Transradial Versus Transfemoral Approach for Coronary Angiography and Angioplasty
Study Question: What is the relative safety and feasibility of the transradial versus transfemoral approach for coronary angiography and intervention?
Methods: The authors randomized a total of 1,024 patients undergoing coronary catheterization to the transradial or transfemoral approach. Patients with an abnormal Allen's test, history of CABG, simultaneous right heart catheterization, chronic renal insufficiency, or known difficulties with the radial or femoral access were excluded.
Results:
- Successful catheterization was more common in the femoral (99.8% vs. 96.5%) compared with the radial group.
- Procedure time (median procedural duration 37.0 minutes vs. 40.2 minutes, p = 0.046) and radiation exposure (median dose area product 38.2 Gycm2 vs. 41.9 Gycm2, p = 0.034) were significantly lower in the transfemoral group compared with the transradial access group.
- There was no difference in the amount of contrast media use between the two groups.
- Vascular access site complications were higher in the transfemoral group (3.71% vs. 0.58%, p = 0.0008).
Conclusions: The use of radial access is associated with an increased procedural duration and radiation exposure, and a marked reduction in vascular complications.
Editors' opinion: The reduction in groin complications and bleeding with the use of a radial approach has been highlighted in multiple studies. However, the increased radiation exposure to the patient and the operator is increasingly being recognized, and may translate into an increased late risk of malignancies. Better shielding strategies are needed to reduce this exposure so that the benefits of the radial approach can be obtained at minimal hazard to the patients or the operators.
JACC Cardiovasc Interv 2009;2:1047-1054
