Choosing the Right Equipment for Radial Access Success

[Chris Beck]
Having seen the radial access practice mature, what are some of the things that you guys do now that maybe you weren't doing at first? I'm thinking things that have set me up for success on the front end. I'll do the EMLA cream with the Nitropaste for patients in pre-op. That to me has been helpful. Things like that, that people may find helpful when you're just getting started that you may not necessarily think about.

[Aaron Fischman]
Well, this is something that is pretty obvious for us, but ultrasound access is an absolute must. Cardiologists really weren't doing that at the time. When you look at papers that look at complication rates, occlusion rates, a lot of that has to do with, in my view, not using ultrasound. That's always been our experience. I wouldn't ever recommend anybody to do this without ultrasound.

… Then using the right closure bands. Using manual compression on the radial artery I think is probably not the way to go. I know some people have done that, but in general, it's really not necessary. We have such good closure devices now for the radial artery that leave nothing in the vessel and allow you to get hemostasis without occluding the vessel. There really is no reason to do that with manual compression. But these are things that maybe come as second nature to us, but there are people that take shortcuts and I've seen a lot of operators that have not followed some of those principles and get problems.

[Aaron Fischman]
Having the right equipment and knowing the catheters that you need if you're doing liver work, and making sure that you have the right length catheter. The catheters that I like for liver are typically the Sarah/Jacky Catheter, or the Ultimate Catheter. Those are really the best catheters and they weren’t really designed for our procedures, but they work really well. When you're going down to the pelvis, making sure that you have a 125 or longer catheter is critical. Having longer microcatheters is also critical.

[Chris Beck]
Just to clarify, as far as celiac or SMA, or any liver-directed therapy, the Sarah/Jacky Catheters are 110 or, or maybe 130?

[Aaron Fischman]
Yeah. Those come in 100 and 110, but I always use the 110 just just because I think, when we first started doing this, we were using the 100 centimeter Cobras which was described in that paper from Japan, but about 20% of patients needed longer catheters. If you have a 110 catheter, you're going to be able to access the Celiac in almost everybody. On top of that, you can take that 110 catheter and you can advance it, a lot of times, into the proper hepatic artery with the 110 length, which is super helpful when you're doing some distal embolization. 110 is really critical.

[Chris Beck]
And then the microcatheter is 150 cm?

[Aaron Fischman]
Yeah, you can do some things with the 130s, but in reality, if you're doing a radial case, you really should have a 150 available. If you don't have it, any of the companies will be able to get you the catheters if you ask. Almost everything now is available in 150 in addition to 130. That wasn't the case six, seven years ago. It was harder to get the 150 catheter. Now you can just get whatever you want in the 150, but it really wasn't so easy to just just all of a sudden say, "Hey, I need a 150 microcatheter." Not everybody had them back then.