To Transfemoral Approach Research Articles

The clinical application of transarterial embolization via radial artery in hemorrhagic diseases in obstetrics and gynecology

PurposeThe present study aimed to explore the feasibility and safety of Transarterial embolization (TAE) in the treatment of obstetrics and gynecological hemorrhagic diseases transradial approach (TRA) compared to transfemoral approach (TFA).MethodsThis cohort study was conducted on patients with obstetrics and gynecology bleeding diseases from June 2021 to November 2022. Clinical characteristics of the patients were comparable between the two groups. The success rate of puncture and embolization, radiation dose, operation time, fluoroscopy time (FT), as well as complications of each patient were recorded and then retrospectively analyzed the data. The European Five-dimensional Health Scale (ED-5Q) and visual analog scale (VAS) were used to assess the quality of life (QOL) on the day of discharge and 30 days after surgery between the two groups.ResultsA total of 71 patients undergoing TAE were allocated to the TRA (n = 31) or TFA (n = 40) group in this study. Puncture and embolization were completed in all patients. Compared to the TFA group, the radiation dose of the TRA group (343.89 ± 108.81 mGy vs. 469.29 ± 198.66 mGy; p = 0.029) is significantly reduced. Minor complications occurred in only one patient (3.2%) in the TRA group. The surgery-related quality of life EQ-5D index score on the day of discharge in the TRA group (0.72 ± 0.12 vs. 0.65 ± 0.11; p = 0.017) was significantly higher than that in the TFA group, and the VAS score (2.55 ± 0.62 vs. 2.95 ± 0.85; p = 0.025) of catheter site discomfort was significantly lower in the TRA group were than in the TFA group, but no significant difference was observed in the QOL assessment at 30 days post-surgery.ConclusionTransradial approach TAE has comparable efficacy and safety to TFA TAE in treating obstetrics and gynecological bleeding diseases. This access can improve patient QOL without affecting surgical safety.

Comparing the Safety and Feasibility of Endovascular Therapy via Transradial and Transfemoral Approaches in Patients with Aortoiliac Occlusive Disease: A Propensity Score-Matched Analysis of the Nationwide Registry.

Our objective was to evaluate the feasibility of performing endovascular therapy (EVT) for aortoiliac artery disease using transradial approach (TRA) as compared to transfemoral approach (TFA). We analyzed 9671 cases with symptomatic lower extremity artery disease due to aortoiliac occlusive disease (AIOD) treated using EVT from a Japanese Nationwide EVT Registry between January and December 2021. We compared the baseline characteristics, procedural information, and 30-day outcomes of patients who received EVT only via TRA (n=863 [16.9%]) and those only via TFA (n=4255 [83.1%]) by using propensity score (PS) matching, after excluding those who required regular dialysis, those who underwent hybrid surgeries, and those who received EVT through 2 or more approach sites. After matching, the final study population consisted of 862 matched patients with similar baseline characteristics in each group. Technical success rate was comparable between the 2 groups (99.3% vs. 99.3%, p>0.99). No significant differences were observed with respect to the composite of all-cause death within 48 hours after EVT and post-procedural complications within 30 days, including severe bleeding that required transfusion, revascularization procedures, urgent surgeries, cerebral infarction, and major limb amputation (0.2% vs. 0.7%, p=0.29). Transradial approach was associated with shorter operation time (85 vs. 90 minutes, p=0.016), but longer fluoroscopy time (26 vs. 20 minutes, p<0.001) and higher contrast agent volume (80 vs. 75 mL, p<0.001). After PS matching, TRA showed the comparable rates of successful EVT and 30-day complications in patients with AIOD compared to TFA. Transradial approach was found to be safe and be a viable alternative of TFA for the treatment of AIOD. The efficacy of transradial approach (TRA) is established in percutaneous coronary intervention; however, its safety and feasibility are unclear in endovascular therapy (EVT). We analyzed 9,671 cases with symptomatic aortoiliac occlusive disease treated using EVT from a Nationwide Registry to compare the 30-day outcomes of those who received EVT only via TRA (n = 863 [16.9%]and those only via TFA (n=4,255 [83.1%]) by using propensity score matching. Technical success rate (99.3% vs. 99.3%, p > 0.99) and 30-day complications (0.2% vs. 0.7%, p = 0.29) were comparable between the two groups. EVT via TRA could be performed safely.

Randomized Comparison Between Radialand Femoral Large-Bore Accessfor Complex Percutaneous Coronary Intervention.

