A comparison of the femoral and radial crossover techniques for vascular access management in transcatheter aortic valve implantation

The milan experience

Helen Curran, Alaide Chieffo, Gill Louise Buchanan, Chiara Bernelli, Matteo Montorfano, Francesco Maisano, Azeem Latib, Davide Maccagni, Mauro Carlino, Filippo Figini, Micaela Cioni, Giovanni La Canna, Remo Daniel Covello, Annalisa Franco, Chiara Gerli, Ottavio Alfieri, Antonio Colombo

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Objective To compare radial and femoral crossover techniques (CT) for vascular access management in transcatheter aortic valve implantation (TAVI). Background Femoral crossover for controlled angiography and balloon inflation of the therapeutic access site to facilitate safe vascular closure is beneficial but technically challenging in patients with complex femoral anatomy. An alternative approach should be available. Methods Between June 2011 and March 2012, 41 transfemoral TAVI patients receiving the femoral CT were compared to 46 transfemoral TAVI patients receiving the radial CT. Outcomes were 30-day valve academic research consortium (VARC) endpoints. Results Patients undergoing the radial CT received higher median contrast volumes (150 interquartile range [IQR]: 105-180 vs. 111 IQR: 90-139 ml; P = 0.025) but procedural radiation dose and fluoroscopy times were comparable. Thirty day all cause and cardiovascular death were similar between radial and femoral CT groups (respectively 2.4% vs. 7.9%, P = 0.258 and 0% vs. 7.9%, P = 0.063). There were no differences in major vascular complications (4.3% vs. 7.3%, P = 0.553), life threatening or major bleeding events (respectively 9.1% vs. 19.5%, P = 0.168 and 13.6% vs. 22%, P = 0.315). Conclusion In TAVI cases with unfavorable contralateral femoral anatomy, radial CT for vascular access management is a reasonable alternative to the femoral CT. © 2013 Wiley Periodicals, Inc.

Original languageEnglish
Pages (from-to)156-161
Number of pages6
JournalCatheterization and Cardiovascular Interventions
Volume83
Issue number1
DOIs
Publication statusPublished - Jan 1 2014

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Thigh
Blood Vessels
Anatomy
Fluoroscopy
Economic Inflation
Transcatheter Aortic Valve Replacement
Cause of Death
Angiography
Radiation
Hemorrhage
Research

Keywords

  • aortic stenosis
  • TAVI
  • vascular closure device

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

A comparison of the femoral and radial crossover techniques for vascular access management in transcatheter aortic valve implantation : The milan experience. / Curran, Helen; Chieffo, Alaide; Buchanan, Gill Louise; Bernelli, Chiara; Montorfano, Matteo; Maisano, Francesco; Latib, Azeem; Maccagni, Davide; Carlino, Mauro; Figini, Filippo; Cioni, Micaela; Canna, Giovanni La; Covello, Remo Daniel; Franco, Annalisa; Gerli, Chiara; Alfieri, Ottavio; Colombo, Antonio.

In: Catheterization and Cardiovascular Interventions, Vol. 83, No. 1, 01.01.2014, p. 156-161.

Research output: Contribution to journalArticle

Curran, Helen ; Chieffo, Alaide ; Buchanan, Gill Louise ; Bernelli, Chiara ; Montorfano, Matteo ; Maisano, Francesco ; Latib, Azeem ; Maccagni, Davide ; Carlino, Mauro ; Figini, Filippo ; Cioni, Micaela ; Canna, Giovanni La ; Covello, Remo Daniel ; Franco, Annalisa ; Gerli, Chiara ; Alfieri, Ottavio ; Colombo, Antonio. / A comparison of the femoral and radial crossover techniques for vascular access management in transcatheter aortic valve implantation : The milan experience. In: Catheterization and Cardiovascular Interventions. 2014 ; Vol. 83, No. 1. pp. 156-161.
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abstract = "Objective To compare radial and femoral crossover techniques (CT) for vascular access management in transcatheter aortic valve implantation (TAVI). Background Femoral crossover for controlled angiography and balloon inflation of the therapeutic access site to facilitate safe vascular closure is beneficial but technically challenging in patients with complex femoral anatomy. An alternative approach should be available. Methods Between June 2011 and March 2012, 41 transfemoral TAVI patients receiving the femoral CT were compared to 46 transfemoral TAVI patients receiving the radial CT. Outcomes were 30-day valve academic research consortium (VARC) endpoints. Results Patients undergoing the radial CT received higher median contrast volumes (150 interquartile range [IQR]: 105-180 vs. 111 IQR: 90-139 ml; P = 0.025) but procedural radiation dose and fluoroscopy times were comparable. Thirty day all cause and cardiovascular death were similar between radial and femoral CT groups (respectively 2.4{\%} vs. 7.9{\%}, P = 0.258 and 0{\%} vs. 7.9{\%}, P = 0.063). There were no differences in major vascular complications (4.3{\%} vs. 7.3{\%}, P = 0.553), life threatening or major bleeding events (respectively 9.1{\%} vs. 19.5{\%}, P = 0.168 and 13.6{\%} vs. 22{\%}, P = 0.315). Conclusion In TAVI cases with unfavorable contralateral femoral anatomy, radial CT for vascular access management is a reasonable alternative to the femoral CT. {\circledC} 2013 Wiley Periodicals, Inc.",
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AU - Curran, Helen

