A new imaging classification for safer radial access visceral intervention (R.A.V.I.) of the liver and optimal case selection; a preliminary report.

BACKGROUND: The aim of this study was to evaluate the use of a new classification for safer transradial access hepatic interventional radiology, based on preoperative evaluation of the location of the left subclavian artery bifurcation in the aortic arch.

METHODS: Thirty-eight consecutive patients with hepatocellular carcinoma (HCC) and 74 sessions of Radial Access for Visceral Intervention (R.A.V.I.) were reviewed. We classified the location of the left subclavian artery bifurcation in the aortic arch in three areas using an oblique view CT image matched with the curve of the aortic arches according to a new criteria Three Areas Criteria For R.A.V.I. (named "TAC-F-R") and measured the required time from initial left radial artery arteriography to celiac artery (CA) or superior mesenteric artery (SMA) arteriography.

RESULTS: The median time required for left radial artery arteriography to the CA or SMA arteriography in each of the three areas were: Area-A, 0:11:10 (hr, min., sec.); Area-B, 0:14:44; Area-C, 0:31:51. There were significant differences between each area after Bonferroni correction (P<0.01; A vs. B, P=0.086; A vs. C, P=0.001; and B vs. C, P=0.045), with Areas A and B requiring a significantly shorter time. Finally, no patients showed neurogenic disfunction within one week after the R.A.V.I.

CONCLUSIONS: The new classification "TAC-F-R" for safer transradial access hepatic interventional radiology is effective for avoiding difficult cases and selects more preferred patients with HCC for the R.A.V.I.

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