Purpose Transradial access (TRA) has been shown to lower morbidity and bleeding complications compared to transfemoral access (TFA) in percutaneous coronary interventions. Transfemoral crossover has been used to describe instances where interventions are initiated via the radial artery but require a secondary access site for completion. In this study, we evaluate the incidence and outcomes of transfemoral crossover in peripheral vascular interventions. Material and Methods A retrospective review was performed for all peripheral interventions for which the initial attempt at vascular access was the radial artery and either ipsilateral or contralateral femoral artery access was obtained prior to completion. A Barbeau test was first performed in all cases. Following this, access to the left radial artery was attempted under ultrasound guidance using a micropuncture with placement of a hydrophilic-coated sheath (5, 6 Fr). Following sheath placement, a standard solution of heparin (3000 units), verapamil (2.5 mg), and nitroglycerin (200 mcg) was administered intra-arterially. Upon completion, a TR-band (Terumo, Somerset, New Jersey) was used for hemostasis. Incidence of femoral crossover, reason for femoral crossover, secondary access site used, and major and minor adverse events were recorded. Results From April 2012 to July 2014, a total of 960 procedures were performed in 633 patients for which the radial artery was intended as the primary access site. Of these, there were 18 procedures in 18 patients (66 ± 13 years, 10 female, 8 male) completed with femoral access yielding an overall femoral crossover rate of 1.9%. Procedures performed were peripheral embolization (n = 7), radioembolization (n = 5), chemoembolization (n = 3), and peripheral vascular stent placement (n = 3). Causes of femoral crossover included vessel spasm/small vessel diameter (n=7; 38%), radial loops (n=5; 28%), proximal occlusion (n=3; 17%), and catheter length limitations (n=3; 17%). There were no complications in 14 of the 18 procedures. Other outcomes in transfemoral crossover cases that occurred in 1 patient each included Grade 2 hematoma in an endoleak repair performed at the contralateral site due to vessel spasm, bruising in a radioembolization performed at the ipsilateral site due to radial loop and bruising in another patient in a renal stent performed at the contralateral site due to vessel spasm, and radial spasm in a radioembolization performed at the ipsilateral site due to vessel spasm. Conclusions In our experience, incidence of transfemoral crossover in peripheral vascular interventions initiated via a transradial approach is extremely low. Recognizing anatomical and experience-related factors contributing to femoral crossover may be helpful in lowering access site complications while analysis of technical limitations may contribute to future product development.
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