Radial access protects from contrast media induced nephropathy after cardiac catheterization procedures

Feldkamp, Thorsten; Luedemann, Maya; Spehlmann, Martina E.; Freitag‐Wolf, Sandra; Gaensbacher, Julia; Schulte, Kevin; Bajrovic, Amer; Hinzmann, Dieter; Hippe, Hans-Joerg; Kunzendorf, Ulrich; Frey, Norbert; Luedde, Mark

doi:10.1007/s00392-017-1166-2

Cited by 29 publications

(20 citation statements)

References 35 publications

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“…9 Given differences in baseline patient comorbid conditions and the procedural risks of coronary angiography, it is intuitive to expect a higher AKI rate following CM exposure with coronary angiography compared to CECT. 21,22 Numerous studies of patients undergoing coronary angiography have demonstrated AKI rates of w13%, which exceeds the average AKI rates of 5% to 6% associated with intravenous CM exposure. 13,[23][24][25] One conclusion of these results, although controversial, is that intra-arterial delivery of CM is more nephrotoxic compared to intravenous administration.…”

Section: Comparison Of Cin With Intra-arterial and Intravenous Contramentioning

confidence: 98%

The Controversy of Contrast-Induced Nephropathy With Intravenous Contrast: What Is the Risk?

Rudnick

Leonberg‐Yoo

Litt

et al. 2020

American Journal of Kidney Diseases

124

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Section: Comparison Of Cin With Intra-arterial and Intravenous Contramentioning

confidence: 98%

The Controversy of Contrast-Induced Nephropathy With Intravenous Contrast: What Is the Risk?

Rudnick

Leonberg‐Yoo

Litt

et al. 2020

American Journal of Kidney Diseases

124

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“…Removing individual studies did not result in significant deviation of the pooled OR (all P < 0.0001) for the occurrence of AKI. Subgroup analysis (Figure (B)) demonstrated a gradient in the impact of TRA according to study design, with higher benefit accrued in retrospective studies than across studies with propensity‐score matching, as compared with the relatively lower treatment effect (namely 13%) observed in the randomized AKI‐MATRIX trial …”

Section: Resultsmentioning

confidence: 99%

Radial vs femoral access for the prevention of acute kidney injury (AKI) after coronary angiography or intervention: A systematic review and meta‐analysis

Andò

Gragnano

Calabrò

et al. 2018

Cathet Cardio Intervent

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Objectives: We sought to investigate the impact of radial vs femoral access on the incidence of acute kidney injury (AKI) after coronary angiography or intervention.Background: There is a growing recognition of the importance of access site selection as an adjudicative measure to mitigate the risk of renal impairment for patients with coronary artery disease undergoing angiography with or without percutaneous coronary intervention.Methods: We conducted a systematic review of the literature and meta-analyzed available evidence comparing the rates of AKI with radial vs femoral access in patients undergoing coronary angiography or intervention. Studies reporting the incidence of AKI as a primary or secondary outcome were pooled in fixed-and random-effects meta-analyses and meta-regression techniques were used to account for across-study heterogeneity.Results: Across data pooled from nine studies (n = 32 181), radial access was significantly associated with a reduction in the incidence of AKI (OR 0.57, 95% CI 0.50 to 0.66, P < 0.0001 with fixed-effects model, OR 0.55, 95% CI 0.45 to 0.67, P < 0.0001 with random-effects model) as compared to femoral. In the meta-regression model, the effect size of radial access effect was related to the number of centers in which studies were conducted.Conclusions: Compared with the femoral approach, radial access was associated with a lower incidence of AKI after coronary angiography or intervention, although this benefit was less pronounced in multicenter than in single-center studies.

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“…When weighing the interests of safety vs. independence, it is mandatory to have specific scientific knowledge about postoperative driving impairments following invasive medical procedures. Even if the transradial approach is increasingly used in CAG and BRT is very likely not affected by it, the transfemoral access in CAG is still widely used [ 24 ]. We, therefore, feel our results are still of relevance even though the transradial access in CAG is gaining ground.…”

Section: Discussionmentioning

confidence: 99%

Driving ability after right-sided puncture of the common femoral artery during coronary angiography

et al. 2018

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Objectives/backgroundTo assess brake reaction time (BRT; key factor in driving ability) in patients receiving transfemoral coronary angiography (CAG). We assumed that patients would have a significantly impaired BRT after the procedure.MethodsA prospective, observational study design was applied. Consecutive patients undergoing right-sided transfemoral CAG as part of the clinical routine were included. An experimental driving simulator was used to determine BRT after receiving a visual stimulus. The subjects applied the brake with their right foot as quickly as possible when a red-light signal appeared. The time interval between stimulus and brake application was taken as BRT. In addition to the total BRT, also its components were determined: neurologic reaction time, foot transfer time and brake travel time. BRT was determined before and 1 day after CAG (pre-post comparison).Results71 patients were included in the analysis (58 male, age 61 ± 9 years). Total BRT was 594 ± 188 and 591 ± 198 ms before and after the CAG procedure, respectively (p = 0.270). Similarly, also the BRT components ‘foot transfer time’ and ‘brake travel time’ did not show significant differences between the two test occasions. However, neurologic reaction time decreased from 269 ± 67 to 255 ± 64 ms (p = 0.036).ConclusionsWe found no impairment of BRT on the first day after puncture of the right-sided femoral artery in patients undergoing CAG. Therefore, with regard to BRT, it is regarded safe to resume driving from day 1 after CAG. Other factors of driving safety beyond BRT must also be considered.

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Radial access protects from contrast media induced nephropathy after cardiac catheterization procedures

Cited by 29 publications

References 35 publications

The Controversy of Contrast-Induced Nephropathy With Intravenous Contrast: What Is the Risk?

The Controversy of Contrast-Induced Nephropathy With Intravenous Contrast: What Is the Risk?

Radial vs femoral access for the prevention of acute kidney injury (AKI) after coronary angiography or intervention: A systematic review and meta‐analysis

Driving ability after right-sided puncture of the common femoral artery during coronary angiography

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