Radial versus femoral approach for percutaneous coronary diagnostic and interventional procedures

Agostoni, Pierfrancesco; Biondi‐Zoccai, Giuseppe; Benedictis, M.Luisa De; Rigattieri, Stefano; Turri, Marco; Anselmi, Maurizio; Vassanelli, Corrado; Zardini, Piero; Louvard, Yves; Hamon, Martial

doi:10.1016/j.jacc.2004.04.034

Cited by 894 publications

(210 citation statements)

References 33 publications

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“…Previous studies showed that the TRA for coronary procedures is a highly safe, effective and comparable technique for both transcatheter diagnostic and therapeutic procedures that yields clinical results similar to transfemoral access (3,5,6,17). Moreover, TRA has several advantages over TFA such as reduced bed rest, shortened hospital length of stay and a reduction in vascular access site complications.…”

Section: Discussionmentioning

confidence: 99%

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: Discussionmentioning

confidence: 99%

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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“…Randomized clinical trials and observational studies demonstrated fewer periprocedural complications, shorter length of stay, and better patient satisfaction associated with transradial intervention (TRI) relative to transfemoral intervention (TFI) 1, 2, 3, 4, 5, 6, 7, 8, 9. Based on this evidence, the current US and European guidelines recommend TRI in patients at high risk of bleeding to decrease access site complications 10, 11.…”

Section: Introductionmentioning

confidence: 99%

Costs and Benefits Associated With Transradial Versus Transfemoral Percutaneous Coronary Intervention in China

Jin

Qiao

et al. 2016

JAHA

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BackgroundTransradial percutaneous coronary intervention (PCI) has been increasingly adopted in clinical practice, given its potential advantages over transfemoral intervention; however, the impact of different access strategies on costs and clinical outcomes remains poorly defined, especially in the developing world.Methods and ResultsUsing data from a consecutive cohort of 5306 patients undergoing PCI in China in 2010, we compared total hospital costs and in‐hospital outcomes for transradial intervention (TRI) and transfemoral intervention. Patients receiving TRI (n=4696, 88.5%) were slightly younger (mean age 57.4 versus 59.5 years), less often women (21.6% versus 33.1%), more likely to undergo PCI for single‐vessel disease, and less likely to undergo PCI for triple‐vessel or left main diseases. The unadjusted total hospital costs were 57 900 Chinese yuan (¥57 900; equivalent to 9190 US dollars [$9190]) for TRI and ¥67 418 ($10,701) for transfemoral intervention. After adjusting for all observed patient and procedural characteristics using the propensity score inverse probability weighting method, TRI was associated with a lower total cost (adjusted difference ¥8081 [$1283]). More than 80% of the cost difference was related to lower PCI‐related costs (adjusted difference −¥5162 [−$819]), which were likely driven by exclusive use of vascular closure devices in transfemoral intervention, and lower hospitalization costs (−¥1399 [−$222]). Patients receiving TRI had shorter length of stay and were less likely to experience major adverse cardiac events or post‐PCI bleeding. These differences were consistent among clinically relevant subgroups with acute myocardial infarction, acute coronary syndrome, and stable angina.ConclusionsAmong patients undergoing PCI, TRI was associated with lower cost and favorable clinical outcomes compared with transfemoral intervention.

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“…It has no nearby important vessels or nerves and due to relatively fixed position of the radial artery, risks of injury to these structures are minimal [17,18]. Also this approach does not need bed rest, allowing for immediate ambulation [1,9,19]. On the other hand, the transradial approach has caused controversies due to its level of success compared to the other method.…”

Section: Discussionmentioning

confidence: 99%

“…However, a transfemoral approach is not possible in all patients, and there are several limitations to this approach. Majority of studies have discussed the advantages of transradial approach since patients find it comfortable and economically advantageous [1][2][3][4][5][6][7]. Today, there is no doubt that a huge number of interventional cardiologists prefer transradial angiography.…”

Section: Introductionmentioning

confidence: 99%

Transradial Neurointerventional Approach to Basilar Tip Aneurysm: Case Report and Technical Note

Ghorbani

Hejazian

2017

IrJNS

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Cerebral angiography through transfemoral approach is preferred in most of the situations though in cardiovascular surgery transradial angiography is accounted as the superior standard. The present study aimed at presenting our early experience of transradial approach to cerebral angiography and intervention of a patient with basilar tip aneurysm that had inappropriate vasculature to perform routine transfemoral approach. The patient was a 65 year-old man with a large basilar tip aneurysm that was candidate for endosacular coiling through transfemoral route. But due to very tortuous iliac artery, aortic arch and its branches, navigation transfemorraly via both vertebral arteries was impossible. Therefore we decided to do the procedure through right transarterial route. The procedure was started by doing Allen`s test to confirm good perfusion of right hand by collateral arteries. After that cerebral angiography and neurointervention was done transradially without any complication. As a result, although a transradial approach is not a routine way for cerebral angiography and intervention, it can be used safely as an alternative way in specific cases.

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Radial versus femoral approach for percutaneous coronary diagnostic and interventional procedures

Cited by 894 publications

References 33 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

Costs and Benefits Associated With Transradial Versus Transfemoral Percutaneous Coronary Intervention in China

Transradial Neurointerventional Approach to Basilar Tip Aneurysm: Case Report and Technical Note

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