From Femoral to Radial Approach in Coronary Intervention

Angiology ◽  
2016 ◽  
Vol 68 (4) ◽  
pp. 281-287 ◽  
Author(s):  
Renatomaria Bianchi ◽  
Ludovica D’Acierno ◽  
Mario Crisci ◽  
Donato Tartaglione ◽  
Maurizio Cappelli Bigazzi ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Coronary Angiography ◽  
Coronary Intervention ◽  
Access Site ◽  
Femoral Access ◽  
Transradial Approach ◽  
Operator Experience ◽  
Transradial Access ◽  
Hemorrhagic Events ◽  
Duration Of Hospitalization

Since the first cardiac catheterization in 1929, this procedure has evolved considerably. Historically performed via the transfemoral access, in the last years, the transradial access has been spreading gradually due to its many advantages. We have conducted a review of published literature concerning efficacy, safety, and cost-effectiveness, and we analyzed our patients’ data, including the results of the recently published Minimizing Adverse hemorrhagic events by TRansradial access site and systemic implementation of angioX (MATRIX) study. This review confirmed the superiority of the transradial access compared to the femoral access, especially regarding complications related to the access site, duration of hospitalization, and comfort for the patient. The transradial approach is an excellent option for coronary angiography, and the procedure’s risks are reduced by increased operator experience.

scholarly journals Medicolegal implications of radial and femoral access for coronary angiography and intervention in 2016: Focus on retroperitoneal hemorrhage

2016 ◽  
Vol 4 (1) ◽  
pp. 29-34 ◽  
Author(s):  
Konstantinos V. Voudris ◽  
Mladen I. Vidovich
Keyword(s):  
Coronary Angiography ◽  
Standard Of Care ◽  
Coronary Intervention ◽  
The United States ◽  
Access Site ◽  
Transfemoral Approach ◽  
Retroperitoneal Hemorrhage ◽  
Femoral Access ◽  
Percutaneous Coronary ◽  
Wrongful Death

Abstract Background and Objectives Retroperitoneal hemorrhage is a rare but serious complication of transfemoral approach (TFA) and TFA percutaneous coronary intervention (PCI). Radial approach for coronary angiography and intervention (transradial approach, TRA) is associated with lower access site complications and reduced blood transfusion rates. Retroperitoneal bleeding has not been described with TRA. This study sought to evaluate the relationship between femoral access for coronary angiography (TFA) and PCI-induced retroperitoneal hemorrhage and the resulting medical litigation in the United States. Methods From 342 lawsuit claim records identified in LexisNexis database search, 17 cases of TFA and TFAPCI-related retroperitoneal hemorrhage decided between 1995 and 2015 were included in the study. Claims were thoroughly reviewed and information about the date the case was decided, patient outcome, the plaintiff, the defendant, the claim, and the trial outcome were extracted. Results The most common filled claim was medical malpractice (53% of the cases), followed by wrongful death (18%) and review of the Commissioner's decision to deny the application for supplemental security income (12%). Forty-seven percent of the cases were won by the defense, 29% by the plaintiff, and 24% were remanded for a new trial. In 82% of the cases, physicians were sued, but only 14% of the cases were won by the plaintiff. In 59% of the claims, the patient died; however, 70% of those cases were decided in favor of the defending physician and hospital. Conclusion Retroperitoneal hemorrhage is an uncommon complication of TFA and TFA PCI and is associated with high mortality rates. Physicians should able to identify this complication early and address it in a timely manner based on the applicable standard of care. TRA and TRA PCI is a reliable alternative and may potentially reduce medicolegal liability related to access site choice.

Republished: Manual reduction of a radial artery loop under direct fluoroscopic visualization

2021 ◽  
pp. neurintsurg-2021-017665.rep
Author(s):  
Evan Luther ◽  
Eric Huang ◽  
Hunter King ◽  
Michael Silva ◽  
Joshua Burks ◽  
...  
Keyword(s):  
Radial Artery ◽  
Preoperative Embolization ◽  
Access Site ◽  
Antecubital Fossa ◽  
Femoral Access ◽  
Manual Reduction ◽  
Transradial Access ◽  
Guide Catheter ◽  
Manual Manipulation ◽  
Standard Techniques

Transradial access has become increasingly used in neurointerventions because it reduces access site complications. However, radial artery anomalies can be difficult to navigate, often necessitating conversion to femoral access. We describe the case of a female patient in her early 70 s who underwent preoperative embolization of a carotid body tumor via right transradial access. Her radial angiogram demonstrated the presence of a radial artery loop which was successfully navigated with a triaxial system but would not spontaneously reduce even after the guide catheter was advanced into the subclavian artery. However, manual manipulation of the catheters in the antecubital fossa under direct fluoroscopic visualization reduced the loop allowing the procedure to continue transradially. Although a majority of radial loops can be traversed and reduced using standard techniques, this case demonstrates that manual reduction can be successful when other measures fail. We recommend attempting this method before converting the access site.

scholarly journals Complex Large-Bore Radial percutaneous coronary intervention: rationale of the COLOR trial study protocol

