scholarly journals Comparison of Radial and Femoral Approaches for Coronary Angiography with or without Percutaneous Coronary Intervention in Relation to Vascular Access Site Complications

2021 ◽  
Author(s):  
◽  
Jonele Maree Woodhead
Keyword(s):  
Cardiovascular Disease ◽  
Percutaneous Coronary Intervention ◽  
Coronary Angiography ◽  
Vascular Access ◽  
Coronary Intervention ◽  
P Value ◽  
Complication Rates ◽  
Access Site ◽  
Radial Approach ◽  
Percutaneous Coronary

<p>Background A major population health objective in New Zealand is to reduce the incidence and impact of cardiovascular disease. Cardiovascular disease (CVD) remains New Zealand's leading cause of death (41%). This high demand on health services indicates the need for improved therapies and treatment. Significant advances in percutaneous coronary intervention (PCI) offers many patients who would not typically be eligible for treatment, the chance for a better quality of life living with coronary artery disease (CAD). At present femoral access is primarily used for coronary angiography and or PCI procedures, however more recently there has been a gradual shift to using the radial access approach. Study objective The study's objective was to look at comparing the different access sites used for coronary angiography (CA) and/or percutaneous coronary intervention (PCI) and the significance of the rates of vascular access site complications. The research question considered was; "Is there a significant difference in the vascular access site complication rates when comparing radial to femoral approaches for coronary angiography?"  Methodology and design A cohort study design used observational prospective data on radial approaches and compared this with historical retrospective data on femoral approaches. The secondary (comparative) data was extracted from historical records, from earlier research I had completed. The collection of the secondary data involved strict criteria so that the observational study participants had similar baseline characteristics to ensure validity of this study. One hundred participants were recruited for each (prospective and retrospective) database and then compared and analysed. Findings The use of a radial approach for CA and PCI has a significant decrease in combined vascular access site complications (haematoma, vasovagal and arterial bleed), (p value 0.001), OR 0.28 (0.13-0.62). Haematoma is the main vascular complication (p value 0.009), OR 0.29 (0.11-0.74). Conclusion This study, although small, can be used as a pilot study for a more detailed and bigger national study within New Zealand. From the results it is clear there is a significant decrease in the vascular site complication rates when a radial approach is undertaken for CA and/or PCI. Through education and clinical practice, the radial approach would ensure better patient safety, satisfaction and comfort which would help reduce the patients length of stay and increase patients treated with timely discharges. It could also help decrease the nurses' workload caring for the patient with the radial approach due to the lesser complication rates. More extensive use of radial approaches for CA and or PCI would ensure the above benefits for the patients, staff and the organisation.</p>

scholarly journals Comparison of Radial and Femoral Approaches for Coronary Angiography with or without Percutaneous Coronary Intervention in Relation to Vascular Access Site Complications

2021 ◽  
Author(s):  
◽  
Jonele Maree Woodhead
Keyword(s):  
Cardiovascular Disease ◽  
Percutaneous Coronary Intervention ◽  
Coronary Angiography ◽  
Vascular Access ◽  
Coronary Intervention ◽  
P Value ◽  
Complication Rates ◽  
Access Site ◽  
Radial Approach ◽  
Percutaneous Coronary

<p>Background A major population health objective in New Zealand is to reduce the incidence and impact of cardiovascular disease. Cardiovascular disease (CVD) remains New Zealand's leading cause of death (41%). This high demand on health services indicates the need for improved therapies and treatment. Significant advances in percutaneous coronary intervention (PCI) offers many patients who would not typically be eligible for treatment, the chance for a better quality of life living with coronary artery disease (CAD). At present femoral access is primarily used for coronary angiography and or PCI procedures, however more recently there has been a gradual shift to using the radial access approach. Study objective The study's objective was to look at comparing the different access sites used for coronary angiography (CA) and/or percutaneous coronary intervention (PCI) and the significance of the rates of vascular access site complications. The research question considered was; "Is there a significant difference in the vascular access site complication rates when comparing radial to femoral approaches for coronary angiography?"  Methodology and design A cohort study design used observational prospective data on radial approaches and compared this with historical retrospective data on femoral approaches. The secondary (comparative) data was extracted from historical records, from earlier research I had completed. The collection of the secondary data involved strict criteria so that the observational study participants had similar baseline characteristics to ensure validity of this study. One hundred participants were recruited for each (prospective and retrospective) database and then compared and analysed. Findings The use of a radial approach for CA and PCI has a significant decrease in combined vascular access site complications (haematoma, vasovagal and arterial bleed), (p value 0.001), OR 0.28 (0.13-0.62). Haematoma is the main vascular complication (p value 0.009), OR 0.29 (0.11-0.74). Conclusion This study, although small, can be used as a pilot study for a more detailed and bigger national study within New Zealand. From the results it is clear there is a significant decrease in the vascular site complication rates when a radial approach is undertaken for CA and/or PCI. Through education and clinical practice, the radial approach would ensure better patient safety, satisfaction and comfort which would help reduce the patients length of stay and increase patients treated with timely discharges. It could also help decrease the nurses' workload caring for the patient with the radial approach due to the lesser complication rates. More extensive use of radial approaches for CA and or PCI would ensure the above benefits for the patients, staff and the organisation.</p>

