Decreased complication rates using the transradial compared to the transfemoral approach in percutaneous coronary intervention in the era of routine stenting and glycoprotein platelet IIb/IIIa inhibitor use: A large single-center experience

Eichhöfer, Jonas; Horlick, Eric; Ivanov, Joan; Seidelin, Peter H.; Ross, John; Ing, Douglas; Daly, Paul; Mackie, Karen; Ridley, B.; Schwartz, Leonard; Barolet, Alan; Džavík, Vladimir

doi:10.1016/j.ahj.2008.06.044

Cited by 103 publications

(56 citation statements)

References 17 publications

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“…TRA nearly abolishes entry site complications in comparison with significantly higher rates in patients undergoing transfemoral catheterization (23). In our study, hematoma, pseudoaneurysm and arteriovenous fistula were more frequent in the TFA group.…”

Section: Discussionsupporting

confidence: 46%

Comparision of pain levels of transradial versus transfemoral coronary catheterization: a prospective and randomized study

Aktürk¹,

Kurtoğlu²,

Ermiş³

et al. 2014

Anadolu Kardiyol Derg

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Objective: The aim of the present study was to assess access site pain levels of patients undergoing coronary catheterization via transradial route. Methods: We performed a prospective and randomized study in which 408 patients underwent coronary angiography (CAG) and/or percutaneous coronary intervention (PCI) via transradial approach (TRA) and 428 patients underwent CAG and/or PCI via transfemoral approach (TFA). Pain levels of patients were assessed with Visual Analog Scale (VAS) after catheterization and at 30 days. Student-t, Mann-Whitney U and chi-square tests were used for statistical analysis. Results: Patients in the TRA group showed higher VAS scores than those in TFA group after catheterization [CAG alone, 3 (2-5) vs. 1 (1-3), p<0.0001; PCI, 4 (2-6) vs. 2 (1-3), p<0.0001, respectively]. One month later, patients in TRA group also showed higher VAS scores than those in TFA group [CAG alone, 1 (0-1) vs. 0 (0-1), p<0.0001; PCI, 1 (0-2) vs. 0 (0-1), p<0.0001, respectively]. By the ROC analysis in TRA group, a level of BMI <24.3 kg/m 2 predicted unacceptable pain with a 87.3% sensitivity and 91.6% specificity [area under curve (AUC): 0.875, 95% CI: 0.839-0.906, p<0.0001], while a wrist circumference <16.7 cm predicted unacceptable pain with 84.6% sensitivity and 89.8% specificity (AUC: 0.900, 95% CI: 0.867-0.928, p<0.0001). Conclusion: The current study suggests that a radial approach for CAG and PCI in patients with a low BMI and small wrist circumference may cause more access site pain as compared with a femoral approach. (Anadolu Kardiyol Derg 2014; 14: 140-6)

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Section: Discussionsupporting

confidence: 46%

Comparision of pain levels of transradial versus transfemoral coronary catheterization: a prospective and randomized study

Aktürk¹,

Kurtoğlu²,

Ermiş³

et al. 2014

Anadolu Kardiyol Derg

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“…The technique is associated with fewer vascular access complications [1][2][3] and has been shown to reduce major bleeding when compared with the femoral approach. 4 Patients prefer the radial approach and score higher on quality-of-life questionnaires after transradial catheterization.…”

mentioning

confidence: 99%

Radial Artery Patency After Transradial Catheterization

Kotowycz

Džavík

2012

Circ: Cardiovascular Interventions

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180

133

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T he transradial approach to cardiac catheterization has many advantages over the transfemoral approach and is increasingly being used for both diagnostic coronary angiography and percutaneous coronary intervention (PCI). The technique is associated with fewer vascular access complications [1][2][3] and has been shown to reduce major bleeding when compared with the femoral approach. 4 Patients prefer the radial approach and score higher on quality-of-life questionnaires after transradial catheterization. 3,5 Radial access allows for earlier patient ambulation and same-day hospital discharge in PCI patients 4 -6 and is associated with decreased cost. 5,7,8 Radial artery occlusion (RAO) is a complication of transradial catheterization that can lead to permanent occlusion of the radial artery. Estimated to occur in 1-10% of cases, 9 -14 it has been described as the "Achilles' heel" of the transradial technique. 15 RAO is usually clinically silent because of the dual blood supply to the hand, and for this reason it is often overlooked. In fact, more than 50% of transradial operators do not routinely assess radial artery patency before hospital discharge. 16 However, the complication is not benign, as hand ischemia resulting from RAO has been reported. [17][18][19] Furthermore, once the artery is occluded, it cannot be used as an access site for future catheterization or as an arterial conduit for bypass surgery. RAO renders the ipsilateral ulnar artery unusable as well, because instrumenting and cannulating the ulnar would put the patient's hand at risk of ischemia. In this report, we review the pathophysiology, clinical presentation, and risk factors for RAO, discuss prevention and treatment options, and suggest directions for future research aimed at minimizing this complication. PathophysiologyAcute loss of radial artery patency after cardiac catheterization is thought to be due to a thrombotic process. Sheath insertion leads to local endothelial injury and cessation of blood flow in the radial artery, creating an environment conducive to thrombosis. Many observations about RAO provide indirect evidence to support this hypothesis. RAO tends to occur early after transradial catheterization, and roughly 50% of patients have spontaneous recanalization of the artery within 1-3 months. 10,12 Furthermore, rates of RAO are higher with prolonged cannulation times, 20 -22 whereas RAO is reduced with anticoagulation 23 and nonocclusive hemostasis. 11,24,25 Direct support for the thrombotic hypothesis has come from recent studies that have confirmed the presence of radial artery thrombus on vascular ultrasound, 26 angiography, 27 and pathology. 28 Transradial catheterization can also negatively affect radial artery structure and function. A study using optical coherence tomography found that 67% of radial arteries had intimal tears and 36% had medial dissections immediately after transradial PCI. 29 Other studies have found that minimal lumen diameter and minimal lumen area are smaller in repeat transradial patients than i...

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“…Compared with the femoral approach patients can be mobilised more rapidly and haemostasis is obtained more easily [1,2]. Although complications seem to be less prevalent, extensive reports are lacking in the literature.…”

Section: Discussionmentioning

confidence: 99%

“…The radial approach is becoming increasingly popular as vascular access site for cardiac catheterisation [1,2].…”

Section: Discussionmentioning

confidence: 99%

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Subclavian artery perforation complicating coronary angiography

et al. 2011

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Decreased complication rates using the transradial compared to the transfemoral approach in percutaneous coronary intervention in the era of routine stenting and glycoprotein platelet IIb/IIIa inhibitor use: A large single-center experience

Cited by 103 publications

References 17 publications

Comparision of pain levels of transradial versus transfemoral coronary catheterization: a prospective and randomized study

Comparision of pain levels of transradial versus transfemoral coronary catheterization: a prospective and randomized study

Radial Artery Patency After Transradial Catheterization

Subclavian artery perforation complicating coronary angiography

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