The aim of this study was to investigate whether transradial (TR) percutaneous coronary intervention (PCI) is superior to transfemoral (TF) PCI in complex coronary lesions with large-bore guiding catheters with respect to clinically relevant access site-related bleeding or vascular complications. The femoral artery is currently the most applied access site for PCI of complex coronary lesions, especially when large-bore guiding catheters are required. With downsizing of TR equipment, TR PCI may be increasingly applied in these patients and might be a safer alternative compared with the TF approach. An international prospective multicenter trial was conducted, randomizing 388 patients with planned PCI for complex coronary lesions, including chronic total occlusion, left main, heavy calcification, or complex bifurcation, to either 7-F TR access (TRA) or 7-F TF access (TFA). The primary endpoint was defined as access site-related clinically significant bleeding or vascular complications requiring intervention at discharge. The secondary endpoint was procedural success. The primary endpoint event rate was 3.6% for TRA and 19.1% for TFA (p<0.001). The crossover rate from radial to femoral access was 3.6% and from femoral to radial access was 2.6% (p=0.558). The procedural success rate was 89.2% for TFA and 86.0% for TRA (p=0.285). There was no difference between TFA and TRA with regard to procedural duration, contrast volume, or radiation dose. In patients undergoing PCI of complex coronary lesions with large-bore access, radial compared withfemoral access is associated with a significant reduction in clinically relevant access-site bleeding or vascular complications, without affecting procedural success. (Complex Large-Bore Radial Percutaneous Coronary Intervention [PCI] Trial [Color]; NCT03846752).

Transradial Approach for Complex Anterior and Posterior Circulation Interventions: Technical Nuances and Feasibility of Using Current Devices.

Despite several studies analyzing the safety of transradial access (TRA) for neurointervention compared to transfemoral approach (TFA), neurointerventionalists are apprehensive about implementing TRA. From our positive institutional experience, we now utilize TRA first line for a majority of our cases. Here, we present our single-institution experience. To determine safety and feasibility of TRA for neurointervention. Through retrospective review of patients receiving TRA for anterior and posterior circulation cerebrovascular interventions at our institution between December 2015 and January 2018, we present our experience regarding this transition, while focusing on technique, complications, feasibility, indications, and limitations. One hundred five procedures were performed on 92 patients (anterior circulation: 77%; posterior circulation: 23%). Radial artery access was achieved in all patients. Twenty-nine cases constituted mechanical thrombectomy, 33 cases represented intracranial aneurysms treatments, and 33 cases included interventions like angioplasty, balloon test occlusion, chemotherapy delivery, and thrombolysis. TRA was used as second-line access to TFA in 5 instances due to aortic arch anomalies and atherosclerotic disease. Minor access-site complications were seen in 2.85% of patients. Ten procedures (9.0%) could not be completed with TRA, with crossover to TFA occurring in 7 cases. TRA is safe and feasible for the majority of neurointerventional procedures and provides decreased risk of major access-site complications compared to TFA. Perceived limitations of TRA can likely be eliminated via operator experience and engineering ingenuity; thus, there is a role for TRA for neurointervention, especially in patients with increased risk of access-site complications from TFA.

Abstract 17350: Comparison of Radiological Risk Between Transfemoral and Transradial Approach: An Updated Meta-Analysis

Background: Studies have shown that transradial approach (TR) is associated with increased radiation exposure compared to transfemoral (TF) approach. However, it is believed that the difference in radiation exposure may not be significant between the two approaches when performed by experienced operators, as TR approach has a challenging learning curve. Newer studies have shown conflicting results in radiation exposure between the two treatment strategies. Hence, we sought to perform a meta-analysis comparing the radiation exposure between TR and TF approach during coronary angiography (CA) and percutaneous coronary intervention (PCI). Methods: We searched PubMed, EMBASE and SCOPUS for eligible studies. 27 randomized controlled trials (RCTs) were included in our analysis. Outcomes analyzed were Fluoroscopy time (FT) in minutes and dose-area product (DAP) in Gy/cm2. We used Inverse variance random effects model to calculate the mean difference (MD) and 95% confidence interval (CI). We performed a subgroup analysis of trials that compared the two approaches for CA and PCI separately. We also performed a subgroup analysis of trials that only included self-identified experienced operators. Results: FT was reported by 26 trials and was significantly higher with TR approach for both CA (MD=1.28, 95% CI 0.78 to 1.77, P &lt;0.00001) and PCI (MD=0.96, 95% CI 0.59 to 1.33, P&lt;0.00001). FT was still higher (MD=0.95, 95% CI 0.63 to 1.27, P&lt;0.00001) in subgroup analysis of trials that only included experienced operators. DAP was only reported in 10 trials and there was no significant difference between TR and TF approach for both CA (MD=1.44, 95% CI -0.52 to 3.41, P=0.15) and PCI (MD=0.54, 95% CI -4.45 to 5.53, P=0.83). There was also no significant difference in DAP (MD=0.81, 95% CI -3.68 to 5.29, P=0.79) between the two approaches in trials that only included experienced operators. Conclusions: TR approach is associated with higher radiation exposure than TF approach even with experienced operators. However, the clinical significance of this finding has to be evaluated in larger RCTs.

