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Comparison of Radial Access, Guided Femoral Access, and Non-Guided Femoral Access Among Women Undergoing Percutaneous
Linda M Koshy1, Laura H Aberle, Mitchell W Krucoff
1Medical Education Program, Department of Medicine, Duke University Medical Center, DUMC Box 3182, Durham, NC 27710 USA. linda.koshy@duke.edu.
Insights
Radial access is safer than non-guided femoral access for percutaneous coronary intervention (PCI). Guided femoral access showed similar bleeding and vascular complication rates to radial access, suggesting it may mitigate risks.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Access
Background:
- Bleeding and vascular complications after percutaneous coronary intervention (PCI) increase morbidity, mortality, and costs.
- The radial approach is generally superior to the femoral approach for reducing these complications.
- It remains unclear if guided techniques (micropuncture, fluoroscopy, ultrasound) in femoral access can minimize these differences.
Purpose of the Study:
- To compare postprocedural bleeding and vascular complications among radial, guided femoral, and non-guided femoral access methods in PCI.
- To determine if guided femoral access mitigates the risks associated with non-guided femoral access compared to radial access.
- To analyze the safety of different vascular access strategies in women undergoing PCI.
Main Methods:
- A post hoc analysis of 643 women from the SAFE-PCI for Women trial who underwent PCI.
- Access methods were categorized into radial, guided femoral (using fluoroscopy, micropuncture, or ultrasound), and non-guided femoral.
- The primary endpoint was adjudicated postprocedure bleeding or vascular complications within 72 hours or at discharge, analyzed using multivariate logistic regression.
Main Results:
- Radial access (n=330) showed a significantly lower incidence of complications compared to non-guided femoral access (n=85).
- No significant difference in complications was observed between radial access and guided femoral access (n=228).
- Guided femoral access demonstrated comparable safety outcomes to radial access.
Conclusions:
- Radial access is a safer option than non-guided femoral access for PCI.
- Guided femoral access, utilizing techniques like fluoroscopy, micropuncture, or ultrasound, offers comparable safety to radial access regarding bleeding and vascular complications.
- These findings suggest that guided femoral access can be a viable alternative to radial access, potentially reducing complication rates.
Objectives:
This study was conducted to determine the association between radial access, guided femoral access, and non-guided femoral access on postprocedural bleeding and vascular complications after percutaneous coronary intervention (PCI).
Background:
Bleeding events and major vascular complications after PCI are associated with increased morbidity, mortality, and cost. While the radial approach has been shown to be superior to the femoral approach in reducing bleeding and vascular complications, whether the use of micropuncture, fluoroscopy, or ultrasound mitigates these differences is unknown.
Methods:
We conducted a post hoc analysis of women in the SAFE-PCI for Women trial who underwent PCI and had the access method identified (n = 643). The primary endpoint of postprocedure bleeding or vascular complications occurring within 72 hours or at discharge was adjudicated by an independent clinical events committee and was compared based on three categories of access technique: radial, guided femoral (fluoroscopy, micropuncture, ultrasound), or non-guided femoral (none of the aforementioned). Differences between the groups were determined using multivariate logistic regression using radial access as the reference.
Results:
Of the PCI population, 330 underwent radial access, 228 underwent guided femoral access, and 85 underwent non-guided femoral access. There was a statistically significant lower incidence of the primary endpoint with radial access vs non-guided femoral access; however, there was no significant difference between radial approach and femoral access guided by fluoroscopy, micropuncture, or ultrasound.
Conclusions:
This post hoc analysis demonstrates that while radial access is safer than non-guided femoral access, guided femoral access appears to be associated with similar bleeding events or vascular complications as radial access.