Distal Radial Secondary Access for Transcatheter Aortic Valve Implantation: The Minimalistic Approach

• Published in: Cardiovascular revascularization medicine 2022-07, Vol.40, p.152-157
• Main Authors: Achim, Alexandru, Szűcsborus, Tamás, Sasi, Viktor, Nagy, Ferenc, Jambrik, Zoltán, Nemes, Attila, Varga, Albert, Bertrand, Olivier F., Ruzsa, Zoltán
• Format: Article
• Language: English
• Subjects: Aortic stenosis; Distal radial access; Distal radial artery approach; Outcome of TAVI; Radial access; Snuffbox approach; TAVI; Transcatheter aortic valve; Vascular complication
• ISSN: 1553-8389; 1878-0938
• DOI: 10.1016/j.carrev.2021.11.021

Although not yet recommended by the guidelines, distal radial access, a new site for cardiovascular interventions, has been rapidly acknowledged and adopted by many centers due to its high rate of success, safety and fewer complications. We present our experience using secondary distal radial access during transcatheter aortic valve implantation (TAVI), proposing a new, even more minimal approach. As of November 2020, a systematic distal radial approach as secondary access site for TAVI was adopted in our center. Primary endpoints were technical success and major adverse events (MAEs). Secondary endpoints: the access site complication rate, hemodynamic and clinical results of the intervention, procedural related factors, crossover rate to the femoral access site, and hospitalization duration (in days). From November 2020, 41 patients underwent TAVI using this strategy. Patients had a mean age of 76 ± 11.2 years, 41% were male. Six (14.63%) patients received a balloon-expandable valve and 35 (85.37%) received a self-expandable valve. TAVI was successful in all cases. No complications occurred due to transradial access. Puncture success, defined as completed sheath placement was maximum (N = 41/41,100%) and emergent transfemoral secondary access was not required in any case. Primary transfemoral vascular access site complications occurred in 7 cases (17%) of which 4 (13.63%) were resolved through distal radial access: one occlusion, two flow-limiting stenoses and four perforations of the common femoral artery. There were no additional major vascular complications at 30 days. Overall MACE rate was 2.4%. The use of the distal radial approach for secondary access in TAVI is safe, feasible and has several advantages over old access sites. •dRA as secondary access for TAVI is safe and feasible with better ergonomics for both patient and operator.•US-guided puncture is highly recommended regardless of the level of prior radial access expertise.•During TAVI, most vascular complications caused by large bore insertion as well as all periprocedural PCI can be managed through dRA.