Conflict of interest: M.M is a proctor for Edwards Lifesciences and F.M is a proctor for Medtronic. The other authors have no conflicts of interest to disclose.
Valvular and Structural Heart Diseases
A comparison of the femoral and radial crossover techniques for vascular access management in transcatheter aortic valve implantation: The milan experience
Version of Record online: 24 AUG 2013
Copyright © 2013 Wiley Periodicals, Inc.
Catheterization and Cardiovascular Interventions
Volume 83, Issue 1, pages 156–161, 1 January 2014
How to Cite
Curran, H., Chieffo, A., Buchanan, G. L., Bernelli, C., Montorfano, M., Maisano, F., Latib, A., Maccagni, D., Carlino, M., Figini, F., Cioni, M., Canna, G. L., Covello, R. D., Franco, A., Gerli, C., Alfieri, O. and Colombo, A. (2014), A comparison of the femoral and radial crossover techniques for vascular access management in transcatheter aortic valve implantation: The milan experience. Cathet. Cardiovasc. Intervent., 83: 156–161. doi: 10.1002/ccd.24913
- Issue online: 18 DEC 2013
- Version of Record online: 24 AUG 2013
- Accepted manuscript online: 8 MAR 2013 07:10AM EST
- Manuscript Accepted: 3 MAR 2013
- Manuscript Revised: 18 FEB 2013
- Manuscript Received: 8 DEC 2012
- aortic stenosis;
- vascular closure device
To compare radial and femoral crossover techniques (CT) for vascular access management in transcatheter aortic valve implantation (TAVI).
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.
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.
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).
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.