title: A comparison of the femoral and radial crossover techniques for vascular access management in transcatheter aortic valve implantation: the Milan experience.
abstract: 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).
  
  
  CONCLUSIONS
  In TAVI cases with unfavorable contralateral femoral anatomy, radial CT for vascular access management is a reasonable alternative to the femoral CT.
authors.affiliation: Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Helen
authors.initials: H
authors.lastname: Curran
authors.forename: Alaide
authors.initials: A
authors.lastname: Chieffo
authors.forename: Gill Louise
authors.initials: GL
authors.lastname: Buchanan
authors.forename: Chiara
authors.initials: C
authors.lastname: Bernelli
authors.forename: Matteo
authors.initials: M
authors.lastname: Montorfano
authors.forename: Francesco
authors.initials: F
authors.lastname: Maisano
authors.forename: Azeem
authors.initials: A
authors.lastname: Latib
authors.forename: Davide
authors.initials: D
authors.lastname: Maccagni
authors.forename: Mauro
authors.initials: M
authors.lastname: Carlino
authors.forename: Filippo
authors.initials: F
authors.lastname: Figini
authors.forename: Micaela
authors.initials: M
authors.lastname: Cioni
authors.forename: Giovanni
authors.initials: G
authors.lastname: La Canna
authors.forename: Remo Daniel
authors.initials: RD
authors.lastname: Covello
authors.forename: Annalisa
authors.initials: A
authors.lastname: Franco
authors.forename: Chiara
authors.initials: C
authors.lastname: Gerli
authors.forename: Ottavio
authors.initials: O
authors.lastname: Alfieri
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000401:mortality; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000401:mortality; D005260:Female; D005263:Femoral Artery; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D006470:Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D006489:Hemostatic Techniques / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D008297:Male; D011677:Punctures; D017534:Radial Artery; D015641:Radiography, Interventional; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: TAVI; aortic stenosis; vascular closure device