A Randomized Comparison of Percutaneous Transluminal Coronary Angioplasty by the Radial, Brachial and Femoral Approaches: The Access Study

Kiemeneij, Ferdinand; Laarman, Gert Jan; Odekerken, D. A. M.; Slagboom, Ton; Wieken, Ron van der

doi:10.1016/s0735-1097(97)00064-8

Cited by 853 publications

(589 citation statements)

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“…It has been reported that increased operator radiation exposure during radial access, as opposed to femoral access, is related to increase in FT, reflecting technical difficulties and to the slightly closer operator's position to the x-ray tube and to the patient, compared with femoral access. 5,15,16 In contrast, decreased operator radiation dose and shorter FT have been reported when using LRA compared with RRA. 10,11,17e20 In our study, there are some details in radiation protection techniques that should be taken into consideration: First, during RRA procedures, the leaded glass mobile panel is positioned less proximally to the table compared with LRA and RFA to facilitate the right radial access.…”

Section: Discussionmentioning

confidence: 99%

Radiation Exposure of the Operator During Coronary Interventions (from the RADIO Study)

Kallinikou

Puricel

Ryckx

et al. 2016

The American Journal of Cardiology

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We sought to compare operator radiation exposure during procedures using right femoral access (RFA), right radial access (RRA), and left radial access (LRA) during coronary angiography (CA) and percutaneous coronary intervention (PCI). Because of an increased incidence of long-term malignancy in interventional cardiologists, operator radiation exposure is of rising concern. This prospective study included all consecutive patients who underwent elective or emergency CA -PCI from September 2014 to March 2015. The primary end point was operator radiation exposure, quantified as the ratio of operator cumulative dose (CD) and patient radiation reported as dose-area product ( The LRA showed lower CD compared with RRA (p <0.001). There were no significant differences in DAP among the 3 access sites. FT was similar for the 3 groups (RFA 7 -7, RRA 5 -5, LRA 6 -5 minutes, RFA vs RRA: p [ 1, RFA vs LRA: p [ 0.16, RRA vs LRA: p [ 0.52). In conclusion, the use of RFA during CA -PCI is associated with significantly lower operator radiation exposure compared with RRA. LRA is associated with significantly lower operator radiation exposure compared with RRA.Because of a presumably increased stochastic risk of cancer induction among interventional cardiologists, especially neoplasms of the unprotected brain, nasopharyngeal tract, and upper extremities, operator radiation exposure during coronary angiography (CA) and/or percutaneous coronary intervention (PCI) is of rising concern. 1,2 Therefore, we undertook a comparison of operator radiation exposure during right femoral access (RFA), left radial access (LRA), and right radial access (RRA) during CA and CA followed by ad hoc PCI in a real-world population. MethodsFrom September 2014 to March 2015 at the University and Hospital Fribourg, all consecutive procedures of elective or emergency CA and CA followed by ad hoc PCI were prospectively considered for operator radiation exposure measurements. Procedures were performed by 5 senior interventional cardiologists with significant experience (>3,000 PCI each) in both femoral and radial access routes. Selection of the percutaneous access site was left to the discretion of the operator. Crossover access site procedures were excluded. This study was part of the Catheterization Registry Fribourg (CardioFR), which was approved by the Ethics Committee of Canton Vaud (protocol no: 339/14).The primary end point of the study was operator radiation exposure, expressed as the cumulative equivalent dose (in mSv) over the lead apron at chest level, normalized for the patient radiation exposure (dose-area product [DAP] in Gycm 2 ). Secondary end points included cumulative dose (CD), DAP, and fluoroscopy time (FT).Procedures were performed on a digital single-plane cineangiography unit (Allura FD10; Philips Medical Systems, Hamburg, Germany) with an undertable x-ray tube MRC20025 with a magnification factor leading to a field of view of 21 cm and an acquisition frequency of 15 frames/s. All procedures were performed with respect to current guidel...

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Section: Discussionmentioning

confidence: 99%

Radiation Exposure of the Operator During Coronary Interventions (from the RADIO Study)

Kallinikou

Puricel

Ryckx

et al. 2016

The American Journal of Cardiology

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“…At present in Japan, balloon angioplasty catheters and stents employed for PTRA require a large lumen sheath and guiding catheter (7)(8), and as a result, a femoral or brachial vascular access site has been traditionally used. However, femoral artery complications, such as the necessity of access-site vascular repair or blood transfusion, were reported to occur in 2-6% of patients undergoing coronary and renal angioplasty.…”

Section: Discussionmentioning

confidence: 99%

“…5,6) The major advantage is a significant reduction in access site-related vascular complications such as vascular repair or blood transfusion during coronary intervention. 7) A few recent reports have shown that renal artery interventions also could employ the radial approach as a vascular access site. [8][9][10] In this report, we describe a successful attempt to relieve RAS with Leriche syndrome by transradial renal artery angioplasty and stenting.…”

mentioning

confidence: 99%

Transradial Renal Artery Angioplasty and Stenting in a Patient With Leriche Syndrome

Shiraishi¹,

Higaki²,

Oguni³

et al. 2005

Int. Heart J.

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SUMMARYPercutaneous interventional procedures in the renal arteries are usually performed employing a femoral or brachial vascular access. In contrast, the transradial approach has been established for coronary angiography and angioplasty. We encountered a patient with Leriche syndrome who had renovascular hypertension ascribed to a severe left renal artery stenosis. To stabilize his blood pressure, we made an attempt to relieve the renal artery stenosis with Leriche syndrome by transradial renal artery angioplasty and stenting, using devices for coronary intervention. The procedure was successful without complications or residual stenosis. His hypertension improved with less antihypertensive medications. This case suggests that the radial approach might become an alternative entry site for renal artery interventions. (Int Heart J 2005; 46: 557-562)

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“…We do not support a standard dose of heparin and default to a weight-based heparin load followed by activated clotting time monitoring, and we do not use the brachial artery for a second arterial access because a randomized angioplasty trial has identified brachial access with the highest rate of complications versus radial with the lowest and femoral arterial next. 14 In this regard, there is no need for an access >6 Fr and likely 5 Fr would suffice, diminishing the merits of a brachial access as a routine. However, we fully support the enhanced…”

Section: See Article By Kische Et Almentioning

confidence: 99%

Caveat Emptor

Horlick

Benson

2015

Circ: Cardiovascular Interventions

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A Randomized Comparison of Percutaneous Transluminal Coronary Angioplasty by the Radial, Brachial and Femoral Approaches: The Access Study

Abstract: With experience, procedural and clinical outcomes of PTCA were similar for the three subgroups, but access failure is more common during transradial PTCA. Major access site complications were more frequently encountered after transbrachial and transfemoral PTCA.

Cited by 853 publications

References 14 publications

Radiation Exposure of the Operator During Coronary Interventions (from the RADIO Study)

Radiation Exposure of the Operator During Coronary Interventions (from the RADIO Study)

Transradial Renal Artery Angioplasty and Stenting in a Patient With Leriche Syndrome

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