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Keywords:

  • TAVI;
  • aortic stenosis;
  • vascular closure device

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.