Implementation of the transradial approach as an alternative vascular access for transcatheter aortic valve replacement guidance: Experience from a high‐volume center

Abstract

Objective This study sought to assess the potential benefits of the transradial approach (TRA) as an alternative vascular access to the classical contralateral femoral approach for transcatheter aortic valve replacement (TAVR). Background Vascular and bleeding complications in TAVR have gradually decreased owing to operator experience and downsizing of the delivery system. However, about 1/4 of vascular access site complications are related to the transfemoral (TF) secondary access. Methods We compared the outcomes at 30 days according to VARC‐2 after TAVR of a prospective cohort of 217 consecutive patients undergoing right or left TRA as the second vascular access (TRA‐TF TAVR) and a retrospective cohort of 194 consecutive patients undergoing TF approach as a second vascular access (TF‐TF TAVR). Results Baseline clinical characteristics and risk scores were well matched in both groups. Procedural success rate was 99.7%. Fluoro time was significantly lower in the TF‐TF TAVR group (16.9 ± 7.2 vs. 19.1 ± 7.8 min, P = 0.003); however, there was no significant difference in x‐ray exposure, procedure time or amount of contrast used. In the TRA‐TF TAVR group, there were no complications related to the TRA access and there were less vascular and bleeding complications (18.0% vs. 9.7%, P = 0.014; 17.0% vs. 9.2%, P = 0.026, respectively), although blood transfusion requirement or hospitalization duration stay were similar in both groups. Conclusions TRA approach as alternative secondary vascular access in TAVR is safe and feasible and is associated with a significant decrease in vascular and bleeding complications. Further, large‐scale studies are warranted to confirm the potential benefit of this approach.

SCAI position statement on optimal percutaneous coronary interventional therapy for complex coronary artery disease

“…86 These hazards may be mitigated by the use of radial or ulnar artery access as the second-access site, bilateral radial access, or single-access femoral techniques for MCS-assisted PCI. 79,87,88 Radial access with newer dedicated long-shaft peripheral equipment may also be effective in both obtaining hemostasis and resolving complications during large-bore femoral access. 89 (e.g., retrograde CTO PCI).…”

“…Multiple arterial access sites are often needed for CTO PCI or adjunctive MCS device use during complex PCI, thereby increasing the periprocedural risks of bleeding, vascular complications, and mortality 86 . These hazards may be mitigated by the use of radial or ulnar artery access as the second‐access site, bilateral radial access, or single‐access femoral techniques for MCS‐assisted PCI 79,87,88 . Radial access with newer dedicated long‐shaft peripheral equipment may also be effective in both obtaining hemostasis and resolving complications during large‐bore femoral access 89 .…”

Clinical outcomes following single access transfemoral transcatheter aortic valve implantation

“…However, increasing the use of cerebral embolic protection devices may prevent right radial secondary access in the future. [8][9][10] Unilateral femoral access using two ipsilateral punctures is also safe and associated with improved patient satisfaction. 11 Isolated case reports have described the successful use of anatomical landmarks, or a small pigtail catheter inserted through an expandable TAVI sheath, for TAVI alignment achieving single access.…”

Simplified TAVR Procedure: How Far Is It Possible to Go?

“…Secondary vascular access is required for angiographic guidance during prosthesis deployment. Although vascular complications dramatically decreased in TF TAVR, one-fourth of these complications occurred at the secondary femoral access site, inciting the operators to use the radial artery for secondary access [ 34 ]. Radial access has been adopted as the default strategy in numerous centers and may decrease all vascular complications following TAVR, improve patient comfort and allow earlier ambulation [ 34 ].…”

“…However, radial access may be particularly challenging on the right in the case of tortuous vessels or spasms. Furthermore, managing the main femoral access vascular complication from the radial access may be challenging but feasible with appropriate tools [ 34 ].…”