Comparison of fluoroscopy time during coronary angiography and interventions by radial and femoral routes- can we decrease the fluoroscopy time with increased experience? An observational study

Farman, Muhammad; Khan, Naveed Ullah; Sial, Jawaid Akber; Saghir, Tahir; Rizvi, Syed Nadeem Hasan; Zaman, Khan Shah

doi:10.5152/akd.2011.163

Cited by 13 publications

(22 citation statements)

References 23 publications

(28 reference statements)

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“…Many authors believe that the fluoroscopy time, an indirect measure of the difficulty of the procedure, is greater in PCI through radial access than through femoral access. The present results were consistent with those described by Farman et al 9 for PCI through radial access, and shorter than that demonstrated by Alli et al 10 for femoral access. It is important to mention that the surgeons must be familiar with the technique in order to achieve angiographic success and a low crossover rate of the access route in order to avoid delay of coronary reperfusion.…”

Section: Discussionsupporting

confidence: 83%

Intervenção coronária percutânea por acesso transradial em pacientes com infarto agudo do miocárdio com supradesnivelamento do segmento ST

Dall'Orto¹,

Lopes²,

Oliveira³

et al. 2012

Rev. Bras. Cardiol. Invasiva

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background: Radial access is the object of increasing interest for interventional cardiologists, providing several advantages, including the reduced rates of major bleeding, which is related to increased risk of death and ischemic events. However, its role as an access technique in primary percutaneous coronary intervention (PCI) remains controversial due to the greater complexity of the procedure and possible delay in obtaining myocardial reperfusion, compared to femoral access. Methods: Retrospective study including consecutive patients with a diagnosis of ST-elevation acute myocardial infarction (STEMI) undergoing primary PCI by radial access. Clinical, angiographic and procedure characteristics were analyzed, as well as early and late follow-up outcomes. results: From October 2010 to February 2012, 61 patients underwent primary PCI by radial access. Mean age was 59 ± 11.1 years, 24.6% were female and 21.3% were diabetic. Door-to-balloon time was 126.1 ± 44.7 minutes, fluoroscopy time was 16.1 ± 9.5 minutes, angiographic success was achieved in 98.5%, with myocardial blush grades 2 and 3 in 77.4% and ST-segment elevation resolution > 50% at 90 minutes in 70.5% of the patients. Hospital mortality was 6.6% and the rate of major bleeding was 1.6%. In the late follow-up, clinical restenosis was observed in 7.2% and additional deaths in 3.5% of the patients. Conclusions: The use of radial access for primary PCI is safe and effective when performed at experienced centers and did not pres-

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Section: Discussionsupporting

confidence: 83%

Intervenção coronária percutânea por acesso transradial em pacientes com infarto agudo do miocárdio com supradesnivelamento do segmento ST

Dall'Orto¹,

Lopes²,

Oliveira³

et al. 2012

Rev. Bras. Cardiol. Invasiva

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“…One observational cohort study evaluated 928 patients who underwent diagnostic coronary angiograms via TFA (n = 734) or TRA (n = 194) and demonstrated FT to be 58% higher in the TRA compared with TFA group. 13 They repeated the analysis with a subgroup of experienced TRA operators and showed FT to be 29% higher in the TRA compared with TFA group. Our results are consistent with this study showing increased FT and radiation exposure with TRA even with experienced operators.…”

Section: Discussionmentioning

confidence: 99%

Radiation exposure during coronary angiography via transradial or transfemoral approaches when performed by experienced operators

Shah

Bangalore

Feit

et al. 2013

American Heart Journal

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Background Studies demonstrate an increase in radiation exposure with transradial approach (TRA) when compared with transfemoral approach (TFA) for coronary angiography. Given the learning curve associated with TRA, it is not known if this increased radiation exposure to patients is seen when procedures are performed by experienced operators. Methods We retrospectively evaluated 1,696 patients who underwent coronary angiography with or without percutaneous coronary intervention (PCI) by experienced operators at a tertiary center from October 2010 to June 2011. Experienced operators were defined as those that perform >75 PCIs/year with >95% of cases performed using the TRA or TFA approach for ≥5 years. The outcomes of interest were dose area product (DAP) and fluoroscopy time (FT). Results Of the 1,696 patients, 1,382 (81.5%) were performed by experienced femoral operators using TFA and 314 (18.5%) were performed by experienced radial operators using TRA. Most of these cases (65.4%) were diagnostic only (870 TFA and 240 TRA) with both DAP (6040 [3210–8786] vs 5019 [3377–6869] μGy·m2, P = .003] and FT [6.2 [4.0–10.3] vs 3.3 [2.6–5.0] minutes, P < .001) significantly higher using TRA versus TFA. For procedures involving PCI, despite similar baseline patient, procedural and lesion characteristics, DAP and FT remained significantly higher using TRA versus TFA (19,649 [11,996–25,929] vs 15,395 [10,078–21,617] μGy·m2, P = .02 and 22.1 [13.3–31.0] vs. 13.8 [9.8–20.3] minutes, P < .001). Conclusions In a contemporary cohort of patients undergoing coronary angiography by experienced operators, TRA was associated with higher radiation exposure when compared with TFA.

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“…Previous studies have attempted to determine whether or not there is a difference in patient radiation exposure for coronary angiography and percutaneous coronary intervention (PCI) depending on the arterial access route. The results of these studies have varied, with most studies finding measures of radiation exposure to be higher with radial access [2,4,7,8,9,10,11,12,13,14], some showing no appreciable difference between access routes [15,16,17] and one study finding higher exposure with femoral compared to radial access [18]. Differences in the results of these studies may be attributed to many study design and patient factors, including study methodology, different measures of radiation exposure, patient demographics and variability in included procedures.…”

Section: Accepted Manuscript Introductionmentioning

confidence: 99%

Radiation Exposure with the Radial Approach for Diagnostic Coronary Angiography in a Centre Previously Performing Purely the Femoral Approach

Castles

Barlis

Ponnuthurai

et al. 2014

Heart, Lung and Circulation

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The radial approach was associated with significantly higher DAP and FT compared to the femoral approach during an initial introductory phase which was likely insufficient to develop radial proficiency. The results of this study are consistent with previous studies and may influence choice of access for non-emergent diagnostic coronary angiography before radial proficiency has been established, particularly for patients more susceptible to radiation risks.

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Comparison of fluoroscopy time during coronary angiography and interventions by radial and femoral routes- can we decrease the fluoroscopy time with increased experience? An observational study

Abstract: Comparison of fluoroscopy time during coronary angiography and interventions by radial and femoral routes-can we decrease the fluoroscopy time with increased experience? An observational study Radiyal

Cited by 13 publications

References 23 publications

Intervenção coronária percutânea por acesso transradial em pacientes com infarto agudo do miocárdio com supradesnivelamento do segmento ST

Intervenção coronária percutânea por acesso transradial em pacientes com infarto agudo do miocárdio com supradesnivelamento do segmento ST

Radiation exposure during coronary angiography via transradial or transfemoral approaches when performed by experienced operators

Radiation Exposure with the Radial Approach for Diagnostic Coronary Angiography in a Centre Previously Performing Purely the Femoral Approach

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