Single arm access for combined transarterial and transvenous neurointerventional procedures - Technical note.

Abstract: A concurrent arterial and venous access is routinely obtained for diagnosis and treatment of various diseases such as dural arteriovenous fistula (DAVFs), arteriovenous malformation (AVMs), inferior petrosal sinus sampling, venous sinus manometry, and stenting. Traditionally venous access is obtained by accessing the femoral vein or through direct internal jugular puncture. Although complication rates are low, life-threatening severe complications have been reported. Moreover, venous access can be challenging in large body habitus patients through these traditional routes. There is a growing trend of utilizing radial artery access for neuroendovascular procedures. Nevertheless, the use of upper limb veins in neuro interventional procedures is rare. We present three cases of the concurrent arterial and venous approach through the radial artery and cephalic or basilic vein of the forearm for diagnostic cerebral arteriography and venography. Radial access was obtained by using the standard technique, and venous access was obtained by cannulating cephalic or basilic vein using ultrasound guidance, and a 5 or 6 F short sheath was placed. Venous angiography and catheterization of right and left internal jugular veins were then performed by using Simmons 2 catheter alone or using 6 F Envoy guide catheter coaxially over the Simmons 2 catheter if an additional support for microcatheter was needed. Procedures were successfully completed with no adverse effects, and patients were discharged home the same day. We also describe the technique for the reformation of the Simmons 2 catheter in the venous system for catheterization of right and left internal jugular veins through the arm access.