AU - Chieffo, Alaide

AU - Buchanan, Gill Louise

AU - Bernelli, Chiara

AU - Montorfano, Matteo

AU - Maisano, Francesco

AU - Latib, Azeem

AU - Maccagni, Davide

AU - Carlino, Mauro

AU - Figini, Filippo

AU - Cioni, Micaela

AU - Canna, Giovanni La

AU - Covello, Remo Daniel

AU - Franco, Annalisa

AU - Gerli, Chiara

AU - Alfieri, Ottavio

AU - Colombo, Antonio

PY - 2014/1/1

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N2 - Objective To compare radial and femoral crossover techniques (CT) for vascular access management in transcatheter aortic valve implantation (TAVI). Background Femoral crossover for controlled angiography and balloon inflation of the therapeutic access site to facilitate safe vascular closure is beneficial but technically challenging in patients with complex femoral anatomy. An alternative approach should be available. Methods Between June 2011 and March 2012, 41 transfemoral TAVI patients receiving the femoral CT were compared to 46 transfemoral TAVI patients receiving the radial CT. Outcomes were 30-day valve academic research consortium (VARC) endpoints. Results Patients undergoing the radial CT received higher median contrast volumes (150 interquartile range [IQR]: 105-180 vs. 111 IQR: 90-139 ml; P = 0.025) but procedural radiation dose and fluoroscopy times were comparable. Thirty day all cause and cardiovascular death were similar between radial and femoral CT groups (respectively 2.4% vs. 7.9%, P = 0.258 and 0% vs. 7.9%, P = 0.063). There were no differences in major vascular complications (4.3% vs. 7.3%, P = 0.553), life threatening or major bleeding events (respectively 9.1% vs. 19.5%, P = 0.168 and 13.6% vs. 22%, P = 0.315). Conclusion In TAVI cases with unfavorable contralateral femoral anatomy, radial CT for vascular access management is a reasonable alternative to the femoral CT. © 2013 Wiley Periodicals, Inc.

AB - Objective To compare radial and femoral crossover techniques (CT) for vascular access management in transcatheter aortic valve implantation (TAVI). Background Femoral crossover for controlled angiography and balloon inflation of the therapeutic access site to facilitate safe vascular closure is beneficial but technically challenging in patients with complex femoral anatomy. An alternative approach should be available. Methods Between June 2011 and March 2012, 41 transfemoral TAVI patients receiving the femoral CT were compared to 46 transfemoral TAVI patients receiving the radial CT. Outcomes were 30-day valve academic research consortium (VARC) endpoints. Results Patients undergoing the radial CT received higher median contrast volumes (150 interquartile range [IQR]: 105-180 vs. 111 IQR: 90-139 ml; P = 0.025) but procedural radiation dose and fluoroscopy times were comparable. Thirty day all cause and cardiovascular death were similar between radial and femoral CT groups (respectively 2.4% vs. 7.9%, P = 0.258 and 0% vs. 7.9%, P = 0.063). There were no differences in major vascular complications (4.3% vs. 7.3%, P = 0.553), life threatening or major bleeding events (respectively 9.1% vs. 19.5%, P = 0.168 and 13.6% vs. 22%, P = 0.315). Conclusion In TAVI cases with unfavorable contralateral femoral anatomy, radial CT for vascular access management is a reasonable alternative to the femoral CT. © 2013 Wiley Periodicals, Inc.

KW - aortic stenosis

KW - TAVI

KW - vascular closure device

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