Left radial vs right femoral: comparison between arterial accesses in c-TACE procedures in terms of operator radiations exposure and patient comfort.

Purpose: This multicenter prospective study aims to compare transradial access versus transfemoral access in conventional transarterial chemoembolization (c-TACE) procedures, focusing on operators radiations exposure, patients comfort, technical success and vascular access complications.
Materials and Methods: Patients were affected by hepatocellularcarcinoma (HCC) in intermediate stage or previous stages unfit for ablation and/or surgery; they were randomized into two groups according to arterial access site (Group F: right femoral access in standard position; Group R: radial access with left arm abduced 90°). Overall fluoroscopy time was recorded. Eight thermoluminescence dosimeters were positioned immediately before each procedure to monitor radiation doses. Technical success was intended as complete HCC nodules lipiodolization at final plain cone-beam CT.
Results: Group F included 23 patients, while group R 19. Mean fluoroscopy time was lower in group F but difference was not statistically significant (p-value > 0.05). In terms of operators radiations exposure, no significant differences were found (p-value > 0.05). Technical success was obtained in 81.5% in group F and 84.8% in group R, without significant differences (p-value > 0.05). Patients discomfort was significantly (p-value < 0.05) higher in group F. Concerning minor complications, no statistical differences were appreciated (p-value > 0.05); no major complications occurred.
Conclusions: In this study, no statistical differences were observed in terms of operators radiations exposure, fluoroscopy time and technical success during c-TACE performed with left radial access compared to right femoral access; patients comfort was significantly better with radial access. These data should lead interventional radiologists to favor radial access in c-TACE interventions.
Competing Interests: Declarations. Conflict of interest: The authors declare that they have no conflict of interest. Ethical approval: The study adhered to the principles of the Declarations of Helsinki and Istanbul. The study was approved by the ethical review board (DEL:233/2024) considering its prospective design. Informed consent: Informed consent was obtained from all patients included in the study, if clinical conditions allowed. Consent to participate: All patients gave written informed consent to participate to the study and data analysis; all written consents are available in the archives of Vascular and Interventional Radiology Dept of Cardarelli Hospital of Naples. Consent to publish: All patients gave written informed consent for data publication. Research involving human participants: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
(© 2024. Italian Society of Medical Radiology.)