Distal Transradial Access For Transarterial Chemoembolization In Elderly Patients With Hepatocel Ular Carcinoma

Objective:To explore the feasibility,safety and durability of distal transradial access（dTRA）for transarterial chemoembolization in elderly patients with hepatocellular carcinoma.Methods:This retrospective study was carried out in a single center.Distal transradial access was attempted in 146 elderly patients with hepatocellular carcinoma who underwent interventional treatment from January 2021 to September 2021 at our department.Patient demographics,technical success,puncture success,puncture time,distal radial artery diameters,times of repeated dTRA procedures,interval between repeated accesses and complications were gathered.For patients who underwent repetitive dTRA procedures,preprocedural artery diameter and puncture time at the first,second,and third dTRA were compared separately.Results:Distal transradial access was attempted in 146 patients who underwent 287 consecutive procedures which includes 272 dTRA procedures.The overall technical success and puncture success were94.8% and 95.8%,respectively,and the puncture time was（1.22±1.13）minutes.The mean interval between repeat punctures was 66.5days（range,22～231 d）.Puncture site complications included 8（2.9%）minor ecchymoses,5（1.8%）distal radial artery spasm,4（1.5%）distal radial artery occlusion and without proximal radial artery occlusion.A total of 136 patients successfully underwent the first dTRA whose mean artery diameter was（2.12±0.39）mm,and the technical success was93.2%.A total of 78 patients successfully underwent the second dTRA whose mean artery diameter was（2.24 ± 0.34）mm,and the technical success was 95%.The artery diameter was found no significant difference between the first and second dTRA（P>0.05）.A total of 32 patients successfully underwent the third dTRA whose mean artery diameter was（2.17±0.47）mm,and the technical success was 97%.The artery diameter was found no significant difference between the first and third dTRA（P>0.05）.The second and third dTRA puncture time were compared with the first respectively,and there was no significant difference（P>0.05）.Conclusions:Distal transradial access is feasible,safe and durable for transarterial chemoembolization in elderly patients with hepatocellular carcinoma,and it is worthy of clinical application.