A Randomized Comparison of Transradial and Transfemoral Approach in Hepatic Arterial Infusion Chemotherapy

Article ID: e110523216782 Pages: 7

  • * (Excluding Mailing and Handling)

Abstract

Introduction: Hepatic arterial infusion chemotherapy (HAIC) has been popular for treating unresectable hepatocellular carcinoma (HCC). However, there are few reports comparing the transradial approach (TRA) and transfemoral approach (TFA) in HAIC.

Objective: This study aimed to compare the duration of the hepatic artery catheterization, fluoroscopy time (FT), radiation exposure, safety, and quality of life associated with the procedure in patients undergoing HAIC via TRA and TFA.

Methods: This prospective, single-center, randomized, controlled study included 120 patients with unresectable HCC undergoing HAIC procedures. Patients were randomly assigned to group A (n = 60, TRA-HAIC) or group B (n = 60, TFA-HAIC). The hepatic artery catheterization time, FT, entrance surface dose (ESD), dose area product (DAP), procedure-related complications, and quality of life associated with the procedure were assessed between the two groups. Independent-sample t-test and analysis of variance (ANOVA) were used to assess differences. Statistical significance was set at P < 0.05.

Results: HAIC procedures were successfully performed in both groups. The hepatic artery catheterization time (19.35 ± 5.84 vs. 18.93 ± 5.62 minutes, P = 0.837), FT (2.35 ± 2.23 vs. 2.25 ± 2.16 minutes, P = 0.901), ESD (259.32 ± 167.46 vs. 250.56 ± 170.58 mGy, P = 0.449), and DAP (125.37 ± 60.65 vs. 120.56 ± 64.33 Gy.cm3, P = 0.566) were comparable between the two groups. The incidence of artery occlusion (10.0% vs. 0%, P < 0.001) in the TRA group was significantly higher than that in the TFA group. TRA was associated with a statistically significant (P < 0.05) improvement in the quality of life.

Conclusion: TRA to HAIC was associated with greater improvement in the quality of life associated with the procedure compared with TFA. Both approaches to HAIC had similar efficiency, safety, radiation exposure, and procedure duration.