TCT-274 Incidence and predictors of forearm hematoma during transradial approach for percutaneous coronary interventions

Transradial approach for percutaneous coronary intervention (TRA-PCI) reduces vascular complications compared to transfemoral approach (TFA) especially bleeding complications. Hematoma even though less frequent than TFA, but is not uncommon and presentation ranges from mild hematoma to compartment

Effect of Left Versus Right Radial Artery Approach for Coronary Angiography on Radiation Parameters in Patients With Predictors of Transradial Access Failure

Left transradial approach (TRA) for coronary angiography is associated with lower radiation parameters than right TRA in an all-comers population. The aim of this study was to determine the effects of left versus right TRA on radiation parameters in patients with predictors of TRA failure. Patients with predictors of TRA failure (≥3 of 4 following criteria: age ≥70years, female gender, height ≤64 inches, and hypertension) referred to TRA operators were randomized to either right (n= 50) or left (n= 50) TRA, whereas those referred to transfemoral approach (TFA) operators were enrolled in a prospective registry (n= 50). The primary end point was the radiation measure of dose-area product (DAP). In an intention-to-treat analysis, DAP (34.1Gy·cm(2) [24.9 to 45.6] vs 41.9Gy·cm(2) [27.3 to 58.0], p= 0.08), fluoroscopy time (3.7minutes [2.4 to 6.3] vs 5.6minutes [3.1 to 8.7], p= 0.07), and operator radiation exposure (516 μR [275 to 967] vs 730 μR [503 to 1,165], p= 0.06) were not significantly different between left and right TRA, but total dose (411mGy [310 to 592] vs 537mGy [368 to 780], p= 0.03) was significantly lower with left versus right TRA. Radiation parameters were lowest in the TFA cohort (DAP 24.5Gy·cm(2) [15.7 to 33.2], p <0.001; fluoroscopy time 2.3minutes [1.5 to 3.7], p <0.001; operator radiation exposure 387 μR [264 to 557]; total dose 345mGy [250 to 468], p= 0.001). Results were similar after adjustment for differences in baseline characteristics. In conclusion, median measurements of radiation were overall not significantly different between left versus right TRA in this select population of patients with predictors of TRA failure. All measurements of radiation were lowest in the TFA group.

THE PREDICTORS AND CLINICAL IMPACT OF FAILURE OF TRANSRADIAL APPROACH FOR PRIMARY PERCUTANEOUS CORONARY INTERVENTION IN STEMI PATIENTS IN THE SINGLE-CENTER REGISTRY

Transradial approach (TRA) improves clinical outcomes driven by less hemorrhagic complications in patients with ST-elevation acute myocardial infarction (STEMI), as compared to transfemoral approach (TFA). However, TRA is sometimes avoided in clinical practice due to its procedural complexity, which

TCTAP A-162 Usefulness of Routine Angiographic Evaluation to Detect Upper-Limb Artery Anomalies

Transradial Approach (TRA) for diagnostic catheterization and percutaneous coronary intervention (PCI) has become popular over the last few years. Increased use of TRA compared to Transfemoral Approach (TFA) is related to patient preference and comfort, low risk of vascular and bleeding

TCT-420 The fluoroscopy time, door to balloon time, contrast volume use and prevalence of vascular access site failure with transradial versus transfemoral approach in ST segment elevation myocardial infarction: A meta-analysis

Transradial approach (TRA) for percutaneous coronary intervention has been shown to decrease access site complications, bleeding and mortality compared to transfemoral approach (TFA). However, concerns about higher access site failure rate and door to balloon time with TRA in ST segment elevation

Predictors of Access Site Crossover in Patients Who Underwent Transradial Coronary Angiography

