Niels van Royen of Radboud University Nijgemene and colleagues conducted a randomized clinical trial and found that the incidence of access site bleeding during transcatheter aortic valve implantation is lower with access through the upper limb than through the lower limb. The TAVI XS trial involved 238 patients (mean age 79.4 years; 63 percent men) with severe aortic stenosis and no contraindications at four Dutch clinical centers. Half of the patients were accessed via the radial artery and, if a temporary pacing lead was needed, via the upper limb vein; the other half were accessed via the femoral artery and vein, respectively. The results were published in JAMA Network Open.
It turned out that clinically significant bleeding at the access site developed significantly less frequently with access through the arm than with 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. Secondary access failure was observed more frequently with the arm (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 access through the lower limb in terms of complications, the authors of the study conclude.
