Radial Catheterization Advantages
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Varun Kumar, M.B.B.S.; Lakshmi Gopalakrishnan, M.B.B.S.
Overview
Advantages of the Radial Approach to Cardiac Catheterization
Reduced Bleeding
Bleeding is a common complication of the available therapies for the treatment of acute coronary syndromes. There are increasing evidences showing that major bleeding is independently associated with increased risk for mortality and ischemic events among patients with acute coronary syndrome undergoing percutaneous coronary intervention.[1][2] The development of ischemic events (i.e., myocardial infarction and stroke) may be explained by the activation of coagulation cascade by major bleeding, cessation or inadequate antiplatelet and antithrombotic therapies, and depletion of coagulation factors as a complication of blood transfusion. According to a meta-analysis study, radial access was associated with a 73% reduction in major bleeding compared with femoral access; a similar trend was also observed with the risk of ischemic events.[3]
Reduced Time to Mobilization, Length of Hospital Stay and Cost
Transradial PCI has also been shown to be associated with a reduced time to mobilization (i.e., early mobilization),[4][5] cost and length of stay among patients with ACS. In a meta-analysis study, there was a reduction in the length of hospital stay by 0.4 days in the radial group when compared with the femoral group.[3] Consequently, there was reduced expenditure per patient and increased patient turnover at the hospitals.
Patients' Preference and Increased Satisfaction
Among patients who had undergone both radial and femoral access procedures, there was a strong patient preference for transradial catheterization as well as improved quality of life measured by reduced body pain, back pain, and ease of walking.[6][7]
Other potential advantages of radial over femoral access include:
- Provides an opportunity for same day/outpatient PCI[8][9]
- Absence of retroperitoneal hematomas, femoral pseudo aneurysms, and arteriovenous fistulas
- Improved access in the obese patient
- Reduced incidence of limb threatening ischemia due to the dual blood supply of the hand (ulnar and radial arteries)
- Advantageous for patients with severe occlusive aortoiliac disease
- Advantageous for patients with back pain, obesity, congestive heart failure who have difficulty laying flat on their back.
- Less likelihood of local nerve injury
- Radial artery is easily compressible due to its superficial course
References
- ↑ Eikelboom, JW.; Mehta, SR.; Anand, SS.; Xie, C.; Fox, KA.; Yusuf, S. (2006). "Adverse impact of bleeding on prognosis in patients with acute coronary syndromes". Circulation. 114 (8): 774–82. doi:10.1161/CIRCULATIONAHA.106.612812. PMID 16908769. Unknown parameter
|month=ignored (help) - ↑ Rao, SV.; O'Grady, K.; Pieper, KS.; Granger, CB.; Newby, LK.; Van de Werf, F.; Mahaffey, KW.; Califf, RM.; Harrington, RA. (2005). "Impact of bleeding severity on clinical outcomes among patients with acute coronary syndromes". Am J Cardiol. 96 (9): 1200–6. doi:10.1016/j.amjcard.2005.06.056. PMID 16253582. Unknown parameter
|month=ignored (help) - ↑ 3.0 3.1 Jolly, SS.; Amlani, S.; Hamon, M.; Yusuf, S.; Mehta, SR. (2009). "Radial versus femoral access for coronary angiography or intervention and the impact on major bleeding and ischemic events: a systematic review and meta-analysis of randomized trials". Am Heart J. 157 (1): 132–40. doi:10.1016/j.ahj.2008.08.023. PMID 19081409. Unknown parameter
|month=ignored (help) - ↑ Louvard, Y.; Lefèvre, T.; Allain, A.; Morice, M. (2001). "Coronary angiography through the radial or the femoral approach: The CARAFE study". Catheter Cardiovasc Interv. 52 (2): 181–7. PMID 11170325. Unknown parameter
|month=ignored (help) - ↑ Suleiman K, Feldman A, Ilan-Bushari L, Turgeman Y (2008). "[Transradial diagnostic and interventional cardiac catheterization in daily practice: advantages, efficacy and safety]". Harefuah. 147 (5): 388–93, 479. PMID 18770958.
- ↑ Cooper, CJ.; El-Shiekh, RA.; Cohen, DJ.; Blaesing, L.; Burket, MW.; Basu, A.; Moore, JA. (1999). "Effect of transradial access on quality of life and cost of cardiac catheterization: A randomized comparison". Am Heart J. 138 (3 Pt 1): 430–6. PMID 10467191. Unknown parameter
|month=ignored (help) - ↑ Jolly, SS.; Yusuf, S.; Cairns, J.; Niemelä, K.; Xavier, D.; Widimsky, P.; Budaj, A.; Niemelä, M.; Valentin, V. (2011). "Radial versus femoral access for coronary angiography and intervention in patients with acute coronary syndromes (RIVAL): a randomised, parallel group, multicentre trial". Lancet. 377 (9775): 1409–20. doi:10.1016/S0140-6736(11)60404-2. PMID 21470671. Unknown parameter
|month=ignored (help) - ↑ Bertrand, OF.; De Larochellière, R.; Rodés-Cabau, J.; Proulx, G.; Gleeton, O.; Nguyen, CM.; Déry, JP.; Barbeau, G.; Noël, B. (2006). "A randomized study comparing same-day home discharge and abciximab bolus only to overnight hospitalization and abciximab bolus and infusion after transradial coronary stent implantation". Circulation. 114 (24): 2636–43. doi:10.1161/CIRCULATIONAHA.106.638627. PMID 17145988. Unknown parameter
|month=ignored (help) - ↑ Gilchrist, IC.; Nickolaus, MJ.; Momplaisir, T. (2002). "Same-day transradial outpatient stenting with a 6-hr course of glycoprotein IIb/IIIa receptor blockade: a feasibility study". Catheter Cardiovasc Interv. 56 (1): 10–3. doi:10.1002/ccd.10093. PMID 11979524. Unknown parameter
|month=ignored (help)