Transradial Access Chemoembolization for Hepatocellular Carcinoma Patients
September 20th, 2020
Transarterial chemoembolization (TACE) is the standard therapy for patients in the intermediate stage of hepatocellular carcinoma and is typically performed through femoral artery access. Compared with transfemoral access, transradial access (TRA) can decrease the rate of bleeding complications and improve patient tolerance. A method is presented here to perform transarterial chemoembolization via radial artery access.
Repetitive TACE is a common effective treatment for unresectable hepatocellular carcinoma, and is often performed via femoral artery access. However, the clinical feasibility or repeated transradial artery usage has not been confirmed. This technique reduces the risk bleeding, facilitates easier hemostasis, is easier to monitor, does not require lying in bed, enhances safety and improves patient comfort.
Demonstrating the procedure will be Dr.Zhang and Dr.Yang. For radial artery access, first place the patient in a supine position on the angiography table, and position the left arm parallel to the body, close to the left waist. Locate the distal radial artery by palpation, and clean the skin surface with 10%povidone iodine surgical scrub solution.
When the solution is air dried, cover the left arm with a surgical drape. In case of potential left radial artery puncture failure, sterilize and drape the right arm or right inguinal region to prepare an alternative access route. Apply topical anesthesia, proximal to the styloid process along the axis of the most powerful pulsation of the left radial artery, and extend the wrist.
Using a 20-gauge needle and modified Seldinger technique, puncture the radial artery. When pulsatile arterial blood return is observed, gently introduce a 0.021-inch hydrophilic guidewire into the vessel. Once access is obtained, remove the needle, and use the guidewire to introduce a four French hydrophilic sheath.
After sheath insertion, use a syringe to gently pump back a small amount of arterial blood to confirm that the sheath tip is located within the vessel, and inject the cocktail. To perform a superselective catheterization and chemoembolization, use a high pressure injector to perform an angiogram through the common catheter to confirm an adequate embolization and the location of the catheter tip within the common hepatic artery, then inject nine to 12 milliliters of the contrast agent at a three-to-four milliliter per second flow rate, and a fluoroscopy time of about 15 seconds, and remove the catheter of the guidewire to avoid damage to radial artery. To induce radial artery hemostasis, remove the catheter over the guidewire to avoid damage to the radial artery, and administer the remaining two milliliters of vasodilation cocktail solution through the radial artery sheath.
Immediately after all of the solution has been delivered, retract the sheath about five centimeters, and place a TR band over the radial access site on the left wrist, use the accompanying syringe to adequately inflate the TR band air bag with air, and completely remove the sheath. Slowly deflate the air bag when leaking is observed at the access site at one milliliter of air back into the cuff, then confirm that there is no bleeding or leakage while also checking that the distal radial artery pulse is palpable during hemostasis, and using a pulse oximeter to confirm the arterial wave form on the left thumb. In this table, the baseline clinical data of representative cases with technical success or failure are compared.
An increased number of catheters were required for patients suffering radial artery access technical failure. No significant correlations were found between the technical success or failure of the procedure and patient age, sex, or combined medical comorbidities. In this table, the numbers of transradial access transarterial chemoembolization procedures were compared.
Due to the low frequency of radial artery occlusions, no significant correlation was found between the increased rate of occlusion and the number of transradial access procedures. It is important to stay calm and collected while performing the procedure. After watching this video, you should have the confidence and ability to perform that technique.
We use ultrasound to improve the efficiency of the radial archery location, especially when the vessel is particularly small.
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Overview
Transarterial chemoembolization (TACE) is a standard therapy for intermediate-stage hepatocellular carcinoma, traditionally performed via femoral artery access. This article presents a method for performing TACE through transradial access, which may enhance patient safety and comfort.
Key Study Components
Area of Science
- Oncology
- Interventional Radiology
- Hepatology
Background
- TACE is commonly used for unresectable hepatocellular carcinoma.
- Transfemoral access is the traditional approach for TACE.
- Transradial access may reduce bleeding complications.
- Clinical feasibility of repeated transradial artery usage is not well established.
Purpose of Study
- To demonstrate a method for TACE via transradial access.
- To evaluate the benefits of transradial access over transfemoral access.
- To enhance patient comfort and safety during the procedure.
Methods Used
- Positioning the patient supine on the angiography table.
- Locating the distal radial artery by palpation.
- Cleaning the skin surface with a surgical scrub solution.
- Demonstration of the procedure by Dr. Zhang and Dr. Yang.
Main Results
- Transradial access reduces the risk of bleeding.
- Facilitates easier hemostasis and monitoring.
- Improves patient comfort as it does not require bed rest.
- Enhances overall safety of the procedure.
Conclusions
- Transradial access is a viable alternative for TACE.
- It may offer significant advantages over traditional transfemoral access.
- Further studies are needed to confirm long-term feasibility.
Frequently Asked Questions
Executive Industry Relevance
Transradial access for transarterial chemoembolization (TACE) offers a potential safety advantage by reducing access site bleeding complications compared to traditional transfemoral approaches. This method may improve patient comfort and procedural feasibility, particularly in high-risk populations such as elderly or obese patients, supporting risk mitigation in interventional oncology workflows.
Strategic Applications in Biopharma R&D
Early Discovery & Target Validation
- Scientific Value: Enables evaluation of locoregional therapeutic delivery systems in preclinical models with reduced procedural morbidity.
- Operational Value: Supports reproducible vascular access techniques for consistent drug delivery in liver-directed therapy studies.
Screening & Assay Development
- Scientific Value: Facilitates development of standardized embolization protocols for assessing drug-eluting bead performance.
- Operational Value: Provides a minimally invasive access route for repeated interventions in longitudinal efficacy studies.
Translational & Preclinical Research
- Scientific Value: Supports translational continuity by enabling image-guided delivery of investigational agents in large animal models.
- Operational Value: Reduces access-related complications, improving survival and data quality in survival endpoint studies.
Pipeline & Workflow Integration
The technique integrates into interventional oncology workflows as a vascular access method for locoregional therapy delivery, supporting early-phase drug delivery validation and preclinical-to-clinical translation.
- Discovery Biology: Enables hypothesis testing of liver-targeted therapeutics via controlled arterial delivery.
- Screening: Supports assay readiness through consistent catheter placement and embolization reproducibility.
- Analytics: Allows quantitative assessment of contrast dynamics and embolization efficacy via fluoroscopy.
- Translational Research: Bridges preclinical vascular access methods to clinical TACE procedures.
- Enterprise Reuse: Represents a scalable vascular access platform adaptable across multiple liver-directed interventions.
Operational & Enterprise Impact
- Scientific Value: Reduces mechanistic confounding from access-site complications in therapy response evaluation.
- Operational Value: Enhances procedural standardization and reproducibility across sites and operators.
- Strategic Value: Improves risk-adjusted decision-making by lowering procedural morbidity in therapeutic studies.
- Portfolio Impact: Enables safer advancement of liver-directed candidates through improved tolerability profiles.
Implementation Considerations
- Requires expertise in radial artery cannulation and microcatheter manipulation.
- Dependent on availability of radial-specific sheaths, guidewires, and hemostasis devices.
- Necessitates training for procedural failure management and crossover protocols.
- Requires adaptation for patient anatomy variations such as radial artery size or tortuosity.
- Limited by operator experience and institutional familiarity with transradial techniques.