scholarly journals Feasibility and Safety of Distal Radial Artery Access in Anatomical Snuffbox for Coronary Angiography and Coronary Intervention

2020 ◽  
Vol 18 (2) ◽  
pp. 259-262
Author(s):  
Arun Maskey ◽  
Birat Krishna Timalsena ◽  
Sheikh Aslam ◽  
Rabindra Pandey ◽  
Madhu Roka ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Angiography ◽  
Radial Artery ◽  
Vascular Access ◽  
Coronary Intervention ◽  
Pain Rating ◽  
Coronary Interventions ◽  
Transradial Access ◽  
Percutaneous Coronary ◽  
Distal Radial Artery

Background: There is limited data on feasibility and safety of coronary interventions performed using radial artery at anatomical snuffbox as vascular access point in South Asian region. Our study attempts to evaluate the feasibility and safety of coronary angiography and percutaneous coronary intervention using transradial access at anatomical snuffbox.Methods: Transradial access at anatomical snuffbox was attempted in 128 consecutive patients, who were planned for coronary angiography and/or percutaneous coronary intervention. Success in vascular access, completion of planned procedure and complications encountered, including patency of radial artery after the procedure, were investigated. Results: A total of 128 patients (76 males [59.4%]; 52 females [40.6%]) between 44-78 years of age (mean age, 59.0 +/- 10.2 years) were included in the study. Distal radial artery puncture and sheath placement was successful in all patients however planned procedure was completed in 126 (98.4%) patients. Total 90 coronary angiographies and 36 percutaneous coronary interventions were performed of which five were primary percutaneous coronary intervention. We encountered brachial artery spasm among two patient (1.5%) and significant pain and swelling among three patients (2.3%). No bleeding complication, numbness or parasthesia were observed on follow-up. Patients had average pain rating of 2.4+/- 1.1 in visual analogue pain rating scale. There were no instances of radial artery occlusion after the procedure.Conclusions: Distal radial artery, at anatomical snuffbox, is a safe and feasible alternative vascular access site for coronary angiography and percutaneous coronary intervention. Keywords: Cardiac catheter; coronary angiography; feasibility studies; percutaneous coronary intervention; radial artery; vascular access device

scholarly journals Comparison of Radial and Femoral Percutaneous Coronary Intervention

2020 ◽  
Vol 18 (3) ◽  
pp. 366-372
Author(s):  
Mahesh Bhattarai ◽  
Arun Maskey ◽  
Ram Kishore Shah ◽  
Buna Bhandari ◽  
Chandramani Adhikari ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Target Lesion ◽  
Access Site ◽  
Femoral Access ◽  
Radial Approach ◽  
Radial Access ◽  
Clinical Events ◽  
Percutaneous Coronary ◽  
Heart Center

Background: The use of radial access for percutaneous coronary intervention is increasing in Nepal. However, there is limited study on the comparison of radial and femoral access in Nepal. This is the study comparing net adverse clinical events of radial with femoral access for intervention. Methods: This prospective study was conducted at Shahid Gangalal National Heart Center from January 2014 to June 2015 among 849 participations who underwent percutaneous coronary interventions, and 418 radial interventions were compared with 418 femoral interventions. A comparison was done in terms of 30- day rate of net adverse clinical events defined as the composite of death, myocardial infarction, stroke, target lesion revascularization and major bleeding. Results: Incidence of net adverse clinical events was significantly lower in radial compared to femoral approach 18(4.30%) vs. 51 (12.2%), p= <0.001). Mortality observed in the radial approach was significantly lower (p=<0.001) compared to femoral. Procedure success was not significantly different p=0.629.  The trans-radial approach had significantly higher crossover rate (p=0.001). Observed vascular access site complications (p=0.026) and hospital stay (p=<0.0001) were lower in the radial group. Radiation exposure measured by fluoroscopy exposure time was not significantly different between the two groups (p=0.290). Conclusions: Radial access is associated with a lower rate of net adverse clinical events at 30 days compared to femoral access. Radial access is safer and equally effective compared to femoral access in the context of Nepal. Keywords: Femoral; percutaneous coronary intervention; radial

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