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04 aimradial2016 fri2 A Roy / Y Louvard

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Radial access for aorto-iliac and femoro-popliteal lesion interventions, A Roy / Y Louvard

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04 aimradial2016 fri2 A Roy / Y Louvard

  1. 1. Safety and efficacy of radial artery access for aortoiliac and femoropopliteal lesion interventions AK Roy, P Garot, A Neylon, M. Spaziano, F. Sawaya, L. Fernandez, Y Roux, R Blanc, M Piotin, S Champagne, O Tavolaro, B Chevalier, T Lefèvre, Y Louvard, T Unterseeh Departments of Cardiology and Interventional Radiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud - Hôpital Claude-Galien Quincy Sous-Senart and Hôpital Privé Jacques Cartier, Massy, France
  2. 2. Disclosures • YL- no relevant disclosures
  3. 3. Background and Aim Limited studies supporting the safety and efficacy of a transradial approach for peripheral interventions. Unlike transradial coronary interventions, uptake has been slow, partly due to catheter and device limitations. The aim was to compare technical and safety outcomes of a radial vs femoral approach for patients undergoing endovascular interventions for peripheral arterial occlusive disease (Rutherford Classes II-IV).
  4. 4. Methods Single center retrospective study of patients with claudication or critical limb ischaemia. Lesions treated were TASC A + B; TASC C and D lesions only if surgery contraindicated. Operator discretion for choice of access. Exclusion criteria TR: Raynaud’s disease, Renal Failure with planned dialysis, known upper limb or aorta PAD, previous TR failure. n=188 patients 65 Transradials attempted 123 Transfemorals84% TF retrograde 26% TF anterograde 22% Left TR 78% Right TR
  5. 5. Methods: Endpoint Definitions + Material PARC criteria- degree of lesion calcification (focal, mild, moderate, severe) Standard vascular access-site and VARC major bleeding criteria Commonly used delivery sheaths Flexor Shuttle Sheath (Cook) 90-110cm Epsylar (Optimed) 120cm Destination (Terumo Corp) 45-90cm
  6. 6. Results TR Failure = 16.9%, requiring switch to femoral due to: Supra-aortic tortuosity (n=2) CTO (n=7) SFA (n=1)
  7. 7. Results: Lesion complexity TR vs TF N=188 Total Successful TR (n=54) Successful TF (n=134) P-value Lesion length (cm) 6.19 ± 3.1 6.14 ± 3.2 6.3 ± 2.9 0.83 Total Occlusions (%) 84 (44.7) 22 (40.7) 62 (46.3) 0.99 Superficial Femoral Artery 59 (31.4) 3 (5.6) 56 (42.1) 0.01* Aorto-Iliac Bifurcation 14 (7.4) 4 (7.4) 10 (7.5) 0.22 Iliac Artery 117 (62.2) 42 (77.8) 75 (56.0) 0.01* Mulitvessel procedure 11 (5.9) 6 (11.2) 5 (3.7) 0.01* TASC Grade A B C D 66 (35.1) 84 (44.7) 30 (16.0) 2 (1.1) 18 (33.3) 24 (44.4) 5 (9.3) 1 (1.9) 48 (35.8) 60 (44.8) 25 (18.7) 1 (0.7) NS
  8. 8. Results N=188 Total Successful Radial artery access (n=54) Femoral artery access (n=134) P-value Procedure time 49.2 ± 28.0 46.8 ± 25.1 50.0 ± 28.9 0.50 Contrast (mL) 107.3 ± 71.2 132.1 ± 98.2 99.9 ± 59.5 0.05* Fluoroscopy Time (mins) 14.0 ± 12.9 14.56 ± 11.8 13.9 ± 13.2 0.77 Dose (Air Kerma) mGy 580.4 ± 752.0 605.7 ± 846.1 573.8 ± 728.4 0.82 Dose total (Dose Area Product) 130.2 ± 150.4 172.8 ± 193.9 117.9 ± 133.6 0.09 Length of Stay (1 day < 24 hours). 2.16 ± 0.6 2.06 ± 0.3 2.19 ± 0.6 0.24 Increased contrast volumes for TR, but no differences in radiation or lengths of stay
  9. 9. N=188 Total Transradial (n=54) Transfemoral (n=133) P-value Stroke 0 0 (0.0) 0 (0.0) 1.0 Major Vascular Bleeding 0 0 (0.0) 0 (0.0) 1.0 Access-site complication 8 (4.2) 2 (3.7) 6 (4.5) 0.72 Arterial Occlusion 2 (1.1) 2 (3.7) 0 (0.0) 0.61 Pseudoaneurysm 6 (3.2) 0 (0.0) 6 (4.5) 0.02 Arterio-venous Fistula 1 (0.5) 0 (0.0) 1 (0.7) 0.53 Haematoma > 5cm 1 (0.5) 0 (0.0) 1 (0.7) 0.11 Haemostasis closure device failure 8 (4.3) 0 (0.0) 8 (6.0) 0.03* Roy AK et al. J Endovasc Ther 2016 Comparison of major vascular and access-site complications for peripheral interventions using TR and TF approaches
  10. 10. Comparison of procedural radiation and contrast exposure for right and left TR approaches Procedural parameters Right radial approach ± SD Left radial approach 95% Confidence Interval P-value Fluoroscopy (mins) 18.31 ± 13.08 9.39 ± 5.09 3.57-14.26 0.002* Contrast (mLs) 135.93 ± 101.22 97.70 ± 40.44 -27.7-104.2 0.25 Dose Air Kerma (mGy) 746.40 ± 983.22 292.37± 268.90 75.1-833.0 0.02* Dose (Dose Area Product) 201.69 ± 198.22 74.48 ± 48.01 57.2-197.2 0.001* Roy AK et al. J Endovasc Ther 2016
  11. 11. Characteristics Odds Ratio 95% Confidence Interval P-value Age 1.01 0.93-1.08 0.98 Female sex 0.90 0.17-4.67 0.90 Height 0.71 0.29-1.74 0.45 Chronic Total Occlusion 0.40 0.10-1.54 0.18 Total lesion length 1.03 0.97-1.09 0.34 Iliac Lesion 1.86 0.39-8.81 0.43 Superficial Femoral Artery Lesion 3.07 0.89-10.63 0.70 TASC C or D 0.32 0.15-6.58 0.46 Moderate to heavy lesion calcification 2.07 0.48-8.92 0.33 Multivariable model for predictors of transradial access failure * Roy AK et al. J Endovasc Ther 2016
  12. 12. Conclusion TR access for peripheral interventions is- (i) safe No strokes No major access-site complications Left TR associated with less radiation (ii) feasible 84% success rate Can treat all lesion subtypes No singular predictors of TR failure
  13. 13. 200cm 150c m 120c m PTA balloon* SX stent* Slender 6F Guiding sheath* 7F Slender guiding catheter* *currently in development TR BandDCB* Popliteal 150 or 180 cm Common femoral 120 or 150 cm Common iliac 105 or 125 cm Superficial femoral 130 or 170 cm 7-in-6 GlideSheath Slender Staniloae CS, et al Catheter Cardiovasc.Interv. 81, 1194–1203 (2013) What does the future hold for TR peripheral interventions?

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