Rationale for Use of Radial vs. Femoral Access in Oncologic Embolization Procedures

COMFORT AND EXPERIENCE WITH FEMORAL ACCESS

[Chris Beck]
I almost always go femoral access….I have a high level of comfort with femoral access, I have a good feel for when the access is going right, when there's something wrong, and all the working catheters that I use or have access to - not that we couldn't get other ones….There are so many reverse curve catheters [that are] kind of just common practice for us to use. And so it ends up being femoral access. And I think that if I had to really get down to the base of it, it's probably just because I feel comfortable with that overall.

ERGONOMICS OF CATH LAB SETUP

[Chris Beck]
...Some of the smaller reasons that I use femoral access, we have a couple of different cath labs that we work in, both at my main hospital and satellite hospital ... the rooms are built for femoral access, and so if I ever do a radial access case, and we can kind of get into the nuts and bolts and Jason may have some good tips to help facilitate it, but it seems like the ergonomics are very geared towards doing femoral access. I can lay everything across the patient, the monitors are directly in front of me, the back table is behind me, and it's just from that standpoint, everything like my hands and my line of sight, everything is directly in front of me at a 90 degree angle.

SHORTER CATHETER WORKING LENGTHS

[Chris Beck]
I wouldn't say we do a lot of them, but for the intra-arterial cases that we do, Y-90 specifically, a lot of the catheters that we try and use are shorter working length catheters like if we're going to do a mapping. I was always taught to try and decrease the length of your catheters as much as possible. So if you can get a 65 centimeter SOS and then a shorter length Renegade that's 105 or 110, you get better injections for your mappings. And I have to admit, I'm a nut about my mapping procedures and I think that using some shorter working length catheters helps you get better injections and better pictures.

You have some special situations….I can think of a case where it included celiac and it was considering whether we were going to have to go via the SMA and pancreaticoduodenal arcade to get to this tumor versus what I ended up doing, was just pulling a Mickelsen catheter into the celiac, which was completely and chronically occluded. And basically what I do is I just take the Mickelsen, park it in the occlusion of the celiac, and then I just kind of chip away with the microcatheter system. And then, ultimately, you kind of treat it like a CTO case, you kind of bust through and then all of a sudden you have access into your hepatic arteries. I'm sure that you could do this if you were doing a radial access case but I have just such a higher level of comfort with the catheters and coming from a femoral approach.

NUSRES AND TECHS MIGHT BE MORE COMFORTABLE WITH MANAGING FEMORAL ACCESS

[Michael Barraza]
So I've made the switch to radial for fibroid embolization, but the only thing that's really keeping me from doing it in cancer therapy ... the barrier is really just having to train inexperienced nurses and techs who are just really very comfortable with managing femoral access patients. The place where I do the majority of my interventional oncology is just a really busy site and I can't waste half an hour having to set up an arm board and get everything set up a way that they're not used to.

[Chris Beck]
I really don't even have that excuse because the cath lab that I work in, it's a cath lab mixed with cardiology and so the techs and nursing staff, everyone is very comfortable with a radial setup. And so for me, if I were to tell the techs, "Hey, let's set up for radial," they don't blink an eye, they'll set up for radial no sweat and they'll have the groins prepped in case of potential crossover. And we use radial access, it's just not my go-to access, especially when it comes to interventional oncology.