Radial artery access for aorto-iliac and femoro-popliteal interventions

Andrew K Roy, P Garot, A Neylon, M. Spaziano, F. Sawaya, Y Roux, L. Fernandez, R Blanc, M Piotin, S Champagne, O Tavolaro, B Chevalier, T LeFèvre, Y Louvard, T Unterseeh

BACKGROUND: Limited data exist for safety, efficacy, and procedural

characteristics of aorto-iliac and femoro-popliteal therapies using radial or hybrid femoral plus radial arterial approaches, for stenotic or occluded vessels. The aim of this study was to compare technical and safety outcomes for both approaches,

using currently available technology. METHODS:

This was a single centre (radial artery access-default approach) Registry study of patients presenting with Critical Limb Ischaemia or claudication, with lesions diagnosed by angiography. Interventions (using balloon angioplasty, self-expanding stents or Paclitaxel DES) were performed using

5-7F short or long sheaths, via right or left radial, and/or either femoral artery. Radial access was performed aided by a

dedicated arm support system (Figure 1).

RESULTS:

188 consecutive patients underwent aorto-iliac/femoro-popliteal interventions over a 2-year period. Patients had a mean age= 66.4 ± 10.8 years, of whom 125 (66.4%) were

hypertensive, 82 (43.6%) smokers, and 52 (27.7%) diabetic. Radial artery intervention was attempted in n=65, with 11/65

crossover to femoral (16.9% crossover rate). Reason for cross-over was 6/11 (54.5%) had CTOs requiring alternative

equipment or support, and n=5 had prohibitive tortuosity of the aortic arch vessels, preventing balloon or stent delivery.

Access for the radial group was 5F in 14/54 (25.9%), 6F in 37/54 (68.5%), and 7F in 3/54 (5.6%); the left radial artery was used in 12/54 (22%) of patients. Target Lesion characteristics were: (i) Iliac artery n=75 femoral access vs 42 radial access,

(ii) Iliac bifurcations n=12 vs 2, (iii) SFA n=64 vs 9, (iv) Popliteal n= 2 vs 4, respectively.

Institut Cardiovasculaire Paris Sud – Hôpitaux Privés Claude Galien et Jacques Cartier, Générale de Santé, Quincy et Massy, France

CONCLUSION:Radial artery access for aorto-iliac and femoro-popliteal interventions is safe and efficacious, with comparable procedural safety outcomes when

compared with access via the femoral artery. Optimal patient and lesion selection is still required to minimize

access failure rates.

Figures 2- 5: Radial access antegrade recanalization of ostial total occlusion of the left iliac artery

Table 1: Clinical, Procedural, and Lesion Characteristics of Radial and Femoral Artery Access Groups

N=188

Total Population (%)

Successful Radial Artery Access (%), n=54

Femoral Artery Access (%),n=134

P-value

Age 66.4 ± 10.76 66.0 ± 11.3 66.5 ± 10.7 0.77Female 72 (38.3) 21 (38.9) 51 (38.1) 0.92Weight 76.8 ± 15.1 73.2 ± 13.8 77.9 ± 15.3 0.07 Height 170.3 ± 10.3 170.0 ± 8.3 170.3 ± 10.8 0.84

Body Mass Index 27.4 ± 16.9 25.3 ± 4.3 28.0 ± 19.1 0.36Body Surface Area 1.89 ± 0.19 1.8 ± 0.2 1.9 ± 0.2 0.08

Diabetes 52 (27.7) 9 (16.7) 42 (31.3) 0.13Hypertension 125 (66.5) 36 (66.7) 89 (66.4) 0.97

Smoker (Active) 82 (43.6) 17 (31.5) 63 (47.0) 0.49

Hyperlipidaemia 114 (60.6) 26 (48.1) 88 (65.7) 0.31

Claudication distance (m) 146.3 ± 100.9 142.9 ± 106.8 157.7 ± 81.3 0.64

Serum creatinine (µmol/L) 95.5 ± 31.9 94.4 ± 21.6 95.9 ± 35.1 0.78

TASC GradeABCD

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)

0.02*

Lesion length (cm) 6.19 ± 3.1 6.14 ± 3.2 6.3 ± 2.9 0.83

Restenosis (%) 8 (4.3) 2 (3.8) 6 (4.5) 0.83

Total Occlusions (%) 84 (44.7) 22 (42.3) 62 (51.6) 0.27

Ostial or proximal lesions (%)

47 (25.0) 6 (11.1) 41 (30.6) 0.32

Paclitaxel-eluting stent implantation (%)

47 (25.0) 5 (9.3) 42 (31.3) 0.01*

Figure1: Radial Support System (CazaConfort Medical, FRA)

OUTCOMES: There were no significant differences between procedure times (50.0 ± 28.9 vs 46.8 ± 25.1

minutes, p=0.50), lengths of stay (2.2± 0.6 vs 2.1 ± 0.3 days, p=0.24) or total Air Kerma Dose (605.7 ± 846.1 vs 573.8 ± 728.4, p=0.82) for femoral vs radial, respectively. Intra-procedural stroke rates were 0% in both groups, and

radial artery occlusion at discharge was noted in n=2 (3.7%) vs 6 (4.5%) femoral access patients requiring

treatment for pseudo-aneurysms (p=0.68). There were 8 (5.7%) Closure device failures (6 ProGlide, 2 AngioSeal).