Transradial versus transfemoral arterial access in DEB-TACE for hepatocellular carcinoma

Abstract

Objectives Transradial access has become increasingly popular in body interventional procedures but has not been ubiquitously adapted. This retrospective study compares the efficacy of this approach versus transfemoral access in hepatocellular carcinoma (HCC) patients who underwent drug-eluting bead transarterial chemoembolization (DEB-TACE). Materials and Methods A total of 130 HCC patients underwent 146 DEB-TACE procedures within our institution from June 2015 to May 2020. About 90 and 56 procedures were logged for the transradial and transfemoral cohorts, respectively. Peak skin dose, fluoroscopy time, administered contrast volume, total procedure time, and equipment cost data for each procedure were reviewed to evaluate for statistical differences between the two groups. Results All 146 cases were technically successful without major complications or access failures in either group. No statistical differences were present between the two access groups in regards to peak skin dose or fluoroscopy time. Transradial access recorded a significantly higher contrast volume (P < 0.05), and a significantly longer procedural time than transfemoral access (P < 0.01). However, transradial access also displayed a significantly lower procedural equipment cost (P < 0.01) between the two groups. Conclusion Transradial DEB-TACE has similar trends to transfemoral DEB-TACE in several pertinent radiation parameters and is also significantly more cost-efficacious. The results of this investigation suggest the consideration of transradial access whenever viable as an alternative to transfemoral access in the DEB-TACE treatment of HCC patients.

Comparison Between Radial and Femoral Artery Access for Transarterial Chemoembolization in Patients With Hepatocellular Carcinoma

“…This is consistent with the results of Ghosh et al who found no differences in terms of radiation dose between RAA (mean, 1578.9 mGy) and FAA (mean, 1383.0 mGy) ( P = .08) and in terms of fluoroscopy time (26.8 min vs. 24.8 min, respectively ( P = .23). 25 Similarly, Yamada et al reported no differences in median radiation dose given to the patient between RAA (811 mGy) and FAA (1200.5 mGy) ( P = .229) in 36 patients with HCC who underwent either transarterial bland embolization or TACE. 30 In a study involving 42 patients undergoing TACE with successive RAA and FAA, Iezzi et al found no significant differences in term of fluoroscopy time between RAA (399.6 ± 85.8 [SD] s) and FAA (356 ± 26 [SD] s) ( P = .071).…”

“…5 Similarly, Ghosh et al reported a 100% technical success rate between RAA (90/90) and FAA (56/56). 25 In another study, Wan et al reported 92.3% (24/26) technical success rate for hepatic arterial infusion chemotherapy using RAA and 100% (43/43) technical success rate using FAA in their retrospective cohort ( P = .139) and 100% technical success rate using RAA or FAA in their prospective cohort. 21 The same results were reported by Iezzi et al who found 100% technical success rates for TACE using either RAA or FAA.…”

“…This is consistent with the results of Ghosh et al who found no differences in terms of radiation dose between RAA (mean, 1578.9 mGy) and FAA (mean, 1383.0 mGy) (P = .08) and in terms of fluoroscopy time (26.8 min vs. 24.8 min, respectively (P = .23). 25 Similarly, Yamada et al reported no differences in median radiation dose given to the patient between RAA (811 mGy) and FAA (1200.5 mGy) (P = .229) in 36 patients with HCC who underwent either transarterial bland embolization or 20 In the more general field of hepatic interventions, a systematic review based on 1096 procedures including TACEs, transcatheter arterial radioembolizations and hepatic arterial infusion chemotherapies, reported no differences in radiation dose (weighted mean difference, À13.11; P = .94) and fluoroscopy time (weighted mean difference, .85; P = .52) between RAA and FAA. 31 Other authors reported no significant differences in dose area products and fluoroscopy time between RAA and FAA in other intraarterial procedures such as splenic or renal embolizations.…”

“…However, several studies reported no differences in hospitalization expenses between the two approaches. 22,25 Third, the choice between RAA and FAA was left to the operator preference, which might have introduced bias due to selection of one approach over the other in light of patients' specificities, and limited the generalizability of our results. 33 Finally, we did not assess the differences in local pain at the puncture site between the two approaches.…”

Use of transradial access to install two sequential stents for pseudoaneurysms along the celiac artery and common hepatic artery axes: A case report

“…Transradial access (TRA) has gained signi cant popularity over the years in body interventional procedures. Many studies have reported on the bene ts of TRA over transfemoral access (TFA) [1][2][3].…”