Comparison of transradial vs. transfemoral approach in the treatment of acute myocardial infarction with primary angioplasty and abciximab

Abstract

Compared to the femoral approach, the use of radial arterial access has been demonstrated to reduce the incidence of access site bleeding complications in staged procedures. The purpose of this study was to evaluate clinical outcomes comparing radial and femoral approaches in the treatment of acute myocardial infarction with primary angioplasty and the GP IIb/IIIa inhibitor abciximab. Between 15 September 1999 and 15 September 2002, we prospectively enrolled 119 consecutive patients undergoing primary angioplasty with abciximab comparing radial (n = 64) and femoral (n = 55) access. In this nonrandomized study, freedom from major cardiac events at 1-month follow-up occurred in 62 (97%) and 52 (94.5%) patients in the radial and the femoral groups, respectively (P = 0.19). There were no major access site bleeding complications in the radial group, as opposed to three (5.5%) in the femoral group (P = 0.03), all requiring transfusions, with surgical repair necessary in two. Uncomplicated clinical course occurred in 62 (97%) of patients in the radial group and 49 (89%) in the femoral group (P = 0.04). Total hospital length of stay was significantly higher in the femoral group (5.9 +/- 2.1 vs. 4.5 +/- 1.2 days; P = 0.05). Cannulation time (from patient arrival at the catheterization laboratory to the effective placement of arterial sheath) and procedural time were not significantly different in the radial and the femoral group (respectively 8.5 +/- 5.2 vs. 9.0 +/- 5.8 min, P = 0.81, and 42 +/- 28 vs. 44 +/- 27 min, P = 0.74). Nevertheless, time of radiation (23.1 +/- 11 vs. 16.5 +/- 10.9 min; P = 0.01) and dose-area product (28,616 +/- 16,571 vs. 18,819 +/- 10,739 R. cm2; P = 0.01) were significantly higher in the radial group. In patients with acute myocardial infarction treated with primary angioplasty and abciximab, the transradial access is efficacious with fewer major access site complications than transfemoral access. Transradial approach produces a shorter length of stay, as compared to the transfemoral approach, although with longer times of radiation and higher dose-area product.

Fluoroscopy-guided procedures in cardiology: is patient exposure being reduced over time?

“…Sandborg et al (6) also reported higher exposure with radial artery access in CA and coronary interventions. Higher values in the cases with radial access were also found in the study by Philippe et al (7) . On the contrary, Geijer and Persliden (8) reported no difference in radiation dose between the two different techniques for interventional procedures.…”

Ionizing radiation exposure in interventional cardiology: current radiation protection practice of invasive cardiology operators in Lithuania

“…There is an ongoing discussion on the impact of the selection of a vascular access site (radial versus femoral) on x-ray exposure doses. Higher patient radiation exposure with the radial compared to the femoral approach is reported [17][18][19]. However, reports that the radial approach does not significantly increase patient exposure when performed by experienced operators are also present [20][21][22].…”

Does Previous Transradial Catheterization Preclude Use of the Radial Artery as a Conduit in Coronary Artery Bypass Surgery?

“…18 Although, traditionally, the femoral artery has been the preferred route, recent studies have demonstrated that the transradial (TR) approach holds numerous advantages over the transfemoral approach, including decreased bleeding site complications, reduced cost, and a reduction in mortality. 19,20 Moreover, patients prefer the TR approach because of its shorter hospital stay, increased comfort, and better physical functioning postprocedure. 21,22 There has been concern for many years, however, that these TR procedures may damage the RA and, as a result, many surgeons opt to avoid its use in CABG for a period of time following catheterization.…”

“…In addition, the RA is now the preferred route of most cardiologists for coronary angiography and percutaneous coronary intervention, because it is associated with fewer complications than the previously favored transfemoral approach. [19][20][21][22] Nonetheless, there has been concern for many years that these TR procedures may detrimentally affect the ability of RA grafts used as CABG conduits.…”