Comparative study of the radial and femoral artery approaches for diagnostic coronary angiography

Abstract

Objectives: Femoral artery access is the standard approach for coronary procedures; however, the radial approach has gained sound recognition as an alternative to femoral access. We present our early experience with the transradial approach.

Methods: A prospective, non-randomised study of 221 candidates for diagnostic coronary angiography was carried out at Sultan Qaboos University Hospital, Oman between December 2008 and April 2009. The patients had their procedure performed from radial or femoral access according to operator discretion and the results were compared. Femoral and radial groups included 116 and 105 patients respectively.

Results: Radial access was associated with a significantly higher rate of procedural failure (17.1%) versus 0% in femoral group (p = 0.001). There were no local vascular complications in the radial group as opposed to 12.1% in the femoral group (p < 0.01). Hospital length of stay was significantly reduced in the radial group (4.06 versus 23.5 hours, p < 0.01). Total procedure time was longer in the radial group (23.7 ± 13.7 min versus 20.1 ± 7.4 min, p < 0.001), but radiation exposure was similar in both groups. There was a trend for a higher risk of major adverse cardiac events noticed in the femoral group; however, it did not reach statistical significance.

Conclusion: The transradial approach for coronary angiography is associated with significantly reduced local vascular complications and shorter hospital stays. The femoral approach is the standard access site for coronary angiography; however, interventional cardiologists should acquire experience in the radial approach as an alternative in specific situations.

Keywords: Coronary angiography; Crossover; Femoral; Hospital stay; Local vascular complications; Radial; bleeding.

Figure 1:

Intense radial artery spasm (continuous arrows) relieved by an additional dose of the vasodilatory cocktail. Dashed arrow shows normal ulnar artery.

Figure 2:

Spasm of radial artery and tortuous brachial artery are evident. The most interesting finding is the absent ulnar artery despite a well perfused palmar arch, well felt pulsations at the ulnar artery and a positive Allen’s test

Figure 3:

Marked tortuosity of the right subclavian artery making manipulation of the catheter difficult.