Radial vs Femoral Artery: A Better Path for Treatment?

Guest post by Aaron Fischman, MD, interventional radiologist and assistant professor of radiology and surgery at Icahn School of Medicine, Mount Sinai Medical Center, New York, NY

Health care continues moving toward a more patient-centered paradigm, striving to adapt a complex system to meet individualized needs. From its inception, interventional radiology (IR) has met that goal by performing image-guided treatments characterized by less risk, less pain and shorter recovery time than traditional surgery, giving patients a better quality of life. Through a tiny incision in the skin, interventional radiologists have been able to deliver precise, targeted treatments to solve the toughest medical problems, many times on an outpatient basis.

Now, this innovative spirit has led our IR team at Mt. Sinai to investigate a new approach to treatment– using the radial artery (transradial access–TRA) as the point of entry, instead of the femoral artery (transfemoral access–TFA), for peripheral and visceral interventions to further refine the practice of IR.

With 3 years of experience using the TRA approach, our team is presenting results on the effectiveness of TRA and its potential benefit to patients this week at the Society of Interventional Radiology’s 40th Annual Scientific Meeting, the world’s largest and most comprehensive IR educational experience.

Our team of interventional radiologists at Mt. Sinai Medical Center performed 1,004 TRAs for 668 patients who had conditions such as liver cancer or uterine fibroids. The detailed procedure breakdown is as follows: chemoembolization (n=371), Y90 mapping (n=249) and infusion (n=168), renal/visceral intervention (n=104), uterine artery embolization (n=65), peripheral intervention (n=37), endoleak (n=8), and other (n=2).

With all those cases, we achieved a technical success rate of 99.4 percent. That is, in 998 of the cases, we were able to perform the treatment completely through transradial access. Only in six cases were we required to cross over to TFA to complete the procedure.

So what does Mt. Sinai’s success with TRA mean for the field of IR and, more importantly, for patients?

In the United States, the vast majority of interventional radiologists are performing IR treatments through the femoral artery. This artery is located deeper under the skin and is substantially larger than the radial artery, increasing the possibility of bleeding and related complications with TFA. This means that TRA is potentially much safer for patients.

Patients can also experience quicker discharge times after receiving therapy with TRA, compared to TFA. Patients who go through TFA are required to remain immobile for three to six hours to allow the incision to heal (with the aid of an arterial closure device) before they can leave. With TRA, patients are mobile immediately after the treatment, and the incision closes in about 90 minutes with just a manual compression device without leaving behind a foreign body in the artery. From our experience, patients seem more satisfied after treatment via TRA because they are able to return to their lives sooner.

This shorter discharge time can also benefit hospitals and other facilities where IR treatments are performed, especially given the trend toward bundled or value-based payments. We’ve also found that TRA uses less equipment, translating to lower direct equipment costs for the hospital.

While our results suggest that TRA is an effective approach that can be safer for patients than TFA, adoption of this approach does not happen overnight. When we started using this method, we had to develop new equipment (catheters, etc.) that was smaller because the radial artery is smaller than the femoral artery. This equipment also had to be longer and have a different maneuverability since we were now taking a different route to the treatment area.

These obstacles, while potentially significant for some clinicians and hospitals, can be overcome, as our team has been able to demonstrate. We are now leveraging our three years of experience with TRA and are working with other interventional radiologists to help reduce their barrier to adoption. We believe that this innovative approach will transform how IR treatments are performed and can make an already targeted, minimally invasive procedure even better. 

“Transradial approach for peripheral and visceral interventions: A single-center review of safety and feasibility in the first 1,000 cases,” R. Posham, R.S. Patel, E. Kim, N.E. Tabori, S.F. Nowakowski, R. Lookstein, A.M. Fischman, department of interventional radiology, Icahn School of Medicine, Mt. Sinai Medical Center, New York, N.Y. SIR’s Annual Scientific Meeting is being held Feb. 28–March 5 in Atlanta. This abstract can be found at www.sirmeeting.org.