[1]
Tang A, Hallouch O, Chernyak V, Kamaya A, Sirlin CB. Epidemiology of hepatocellular carcinoma: Target population for surveillance and diagnosis. Abdom Radiol 2018; 43(1): 13-25.
[http://dx.doi.org/10.1007/s00261-017-1209-1] [PMID: 28647765]
[2]
Mise Y, Sakamoto Y, Ishizawa T, et al. A worldwide survey of the current daily practice in liver surgery. Liver Cancer 2013; 2(1): 55-66.
[http://dx.doi.org/10.1159/000346225] [PMID: 24159597]
[3]
Verslype C, Rosmorduc O, Rougier P, Group EGW. Hepatocellular carcinoma: ESMO-ESDO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2012; 23(S7): vii41-8.
[4]
Marrero JA, Kulik LM, Sirlin CB, et al. Diagnosis, staging, and management of hepatocellular carcinoma: 2018 practice guidance by the american association for the study of liver diseases. Hepatology 2018; 68(2): 723-50.
[http://dx.doi.org/10.1002/hep.29913] [PMID: 29624699]
[5]
Ikeda M, Morizane C, Ueno M, Okusaka T, Ishii H, Furuse J. Chemotherapy for hepatocellular carcinoma: Current status and future perspectives. Jpn J Clin Oncol 2018; 48(2): 103-14.
[http://dx.doi.org/10.1093/jjco/hyx180] [PMID: 29253194]
[6]
Ikeda M, Mitsunaga S, Ohno I, et al. Systemic chemotherapy for advanced hepatocellular carcinoma: Past, present, and future. Diseases 2015; 3(4): 360-81.
[http://dx.doi.org/10.3390/diseases3040360] [PMID: 28943630]
[7]
Nouso K, Miyahara K, Uchida D, et al. Effect of hepatic arterial infusion chemotherapy of 5-fluorouracil and cisplatin for advanced hepatocellular carcinoma in the Nationwide Survey of Primary Liver Cancer in Japan. Br J Cancer 2013; 109(7): 1904-7.
[http://dx.doi.org/10.1038/bjc.2013.542] [PMID: 24008659]
[8]
Shi M, Lu LG, Fang WQ, et al. Roles played by chemolipiodolization and embolization in chemoembolization for hepatocellular carcinoma: Single-blind, randomized trial. J Natl Cancer Inst 2013; 105(1): 59-68.
[http://dx.doi.org/10.1093/jnci/djs464] [PMID: 23150720]
[9]
Jolly SS, Yusuf S, Cairns J, et al. Radial versus femoral access for coronary angiography and intervention in patients with acute coronary syndromes (RIVAL): A randomised, parallel group, multicentre trial. Lancet 2011; 377(9775): 1409-20.
[http://dx.doi.org/10.1016/S0140-6736(11)60404-2] [PMID: 21470671]
[10]
Shiozawa S, Tsuchiya A, Endo S, et al. Transradial approach for transcatheter arterial chemoembolization in patients with hepatocellular carcinoma: Comparison with conventional transfemoral approach. J Clin Gastroenterol 2003; 37(5): 412-7.
[http://dx.doi.org/10.1097/00004836-200311000-00013] [PMID: 14564191]
[11]
Rastegar RF, Hou D, Harris A, et al. Is a liver biopsy necessary? investigation of a suspected hepatocellular carcinoma: A pictorial essay of hepatocellular carcinoma and the revised american association for the study of liver disease criteria. Can Assoc Radiol J 2012; 63(4): 329-40.
[http://dx.doi.org/10.1016/j.carj.2011.09.004]
[12]
Mason PJ, Shah B, Tamis-Holland JE, et al. An update on radial artery access and best practices for transradial coronary angiography and intervention in acute coronary syndrome: A scientific statement from the american heart association. Circ Cardiovasc Interv 2018; 11(9): e000035.
[http://dx.doi.org/10.1161/HCV.0000000000000035] [PMID: 30354598]
[13]
Li QJ, He MK, Chen HW, et al. Hepatic arterial infusion of oxaliplatin, fluorouracil, and leucovorin versus transarterial chemoembolization for large hepatocellular carcinoma: A randomized phase III trial. J Clin Oncol 2022; 40(2): 150-60.
[http://dx.doi.org/10.1200/JCO.21.00608] [PMID: 34648352]
[14]
Kiemeneij F, Laarman GJ, de Melker E. Transradial artery coronary angioplasty. Am Heart J 1995; 129(1): 1-7.
[http://dx.doi.org/10.1016/0002-8703(95)90034-9] [PMID: 7817902]
[15]
Dariushnia SR, Redstone EA, Heran MKS, et al. Society of interventional radiology quality improvement standards for percutaneous transcatheter embolization. J Vasc Interv Radiol 2021; 32(3): 476 e1-e33.
[http://dx.doi.org/10.1016/j.jvir.2020.10.022]
[16]
Gayed A, Yamada R, Bhatia S, et al. Society of interventional radiology quality improvement standards on radial artery access. J Vasc Interv Radiol 2021; 32(5): 761 e1-e21.
[http://dx.doi.org/10.1016/j.jvir.2020.12.013]
[17]
