Radial approach for left gastric artery angiography and embolization for the treatment of obesity: Technical considerations

Abstract Background/Purpose Bariatric embolization of the left gastric artery (LGA) is being investigated as a technique to induce substantial weight loss in obese patients. Radial access is associated with less vascular complications than femoral access, especially in patients with severe obesity. We sought to assess the feasibility, safety and technical challenges of LGA angiography through radial access. Methods/Materials Patients with suspected coronary artery disease (CAD) and obesity (BMI > 30 kg/m 2 ) referred for diagnostic catheterization and/or percutaneous coronary intervention (PCI) were eligible. After completion of diagnostic and/or PCI, selective cannulation of celiac artery was performed and images of the LGA were taken from multiple views. Detailed procedural parameters such as procedure time, contrast volume and radiation data as well as anatomical variations were assessed. Results Between February and December 2018, we successfully achieved 50 selective angiographies of celiac artery from 54 enrolled patients (92.6%) and LGA was optimally visualized in 47/50 (97%) of cases. Right radial access was used in 50 cases. Mean age was 63.9 ± 8.0 years and 74% were men. Median BMI was 34.4 kg/m 2 [32.2–39.4]. The median procedural time was 7 (Piche et al., 2015; Pirlet et al., 2019, 2018; Bai et al., 2017; Elens et al., 2019; Kipshidze et al., 2015 [5–10]) minutes, contrast volume was 41 [33–63], fluoroscopy time was 160 [103–248] seconds and radiation exposure was 3125 [1906–4735] Gy.cm2. No complications were noted. The mean difficulty of the procedure on a visual analogue scale was 4/10. Conclusions LGA angiography via transradial approach was feasible in the large majority of CAD patients with obesity. No safety issues were encountered.