Transradial vs transfemoral access for iliac, femoral and poplital interventions - Andras Nyerges

1. Comparison of Transradial vs Transfemoral
Access for Iliac, Femoral, and Popliteal
Interventions:
A Single-Center Experience
András Nyerges MD, Péter Pajor MD, Károly Tóth MD, Róbert
Bellavics MD, Ferenc Kuti MD, Kálmán Hüttl MD PhD,
Zoltán Ruzsa MD PhD
AIM Radial 2017

2. Disclosure Statement of
Financial Interest
I, András Nyerges MD,
DO NOT have a financial interest/arrangement or
affiliation with one or more organizations that could be
perceived as a real or apparent conflict of interest in
the context of the subject of this presentation.

3. Background of the study
• There are limited data in the literature about transradial lower limb
interventions (iliac and femoro-popliteal)
The aim of this study:
to compare the procedure and safety outcomes of the transradial (TR)
approach with the transfemoral (TF) approach for treating iliac, and
femoro-popliteal stenoses and occlusions

4. Methods
• Single-center retrospective study
• 1101 patients with lower limb claudication or critical limb ischemia
• 137 iliac, 897 femoral, 434 popliteal angioplasties (+ BTK interventions) between 2011-2016
• Analyzing the groups according to the access site: transradial, transbrachial and transfemoral
interventions (256 primary TR, 48 TB, 797 TF access)
• Inclusion criteria: We included patients with significant iliac and/or femoral and/or popliteal
artery stenosis or occlusion, who had intermittent claudication (IC), or critical limb ischemia
(CLI), with proven limb viability
• Exclusion criteria for TR access: Raynaud’s disease, upper limb claudication or upper limb
occlusive disease confirmed by former angiography, previous difficulties of transradial access,
ongoing or planned hemodialysis treatment
• PRIMARY endpoints: Technical success (angiographic result), intraprocedural and access site
vascular complications, MAE, MACCE
• SECONDARY endpoints: Procedural time, X-ray dose, fluoroscopy time, hospitalization

5. WHY RADIAL?
• Anatomic reasons (…)
• Patient comfort (mobilization; patients with special conditions…)
• Reduced time of hospitalization
• Lower rates of vascular complications, MAEs and MACCEs (…)
WHY NOT RADIAL?
• Equipment lenght (poplitea, BTK)
• Impairment of the radial artery (size, calcification, occlusion… hand ischemia??)
• Complex lesions (support, catheter size…)
• (Operator skills)

6. • Medication: - Radial „cocktail” (5000 U Na-heparin + 2,5 mg verapamil)
- Per os aspirin and clopidogrel
• Punction: - Local anesthesia and 5F TR sheath
• Diagnostic angiography: - 125 cm Pigtail catheter
• Cannulation: TR access – 5F, 6F sheath or sheathless
guiding systems (100-120 cm); TF access – 6F sheath usually / shorter sheathless
• Angioplasty: After „road map” imaging, balloon angioplasty, or stenting with self-
expandable or balloon-expanded stent. Predilatation if needed, and
postdilatation. Final angiograpy to assess the result, and exclude complications.
• Postop. treatment: Non-occlusive tourniquet; earliest mobilization (TR -> < TF!)
Methods – Angiography, angioplasty

7. Demographic
and clinical data
(679 men, 423 women)

8. Procedural characteristics

9. Summary of complications and FU

10. RESULTS
• 1101 PTA-s – 256 from TR, 48 from TB, 797 from TF access
• Indication: IC 33,88% (TR 42,58%, TB 50%, TF 30,11%); CLI 60,67% (TR 50%, TB 50%, TF 64,74%).
• Technical success (good angiographic result): 96,63% in all; TR – 97,26%, TF – 96,61%
• MAE: TR – 26,69%, TF – 42,53%
• MACCE: TR – 12,89%, TF – 17,82%
• ACCESS SITE complications: MAJOR: TR – 1,95% vs. TF – 4,02%
MINOR: TR – 8,98% vs. TF – 8,91%
• Intraprocedural complications: TR – 5,08% vs. TF – 4,39%
• Secondary endpoints: Time of the procedures, the radiation dose, and fluoroscopy time is
significantly higher in the transfemoral group, while there was no significant difference in
the contrast consumption -> <- BUT (!! – BTK interventions)
• The time of hospitalization was significantly higher in the TF group (4,61 days) than in the TR
group (3,29 days) – Faster mobilization, less vascular and access site complications.

11. Limitations of the study
• Single-center study – Enough number of cases to produce valid statistics, and
represent everyday reality (?)
• Retrospective analysis
- Processing data from six years of interventions
- At least 6 operators, different skills and preferred techniques
- Difficulties of collecting data (method of documentation has changed)
• Big difference in the number of cases in the transradial and the transfemoral group
• Primary transbrachial access was only defined in 2016; between 2011 and 2015
interventions from the brachial access were assigned in the radial access group, since the
primary access site was the radial artery (however, sometimes only for the angiography).

12. The transradial approach for iliac and femoro-popliteal interventions is
safe and efficacious compared with the transfemoral approach for a
wide range of lesion subtypes.
The radial access is associated with significantly less major access site
complications and long term MAEs.
Conclusions