Initial Experience of Trans-radial Access for Hepatic Chemoembolization and Comparison to Trans-femoral Access

Abstract Description

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Authors (including presenting author) :

TS Chan, LF Cheng, T Wong, HF Chan, NY Pan, WH Luk, KF Ma

Affiliation :

Department of Radiology, Princess Margaret Hospital

Introduction :

Trans-radial access has emerged as a valid alternative to the trans-femoral access for transcatheter arterial chemoembolization. Shorter monitoring time after the procedure, earlier ambulation, shorter hospital stay, and less discomfort associated with potentially reduced bleeding risks make trans-radial access an attractive alternative to trans-femoral access.

Objectives :

(1)To compare the fluoroscopy time of trans-radial approach and trans-femoral approach in patients undergoing hepatic chemoembolization, also in terms of (2) safety, (3) length of hospitalization and (4) patient satisfaction.

Methodology :

From September 2017, trans-radial access became another possible approach apart from the usual trans-femoral access for sub-diaphragmatic vascular interventions in our department. This study was a retrospective, single-center, intra-patient comparison of trans-femoral and trans-radial chemoembolization for patients with hepatic malignancies, who had underwent trans-femoral chemoembolization previously and then performed via trans-radial approach. This study included 14 consecutive patients and total 20 procedures were performed trans-radially. All procedures were performed by interventional radiologists (with at least 3 years of experience in interventional radiology). The primary outcome was the fluoroscopy time. The secondary outcomes included major complications, day of discharge after the procedure, patient’s preference on trans-radial access and trans-femoral access, and the reasons.

Result & Outcome :

The fluoroscopy time of trans-radial hepatic chemoembolization was not longer than trans-femoral approach (11.85±3.85 min VS 16.35±6.60 min, P =0.025 - derived from paired t-test and Wilcoxon signed-rank test). There were no major complications in trans-radial chemoembolization. Patients were discharged earlier with trans-radial access (1.58±1.61 VS 2.25±1.09, P =0.104), with some patients discharged on the same day after trans-radial hepatic chemoembolization. Trans-radial access was preferred by all the patients (14/14) for potential future trans-arterial procedures. The fluoroscopy time of trans-radial hepatic chemoembolization was not longer than trans-femoral approach. Trans-radial access is a safe alternative, with reduced length of hospitalization and improved patient satisfaction.