Effectiveness of right or left radial approach for coronary angiography

Kawashima, Osamu; Endoh, Norio; Terashima, Minoru; Ito, Yuko; Abe, Sinnya; Ootomo, Tatsushi; Ogata, Kazunori; Honda, Hidehiko; Takizawa, Kazuyasu; Miyazaki, Yasusuke; Sugawara, Daisuke; Komatsu, Masayuki; Sawazi, Yoichi; Ozaki, Takeshi; Uchimuro, Tomoya; Meguro, Takeshi; Isoyama, Shogen

doi:10.1002/ccd.10769

Cited by 60 publications

(43 citation statements)

References 35 publications

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“…Conversely, operator positions and insertion sites near the edge of the x-ray beam can result in a higher operator dose. During PM or ICD implantation, the operator generally uses a subclavian approach, as opposed to the femoral or radial/brachial approach used for other procedures (Kawashima et al 2004). The subclavian approach requires the operator to stand close to the patient's shoulder and adjacent to the x-ray tube, where exposure rates are considerably higher than for the radial/brachial approach (Lindsay et al 1992;Limacher et al 1998).…”

Section: Discussionmentioning

confidence: 99%

Occupational Radiation Doses to Operators Performing Cardiac Catheterization Procedures

et al. 2008

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Cardiac catheterization procedures using fluoroscopy reduce patient morbidity and mortality compared to operative procedures. These diagnostic and therapeutic procedures require radiation exposure to patients and physicians. The objectives of the present investigation were to provide a systematic comprehensive summary of the reported radiation doses received by operators due to diagnostic or interventional fluoroscopically-guided procedures, to identify the primary factors influencing operator radiation dose, and to evaluate whether there have been temporal changes in the radiation doses received by operators performing these procedures. Using PubMed, we identified all English-language journal articles and other published data reporting radiation exposures to operators from diagnostic or interventional fluoroscopically-guided cardiovascular procedures from the early 1970's through the present. We abstracted the reported radiation doses, dose measurement methods, fluoroscopy system used, operational features, radiation protection features, and other relevant data. We calculated effective doses to operators in each study to facilitate comparisons. The effective doses ranged from 0.02-38.0 microSv for DC (diagnostic catheterizations), 0.17-31.2 microSv for PCI (percutaneous coronary interventions), 0.24-9.6 microSv for ablations, and 0.29-17.4 microSv for pacemaker or intracardiac defibrillator implantations. The ratios of doses between various anatomic sites and the thyroid, measured over protective shields, were 0.9 +/- 1.0 for the eye, 1.0 +/- 1.5 for the trunk, and 1.3 +/- 2.0 for the hand. Generally, radiation dose is higher on the left side of an operator's body, because the operator's left side is closer to the primary beam when standing at the patient's right side. Modest operator dose reductions over time were observed for DC and ablation, primarily due to reduction in patient doses due to decreased fluoroscopy/cineradiography time and dose rate by technology improvement. Doses were not reduced over time for PCI. The increased complexity of medical procedures appears to have offset dose reductions due to improvements in technology. The large variation in operator doses observed for the same type of procedure suggests that optimizing procedure protocols and implementing general use of the most effective types of protective devices and shields may reduce occupational radiation doses to operators. We had considerable difficulty in comparing reported dosimetry results because of significant differences in dosimetric methods used in each study and multiple factors influencing the actual doses received. Better standardization of dosimetric methods will facilitate future analyses aimed at determining how well medical radiation workers are being protected.

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Section: Discussionmentioning

confidence: 99%

Occupational Radiation Doses to Operators Performing Cardiac Catheterization Procedures

et al. 2008

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“…At present, the right radial approach (RRA) has become the first choice for the performance of routine coronary angiography and interventions for comfort reasons in daily clinical practice despite more marked subclavian artery tortuosity 9. Although the left radial approach (LRA) may reduce fluoroscopy time and cerebrovascular complications compared with RRA,10–12 several studies have also obtained conflicting results 13–16. Additionally, most of the investigations evaluating the efficacy of the transradial approach have been conducted among Caucasian persons.…”

Section: Introductionmentioning

confidence: 99%

A prospective randomized comparison of left and right radial approach for percutaneous coronary angiography in Asian populations

