Transradial versus transfemoral ancillary approach in complex structural, coronary, and peripheral interventions. Results from the multicenter ancillary registry: A study of the Italian Radial Club

Abstract

Objectives: to understand the role of a transradial (TR) secondary approach during complex percutaneous interventions. Background: The value of the TR route for ancillary vascular approach has not been adequately validated in this setting, and there is scant data on its role in reducing bleeding complications. Methods: In the present study we retrospectively included patients undergoing the following interventions requiring two vascular approaches at nine high-volume centers in Italy: structural cardiac interventions, complex PCI, endovascular aortic repair (EVAR) and complex lower limb angioplasty. We compared procedural outcomes according to the type of ancillary vascular approach selected, namely TR or transfemoral/transbrachial (TF/TB). Primary endpoints of the study were procedural success and in-hospital BARC grade 3-5 bleedings. Results: We included 906 patients, 433 receiving TR and 473 TF/TB ancillary approaches. Baseline characteristics did not differ significantly. Patients underwent the following types of intervention: structural 50%, complex coronary PCI 37%, EVAR 11%, peripheral angioplasty 2%. Procedural success was similar (90% in TR and 92% TF/TB, P 5 NS). In-hospital BARC 3/5 bleedings were more common in TF/TB group as compared to TR group (19.7% vs. 6.7%,P < 0.001). In TF/TB group we also observed a higher postprocedural hemoglobin drop (1.92 vs 1.13 g/dl, P 5 0.008) and longer hospital stay as compared to TR group. Similar results were observed in a propensity scorematched population of 450 patients. Conclusions: In our study TR ancillary approach was associated with a significant reduction in the risk of major bleedings, without jeopardizing the success of complex structural, coronary, and peripheral percutaneous interventions. The value of the transradial route for ancillary vascular approach during percutaneous interventions has not been adequately validated yet. We retrospectively

A less‐invasive totally‐endovascular (LITE) technique for trans‐femoral transcatheter aortic valve replacement

“…A very attractive way to reduce “secondary” access‐related complications is represented by the radial approach since it has been found to enhance safety across various percutaneous cardiovascular procedures. A large multicenter study compared the selection of “ancillary” radial or femoral approach in 906 patients undergoing complex structural, coronary, and peripheral percutaneous interventions (50% structural interventions with high prevalence of TAVR) . The trans‐radial ancillary approach was used in patients with similar complexity but was associated with a significant lower occurrence of major bleedings.…”

“…A large multicenter study compared the selection of "ancillary" radial or femoral approach in 906 patients undergoing complex structural, coronary, and peripheral percutaneous interventions (50% structural interventions with high prevalence of TAVR). 17 The trans-radial ancillary approach was used in patients with similar complexity but was associated with a significant lower occurrence of major bleedings. Moving to the specific TAVR setting, different groups started using the radial approach and first results look promising.…”

Transradial renal salvage after complex endovascular aneurysm repair complicated by left renal artery thrombosis

“…A transradial approach has demonstrated a favorable safety profile compared with a transbrachial approach. Transradial access has also been associated with lower postoperative hemorrhage rates and increased comfort for the patient 8, 11, 12. Furthermore, the risk of proximal access site complication, including hematoma and subsequent brachial plexus injury, is obviated with a transradial approach 13 …”

Transradial interventions in contemporary vascular surgery practice

“…TRA is particularly compelling for patients who carry a high risk of complications from a femoral approach (e.g. obese patients, those a with bleeding diathesis, orally anticoagulated patients) 6,27,28 and patients undergoing procedures with anatomic considerations that favor upper extremity access such as visceral artery interventions. 29 An antegrade approach to the mesenteric vasculature, such as in patients with mesenteric occlusive disease, often provides a more straight and coaxial approach to cannulation, as target vessels such as the celiac and superior mesenteric arteries are often acutely and caudally angled off of the aorta.…”