Skip to main content

Advertisement

SpringerLink
Log in

Transradial versus transfemoral access without closure device for transarterial chemoembolization in patients with hepatocellular carcinoma: a randomized trial

  • Interventional
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To compare patient satisfaction, procedural variables, and safety with transradial access (TRA) and transfemoral access (TFA) in patients undergoing transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC).

Materials and methods

From February 2019 to August 2021, 130 patients undergoing TACE for HCC were randomly allocated to the TRA (n = 65) or TFA (n = 65) group. Vascular closure devices were not used after TFA-TACE. All patients completed the post-catheterization questionnaire and 8-item Short-Form Health Survey 1 day after TACE.

Results

Technical success rate, crossover rate, contrast agent dose, fluoroscopy time, procedure time, air kerma, dose-area product, length of hospital stay, and total cost were similar between the two groups (all p > 0.05). The incidence and severity of adverse events were also similar between the two groups (all p > 0.05). However, overall discomfort, difficulty going to the bathroom, difficulty feeding or self-caring, difficulty walking, general health, physical function, role physical function, social function, mental health, and role emotional function were better in the TRA group than in the TFA group (all p < 0.001). Consequently, more patients preferred the current access for their next procedure in the TRA group than in the TFA group (90.8% vs. 24.6%; p < 0.001).

Conclusion

In patients undergoing TACE for HCC, using TRA instead of TFA can improve patient satisfaction without compromising procedural variables and safety.

Key Points

• Transradial access (TRA) enabled early ambulation after transarterial chemoembolization (TACE), resulting in significant increase in activities of daily living and health-related quality of life (HRQoL) compared to transfemoral access (TFA) when vascular closure devices were not used.

• Procedural variables (contrast agent dose, fluoroscopy time, procedure time, air kerma, dose-area product, length of hospital stay, and total cost) were not significantly different between patients who received TRA-TACE and TFA-TACE.

• The incidence and severity of adverse events were similar between patients who received TRA-TACE and TFA-TACE.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Abbreviations

DAP:

Dose-area product

HCC:

Hepatocellular carcinoma

HRQoL:

Health-related quality of life

LoHS:

Length of hospital stay

SF-8:

8-item Short-Form Health Survey

TACE:

Transarterial chemoembolization

TFA:

Transfemoral access

TRA:

Transradial access

US:

Ultrasound

VCDs:

Vascular closure devices

References

  1. Heimbach JK, Kulik LM, Finn RS et al (2018) AASLD guidelines for the treatment of hepatocellular carcinoma. Hepatology 67:358–380

    Article  Google Scholar 

  2. European Association for the Study of the Liver (2018) EASL Clinical Practice Guidelines: management of hepatocellular carcinoma. J Hepatol 69:182–236

    Article  Google Scholar 

  3. Shiozawa S, Tsuchiya A, Endo S et al (2003) Transradial approach for transcatheter arterial chemoembolization in patients with hepatocellular carcinoma: comparison with conventional transfemoral approach. J Clin Gastroenterol 37:412–417

    Article  Google Scholar 

  4. Posham R, Biederman DM, Patel RS et al (2016) Transradial approach for noncoronary interventions: a single-center review of safety and feasibility in the first 1,500 cases. J Vasc Interv Radiol 27:159–166

    Article  Google Scholar 

  5. Bhatia S, Harward SH, Sinha VK, Narayanan G (2017) Prostate artery embolization via transradial or transulnar versus transfemoral arterial access: technical results. J Vasc Interv Radiol 28:898–905

    Article  Google Scholar 

  6. Cooper CJ, El-Shiekh RA, Cohen DJ et al (1999) Effect of transradial access on quality of life and cost of cardiac catheterization: a randomized comparison. Am Heart J 138:430–436

    Article  CAS  Google Scholar 

  7. Jolly SS, Yusuf S, Cairns J et al (2011) Radial versus femoral access for coronary angiography and intervention in patients with acute coronary syndromes (RIVAL): a randomised, parallel group, multicentre trial. Lancet 377:1409–1420

    Article  Google Scholar 

  8. Valgimigli M, Gagnor A, Calabró P et al (2015) Radial versus femoral access in patients with acute coronary syndromes undergoing invasive management: a randomised multicentre trial. Lancet 385:2465–2476

    Article  Google Scholar 

  9. Iezzi R, Pompili M, Posa A et al (2017) Transradial versus transfemoral access for hepatic chemoembolization: intrapatient prospective single-center study. J Vasc Interv Radiol 28:1234–1239

    Article  Google Scholar 

  10. Yamada R, Bracewell S, Bassaco B et al (2018) Transradial versus transfemoral arterial access in liver cancer embolization: randomized trial to assess patient satisfaction. J Vasc Interv Radiol 29:38–43

    Article  Google Scholar 

  11. Wang S, R-s L, Lei Y, Kuang C, He C, Chen Y (2007) Development and evaluation of Chinese version of short form 8. Modern Prev Med 34:1022–1036

    Google Scholar 

  12. US Department of Health and Human Services; National Institutes of Health; National Cancer Institute (2017) Common Terminology Criteria for Adverse Events (CTCAE) v5.0. Available via https://ctep.cancer.gov/protocolDevelopment/electronic_applications/ctc.htm. Accessed 6 June 2018

