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Transradial approach for aortoiliac, femoropopliteal lesions safe, effective vs. transfemoral access
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In patients undergoing intervention for aortoiliac and femoropopliteal stenoses and occlusions, the use of a transradial approach appears to yield comparable safety and efficacy vs. a transfemoral approach, according to recent findings.
In the single-center, retrospective study, researchers evaluated 188 patients (mean age, 66 years; 116 men) with lower limb claudication (n = 158; 84%) or critical limb ischemia (n = 30; 16%) who were treated with aortoiliac (n = 117; 62.4%) or femoropopliteal (n = 71; 37.6%) interventions on 210 lesions from 2013 to 2015.
Patients’ suitability for a transradial approach was determined in a case-by-case manner by operators who had performed more than 2,500 transradial procedures. The following exclusion criteria for transradial approach were applied: known Raynaud’s disease, symptoms of upper limb claudication, absent pulses, or end-stage renal failure and planned dialysis.
Intervention was performed using transfemoral access in 123 (65.4%) patients originally, and a transradial approach was used in 65 (34.6%) patients.
Patients were seen for follow-up at hospital discharge and 4 to 6 weeks after the procedure, at which time access sites were evaluated.
The researchers defined femoral approach failure as the need to convert to the contralateral femoral artery to complete the procedure, and transradial approach failure was defined as the need for any type of alternative access to complete the procedure. Major access-site vascular complications included vessel perforation, occlusion, pseudoaneurysm, arterial dissection, compartment syndrome, retroperitoneal hematoma, hematoma > 5 cm, the need for blood transfusion, drop in hemoglobin > 3 g/dL, and any event necessitating vascular intervention.
Failure data
The researchers found that 11 (16.9%) transradial approach procedures were not successful vs. nine (7.3%) femoral approach procedures (P = .42). Of the cases in which crossover to femoral approach was needed, nine were due to lesions needing alternative equipment and two were due to aortic arch vessel tortuosity.
Of the 11 transradial approach failures, seven (63.6%) were in chronic total occlusions, whereas 22 (40.7%) of 54 successful transradial approach procedures were CTOs (P = .16).
Of the 134 femoral approach procedures (balloon angioplasty, stents), 112 (83.6%) were retrograde and 22 (16.4%) were antegrade. The femoral approach group had more Trans-Atlantic Inter-Society Consensus (TASC) type C and D lesions vs. the transradial approach group (P = .02).
The two groups did not demonstrate disparities in sheath sizes (5F to 8F) and no significant differences were observed in procedure time (successful transradial approach, 46.8 minutes; transfemoral approach, 50 minutes) or hospital length of stay (transfemoral group, 2.2 days; transradial group, 2.1 days; P = .24).
Safe and feasible
No intraprocedural strokes occurred, but a hematoma > 5 cm requiring surgical drainage occurred in one (0.7%) patient in the transfemoral group (P = .56). There were two (3.7%) asymptomatic radial artery occlusions, neither of which occurred in those for whom the transradial approach failed. Overall, access-site complications occurred in 6% of femoral approach patients vs. 3.7% of transradial approach patients (P = .12). However, further intervention was required for all access-site complications in the femoral approach group vs. none of the access-site complications in the transradial approach group (P < .001).
“This study provides further evidence that transradial arterial access, in particular from the left radial artery, has comparative safety and efficacy to transfemoral access for peripheral interventions and is feasible for the majority of lesion subjects,” the researchers wrote. “Outstanding issues still remain regarding dedicated device lengths and the need for appropriate [randomized controlled trial] data.” – by Jennifer Byrne
Disclosure: The researchers report no relevant financial disclosures.
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