Vol. 40 | No. 2 | July-December 2012 Back

Open Access

A Retrospective Study on the Use of Transradial Versus Transfemoral Approach for Coronary Angiography and Intervention at a Tertiary Hospital

Gerard Ryan T. Mercadal, Jose Paolo A. Prado, Raul E. Ramboyong
Dec 2012 DOI 10.69944/pjc.6478b85188

Abstract

OBJECTIVES: The aim of this study is to analyze and compare femoral versus radial access for coronary angiography and intervention at the Cardiac Catheterization Laboratory of The Medical City, a tertiary hospital in the Philippines, from October 2010 to January 2011. 

METHODOLOGY: This is a retrospective study of all patients who underwent coronary angiography with or without intervention. Medical records of identified patients were reviewed to determine, analyze and compare the baseline characteristics, course, outcome and complications of the two groups. 

RESULTS: A total of 231 coronary procedures were performed on 219 patients, with 141 (61.04%) utilizing the radial artery for vascular access compared to 90 (38.96%) for the femoral artery. The overall success rate at first attempt to vascular access was 95.24%, with failure rate to vascular access of 7.28% and 1.25% in the radial and femoral group, respectively. The cross-over rate from radial to femoral access was 4.33%. Procedural success rates for percutaneous coronary intervention (PCI) were 100% and 95.45% for radial and femoral access, respectively. Arterial access was obtained with a significantly smaller introducer sheath in the radial compared to the femoral group in both coronary angiography (5.55 mm vs. 6.05 mm, respectively; p<0.000) and PCI procedures (5.86 mm vs. 6.36mm, respectively; p<0.000). Amount of contrast used and procedural time were similar between the two groups. Fluoroscopy time was significantly longer in the radial (39.87 min) compared to the femoral group (19.41 min; p<0.000). Complication rates were similar between the two groups. The incidence of bleeding was 2.13% and 2.22% in radial and femoral group, respectively (p>0.05). 

CONCLUSION: The present study demonstrates that radial vascular access is increasingly being utilized in our institution. Transradial approach can be safely offered to patients with its high success rate and low conversion to femoral route. Complications of coronary procedures in the femoral and radial group were comparable in this study.

References
  1. Archbald, RA, et al. Radial Artery Access for Coronary Angiography and Percutaneous Coronary Intervention. British Medical Journal Clinical Review, August 21, 2004; 329: 443-446. 
  2. Almany, SL MD FACC, O’Neill, WW MD FACC. Radial Artery Access for Diagnostic and Interventional Procedures. Radial Access, 1999; 1-17. 
  3. Campeau, L MD. Percutaneous radial artery approach for coronary angiography. Catheterization and Cardiovascular Diagnosis, 1989.16:3-7. 
  4. Agostoni,P MD, et al. Radial versus femoral approach for percutaneous coronary diagnostic and interventional procedures: Systematic overview and meta-analysis of randomized trials. Journal of the American College of Cardiology, 2004; 44(2):349-356. 
  5. Jolly, SS MD, et al. Design and rationale of the RadIal Vs. femorAL access for coronary intervention (RIVAL) trial: A randomized comparison of radial versus femoral access for coronary angiography or intervention in patients with acute coronary syndromes. American Heart Journal, 2011; 161:254-260.e4. 
  6. Choussat, R, et al. Vascular Complications and Clinical Outcome after Coronary Angioplasty with Platelet IIb/IIIa Receptor Blockade. European Heart Journal, 2000; 21: 662-7. 
  7. De-an, J, et al. Incidence and Predictors of Radial Artery Spasm during Transradial Coronary Angiography and Intervention. Chinese Medical Journal, 2010; 123(7):843-47. 
  8. Popma, JJ MD, et al. Vascular Complications After Balloon and New Device Angioplasty. Circulation, 1993; 88(part 1)1569-78.
  9. Wang, L, et al. Prevalence of transradial coronary angiography and intervention in China: Report from the Transradial coronary intervention Registration Investigation in China (TRI-China). Letters to the Editor, 2009. 246-247. 
  10. Brueck, M, et al. A Randomized Comparison of Transradial Versus Transfemoral Approach for Coronary Angiography and Angioplasty. Journal of the American College of Cardiology, 2009; 2(11): 1047-54. 
  11. Guedes, A MD, et al. Low Rate of Conversion to Transfemoral Approach When Attempting Both Radial Arteries for Coronary Angiography. The Journal of Invasive Cardiology,2010; 22: 391-397. 
  12. Mann, T, et al. Stenting in acute coronary syndromes: a comparison of radial versus femoral access sites. Journal of the American College of Cardiology, 1998; 32(3): 572-6. 
  13. Lotan, Chaim, MD, et al. Transradial approach for coronary angiography and angioplasty. The American Journal of Cardiology, 1995;76:164-7. 
  14. Dehghani, P MD, et al. Mechanism and predictors of failed transradial approach for percutaneous coronary interventions. Journal of the American College of Cardiology, 2009; 2(11):1057-64. 
  15. Chase, AJ, et al. Association of the arterial access site angioplasty with transfusion and mortality: the M.O.R.T.A.L. study (Mortality benefit of Reduced Transfusion after percutaneous coronary intervention via the Arm of Leg). Interventional Cardiology,2008;94:1019-25.
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