Hu¹,

Fu²,

Chen³

et al. 2014

CIA

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BackgroundThe efficacy of coronary angiography may be different in the right radial approach (RRA) and the left radial approach (LRA) due to more common vascular tortuosity in the RRA. The aim of the study was to determine whether LRA is a valid alternative for coronary angiography compared with RRA in Asian populations.MethodsThis is a single-center, prospective, randomized controlled study. A total of 1,400 consecutive patients undergoing diagnostic coronary angiography were recruited and randomized to the RRA (number [n]=700) or LRA (n=700) group. The primary end point was total procedural duration. Secondary end points included fluoroscopy time, dose of radiation including cumulative air kerma and dose area product, contrast volume, and the incidence of vascular complications.ResultsCoronary procedural success was achieved in 682 of 700 (97.4%) patients in the RRA and 680 of 700 (97.1%) in the LRA. The total procedural time (RRA 14.1±6.3 minutes versus LRA 13.2±6.0 minutes; P=0.006) and fluoroscopy time (RRA 3.8±3.3 minutes versus LRA 3.4±2.8 minutes; P=0.046) were significantly shorter via LRA in comparison to RRA. The percentage of hydrophilic wire use was also lower in the LRA group (14% [RRA] versus 10% [LRA]; P=0.016). The dose of radiation and contrast volume were not different between the two approaches. No cases of major bleeding and vascular complications requiring surgical intervention were reported, other than with one patient who experienced a symptomatic stroke and died in the RRA group compared with none in the LRA group.ConclusionThe LRA seems to be a feasible alternative for coronary angiography in Asian patients due to shorter procedural duration and fluoroscopy time, as well as less hydrophilic wire use in comparison to RRA.

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“…Louvard et al 25 reported the volume of contrast was similar in radial and femoral approaches for CAG. Kawashima et al 28 reported the amount of contrast material in CAGdid not differ between the left radial and right radial approach group (79±27 vs. 83±25 mL; p>0.05).Khan and Kabir 29 reported a trend toward a lower dose of contrast media used during diagnostic coronary procedures in the left radial approach compared with the right radial approach (37±16 and 47±11.9 mL respectively, p =0.006) in 512 diabetic patients.…”

Section: Discussionmentioning

confidence: 96%

“…Louvard et al 27 reported fluoroscopy time was significantly shorter in the femoral group (3.1±1.7 min) than in both radial groups (right: 3.8±2.2 min; left: 4.2±1.7 min), p <0.01. Kawashima et al 28 reported the fluoroscopy time in CAGwas shorter in the left radial than in the right radial approach group (3.7 ± 2.5 vs. 5.0 ± 3.3 min;p <0.001). Again Louvard et al 25 conducted another study to compare TR and TF approaches for CAGand angioplasty in octogenarians and they reported that fluoroscopy time was shorter in the femoral group versus the radial group (4.5±3.7 vs. 6.0±4.4 min; p <0.05) for the CAG.…”

Section: Discussionmentioning

confidence: 97%

“…Again Louvard et al 25 reported in another study for octogenarians population that procedure duration was 15.9±9.5 min in the femoral group vs 18.5±10.5 min in the radial group (right and left radial in a common pool); p <0.05. Kawashima et al 28 reported the procedural duration in CAG(time from the initiation of local anesthesia to completion of the procedure) was shorter in the left radial than in the right radial approach group (11.4±4.8 vs. 13.7±6.4 min; p <0.001). Sciahbasi et al 17 reported procedural time (the time from local anesthesia to the end of the procedure) was not significantly different between the 2 arms (left radial approach 13 min vs right radial approach 13 min; p =0.56).The overall procedure time between the time from initiation of local anesthesia to completion of the procedure in our study -was not significantly different (11.87±4.61 vs. 13.74±6.33 min respectively, p=0.180) for both radial and femoral approaches.…”

Section: Discussionmentioning

confidence: 99%

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Safety of Radial vs. Femoral Artery Access in Coronary Angiography

et al. 2016

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Abstract:Background: To evaluate the safety of radial versus femoral artery approach in routine coronary angiography (CAG) practice. Results: 3346 patients who underwent a diagnostic CAG were included in this study. The radial approach was used in 3030 patients (90.5%) and the femoral approach in 316 patients (9.5%). As the radial group was disproportionately large compared to femoral group the size of the radial group was reduced to 1010 using a systematic sampling procedure, where every 3 rd patient of radial group was chosen.Fluoroscopy and procedural times were not significantly different (3.41±1.14 vs. 3.85±1.43 min, p=0.314 & 11.87±4.61 vs. 13.74±6.33 min, p=0.180, respectively) comparing the radial and femoral approaches. While contrast utilization during the procedure was significantly lower in the radial than the femoral approach (57.60±22.42 vs. 69.52±24.30 mL respectively, p=0.030). MethodsConclusion: Transradial coronary angiography can be safely performed as the transfemoral approach.

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Effectiveness of right or left radial approach for coronary angiography

Cited by 60 publications

References 35 publications

Occupational Radiation Doses to Operators Performing Cardiac Catheterization Procedures

Occupational Radiation Doses to Operators Performing Cardiac Catheterization Procedures

A prospective randomized comparison of left and right radial approach for percutaneous coronary angiography in Asian populations

Safety of Radial vs. Femoral Artery Access in Coronary Angiography

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