Comparison of Access Site-Related Complications and Quality of Life in Patients after Invasive Cardiology Procedures According to the Use of Radial, Femoral, or Brachial Approach

Abstract

The radial approach (RA) is the most common in invasive cardiology, but depending on the clinical situation, the femoral approach (FA) and brachial approach (BA) are also used. The BA is associated with the highest odds of complications so it is used mainly if a first-choice approach fails. The aim of the study was to assess clinical outcomes after invasive cardiology procedures stratified by the use of the RA, FA, and BA, with a focus on access site-related complications, quality of life (QoL), and patients’ perspective. A total of 250 procedures (RA: 98; FA: 99; BA: 53) performed between 2013 and 2020 were retrospectively analyzed. Puncture site-related complications, vascular events, patient preferences, and QoL were assessed by the analysis of medical records and telephone follow-up using a proprietary questionnaire and the modified EQ-5D-3L questionnaire. Patients from the RA group received the smallest volume of contrast during a percutaneous coronary interventions (PCI) procedure (RA vs. FA vs. BA: 180 (150–240) ml vs. 200 (180–270) ml vs. 190 (100–200) ml, p = 0.045). The access site was changed most frequently in the procedures initiated from the RA (p < 0.04). Overall puncture site-related complications, especially local hematomas, occurred most commonly in the BA group (7.1, 14.1, and 24.5% for RA, FA, and BA, respectively, p = 0.01). During the index procedure, the access site was changed most frequently in procedures initiated from the RA (19.7, 8.5 and 0%, p = 0.04). The RA was indicated as an approach preferred by the patient for a hypothetical next procedure (87.9, 55.4, and 70.0% for subjects preferring the same approach out of patients who underwent a procedure by the RA, FA, and BA, respectively, p < 0.001). For the RA and FA, the prevalence of moderate or extreme access site-related problems in self-care decreased significantly (RA: p < 0.01, FA: p < 0.05) within 1 month after the index procedure (RA: 18.1, 4.2, and 1.4%; FA: 20.7, 11.1, and 9.6% periprocedurally, after 1 and 6 months, respectively). In contrast, for the BA these percentages were higher and a significant improvement (p < 0.05) was delayed until 6 months (54.6, 36.4, and 18.2% periprocedurally, after 1 and 6 months, respectively). In conclusion, compared to the BA and FA, the RA appears to be not only the safest, mainly due to the lowest risk of puncture site-related complications after coronary procedures but also represents a preferable approach from the patient’s perspective. Although overall post-procedural QoL outcomes did not differ significantly according to the access site, nevertheless, the BA was associated with more frequent self-care problems whose improvement was delayed until more than one month after the index procedure.

Quality of Life in Patients Undergoing Percutaneous Coronary Intervention

“…The results of the present study showed moderate levels of QoL in the pre-PCI period, and an increase in QoL scores 6 and 12 months post-PCI. The QoL measurement prior to this minimally invasive procedure provides significant insights into the selection of patients and offers a base to clinicians to provide individualized care afterward [ 6 , 12 , 14 ].…”

“…Moreover, QoL is monitoring the performance of clinical care, improving safety and outcomes, thus contributing to treatment cost reduction [ 10 , 11 ]. Furthermore, QoL provides the basis for comparing different treatment options, such as the choice of vascular access site and determining predictors of health benefits [ 12 ].…”

Rota-Lithotripsy as a Novel Bail-Out Strategy for Highly Calcified Coronary Lesions in Acute Coronary Syndrome

“…Even though the need for additional S-IVL may be reduced by an escalation of burr size, when the burr-to-artery ratio exceeds over 0.5/0.6, this leads to an increased rate of complications (i.e., slow flow phenomena, dissection, or perforations) [ 39 , 40 , 41 , 42 ]. In addition, this often implies the need for guiding size escalation or even force switching to the transfemoral approach, which additionally affects the amount of peri-procedural access-side bleeding [ 43 , 44 ]. Until rota-lithotripsy’s introduction to clinical practice, the burr escalation maneuver was considered a basic bailout strategy for primarily undilatable lesions.…”

Culprit plaque location within the left circumflex coronary artery predicts clinical outcomes in patients experiencing acute coronary syndromes with percutaneous coronary intervention: Data from the ORPKI registry

“…Risk factors determined in this study indicate that vascular access do not have an impact on serious complications, and thus on clinical outcomes in patients with ACS. However, they do influence overall complications, probably due to the most common, mild complication -puncture-site hematoma, which occurs more often in brachial access [28].…”