BMJ Open ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. e038042
Author(s):  
Thomas A Meijers ◽  
Adel Aminian ◽  
Koen Teeuwen ◽  
Marleen van Wely ◽  
Thomas Schmitz ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Vascular Complications ◽  
Coronary Intervention ◽  
Ethics Committee ◽  
Bleeding Complications ◽  
Access Site ◽  
Femoral Access ◽  
Coronary Syndrome ◽  
Percutaneous Coronary ◽  
Coronary Lesions

IntroductionThe radial artery has become the standard access site for percutaneous coronary intervention (PCI) in stable coronary artery disease and acute coronary syndrome, because of less access site related bleeding complications. Patients with complex coronary lesions are under-represented in randomised trials comparing radial with femoral access with regard to safety and efficacy. The femoral artery is currently the most applied access site in patients with complex coronary lesions, especially when large bore guiding catheters are required. With slender technology, transradial PCI may be increasingly applied in patients with complex coronary lesions when large bore guiding catheters are mandatory and might be a safer alternative as compared with the transfemoral approach.Methods and analysisA total of 388 patients undergoing complex PCI will be randomised to radial 7 French access with Terumo Glidesheath Slender (Terumo, Japan) or femoral 7 French access as comparator. The primary outcome is the incidence of the composite end point of clinically relevant access site related bleeding and/or vascular complications requiring intervention. Procedural success and major adverse cardiovascular events up to 1 month will also be compared between both groups.Ethics and disseminationEthical approval for the study was granted by the local Ethics Committee at each recruiting center (‘Medisch Ethische Toetsing Commissie Isala Zwolle’, ‘Commissie voor medische ethiek ZNA’, ‘Comité Medische Ethiek Ziekenhuis Oost-Limburg’, ‘Comité d’éthique CHU-Charleroi-ISPPC’, ‘Commission cantonale d'éthique de la recherche CCER-Republique et Canton de Geneve’, ‘Ethik Kommission de Ärztekammer Nordrhein’ and ‘Riverside Research Ethics Committee’). The trial outcomes will be published in peer-reviewed journals of the concerned literature.Trial registration numberNCT03846752.

scholarly journals PREDILECTION & SAFETY OF TRANSRADIAL CORONARY INTERVENTION IN THE ELDERLY POPULATION

2019 ◽  
pp. 1-2
Author(s):  
Mahadevan V ◽  
Jaisankar P
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Angiography ◽  
Elderly Population ◽  
Chronic Stable Angina ◽  
Coronary Intervention ◽  
The Elderly ◽  
Elderly Group ◽  
Access Site ◽  
Coronary Syndrome ◽  
Procedural Time

BACKGROUND: Transradial artery access for coronary intervention procedures is a safe and beneficial technique1. The safety aspects are well established in young individuals2. Elderly patients have been considered as a higher risk due to increased vascular tortuosity,calcifications and other access site related complications in comparison to younger individuals3. This study was done to assess the feasibility, efficacy and safety of transradial coronary angiography or intervention in the elderly. MATERIALS & METHODS:This study was conducted in the department of Cardiology,Chengalpattu Medical College Hospital in patients admitted coronary angiogram either for acute coronary syndrome or chronic stable angina during the period from November 2018 to April 2019. A total of 149 patients who underwent coronary angiography/ intervention through radial artery access were studied. Patients were divided into elderly population with age at or above 65 years (n = 24) & non elderly with age less than (n=125).Most of the patients who underwent procedure in both the groups are for acute coronary syndrome (ACS) than chronic stable angina (CSA) ,elderly arm (ACS vs.CSA – 91.6% vs.8.3%) & non elderly arm (ACS vs.CSA – 90.4% vs 9.6%).The two groups of population were analyzed with respect to complications such as vascular site bleeding,stroke,procedural time & access site cross over. RESULTS: The mean age was 72 ± 3.3 years in the elderly group and 49 ± 5.3 years in the non-elderly group. Baseline serum creatinine values were slightly elevated in elderly arm.The procedural time was higher in elderly arm than non elderly arm both in diagnostic (16 min 20 secs vs.2 min 45secs) as well as in interventional (41min 32 secs vs.19 min 18 secs)procedures. But the volume of contrast utilized is same in both arms with average of 40ml vs 42ml in elderly vs.non elderly arm respectively. Occurrence of puncture site bleeding or occlusion of radial artery showed no difference between two arms. The procedure completion was equally safe in both elderly and non elderly group (85 % vs.86% ). Access site cross over rate due to vessel tortuosity was higher in elderly arm (8% vs.1.5%) where as vasospasm was less in elderly compared to non elderly group (2.4% vs 7%). No case of thrombotic or bleeding risk or stroke were seen in both the arm. CONCLUSION: Transradial coronary angiography or intervention is safe and complication rates are comparable with those in non elderly patients.Procedural time for the completion of procedure is high in elderly than in non elderly due to tortuous vessel anatomy,difficulty in engaging the coronary artery & operator efficacy etc.

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