Bernardo Cortese1, Carlo Trani2, Roberto Lorenzoni3, Paolo Sbarzaglia4, Azeem Latib5, Antonella Tommasino2, Francesco Bovenzi3, Alberto Cremonesi4, Francesco Burzotta2, Antonino Pitì6, Fabio Tarantino7, Antonio Colombo5. 1. Interventional Cardiology, A.O. Fatebenefratelli Milano, Italy. Electronic address: bcortese@gmail.com. 2. Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy. 3. U.O. Cardiologia, Ospedale Campo di Marte, Lucca, Italy. 4. U.O. di Cardio-Angiologia Diagnostica e Interventistica, Villa Maria Cecilia Hospital, Cotignola, Italy. 5. Interventional Cardiology Unit, EMO-GVM Centro Cuore Columbus, and Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy. 6. Cardiac Dpt., Cliniche Gavazzeni, Bergamo, Italy. 7. Interventional Cardiology, AUSL Forlì, Italy.
Abstract
BACKGROUND: Percutaneous angioplasty of lower limb disease is commonly performed with a transfemoral access. In the coronary field, a transradial approach has shown to reduce access-site bleeding and adverse clinical events. This route has not yet been well studied for the majority of peripheral interventions, like those involving the iliac arteries. In this study we sought to evaluate the feasibility and safety of this approach for iliac interventions. METHODS: Multicenter study was performed at high-volume centers with experience in transradial percutaneous interventions. Primary endpoint of the study was procedural success; secondary endpoints included in-hospital bleeding, 1-month freedom from adverse events and the rate of radial occlusion. Feasibility of this technique was evaluated by recording procedural and fluoroscopy time and contrast load. RESULTS: A total of 149 patients from 5 centers were enrolled. The population had a medium risk profile, with 48% of patients having TASC 2 or 3 lesions. Procedural success was achieved in 98.7% of the population, and we did not register in-hospital complications, including both vascular access site and procedural-related complications. An ancillary transfemoral approach was used in 13% of patients. One-month freedom from symptoms was achieved in 97.3% of patients, and the rate of radial occlusion was 2.7%. Major determinants of an unsuccessful procedure were the use of normal 6 or 7-Fr introducer with guiding catheter, TASC D lesion attempt, lesion length>30 mm and total occlusion. CONCLUSIONS: A transradial approach for iliac disease may be a feasible and safe alternative to the transfemoral route in experienced hands, in the light of significant technical improvements and dedicated devices.
BACKGROUND: Percutaneous angioplasty of lower limb disease is commonly performed with a transfemoral access. In the coronary field, a transradial approach has shown to reduce access-site bleeding and adverse clinical events. This route has not yet been well studied for the majority of peripheral interventions, like those involving the iliac arteries. In this study we sought to evaluate the feasibility and safety of this approach for iliac interventions. METHODS: Multicenter study was performed at high-volume centers with experience in transradial percutaneous interventions. Primary endpoint of the study was procedural success; secondary endpoints included in-hospital bleeding, 1-month freedom from adverse events and the rate of radial occlusion. Feasibility of this technique was evaluated by recording procedural and fluoroscopy time and contrast load. RESULTS: A total of 149 patients from 5 centers were enrolled. The population had a medium risk profile, with 48% of patients having TASC 2 or 3 lesions. Procedural success was achieved in 98.7% of the population, and we did not register in-hospital complications, including both vascular access site and procedural-related complications. An ancillary transfemoral approach was used in 13% of patients. One-month freedom from symptoms was achieved in 97.3% of patients, and the rate of radial occlusion was 2.7%. Major determinants of an unsuccessful procedure were the use of normal 6 or 7-Fr introducer with guiding catheter, TASC D lesion attempt, lesion length>30 mm and total occlusion. CONCLUSIONS: A transradial approach for iliac disease may be a feasible and safe alternative to the transfemoral route in experienced hands, in the light of significant technical improvements and dedicated devices.
Authors: Max M Meertens; Eugene Ng; Stanley E K Loh; Miny Samuel; Barend M E Mees; Andrew M T L Choong Journal: J Endovasc Ther Date: 2018-08-08 Impact factor: 3.487