy. © 2020 Minerva Medical Treatment Pvt Ltd

    Medical Dialogues Bureau
    Medical Dialogues Bureau
      Show Full Article
      Next Story
      Similar Posts
      NO DATA FOUND

      • Email: info@medicaldialogues.in
      • Phone: 011 - 4372 0751

      Website Last Updated On : 12 Oct 2022 7:06 AM GMT
      Company
      • About Us
      • Contact Us
      • Our Team
      • Reach our Editor
      • Feedback
      • Submit Article
      Ads & Legal
      • Advertise
      • Advertise Policy
      • Terms and Conditions
      • Privacy Policy
      • Editorial Policy
      • Comments Policy
      • Disclamier
      Medical Dialogues is health news portal designed to update medical and healthcare professionals but does not limit/block other interested parties from accessing our general health content. The health content on Medical Dialogues and its subdomains is created and/or edited by our expert team, that includes doctors, healthcare researchers and scientific writers, who review all medical information to keep them in line with the latest evidence-based medical information and accepted health guidelines by established medical organisations of the world.

      Any content/information on this website does not replace the advice of medical and/or health professionals and should not be construed as medical/diagnostic advice/endorsement or prescription.Use of this site is subject to our terms of use, privacy policy, advertisement policy. You can check out disclaimers here. © 2025 Minerva Medical Treatment Pvt Ltd

      © 2025 - Medical Dialogues. All Rights Reserved.
      Powered By: Hocalwire
      X
      We use cookies for analytics, advertising and to improve our site. You agree to our use of cookies by continuing to use our site. To know more, see our Cookie Policy and Cookie Settings.Ok