Vascular access and radiation exposure during percutaneous coronary procedures
Alessandro Sciahbasi1, Mario Babbaro2, Pierpaolo Confessore3
1Department of Interventional Cardiology, Sandro Pertini Hospital, ASL RM2, Rome, Italy - asciahbasi@gmail.com.
Insights
Transradial access for percutaneous coronary procedures reduces bleeding but increases radiation exposure. Protective drapes can significantly lower operator radiation dose, mitigating long-term risks.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Imaging
Background:
- Transradial access is increasingly preferred over transfemoral access for percutaneous coronary procedures due to reduced bleeding and vascular events.
- This approach has also been linked to lower mortality in acute coronary syndromes.
Purpose of the Study:
- To compare radiation exposure between radial and femoral access during percutaneous coronary procedures.
- To discuss the clinical implications of radiation exposure differences.
- To present methods for reducing operator radiation exposure.
Main Methods:
- Review of existing literature comparing radiation doses for radial versus femoral access.
- Analysis of potential long-term health risks associated with increased radiation exposure for interventional cardiologists.
- Evaluation of protective measures to minimize operator radiation exposure.
Main Results:
- The transradial approach is associated with a slight but significant increase in radiation exposure for patients and operators compared to transfemoral access.
- Interventional cardiologists face high radiation doses, increasing concerns about stochastic health effects.
- Adjunctive protective drapes can reduce operator radiation exposure by up to 81%.
Conclusions:
- While transradial access offers significant clinical benefits, the increased radiation exposure necessitates risk mitigation strategies.
- Awareness and implementation of protective measures are crucial for interventional cardiologists to minimize long-term radiation-related health risks.
Abstract:
In the cardiology community, the use of transradial access for percutaneous coronary procedures is progressively increasing all around the world overtaking the use of transfemoral access. The advantages of the transradial access are based on a significant reduction in bleeding and vascular events compared to the femoral access and on a reduction in mortality in the setting of acute coronary syndromes. However, in recent years a slight but significant increase in radiation exposure for patients and operators associated with the radial approach has been detected, increasing concerns about possible long term increased stochastic risk. In particular interventional cardiologists are among physicians performing interventional procedures using X-rays, those exposed to the highest radiation dose during their activity and this exposure is not without possible long-term clinical consequences in term of deterministic and stochastic effects. All the operators should be aware of these risks and manage to reduce their radiation exposure. In this review we analysed the differences in term of radiation exposure comparing the radial and the femoral access for percutaneous coronary procedures. Then, we discussed the possible clinical consequences of these differences and finally we showed the available tools aimed to reduce the operator radiation exposure. In particular the use of adjunctive protective drapes placed on the patient might reduce operator radiation exposure in up to 81% of the dose.
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