Operator learning curve for transradial liver cancer embolization: implications for the initiation of a transradial access program

Özet

PURPOSEWe aimed to analyze transradial access (TRA) learning curve on patients undergoing hepaticchemoembolization, investigating the relationship between procedural volumes and variousbenchmarks of procedural success.METHODSWe enrolled 60 consecutive patients who received two unilobar hepatic chemoembolizationswithin a 4-week interval performed by a single interventional radiologist, highly-trained in conventional transfemoral access (TFA) procedures, but without any previous practical experiencein TRA procedures and with a preliminary 2-day theoretical training only. Consecutive patientswere prospectively enrolled and analyzed in 3 groups: A (cases 1 to 20), B (cases 21 to 40), andC (cases 41 to 60). All patients underwent one hepatic chemoembolization using TRA and theother one using TFA in random order. All TFA procedures performed by the same operator in thesame series of patients were considered as the control group. Primary endpoint was to analyzethe relationship between TRA procedure operator experience and benchmarks of proceduralsuccess, to define the optimal procedural learning curve.RESULTSTechnical success was obtained in all patients, with a crossover rate (radial to femoral access) of0%. An association between incremental TRA operator experience (in terms of performed procedures) and decrease of preparation, puncture, fluoroscopy, and total examination times wasobserved. Similarly, inverse associations between incremental TRA operator experience and contrast medium (CM) volumes (P < 0.001) and radiation dose (RD) values (in terms of RAK - Reference Air Kerma) (P < 0.001) were also observed. Compared with TFA, CM volumes and RD valueswere significantly higher only in group A (cases 1–20). Procedure success remained high in allTRA groups and no significant association between TRA incremental experience and postprocedural outcomes was found. Higher postprocedural complaints at the access route and morelimitations in performing basic activities were recorded after TFA vs. TRA (P < 0.001).CONCLUSIONTRA catheterizations can be safely performed in patients treated for liver cancer embolizationafter a relatively short training in controlled conditions and with a better performance in comparison with TFA. Operator proficiency improves with greater TRA experience, with a thresholdneeded to overcome the learning curve represented by about 20 procedures.