Despite increasing use of the transradial approach (TRA) for coronary angiography, TRA failure and subsequent access site crossover remain a barrier to TRA adoption. The aim of this study was to elucidate patient and procedural characteristics associated with TRA to transfemoral approach (TFA) crossover and examine TRA to TFA crossover by operator experience over time. This retrospective analysis identified 1,600 patients who underwent coronary angiography with possible percutaneous coronary intervention through TRA by operators with varied TRA experience in an urban tertiary care center from October 2010 to August 2013. Univariate and multivariable logistic regression were used to identify independent predictors of access site crossover, from TRA to TFA, and strength of association is presented as odds ratio (OR, 95% confidence interval [CI]). Access site crossover was noted in 166 patients (10.4%). Multivariable predictors of access site crossover included age >75years (OR 1.90, 95% CI 1.23 to 2.91, p= 0.004) and operator experience (OR 2.98, 95% CI 1.96 to 4.52, p <0.0001). Less experienced operators (≤5years TRA experience) had a decrease in access site crossover over time (quartile 1: 8.9%, quartile 2: 18.8%, quartile 3: 16.4%, and quartile 4: 8.6%, p <0.001), which paralleled an increase in the proportion of procedures using initial TRA over time (quartile 1: 38.0%, quartile 2: 53.7%, quartile 3: 54.8%, and quartile 4: 70.3%, p <0.001). Experienced operators (>5years TRA experience) had no significant change in proportion of access site crossover over time (quartile 1: 2.8%, quartile 2: 6.4%, quartile 3: 5.6%, quartile 4: 5.8%, p= 0.54). In conclusion, rate of access site crossover in the contemporary era is relatively low and can be mitigated with operator experience.

Does Transradial Approach become a Golden Standard for Percutaneous Coronary Interventions?

Transradial approach (TRA) in percutaneous coronary interventions (PCI) today becomes widely accepted and practiced procedure worldwide. TRA for PCI is safe and fast growing alternative to transfemoral approach (TFA) in many clinical settings and it is the desirable vascular access for most highly experienced operators. Although the TRA provides many clinical and economical benefits, may be the most important advantage is a decreased rate of vascular access-related bleeding complications after PCI. TRA is associated with certain learning curve and generally it requires higher technical skills of the operator compared to TFA. If progressive use of TRA for PCI continues to rise over next several years, we can expect soon TRA to become a golden standard for PCI procedures. Radial artery occlusion (RAO) remains one of the possible consequences of TRA especially if repeated PCI is performed via the same radial artery. TRA is feasible and effective approach for PCI in vast majority of patients and its value becomes especially important in high risk subset of patients including STEMI patients. The main advantages over TFA include lower rate of access-site bleeding complications, lower mortality in STE-ACS, better patient comfort, early ambulation and shorter in-hospital stay and they are clearly documented today.

Comparison of Procedural and Long-Term Outcomes between Transradial and Transfemoral Approach in One-Stage Intervention for Triple Vessel Coronary Artery Disease

The aim of the present study was to evaluate the safety, feasibility, procedural, and long-term outcomes by the transradial (TR) approach as compared to transfemoral (TF) approach in patients with triple vessel coronary artery disease undergoing one-stage percutaneous coronary intervention. The feasibility, safety, and efficacy between the TR and TF approach for coronary interventional treatment have been compared in some complex situations including AMI and unprotected left main disease. However, in terms of triple vessel disease (3VD) intervention, there has been no comparison regarding procedural and long-term outcomes between the TR and TF approach. A total of 4,974 consecutive patients (TR n = 3,856, TF n = 1,118), who were diagnosed with 3VD without LM disease and underwent one-stage percutaneous revascularization, were enrolled in the study. Procedural results and clinical outcomes were obtained through database and follow-up. We used the propensity score matching method and obtained 930 pairs of patients with comparable baseline data in order to compare the procedural and long-term outcome between TR and TF groups. In the study cohort, risk reduction of all the clinical outcomes were evaluated with Cox's proportional-hazards models. Cumulative incidences concerning safety and efficacy of the cohort were estimated by the Kaplan-Meier method and a comparison was made utilizing the log-rank test. After propensity score matching, the baseline clinical and angiographic characteristics were similar between the 2 groups. Regarding procedural results, no significant differences were observed between the 2 groups, with the exception of a decreased hospital stay (TR 7.49 ± 4.46 days vs. TF 8.63 ± 6.23 days, P < 0.0001) and fewer bleedings (TR 1.0% vs. TF 2.9, P = 0.003) in the TRI group. After an average 21-month follow-up, the all-cause mortality (TR 1.7% vs. TF 4.2%, P = 0.0014; HR 0.44, 0.25-0.79) was significantly lower with TRI patients. Other clinical outcomes were comparable between the 2 groups. As compared to TFI, TRI for 3VD intervention is feasible, safe, and associated with similar procedural success, shorter hospitalization, reduced bleeding, lower incidence of death, and comparable long-term efficacy.

