E-027 Trans-femoral 5Fr diagnostic catheter angiography from a 4Fr access using a 5/4 slender radial sheath: Experience in 50 consecutive cases

BackgroundFemoral access has long been the standard for diagnostic angiography but recently radial access techniques have gained popularity due to their perceived enhanced safety. The slender 5/4 radial sheath (5/4RS) (Terumo, Japan) is the commonly used sheath for radial access that allows the use of 5 Fr diagnostic catheters with the arteriotomy of a traditional 4Fr sheath. This is achieved by decreasing the wall thickness of the sheath thereby making it much softer and more likely to kink. We report our experience using this for femoral angiography.MethodsWe retrospectively reviewed a prospectively-maintained IRB-approved institutional database of the senior authors to identify all cases where the 5/4RS was utilized. Case details were recorded including types of catheters used, incidence of kinking, closure technique, and length of lying flat (LOF). Technical success was defined as femoral access that allowed catheterization of all desired vessels with a 5Fr diagnostic catheter.ResultsOver the study period, 50 consecutive femoral access diagnostic angiography cases were identified where the 5/4RS was utilized. A 5Fr JB1 glide catheter (Terumo) was utilized in all 50 cases and a SIM2 (Terumo) was utilized in 12 (24%). Kinking of the 5/4RS occurred in 5 (10%) patients, which was managed by restoring the lumen with the 5Fr diagnostic catheter, did not preclude technical success. Each of the incidents of kinking occurred in patients with BMI > 30. Exovascular non-dilating groin closure (Mynx, Cardinal) was performed in 32 (64%) cases and manual compression in 18 (36%). All patients were discharged from recovery with 4 hours of total flat time with no symptomatic groin hematomas.ConclusionThe safety of trans-femoral cerebral angiography can be enhanced using a 4Fr groin access with a radial 5/4 slender sheath with the known benefits of utilizing 5Fr diagnostic catheters.DisclosuresJ. Campos: None. Z. Hsu: None. D. Zarrin: None. K. Golshani: None. N. Beaty: 2; C; Medtronic Neurovascular, Stryker Neurovascular. M. Bender: None. G. Colby: 2; C; Medtronic Neurovascular, MicroVention-Terumo, Stryker Neurovascular. L. Lin: 2; C; Medtronic Neurovascular, MicroVention-Terumo, Stryker Neurovascular. A. Coon: 2; C; Avail MedSystems, Imperative Care, InNeuroCo, Medtronic Neurovascular, MicroVention-Terumo, Q’apel, Rapid Medical, Stryker Neurovascular.