Tim Schäufele, MD at the MediClin Heart Center Lahr/Baden in Germany offered a report at the recent American Heart Association meeting that suggested the routine use of the radial artery as an access point resulted in fewer bleeding complications and less pain without substantial increases in procedure time. This represents a growing movement to switch from using the femoral artery.
Although using the radial artery resulted in more radiation exposure for the interventionalist for diagnostic procedures, the difference disappeared when a percutaneous coronary intervention was performed.
The radial approach has been shown in previous studies to result in less bleeding, more rapid ambulation, increased patient comfort and require the use of fewer human and hospital resources, but the femoral artery seems to remain the access point of choice for many. In some European and Asian countries, up to 50 percent of cardiac procedures are performed through the radial artery, but in the U.S., that number drops to less than 5 percent.
Those who favor the femoral approach cite familiarity and concerns over possible entry site failure, unsuccessful arterial puncture, higher radiation doses, longer procedural times, and occlusion or spasm of the artery.
Here are some additional findings from the study:
- It is estimated that the added radiation exposure could account for 96 more deadly cancers in 100,000 people over 40 years, compared with 20,000 cancers that would occur naturally.
- In terms of staff resources, the radial approach resulted in a greater time spent handling the patient in the cath lab for diagnostic procedures.
- The femoral approach led to more hematomas (19 vs. four), cases of pain in the back or at the puncture site (43 vs. eight), puncture site bleedings (18 vs. four), and vagal reactions (19 vs. zero). There were eight access site failures in each group.
- Patients tolerated the punctures and procedures equally well in each group, but patients who had a procedure using the radial approach had less pain due to compression.