Working through complexities of radial and brachial vasculature during transradial approach

The aim of this review is to discuss different methods of working through radial artery (RA) and brachial artery (BA) vascular complexities to increase the success rate of transradial approach (TRA). Anatomical complexities of RA and BA vasculature are an important reason for failure of TRA. There are few current data describing methods to overcome these challenges and reduce TRA failure. A series of the primary RA and BA anatomical complexities are identified and management techniques to overcome these variants are discussed. RA and BA vascular complexities can be divided into three subsets including (1) radial artery spasm (RAS); (2) variant anatomy including tortuosity, loops, and anomalous origin of RA; (3) acquired abnormalities including perforations, atherosclerotic lesions, and calcification of RA. In-depth discussion with supportive examples for the identification and management of these challenges are provided. A classification of RAS and perforations is shown and simple algorithms that have been developed for management of RAS, perforations and loops are explained. Despite lower rates of bleeding and vascular complications as compared to transfemoral approach (TFA), the adoption has been relatively slow particularly due to higher failure rates. Anatomical complexities of RA and BA vasculature play an important role for TRA failure cases. Using a simply framework to classify the anatomical or functional problem, and then approach these challenges in a logical sequence should facilitate management and increase success rate for TRA.

Emerging Evidence that Radial is Safer than Femoral Percutaneous Coronary Intervention in Subjects with ST Segment Elevation Myocardial Infarction.

Bleeding complications in patients with acute coronary syndromes are a significant predictor of mortality. Trans-radial approach (TRA) is a promising strategy to reduce bleedings in patients undergoing invasive coronary procedures. Recently, two multicentre prospective randomized trials aimed to test whether TRA, compared to trans-femoral approach (TFA), may improve clinical outcome in patients with ST-elevation myocardial infarction: the RIFLE STEAC and STEMI-RADIAL. In the RIFLE STEACS, the primary endpoint of 30-day NACEs occurred in 68 patients (13.6%) in the TRA arm and 105 patients (21.0%) in the TFA arm (p = 0.003). In particular, compared with TFA, TRA was associated with significantly lower rates of cardiac mortality (5.2% vs. 9.2% , p = 0.020), bleeding (7.8% vs. 12.2%, p = 0.026), and shorter hospital stay (5 days, [range, 4 to 7 days]; vs. 6 [range, 5 to 8 days]; p = 0.03). In the STEMI-RADIAL, the primary endpoint of major bleeding or access site complications occurred in 7.2 percent of the TFA patients and 1.4 percent of the TRA patients (p=0.0001). The rate of MACE at 30 days was 4.2 percent in the TFA group, and 3.5 percent in the TRA group (p=0.7). The results of two recent trials support the systematic adoption of TRA instead of TFA approach to improve the clinical outcome of STEMI patients. In the present paper, we overview the results of these two trials and put them in the context of previous scientific evidences collected in this field.

Partner IA: What It Means for Surgeons

Since commercialization of transcatheter aortic valves in 2007, there have been an estimated 40,000 valves implanted in patients in 42 countries outside of the United States. Despite this extensive experience, there has been only one randomized controlled trial completed and a second one that is currently underway. The completed trial, the Partner Trial, was a randomized trial of the Edwards Lifesciences Sapien Valve, a bovine pericardial tissue valve mounted in a balloon deployable stainless steel stent. The Partner Trial was in fact 2 parallel trials of patients with severe aortic stenosis deemed to be either inoperable or at high risk for surgical aortic valve replacement (AVR) who were randomized against separate control groups. Inoperable patients, termed Cohort B, were randomized to transfemoral (TF) transcatheter aortic valve replacement (TAVR) or medical therapy, which included balloon valvuloplasty in 84% of patients.1 Three hundred fifty-eight patients were randomized equally between the 2 groups. The primary trial end point was superiority, and patients who received the transcatheter valve had an absolute 20% survival benefit at 1 year over control patients who received medical therapy only. These results were presented in July 2011 to an Expert Advisory Panel to the U.S. Food and Drug Administration, which recommended regulatory approval.2 That approval was granted in November 2011, and this valve is now available for commercial implantation for inoperable patients in the United States. The other arm of the trial, so-called Partner Cohort A, randomized 699 patients to TAVR by a TF approach or if they were not candidates for a TF approach to a transapical (TA) approach.3 That cohort of the trial resulted in 2 arms in which 244 patients received a TF valve and were compared with 248 surgical AVR controls. Those patients who were not candidates for the TF approach were random-