Radial secondary access during TAVR limits complications
Transradial secondary access (TR-SA) is associated with fewer access site complications and severe bleeding events than transfemoral secondary access (TF-SA) during transcatheter aortic valve replacement (TAVR) procedures, according to new data published in JACC: Cardiovascular Interventions.[1]
Radial access is already the “primary choice” for percutaneous coronary intervention procedures due to a significantly lower risk of complications, researchers explained; they aimed to see if similar benefits would be seen if care teams turned to a radial approach for secondary access during TAVR.
The study’s authors tracked data from more than 10,000 patients who underwent transfemoral TAVR from 2016 to 2021. The median age was 82 years old and 50.9% of patients were men. While 81% of TAVR procedures used TF-SA, the other 19% used TR-SA.
Overall, the rates of secondary access vascular complications were 3.2% when TF-SA was used and 0.3% when TR-SA was used. Surgical repair was required for 0.9% of patients treated with TF-SA. For TR-SA, however, no patients required surgical repair.
Primary access vascular complications, meanwhile, occurred at similar rates for the two treatment strategies.
“Our data showed that TR-SA was associated with significantly lower major, minor, and overall access-related complications compared to TF-SA in this large multicenter registry, which is in line with previous smaller studies,” wrote first author David Grundmann, MD, a cardiologist with University Heart & Vascular Center Hamburg in Germany, and colleagues. “Of note, almost one-third of these secondary access complications in the femoral group led to a surgical repair, emphasizing the clinical significance of these results that were exclusively linked to complications at the small 6-F femoral access.”
Researchers also used propensity score matching to complete a separate analysis. This uncovered the same trend: secondary access-related vascular complications were seen in 2.9% of patients treated with TF-SA and 0.2% of patients treated with TR-SA.
“Moreover, radial access was associated with shorter total length of in-hospital stay compared to femoral access in our study and other studies, likely because of increased patient mobility,” the authors added.
Click here to read the full analysis in JACC: Cardiovascular Interventions.
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.