  13. Hung ML, Lee EW, McWilliams JP, Padia SA, Ding P, Kee ST (2019) A reality check in transradial access: a single-centre comparison of transradial and transfemoral access for abdominal and peripheral intervention. Eur Radiol 29:68–74

    Article  Google Scholar 

  14. Kis B, Mills M, Hoffe SE (2016) Hepatic radioembolization from transradial access: initial experience and comparison to transfemoral access. Diagn Interv Radiol 22:444–449

    Article  Google Scholar 

  15. Hess CN, Peterson ED, Neely ML et al (2014) The learning curve for transradial percutaneous coronary intervention among operators in the United States: a study from the National Cardiovascular Data Registry. Circulation 129:2277–2286

    Article  Google Scholar 

  16. Andò G, Capodanno D (2015) Radial versus femoral access in invasively managed patients with acute coronary syndrome: a systematic review and meta-analysis. Ann Intern Med 163:932–940

    Article  Google Scholar 

  17. Ferrante G, Rao SV, Jüni P et al (2016) Radial versus femoral access for coronary interventions across the entire spectrum of patients with coronary artery disease: a meta-analysis of randomized trials. JACC Cardiovasc Interv 9:1419–1434

    Article  Google Scholar 

  18. Liu LB, Cedillo MA, Bishay V et al (2019) Patient experience and preference in transradial versus transfemoral access during transarterial radioembolization: a randomized single-center trial. J Vasc Interv Radiol 30:414–420

    Article  Google Scholar 

  19. Du N, Yang MJ, Ma JQ et al (2019) Transradial access chemoembolization for hepatocellular carcinoma in comparation with transfemoral access. Transl Cancer Res 8:1795–1805

    Article  CAS  Google Scholar 

  20. Yatskar L, Selzer F, Feit F et al (2007) Access site hematoma requiring blood transfusion predicts mortality in patients undergoing percutaneous coronary intervention: data from the National Heart, Lung, and Blood Institute Dynamic Registry. Catheter Cardiovasc Interv 69:961–966

    Article  Google Scholar 

  21. Doyle BJ, Ting HH, Bell MR et al (2008) Major femoral bleeding complications after percutaneous coronary intervention: incidence, predictors, and impact on long-term survival among 17,901 patients treated at the Mayo Clinic from 1994 to 2005. JACC Cardiovasc Interv 1:202–209

    Article  Google Scholar 

  22. Schulz-Schüpke S, Helde S, Gewalt S et al (2014) Comparison of vascular closure devices vs manual compression after femoral artery puncture: the ISAR-CLOSURE randomized clinical trial. JAMA 312:1981–1987

    Article  Google Scholar 

  23. Wong SC, Laule M, Turi Z et al (2017) A multicenter randomized trial comparing the effectiveness and safety of a novel vascular closure device to manual compression in anticoagulated patients undergoing percutaneous transfemoral procedures: the CELT ACD trial. Catheter Cardiovasc Interv 90:756–765

    Article  Google Scholar 

  24. Gewalt SM, Helde SM, Ibrahim T et al (2018) Comparison of vascular closure devices versus manual compression after femoral artery puncture in women. Circ Cardiovasc Interv 11:e006074

    Article  Google Scholar 

  25. Jakobsen L, Holm NR, Maeng M et al (2022) Comparison of MynxGrip vascular closure device and manual compression for closure after femoral access angiography: a randomized controlled trial: the closure devices used in every day practice study, CLOSE-UP III trial. BMC Cardiovasc Disord 22:68

    Article  Google Scholar 

  26. Abdelaal E, Molin P, Plourde G et al (2013) Successive transradial access for coronary procedures: experience of Quebec Heart-Lung Institute. Am Heart J 165:325–331

    Article  Google Scholar 

  27. Chen SH, Brunet MC, Sur S, Yavagal DR, Starke RM, Peterson EC (2020) Feasibility of repeat transradial access for neuroendovascular procedures. J Neurointerv Surg 12:431–434

    Article  Google Scholar 

Download references

Funding

This study was supported by a grant from the Beijing Hope Run Special Fund of Cancer Foundation of China (Grant No. LC2017B09).

Author information

Author notes

  1. Xiaowu Zhang and Yingen Luo contributed equally to this work and are co-first authors.

Authors and Affiliations

  1. Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China

    Xiaowu Zhang, Yingen Luo, Jiaywei Tsauo, He Zhao, Tao Gong, Jingui Li, Yawei Li, Huiying Zeng, Wei Sun & Xiao Li

Authors
  1. Xiaowu Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yingen Luo
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jiaywei Tsauo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. He Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tao Gong
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jingui Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yawei Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Huiying Zeng
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Wei Sun
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Xiao Li
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Xiao Li.

Ethics declarations

Guarantor

The scientific guarantor of this publication is Xiao Li.

Conflict of Interest

The authors declare no competing interests.

Statistics and Biometry

No complex statistical methods were necessary for this paper.

Informed Consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical Approval

Institutional Review Board approval was obtained.

Methodology

• prospective

• randomized controlled trial

• performed at one institution

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

ESM 1

(PDF 248 kb)

Rights and permissions

Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zhang, X., Luo, Y., Tsauo, J. et al. Transradial versus transfemoral access without closure device for transarterial chemoembolization in patients with hepatocellular carcinoma: a randomized trial. Eur Radiol 32, 6812–6819 (2022). https://doi.org/10.1007/s00330-022-09038-1

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-022-09038-1

Keywords

Search

Navigation