“While both radial and femoral accesses are safe and effective for transarterial liver embolization, it is clear that the patients prefer radial access,” said Marcelo Guimaraes, Charleston, USA, who was presenting on the BEST ACCESS trial at the Super Tuesday session during the 2017 CIRSE annual meeting.
The BEST ACCESS trial is a randomised, prospective, single institutional, intra- and inter-patient controlled trial, which compared of radial vs. femoral access in transarterial liver embolization in the treatment of primary or metastatic liver cancer. The trial set out to evaluate patients’ preference, crossing from radial to femoral, effectiveness, safety, advantages, and appropriateness of performing transarterial hepatic embolization of liver cancer via arterial access from the radial artery vs. conventional transfemoral arterial access. The procedures that were used included transarterial chemoembolization, specifically performed for hepatocellular carcinoma, and transarterial bland embolization which is performed for types of liver tumours such as carcinoid tumours or liver metastases.
Randomisation
The researchers randomly, and then sequentially, assigned all patients who underwent at least two interventions so that they underwent one transradial procedure and one transfemoral procedure.
“If a third procedure was needed, the patient selected the access type,” noted Guimaraes, who is director, Vascular and Interventional Radiology and professor of Radiology and Surgery, Medical University of South Carolina, USA.
The primary endpoint of the trial was patient access preference, and secondary endpoints were access-related complications, radiation exposure to operator and patients, contrast volume, procedure time. All patients were assessed the day after the intervention and at 30 days post-intervention. The assessment included a questionnaire and physical exam followed by ultrasound.
Results
The researchers initially randomly assigned 55 patients with liver cancer (31 hepatocellular carcinoma and 24 metastatic disease) to either radial or femoral access. A total of 124 transarterial liver embolizations were performed. Thirty-six patients completed the trial which was terminated early as the primary endpoint was achieved sooner than expected.
After undergoing treatment via both accesses, 81% of patients preferred radial and 19% preferred femoral access (ratio 4:1). There were no major adverse events in either access group, including ultrasound exams arterial occlusion and clinically evident stroke. Thirty seven per cent of patients had minor complications that were mainly bruising and local pain, without any significance difference between the two groups. No difference was found in patient radiation exposure.
“However, the other major finding was the threefold reduction in radiation exposure to the operator when radial access was used. This was possible due to the type of shielding and left arm being positioned open at 70–90 degrees,” Guimaraes concluded.
