Niels van Royen of Radboud University Nijmegen and colleagues conducted a randomized clinical trial and found that the incidence of access-site bleeding in transcatheter aortic valve implantation is lower with access through the upper limb than through the lower limb. The TAVI XS trial enrolled 238 patients (mean age 79.4 years; 63 percent men) with severe aortic stenosis and no contraindications at four Dutch clinical centers. Half of them had access via the radial artery and, if a temporary pacing lead was needed, via the upper limb vein; the other half had access via the femoral artery and vein, respectively. The results are published in JAMA Network Open.
It turned out that with access through the arm, clinically significant bleeding at the access site develops significantly less frequently than when using leg vessels - 4.2 versus 13.4 percent (odds ratio (OR) 0.28; p = 0.01) with secondary access and 21.0 versus 34.5 percent (OR 0.51; p = 0.02) overall. At the same time, secondary access failure when using the arm was observed more often (11.8 versus 0.8 percent), and the procedure took longer on average (60 versus 48 minutes). Thus, access through the upper limb for transcatheter aortic valve implantation may be preferable to through the lower limb in terms of complications, the authors of the study conclude.