Safety of transradial compaired to transfemoral approach in interventional cardiology

• Main Authors: Mamdouh Maher, Hossam B Kashlon
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2020-01-01
• Series: Journal of Medicine in Scientific Research
• Subjects: cardiac catheterization; femoral artery; percutaneous coronary intervention; radial artery
• Online Access: http://www.jmsr.eg.net/article.asp?issn=2537-091X;year=2020;volume=3;issue=1;spage=68;epage=73;aulast=Maher
• ISSN: 2537-091X; 2537-0928

Background The femoral approach has been preferably used to access in interventional cardiology, being perceived as easy and facilitating quick access with relatively low risk. In the hands of experienced operators and high-volume centers, the radial approach offers improved patient comfort, decreased access-site complications, and decreased costs without compromising procedural success on long-term outcomes. Patients presenting with ST-elevation myocardial infarction, in particular, benefit from a transradial approach to coronary intervention. Owing to the results of the latest studies, the radial approach has become increasingly popular. Radial access is known to have a steep learning curve. The effect of this results in the hesitation of performing percutaneous coronary intervention through radial route by conventional femoral access operators. A growing body of evidence supports the adoption of transradial artery access to improve acute coronary syndrome-related outcomes, to improve healthcare quality, and to reduce cost. The purpose of this study was to propose and support a transradial strategy for patients with stable coronary artery disease as well as those presenting with acute coronary syndromes. The aim of this study was a safety analysis of coronary interventional procedures according to the access vessel. Materials and methods A total of 204 coronary interventions done in the Department of Interventional Cardiology were retrospectively analyzed. All the procedures were classified according to femoral or radial access. The incidence of local complications (e.g. major bleedings and hematomas) was assessed as well as the volume of contrast agent administered during the procedure and the fluoroscopy time of the procedure. Results It has been shown that radial approach, which is obviously more comfortable for patients, reduces the risk of local complications (0 vs 2.97% and 0 vs 3.96%). However, there could be a larger volume of contrast agent administered (P=0.029), which in some cases could increase the risk of contrast-induced nephropathy, and redial access has a longer fluoroscopy time. Conclusion The radial approach should be recommended as a first choice because it is safer than the classical femoral approach because it is associated with a lower incidence of complications, but one must be cautious in choosing radial-approach patients with renal insufficiency, especial in early learning because of the use of high contrast volume.