Radial Artery for Secondary Access in TAVI: A Safer Alternative
Radial artery access appears to be a safer option than traditional transfemoral access for secondary access during TAVI in patients with symptomatic severe aortic stenosis, according to an observational study.
Transfemoral secondary access (TF-SA) was more commonly used, but the rate of vascular complications was about 10 times higher compared to transradial secondary access (TR-SA).
The study suggests the radial approach should become the preferred choice for secondary access to minimize vascular and bleeding complications.
According to the investigators, any additional femoral puncture should be avoided to prevent negative outcomes.
The study, part of the PULSE registry, involved 10 hospitals and 8,851 patients, though it was not a randomized controlled trial.
Secondary access in TAVI is used for pigtail catheter placement and aortography, with radial access gaining favor due to its lower complication rates in PCI.
Study Findings
Data from 10,120 TAVI patients (2016–2021) revealed that TF-SA was used in 7,165 cases and TR-SA in 1,686 cases.
Vascular complications occurred in 3.2% of TF-SA patients and 0.3% of TR-SA patients.
Major complications were 1.5% with TF-SA and 0.2% with TR-SA (P < 0.001).
Bleeding was the most frequent issue (1.5% TF-SA vs 0.2% TR-SA), followed by pseudoaneurysm (1.5% TF-SA vs 0.1% TR-SA).
Up to one-third of TF-SA complications required surgical repair.
Matched Comparisons
In propensity-matched patients, vascular complications were still higher with TF-SA.
30-day mortality was 3.6% in TF-SA and 1.2% in TR-SA (P = 0.021).
Despite increased use, TF-SA remained more common than TR-SA by 2021.
Advantages of Radial Access
Shorter hospital stays for TR-SA patients.
Reduced workload for medical staff, critical in resource-limited settings.
No additional primary site complications were observed in TR-SA patients.
Ultrasound guidance is essential to ensure safe radial access, particularly in elderly patients.
Limitations of Radial Access
Radial tortuosity may pose challenges, especially in older patients.
No straightforward crossover option exists for TR-SA in case of primary access issues.
Take-Home Points
TR-SA is associated with significantly lower vascular and bleeding complications compared to TF-SA.
The radial approach offers benefits like earlier discharge and reduced medical workload.
Ultrasound guidance is critical for the safe implementation of TR-SA.
While challenges remain, the radial artery is emerging as a preferred secondary access site in TAVI procedures.
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