TRANSRADIAL APPROACH FOR PERCUTANEOUS ENDOVASCULAR INTERVENTIONS OF DYSFUNCTIONAL ARTERIO-VENOUS FISTULA (TAPE- AVF): SAFETY AND OUTCOMES STUDY

Introduction:

Percutaneous transluminal angioplasty (PTA), an established therapy to salvage dysfunctional arteriovenous fistula (AVF), is mostly performed via retrograde transvenous approach through the outflow vein of the AVF. The transradial approach, a standard of care in coronary artery interventions, has not been extensively studied for AVF interventions even though it carries the advantage of direct visualization of the whole AV access with a single contrast injection and provides direct guidewire access to both the inflow and outflow of the AVF without need for additional sheaths. However, one drawback is related to the risk of radial artery occlusion (RAO), spasm and perforation.

Methods:

In this single-centre study, a total of 171 cases of dysfunctional radiocephalic AV fistula (RC-AVF) were included with the transradial approach in 102 and the transvenous approach in 69 cases. The study evaluated the clinical and technical success, complications, and safety of the transradial and transvenous approaches in PTA. 

To evaluate the incidence of RAO, 11 cases of brachiocephalic AV fistula (BC-AVF) were also included where transradial approach was used.

Results:

The baseline clinical characteristics are shown in Table 1.

A significantly higher technical and clinical success rate for RC-AVF dysfunction with the transradial approach (98% and 97.1% respectively) as compared to the transvenous approach (84.1% and 76.8% respectively) was reported (P<0.05). A significantly higher increase in mean brachial artery flow pre to post procedure in successful cases was noted with the transradial approach (630.80 ± 225.91 ml/min) as compared to the transvenous approach (491.72 ± 190.70 ml/min) (P=0.003) (Table 2).

Contrary to the belief, among successful cases, the mean procedure time, mean radiation time and mean radiation dose were higher with the transradial approach (72.2±39.941 min, 19.02±15.826 min and 56.549±29.984 mGy, respectively) than with the transvenous approach (63.40±46.125 min, 18.357±17.151 min and 42.321±27.869 mGy respectively), even though only the difference in mean radiation dose reached statistical significance.

Overall, a significantly higher rate of complication was seen in the transradial approach (17%), although minor, as compared to the transvenous approach (6.8%) (P=0.01), with the most common complication being a tear at the site of stenosis induced by balloon inflation (12 with transradial approach and 2 with transvenous approach) which was managed conservatively except in one case which required revision of AVF. A higher complication rate was probably due to the significantly higher diameter of the balloon dilatation catheter used in the transradial approach.

In transradial approach, the rate of radial artery occlusion (RAO) was 3.9% on day-1 and 2.9% on day-15 and day-90 among patients with RC-AVFs. However, of the 11 patients with BC-AVF in whom trans-radial approach was used, RAO was seen in 36.4% on day-1, 27.3% on day-15 and day-90. Those with BC-AVFs had a significantly higher chance of having RAO than those with RC-AVFs on day-1, day-15, and day-90 (P=0.001) (Table 3). None of the patients had symptomatic RAO.

Conclusions:

The transradial approach is an excellent alternative to the transvenous approach with higher technical and clinical success rate, low rates of RAO and acceptable safety profile for the management of radiocephalic AV fistula dysfunction.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.