Exposição radiológica em procedimentos coronários realizados pelas vias radial e femoral

Abstract

background: Although the transradial approach had significantly reduced vascular complications, studies have demonstrated that it may be related to higher radiation exposure. The objective of this study is to compare radiation exposure in invasive cardiologic procedures using the transradial and transfemoral approaches. Methods: Prospective cohort study including patients undergoing diagnostic cardiac catheterization or percutaneous coronary intervention (PCI) between August 2010 and December 2011. Clinical, angiographic and radiation exposure characteristics were recorded in a dedicated database. Patients were analyzed according to the access route: femoral or radial. Results: Of the 1,197 patients included in the study, 782 were submitted to procedures using the femoral access and 415 using the radial access. There was a lower prevalence of females (36.2% vs. 45.6%; P < 0.01), previous coronary artery bypass graft surgery (4% vs. 12.7%; P < 0.01) and severe valvular heart disease (0.3% vs. 1.4%; P = 0.07) in the radial group. The median radiation dose received by the patients was higher with the radial approach, both for diagnostic (621.6 mGy vs 445.7 mGy; P < 0.01) and therapeutic procedures (1,241.6 mGy vs 990.9 mGy; P < 0.01). Less experienced operators in the radial approach exposed patients to higher radiation doses (1,463 mGy vs 1,196 mGy; P = 0.02), which did not occur with the more experienced operators (1,311 mGy vs 1,449 mGy; P = 0.84). Conclusions: Patients undergoing invasive cardiologic procedures are exposed to higher radiation levels when the

Comparação entre os Tempos de Procedimento e Fluoroscopia e o Volume de Contraste das Vias de Acesso Radial e Femoral em Pacientes Submetidos a Cateterismo Cardíaco

“…Studies have demonstrated that the use of the radial route brings comfort to the patient and reduces the risk of bleeding, vascular complications, and hospitalization time, with lower costs. [1][2][3] However, there are conflicting data regarding the use of the radial route, in relation to the amount of contrast and increased exposure to ionizing radiation, which may be related to the learning curve of the operating physician or type of procedure. 4,5 In this context, this study was conducted in order to compare radial and femoral access routes in relation to total procedure and fluoroscopy times, as well as the volume of contrast used in patients undergoing cardiac catheterization.…”

“…This finding conflicts with data from studies in the literature, which tend to favor femoral access, due to their suggestion of an increased exposure to radiation with the use of the radial route. 3,4 In the study by Mattos et al, 3 the fluoroscopy time was longer in the radial group, but it was also found that operating physicians with an extensive experience in radial puncture performed the catheterization procedures with similar radiological exposure for these two access routes.…”

“…This suggests that the operating physician was in line with the global trend, using the radial route technique. 3,7 The use of this route began approximately 20 years ago, 8 and some authors consider it as a default strategy for cardiac procedures in a catheterization laboratory, 9 since the technique presents lower bleeding and vascular complication rates, brings more comfort for the patient, and allows for a shorter hospital stay with lower costs when compared with the femoral route. 2,7,10,11 Nonetheless, the femoral route remains the most used technique in hemodynamic laboratories for diagnostic cardiac catheterizations and percutaneous coronary interventions, both on national and international scenarios.…”

“…12,13 This factor is linked to the characteristics of the vessel, with its smaller size compared to femoral artery; to anatomical variations; and to the potential risk of spasm in this artery, resulting in longer procedures and greater exposure to ionizing radiation. 3,6 The learning curve is closely related to the technical improvement of the operating physician, which should minimize patient exposure during the procedure. 8,12,13 In this study, the total exam time was longer in the group with femoral access, possibly due to the need to exchange catheters.…”

Riscos da Radiação X e a Importância da Proteção Radiológica na Cardiologia Intervencionista: Uma Revisão Sistemática

“…Por outro lado, Mattos et al 56 demostraram que pacientes submetidos a procedimentos cardiológicos invasivos, tanto diagnósticos como terapêuticos, eram expostos a maiores níveis de radiação pela via de acesso radial, e sugeriram que a experiência do operador pode reduzir, de forma significativa, o nível de dose do procedimento.…”