Does Transradial EVT Speed up or Slow Down the Clock?

Transradial access for endovascular therapy (EVT) is gaining traction as a viable alternative to traditional femoral access, offering distinct advantages in certain cases. That was the message today for Masahiko Fujihara, MD, from Kishiwada Tokushukai Hospital in Kishiwada, Osaka, Japan, who shared his insights on procedural times, techniques, and the future potential of transradial EVT, drawing on findings from recent study, and his extensive clinical experience.

When asked how procedural times for transradial EVT compare to traditional femoral access, Dr Fujihara emphasized his patient selection approach. “Since we have primarily selected simple aortoiliac lesions for transradial procedures, there has been no significant difference in procedural time compared to traditional femoral access,” he explained.

Efficiency in transradial endovascular therapy relies heavily on optimized devices and techniques. “Most of the time, I use the Cordis system (Radianz), a guiding catheter, and a 0.018-inch system, performing the procedure from the left radial artery,” Dr Fujihara shared. These tools allow for precise and effective interventions, even in challenging cases.

A previous study, AVOCADO, led by Dr Fujihara, evaluated the safety and efficacy of the Viabahn® VBX Balloon Expandable Endoprosthesis (W.L. Gore & Associates) in treating complex aortoiliac artery disease. The primary endpoint was one-year primary patency, while secondary endpoints included procedural complications, freedom from occlusion, and clinically driven target lesion revascularization.

AVOCADO demonstrated a 92.6% technical success rate for complex aortoiliac disease using the Viabahn VBX stent graft. This success predominantly came from cases using transfemoral access, but Dr Fujihara sees the potential for transradial access in similar scenarios. “Now that the Viabahn VBX stent graft can also be used with transradial systems, I’d like to compare outcomes in the future,” he said, adding that he believes the success rate would likely remain similar.

Dr Fujihara emphasized the importance of understanding anatomical factors when performing transradial endovascular therapy. “Considering aortic branches and curvatures is essential, and we avoid shaggy aortas based on preoperative computed tomography angiography,” he noted.

Chronic total occlusions also present unique challenges. “In real-world cases, we sometimes perform transfemoral access without a sheath, inserting only the guidewire,” Dr Fujihara explained.

For Dr Fujihara, the learning curve for transradial access is manageable, even for specialists less familiar with the technique. “Radial puncture is relatively easy for all specialties,” he explained. “Once operators become comfortable with device length considerations, they can quickly overcome the learning curve.”

Radiation exposure remains an area for future research, continued Dr Fujihara. “While there was no difference in the amount of contrast agent used, radiation exposure may slightly increase with the transradial approach,” he noted.

However, transradial access offers significant advantages in terms of recovery. “The ‘time’ in endovascular therapy consists of three components: procedural time, hemostasis time, and resting time,” Dr Fujihara explained. “In one case study, we saw a 4.5-hour difference in total time from puncture to ambulation, demonstrating significant benefits in patient comfort and healthcare cost reduction.”

Looking ahead, Dr Fujihara is optimistic about the potential of transradial access. “Since the Viabahn VBX stent graft became available for transradial use, we are entering an era where more complex endovascular therapies can be performed via transradial access. This will likely allow us to take on more challenging cases with a higher risk of complications,” he said.

To further optimize the approach, Dr Fujihara believes device development and evidence-based research will be critical. “We need to accumulate more expertise on complications and preoperative evaluations. Conducting randomized controlled trials comparing transradial and transfemoral approaches will be essential for obtaining detailed insights.”