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

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Transradial versus transfemoral access without closure device for transarterial chemoembolization in patients with hepatocellular carcinoma: a randomized trial
European Radiology ( IF 4.7 ) Pub Date : 2022-08-26 , DOI: 10.1007/s00330-022-09038-1
Xiaowu Zhang ₁ , Yingen Luo ₁ , Jiaywei Tsauo ₁ , He Zhao ₁ , Tao Gong ₁ , Jingui Li ₁ , Yawei Li ₁ , Huiying Zeng ₁ , Wei Sun ₁ , Xiao Li ₁

Affiliation

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.

中文翻译：

经桡动脉与经股动脉通路在肝细胞癌患者经动脉化疗栓塞中的应用：一项随机试验

目标

比较肝细胞癌 (HCC) 经动脉化疗栓塞 (TACE) 患者经桡动脉通路 (TRA) 和经股动脉通路 (TFA) 的患者满意度、程序变量和安全性。

材料和方法

从 2019 年 2 月到 2021 年 8 月，130 名接受 TACE 治疗 HCC 的患者被随机分配到 TRA（n = 65）或 TFA（n = 65）组。TFA-TACE 后未使用血管闭合装置。所有患者在 TACE 后 1 天完成了导管插入后问卷和 8 项简短健康调查。

结果

两组的技术成功率、交叉率、造影剂剂量、透视时间、手术时间、空气比释动能、剂量面积乘积、住院时间和总费用相似（均p > 0.05）。两组之间不良事件的发生率和严重程度也相似（均p > 0.05）。然而，TRA 组的总体不适、如厕困难、进食或自理困难、行走困难、一般健康、身体机能、角色身体机能、社会功能、心理健康和角色情绪功能在 TRA 组中优于TFA 组（所有p < 0.001）。因此，与 TFA 组相比，与 TFA 组相比，TRA 组更多的患者更喜欢当前的下一次手术（90.8% 对 24.6%；p < 0.001)。