title: Transradial Secondary Arterial Access for Transcatheter Aortic Valve Implantation: Experience and Limitations.
abstract: OBJECTIVE
  The transradial approach limits vascular complications in coronary interventions. The same may be true for transcatheter aortic valve implantation (TAVI). We present our experience using secondary transradial arterial access.
  
  
  METHODS
  Secondary transradial arterial access has been our default strategy for TAVI since 2007. Procedural data is collected prospectively. We assessed procedural success and complications.
  
  
  RESULTS
  Data from 282 patients aged 81±5.2 yrs was examined. Secondary arterial access was transradial (74%), femoral (24%) and none (2%). Secondary femoral access was reserved for failed radial access (3%), anatomical anomalies (4%), operator preference (7%), trial requirements (6%) or proctor preference (4%). The principal pathology was aortic stenosis (90.8%), aortic regurgitation (6.7%) or a combination (2.5%). CoreValve (91.4%), Edwards (7%) or Lotus valves (1.7%) were delivered via transfemoral (88.6%), direct aortic (5.3%), subclavian (3.9%) or transapical approaches (1.8%). Significant vascular complications occurred in 25 cases (9.4%), including surgical repair of a failed percutaneous closure device (n=16), ilio-femoral dissection (n=3), iliac perforations (n=3), plaque disruption (n=1) and false aneurysm (n=2), one of which was from the secondary femoral access site. There was no local vascular complication from the secondary radial site.
  
  
  CONCLUSIONS
  The transradial secondary access route for TAVI is safe and effective. The transradial route may limit vascular access complications from secondary transfemoral access.
authors: Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Eastern Road Brighton, East Sussex BN25BE, United Kingdom.
authors: Dylan G
authors: DG
authors: Wynne
authors: Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Eastern Road Brighton, East Sussex BN25BE, United Kingdom. Electronic address: rampat@doctors.org.uk.
authors: Rajiv
authors: R
authors: Rampat
authors: Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Eastern Road Brighton, East Sussex BN25BE, United Kingdom.
authors: Uday
authors: U
authors: Trivedi
authors: Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Eastern Road Brighton, East Sussex BN25BE, United Kingdom.
authors: Adam
authors: A
authors: de Belder
authors: Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Eastern Road Brighton, East Sussex BN25BE, United Kingdom.
authors: Andrew
authors: A
authors: Hill
authors: Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Eastern Road Brighton, East Sussex BN25BE, United Kingdom.
authors: Nevil
authors: N
authors: Hutchinson
authors: Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Eastern Road Brighton, East Sussex BN25BE, United Kingdom.
authors: David
authors: D
authors: Hildick-Smith
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve; D001024:Aortic Valve Stenosis / Q000601:surgery*; D005260:Female; D005263:Femoral Artery; D006801:Humans; D008297:Male; D017534:Radial Artery; D012189:Retrospective Studies; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods*
keywords: Aortic Stenosis; Outcome of TAVI; Radial access; Transcatheter aortic valve; Vascular complication