Can brain angiography (DSA) be done from hand instead of leg so that I can walk after the procedure?
The Traditional Approach:
Conventionally, brain angiography is conducted through the femoral artery in the leg. While this method provides clear imaging of cerebral blood vessels, it necessitates prolonged bed rest to prevent bleeding complications at the puncture site. This limitation often prolongs hospital stays and impedes patients’ ability to resume normal activities promptly.
The Emergence of Hand Angiography:
Hand angiography, a novel approach gaining traction in the Interventional Radiology, offers a promising solution to the mobility challenges associated with traditional femoral access. This technique involves accessing the radial or ulnar artery in the hand, offering several potential advantages over the conventional femoral approach. Performing angiography via the radial artery in the wrist, often referred to as “hand angiography” or “transradial angiography,” is a minimally invasive procedure used to visualize blood vessels in various parts of the body, including the brain.
Procedure Overview:
Hand angiography involves accessing the radial artery in the wrist using a specialized catheter inserted through a small puncture site. Once access is obtained, contrast dye is injected through the catheter to visualize the blood vessels of interest using fluoroscopy, a real-time X-ray imaging technique. By selectively injecting contrast dye into specific arteries, radiologists can obtain detailed images of the vascular anatomy and identify any abnormalities or blockages.
Advantages of Transradial DSA:
1.Enhanced Patient Comfort: The transradial approach is generally associated with less discomfort and a lower risk of complications compared to the transfemoral approach. Patients often report less pain and bruising at the puncture site in the wrist.
2.Recovery time: following transradial DSA is typically shorter, allowing patients to ambulate and resume normal activities sooner after the procedure. This can lead to a quicker return to daily routines and decreased post-procedure downtime.
3.Lower Risk of Bleeding: The radial artery in the wrist is smaller and more superficial than the femoral artery in the groin, reducing the risk of bleeding complications following arterial puncture. This may be particularly advantageous for patients at increased risk of bleeding or those on blood thinner medications.
4.Improved Patient Mobility: One of the significant advantages of transradial DSA is the ability for patients to mobilize and walk shortly after the procedure. This can enhance patient comfort and satisfaction by allowing them to move freely and avoid prolonged bed rest.
Considerations for Transradial DSA:
1.Operator Experience: Performing DSA via the radial artery requires specialized training and expertise on the part of the interventional radiologist or neurointerventional surgeon. Operators should be proficient in radial artery access techniques and familiar with potential complications.
2.Anatomical Variability: The radial artery may exhibit anatomical variations or tortuosity that can make arterial access challenging in some patients. Pre-procedural assessment with ultrasound or angiography may help identify suitable access sites and minimize complications.
3.Equipment and Technology: Specialized equipment and catheters designed for transradial access are necessary for performing DSA via the radial artery. Access sheaths, catheters, and guidewires optimized for radial access should be available to facilitate the procedure.
4.Patient Selection: Not all patients may be suitable candidates for transradial DSA, particularly those with small or tortuous radial arteries, significant peripheral vascular disease, or prior radial artery interventions. Patient selection should be based on individual factors and anatomical considerations.
This innovative approach offers patients the potential for enhanced mobility and faster recovery, thereby improving their overall experience and outcomes. While further research and advancements are needed to optimize the safety and efficacy of hand angiography, it represents a significant step forward in the field of cerebral vascular imaging
Conclusion:
Hand angiography represents a compelling alternative to traditional femoral access for brain angiography for visualizing blood vessels in the brain, with potential benefits including enhanced patient comfort, shorter recovery times, and improved mobility. However, successful implementation requires operator expertise, appropriate patient selection, and access to specialized equipment. Discussing the benefits and risks of transradial DSA with your interventional neuro radiologist can help determine the most suitable approach for your specific needs and circumstances. While hand angiography holds promise, its widespread adoption depends on various factors, including the operator’s expertise, patient anatomy, and equipment availability. Dr Suresh Giragani, with his vast experience in neurointerventions, has pioneered transradial technique for DSA as well as neurointerventions in Hyderabad, facilitating many DSA procedures to be done as short day care procedures.
About the Author:
Name: DR . SURESH GIRAGANI
INTERVENTIONAL RADIOLOGIST
DR. SURESH GIRAGANI CONSULTANT INTERVENTIONAL RADIOLOGIST at Apollo hospitals Jubilee Hills has more than sixteen years of clinical experience in vascular interventions with a special interest in neurovascular and peripheral vascular disease interventional procedures.