Comparison of radial, brachial, and femoral accesses using hemostatic devices for percutaneous coronary intervention

Abstract

Some studies have suggested that radial access (RA) for percutaneous coronary intervention (PCI) reduces vascular complications and bleeding compared to femoral access (FA). The purpose of this study was to investigate the routine use of hemostatic devices and bleeding complications among RA, brachial access (BA), and FA. Between January 2015 and December 2015, 298 patients treated for PCI with RA were compared with 158 patients using BA and 206 patients using FA. The radial sheath was routinely removed with ADAPTY, the brachial sheath with BLEED SAFE, and the femoral sheath with Perclose ProGlide. In-hospital bleeding complications were investigated. Cardiogenic shock was most frequent in patients in the femoral group (RA 1.3%, BA 2.5%, FA 9.2%, p < 0.0001). The rate of major bleeding was highest in the femoral group (RA 1.0%, BA 2.5%, FA 5.3%, p = 0.01). Blood transfusion rates were highest in the femoral group (RA 0.7%, BA 1.3%, FA 4.4%, p = 0.01). Retroperitoneal bleeding was observed in 1.9% of patients in the femoral group. Patients in the brachial group had large hematomas (RA 0.7%, BA 4.4%, FA 1.5%, p = 0.01). Pseudoaneurysm formation needing intervention occurred most frequently in the brachial group (RA 0%, BA 1.3%, FA 0%, p = 0.04). In conclusion, compared to the brachial and femoral approaches, the radial approach appears to be the safest technique to avoid local vascular bleeding complications. The brachial approach has the highest risk of large hematoma and pseudoaneurysm formation among the three groups.

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

“…Additionally, in our research, the BA was associated with the highest risk of a puncture site hematoma, which occurred in 23% of patients. In comparison to other studies, hematomas also occurred most commonly in the BA group or were a frequent complication related to the BA, nevertheless, it was generally less common in previous reports compared to the present study, ranging from 1% to 14% [ 7 , 8 , 17 , 18 ]. According to Otsuka et al [ 17 ], pseudoaneurysm was also most common in the BA group (1.3%) versus the RA or FA groups, which was also observed in our study (1.9%), although the respective difference did not reach statistical significance, presumably owing to the number of study subjects.…”

“…In comparison to other studies, hematomas also occurred most commonly in the BA group or were a frequent complication related to the BA, nevertheless, it was generally less common in previous reports compared to the present study, ranging from 1% to 14% [ 7 , 8 , 17 , 18 ]. According to Otsuka et al [ 17 ], pseudoaneurysm was also most common in the BA group (1.3%) versus the RA or FA groups, which was also observed in our study (1.9%), although the respective difference did not reach statistical significance, presumably owing to the number of study subjects. Although often mentioned as a complication of BA interventions [ 7 , 8 , 19 ], brachial artery thrombosis did not occur in any of the cases in our study.…”

“…Baker and Baker [ 20 ] reported that the rate of bleeding complications was about 3–6% with the FA, with many patients developing retroperitoneal bleeding and up to 1% of those patients requiring blood transfusions [ 20 ]. Additionally, the rate of major bleeding assessed by Otsuka et al was highest for the FA and, consequently, blood transfusion rates were highest in that group [ 17 ]. In our analysis, the FA was associated with only one significant bleeding and local hematoma occurred in 11% cases from the FA group, while blood transfusion was required most commonly in the FA group, albeit below the level of significance.…”

Percutaneous treatment of right-sided subclavian stenosis using radial approach

“…3 However, subcutaneous bleeding from arteriovenous fistula (AVF) cannulation that compromise skin and tissue perfusion is rarely reported. 4 A 69-year-old woman with end-stage renal disease, who has undergone hemodialysis via her left wrist radiocephalic AVF, came to our hospital with a painful swelling and blister on her left forearm after a brief episode of dialysis needle dislodgment due to a heavy cough. The dialysis session was immediately stopped.…”

“…Indeed, in a study comparing radial and brachial approaches, it has been demonstrated that the latter is associated with an increased formation of hematomas and pseudoaneurysm and a greater procedure duration, fluoroscopy time, and total radiation dose. 4 However, radial access for peripheral intervention has some limitations needed to be discussed. First, the smaller vessel diameter.…”