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Abstract
Summary
The femoral artery is by far the most frequently used access for both peripheral and coronary angiography; however femoral access isn’t always possible in all patients due to many reasons. In those patients radial access must be considered.
Coronary angiography and intervention via the radial artery is gaining popularity worldwide, as it combines early mobilization with a low incidence of local vascular complications.
Our study aimed primarily at comparing the success, feasibility and safety of transradial (TRA) versus transfemoral artery (TFA) approach for diagnostic coronary angiography, during the early phase of learning curve of our centre.
It was a randomized comparative study including 120 patients undergone diagnostic coronary angiography. Patients were randomly divided into two groups regarding to arterial access transradial or transfemoral approach (TRA or TFA), all patients had the same probability to be included in either TRA or TFA group.
The following parameters were observed, recorded during the procedure and analyzed later on:
• Sociodemographic data : (Age, sex, weight,height,and Body mass index),
• Risk factors for CAD:
• Diagnostic coronary angiography indications, diagnostic catheterization characteristics:(Access site either transradial approach
(TRA) or transfemoral approach (TFA), left coronary artery engagement time (min) and right coronary artery engagement time (min),
• Primary and secondary end points: (Access and procedure success, access and procedure time (min),fluoroscopy time (min) and contrast volume(ml),
• Procedure related complications :
• Post procedure hospital stay (hours):
The study included 120 patients, 57.5% of them were males and 42.5% were females with mean age 53.5 ± 9.7 years.
There was no significant difference between the two groups in sociodemographic data. The most prevalent risk factor was hypertension as it was reported in 68.3% of the studied patients. 50% of the patients were smokers.
Sixty patients were subjected to coronary angiography through radial access while the remaining 60 patients were having coronary angiography via femoral access.
There was no significant difference in access success between patients underwent femoral or radial access. But transfemoral approach was associated with significantly higher procedure success than transradial one (96.7% versus 76.7% respectively).
We have found that transradial approach was more time consuming than transfemoral one as TRA encountered more access and procedure time than TFA. Patients with transradial approach had also longer X-ray exposure time and needed larger amount of contrast material than patients having transfemoral access.
Regarding right and left coronary engagement time, our data showed that both coronary arteries engagement time was significantly shorter with femoral access than with radial one.
Regarding procedure related complications, there’s a significant increase in the rate of arterial spasm in patients with transradial approach, also there’s a statistically significant increase in the rate of access site heamatoma in TFA group.
There’s a highly statistically significant difference in the length of post procedural hospital stay favoring transradial approach (5.1 ± 1.2 vs. 8.9 ± 1.5 hour) in TRA and TFA group respectively.
So transradial approach for coronary angiography may be safely and effectively performed in our country in eligible patients with reasonable procedural success after completing the learning curve. It is a good alternative to TFA because of lower complication rate and shorter hospital stay. The procedural success rate improves with accumulating experience.