Transradial Approach for Aortoiliac and Femoropopliteal Interventions: A Systematic Review and Meta-analysis

Abstract

Purpose: To present a systematic review and meta-analysis comparing the transradial approach for aortoiliac and femoropopliteal interventions to the traditional transfemoral access. Methods: A search of the public domain databases MEDLINE, SCOPUS, Web of Science, and Cochrane Library Databases was performed to identify studies related to the use of the transradial approach for infra-aortic procedures. Meta-analysis was used to compare the transradial to the transfemoral route in terms of procedure success, complications, procedure parameters, and hospital length of stay. Results are presented as the odds ratio (OR) and 95% confidence interval (CI). Results: Nineteen studies containing 638 patients with transradial access for lower limb interventions were selected. Lesions were treated from the aortic bifurcation down to the popliteal artery. The mean technical success rate was 90.9%, conversion to a transfemoral approach was necessary in 9.9%, and complications were reported in 1.9%. The meta-analysis included 4 comparative studies involving 114 transradial and 208 transfemoral procedures. There was no significant advantage of either approach in terms of procedure success (OR 5.0, 95% CI 0.49 to 50.83, p=0.17), but the risk of developing a complication was significantly lower (OR 0.25, 95% CI 0.07 to 0.86, p=0.03) with the transradial approach. Conclusion: Transradial access for lower limb endovascular interventions can be performed with comparable technical success and a lower overall complication profile compared to transfemoral access.

Cerebrovascular Complications After Upper Extremity Access for Complex Aortic Interventions: A Systematic Review and Meta-Analysis

“…Furthermore, it is unclear how experienced the interventionists were regarding upper extremity access of any kind. This might be important as there is a clear learning curve in upper extremity access, as it is known for the transradial access [42]. All of these factors influence the external validity of our findings.…”

European guidelines on chronic mesenteric ischaemia – joint United European Gastroenterology, European Association for Gastroenterology, Endoscopy and Nutrition, European Society of Gastrointestinal and Abdominal Radiology, Netherlands Association of Hepatogastroenterologists, Hellenic Society of Gastroenterology, Cardiovascular and Interventional Radiological Society of Europe, and Dutch Mesenteric Ischemia Study group clinical guidelines on the diagnosis and treatment of patients with chronic mesenteric

“…A meta-analysis of radial and femoral access in infra-aortic interventions, using a maximum sheath size of 6-8.5 French, reported significantly fewer complications when radial access was used (OR 0.25, 95% CI 0.07-0.86). 102 A metaanalysis of hepatic artery interventions in patients with primary or secondary liver malignancy reported no differences in access-site-related outcomes of radial and femoral access, but did show a patient preference for radial access. 103 Based on extensive experience with femoral access, the still limited evidence supporting radial access, and the substantial complication rate of brachial access, the preferred entry site for PMAS is currently femoral, followed by (left) brachial or radial, but is primarily dependent on the expertise of the operator.…”

Commentary: The Long and Winding Road

“…In the article by Meertens et al, 1 the hospital length of stay was not statistically lower in TRA patients, and the radiation burden with the 2 accesses was similar. The operator working on lower extremity arteries via a TFA is very near the x-ray source.…”

“…The meta-analysis by Meertens et al 1 reported a need for a second access in about 10% of TRA procedures, which may appear as a limitation. However, if the transradial strategy fails, injections from this access can be used to better guide a femoral puncture and subsequent retrograde navigation of guidewires and also a more precise positioning of balloons and stents.…”