Use of Radial Access in the Thiel cadaveric flow model for training in endovascular interventions

Learning Objectives
To introduce a human cadaveric model for training in endovascular interventions through the radial access (RA).

Background
Interest in RA is gradually increasing with mounting evidence of its clinical benefits, particularly the lower incidence of bleeding and vascular complications. However, RA requires a steep learning curve and is technically challenging because of anatomical complexities, such as subclavian artery tortuosity and radioulnar loops. More catheter exchanges are requested, with a consequent increase in procedure and radiation time and volume of contrast used. Recent data suggest that the exposure time using RA approaches that using transfemoral access with an increase in the experience of the operator.

Clinical Findings/Procedure
Proof of concept was demonstrated using a Thiel-embalmed human cadaver with extracorporeal arterial flow. The extracorporeal circuit was prepared by inserting ports into the right auxiliary and femoral arteries and connected to a heart–lung bypass machine to provide continuous retrograde flow of up to 1 L per minute. Left RA was gained through ultrasound guidance using a 5-F sheath. Aortic and coronary angiogram, coronaroplasty, renal and lower limb angiography, and angioplasty were performed by a senior interventionalist, showing the patency and accessibility of vessels through RA. All endovascular procedures were conducted under fluoroscopic guidance using contrast.

Conclusion
Thiel cadavers have the potential to provide a robust and realistic training model for fellows and consultants who want to improve or practice interventions. Using the Thiel-embalmed human cadaver for training in endovascular peripheral intervention through RA is feasible and could reduce the learning curve for endovascular procedures.