Agostoni P, Biondi-Zoccai GGL, De Benedictis ML, et al. Radial versus femoral approach for percutaneous coronary diagnostic and interventional procedures. J Am Coll Cardiol 2004; 44(2): 349-56.
[http://dx.doi.org/10.1016/j.jacc.2004.04.034] [PMID: 15261930]
[18]
Kis B, Mills M, Hoffe SE. Hepatic radioembolization from transradial access: Initial experience and comparison to transfemoral access. Diagn Interv Radiol 2016; 22(5): 444-9.
[http://dx.doi.org/10.5152/dir.2016.15571]
[19]
Zanon C, Grosso M, Zanon E, et al. Transaxillary access to perform hepatic artery infusion (HAI) for secondary or primitive hepatic tumors. Minerva Chir 1996; 51(9): 755-8.
[PMID: 8968147]
[20]
Arai Y, Takeuchi Y, Inaba Y, et al. Percutaneous catheter placement for hepatic arterial infusion chemotherapy. Tech Vasc Interv Radiol 2007; 10(1): 30-7.
[http://dx.doi.org/10.1053/j.tvir.2007.08.007] [PMID: 17980316]
[21]
Kudo M, Ueshima K, Yokosuka O, et al. Sorafenib plus low-dose cisplatin and fluorouracil hepatic arterial infusion chemotherapy versus sorafenib alone in patients with advanced hepatocellular carcinoma (SILIUS): A randomised, open label, phase 3 trial. Lancet Gastroenterol Hepatol 2018; 3(6): 424-32.
[http://dx.doi.org/10.1016/S2468-1253(18)30078-5] [PMID: 29631810]
[22]
Thawabi M, Tayal R, Hawatmeh A, Cohen M, Wasty N. Percutaneous transaxillary approach for peripheral endovascular interventions. Catheter Cardiovasc Interv 2019; 94(2): 243-8.
[http://dx.doi.org/10.1002/ccd.28333]
[23]
Michael TT, Alomar M, Papayannis A, et al. A randomized comparison of the transradial and transfemoral approaches for coronary artery bypass graft angiography and intervention: The RADIAL-CABG Trial (RADIAL versus Femoral Access for Coronary Artery Bypass Graft Angiography and Intervention). JACC Cardiovasc Interv 2013; 6(11): 1138-44.
[http://dx.doi.org/10.1016/j.jcin.2013.08.004] [PMID: 24139930]
[24]
Sherev DA, Shaw RE, Brent BN. Angiographic predictors of femoral access site complications: Implication for planned percutaneous coronary intervention. Catheter Cardiovasc Interv 2005; 65(2): 196-202.
[http://dx.doi.org/10.1002/ccd.20354]
[25]
Sanghvi KA, Montgomery M, Varghese V. Effect of hemostatic device on radial artery occlusion: A randomized comparison of compression devices in the radial hemostasis study. Cardiovasc Revasc Med 2018; 19(8): 934-8.
[http://dx.doi.org/10.1016/j.carrev.2018.08.013] [PMID: 30243962]
[26]
Goni H, Tsalafoutas IA, Tzortzis G, et al. Radiation doses to patients from digital subtraction angiography. Radiat Prot Dosimetry 2005; 117(1-3): 251-5.
[http://dx.doi.org/10.1093/rpd/nci758] [PMID: 16461514]
[27]
Stewart FA. Mechanisms and dose-response relationships for radiation-induced cardiovascular disease. Ann ICRP 2012; 41(3-4): 72-9.
[http://dx.doi.org/10.1016/j.icrp.2012.06.031] [PMID: 23089006]
[28]
Scott AM. Current issues in radiation dose monitoring and reporting. Radiol Technol 2014; 85(5): 501-16.
[PMID: 24806053]
[29]
Paul J, Jacobi V, Farhang M, Bazrafshan B, Vogl TJ, Mbalisike EC. Radiation dose and image quality of X-ray volume imaging systems: Cone-beam computed tomography, digital subtraction angiography and digital fluoroscopy. Eur Radiol 2013; 23(6): 1582-93.
[http://dx.doi.org/10.1007/s00330-012-2737-2] [PMID: 23250112]
[30]
Pacchioni A, Versaci F, Mugnolo A, et al. Risk of brain injury during diagnostic coronary angiography: Comparison between right and left radial approach. Int J Cardiol 2013; 167(6): 3021-6.
[http://dx.doi.org/10.1016/j.ijcard.2012.09.024] [PMID: 23046593]
[31]
Shah RM, Patel D, Abbate A, Cowley MJ, Jovin IS. Comparison of transradial coronary procedures via right radial versus left radial artery approach: A meta-analysis. Catheter Cardiovasc Interv 2016; 88(7): 1027-33.
[http://dx.doi.org/10.1002/ccd.26519]
[32]
Kanei Y, Nakra NC, Liou M, et al. Randomized comparison of transradial coronary angiography via right or left radial artery approaches. Am J Cardiol 2011; 107(2): 195-7.
[http://dx.doi.org/10.1016/j.amjcard.2010.08.065] [PMID: 21129711]
[33]
Sciahbasi A, Rigattieri S, Sarandrea A, et al. Operator radiation exposure during right or left transradial coronary angiography: A phantom study. Cardiovasc Revasc Med 2015; 16(7): 386-90.
[http://dx.doi.org/10.1016/j.carrev.2015.07.004] [PMID: 26235976]