Extremity Dysfunction After Large-Bore Radial and Femoral Arterial Access

Abstract

Background The use of large-bore (LB) arterial access and guiding catheters has been advocated for complex percutaneous coronary intervention. However, the impact of LB transradial access (TRA) and transfemoral access (TFA) on extremity dysfunction is currently unknown. Methods and Results The predefined substudy of the COLOR (Complex Large-Bore Radial PCI) trial aimed to assess upper and lower-extremity dysfunction after LB radial and femoral access. Upper-extremity function was assessed in LB TRA-treated patients by the Quick Disabilities of the Arm, Shoulder, and Hand questionnaire and lower-extremity function in LB TFA-treated patients by the Lower Extremity Functional Scale questionnaire. Extremity pain and effect of access site complications and risk factors on extremity dysfunction was also analyzed. There were 343 patients who completed analyzable questionnaires. Overall, upper and lower-extremity function did not decrease over time when LB TRA and TFA were used for complex percutaneous coronary intervention, as represented by the median Quick Disabilities of the Arm, Shoulder, and Hand score (6.8 at baseline and 2.1 at follow-up, higher is worse) and Lower Extremity Functional Scale score (56 at baseline and 58 at follow-up, lower is worse). Clinically relevant extremity dysfunction occurred in 6% after TRA and 9% after TFA. A trend for more pronounced upper-limb dysfunction was present in female patients after LB TRA (P=0.05). Lower-extremity pain at discharge was significantly higher in patients with femoral access site complications (P=0.02). Conclusions Following LB TRA and TFA, self-reported upper and lower-limb function did not decrease over time in the majority of patients. Clinically relevant limb dysfunction occurs in a small minority of patients regardless of radial or femoral access. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT03846752.

Keywords: chronic total occlusion; complex PCI; extremity dysfunction; large‐bore arterial access.

Figure 1. Flowchart representing access site distribution and questionnaire response.

The percentages shown reflect the proportion of patients with analyzable questionnaires. Fr indicates French; LEFS, Lower Extremity Functional Scale; and QD, QuickDASH, Quick Disabilities of Arm, Shoulder, and Hand. COLOR indicates Complex Large‐Bore Radial PCI trial.

Figure 2. Quick Disabilities of Arm, Shoulder, and Hand (QuickDASH) score for primary transradial‐treated patients and Lower Extremity Functional Scale (LEFS) score for primary transfemoral‐treated patients at baseline and at the 30‐day follow‐up.