A Comparison of the Femoral and Radial Crossover Techniques for Vascular Access Management in Transcatheter Aortic Valve Implantation: The Milan Experience Helen Curran, MD, FRCPC, Alaide Chieffo, MD, Gill Louise Buchanan, MBCHB, Chiara Bernelli, MD, Matteo Montorfano, MD, Francesco Maisano, MD, Azeem Latib, MD, Davide Maccagni, RT , Mauro Carlino, MD, Filippo Figini, MD, Micaela Cioni, MD, Giovanni La Canna, MD, Remo Daniel Covello, MD, Annalisa Franco, MD, Chiara Gerli, MD, Ottavio Alfieri, MD, and Antonio Colombo, * MD Objective: To compare radial and femoral crossover techniques (CT) for vascular access management in transcatheter aortic valve implantation (TAVI). Background: Femoral crossover for controlled angiography and balloon inflation of the therapeutic access site to facilitate safe vascular closure is beneficial but technically challenging in patients with complex femoral anatomy. An alternative approach should be avail- able. Methods: Between June 2011 and March 2012, 41 transfemoral TAVI patients receiving the femoral CT were compared to 46 transfemoral TAVI patients receiving the radial CT. Outcomes were 30-day valve academic research consortium (VARC) end- points. Results: Patients undergoing the radial CT received higher median contrast vol- umes (150 interquartile range [IQR]: 105–180 vs. 111 IQR: 90–139 ml; P 5 0.025) but procedural radiation dose and fluoroscopy times were comparable. Thirty day all cause and cardiovascular death were similar between radial and femoral CT groups (respec- tively 2.4% vs. 7.9%, P 5 0.258 and 0% vs. 7.9%, P 5 0.063). There were no differences in major vascular complications (4.3% vs. 7.3%, P 5 0.553), life threatening or major bleeding events (respectively 9.1% vs. 19.5%, P 5 0.168 and 13.6% vs. 22%, P 5 0.315). Conclusion: In TAVI cases with unfavorable contralateral femoral anatomy, radial CT for vascular access management is a reasonable alternative to the femoral CT. V C 2013 Wiley Periodicals, Inc. Key words: TAVI; aortic stenosis; vascular closure device INTRODUCTION Transcatheter aortic valve implantation (TAVI) is rec- ognized as a viable treatment option in patients with severe symptomatic aortic stenosis at high risk for con- ventional surgical aortic valve replacement (AVR) [1–3]. Transfemoral TAVI is associated with risks of bleeding and vascular complications secondary to use of large di- ameter sheaths, the presence of diffusely diseased periph- eral vasculature and the general frailty of patients [4]. Consequently, meticulous attention to vascular access management is crucial to reduce the occurrence of complications. Our group previously described a technique used to facilitate safe therapeutic vascular access closure called the crossover technique (CT) utilizing the contralateral femoral artery [5]. Although instrumental in assisting effective vascular closure, the femoral approach is not feasible in occluded femoral arteries and can prove challenging in diffusely diseased, excessively tortuous vessels with narrow iliac carina angles. In these Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy Conflict of interest: M.M is a proctor for Edwards Lifesciences and F.M is a proctor for Medtronic. The other authors have no conflicts of interest to disclose. *Correspondence to: Antonio Colombo, MD, Interventional Cardiol- ogy Unit, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy. E-mail: colombo.antonio@hsr.it Received 8 December 2012; Revision accepted 3 March 2013 DOI: 10.1002/ccd.24913 Published online 8 March 2013 in Wiley Online Library (wileyonlinelibrary.com). V C 2013 Wiley Periodicals, Inc. Catheterization and Cardiovascular Interventions 83:156–161 (2014)