Transradial vs Transfemoral Access for Chemoembolization: Which Is Safer?

The transradial approach appears to allow safe access and is feasible in patients undergoing hepatic chemoembolization, researchers reported in the Journal of Vascular and Interventional Radiology.

Although the transradial approach is often used in coronary angioplasty and stent placement, it is not typically the method-of-choice among interventional radiologist due to concerns about radiation exposure, procedure time, and distance from the access site.

To better understand the advantages of each method of access, researchers performed an intrapatient comparison between transfemoral access and transradial access in patients undergoing hepatic chemoembolization. The study evaluated the safety and feasibility of the two methods of access.

The prospective comparative study took place at a single center and involved 42 consecutive patients with hepatic malignancies. During a 6-month period, the patients received 2 consecutive treatment sessions of unilobar hepatic chemoembolization within a 4-week interval with both transradial and transfemoral access.

There was a 100% technical success rate, and no patients were switched from radial to femoral access during the procedure, the study’s authors noted. No major vascular complications were observed, and minor complications occurred at similar rates in both transradial and transfemoral procedures. After transradial access, no patients had hand ischemia or absence of radial pulse after the procedure or when followed-up at 4 weeks.

Preparation for treatment was longer in procedures with transradial access, but no other significant differences in procedural variables were seen. Although there were no reported differences in intraprocedural pain with either access method, patients experienced more discomfort at the access route with transfemoral access. They also reported greater inability to perform basic activities following the procedure.

When asked, the majority of patients (35/42) said that they would prefer transradial access for future procedures.

“Based on its advantages, TRA seems to be a promising alternative as a primary route compared with TFA for all hepatic intraarterial procedures,” the study’s authors concluded. They cautioned, though, that more research is necessary. “Future randomized prospective comparative studies performed on larger populations involving more complex superselective intrahepatic cannulations as well as the routine use of closure devices will be necessary to more thoroughly evaluate the effect of the arterial access choice on technical and clinical outcomes.”

Reference

Iezzi R, Pompili M, Posa A, et al. Transradial versus transfemoral access for hepatic chemoembolization: intrapatient prospective single-center study. J Vasc Interv Radiol. 2017;28(9):1234-1239.