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Transradial artery coronary angiography and intervention in patients with severe peripheral vascular disease
A J de Belder1, R E Smith, R J Wainwright
1Department of Cardiology, King's College Hospital, London, UK.
Insights
Transradial coronary catheterization is a safe and effective alternative for patients with severe peripheral vascular disease, offering high success rates and early discharge. This approach minimizes complications compared to traditional methods.
Area of Science:
- Cardiology
- Vascular Surgery
- Interventional Radiology
Background:
- Severe aorto-iliac disease traditionally necessitates brachial arteriotomy for cardiac catheterization, posing risks of vascular and neuronal complications.
- Advancements in catheter technology enable transradial artery access for coronary procedures, offering a potentially safer alternative.
- The radial artery's anatomical features suggest a lower complication profile for catheterization procedures.
Purpose of the Study:
- To evaluate the efficacy and safety of percutaneous transradial diagnostic and interventional coronary catheterization.
- To assess this technique in patients with severe peripheral vascular disease where femoral access is challenging.
Main Methods:
- A prospective, non-randomized analysis of 75 patients with contraindications or failure of femoral angiography.
- Inclusion criteria focused on patients with severe peripheral vascular disease, previous aorto-iliac interventions, or failed femoral access.
- Exclusion of three patients due to absent ulnar arteries.
Main Results:
- Successful radial artery cannulation in 97% of cases, with 95% achieving a successful diagnostic study.
- High prevalence of three-vessel disease (73%), with 64% referred for coronary bypass surgery.
- Successful interventions in 12 patients, including stent placement; early discharge was noted for diagnostic (same day) and interventional (next day) procedures.
Conclusions:
- Percutaneous transradial coronary procedures demonstrate high success and low complication rates in patients with severe peripheral vascular disease.
- The transradial approach facilitates early mobilization and discharge, improving patient outcomes.
- This technique is a viable alternative to the Sones' technique for selected patient populations.
Background:
Traditionally, cardiac catheterization in patients with severe aorto-iliac disease has been performed using a brachial arteriotomy. This approach is associated with significant vascular and neuronal complications and requires considerable training to achieve an adequate level of expertise. Improvement and miniaturization of catheter equipment now allows the radial artery to be used for coronary investigation and intervention. The lack of important structures close to the radial artery, a good collateral ulnar artery circulation and its superficial position suggests that these procedures should have a low complication rate. The purpose of this study was to assess the efficacy and safety of percutaneous transradial diagnostic and interventional coronary catheterization in patients with severe peripheral vascular disease.
Patients And Methods:
We undertook a non-randomized prospective analysis of 75 patients who had transradial artery diagnostic and interventional coronary catheterization in whom femoral angiography was impossible or relatively contraindicated (22 patients with severe claudication and absent femoral pulses, 24 patients with previous aorto-iliac surgery or intervention, 20 patients with a failed femoral approach, 9 patients with an aortic aneurysm). Three patients had an absent ulnar artery and were excluded.
Results:
Radial artery cannulation was successful in 73/75 (97%) cases. Seventy-one (95%) patients had a successful diagnostic study. There was a high incidence of 3 vessel disease (73%), and the majority of patients (64%) were referred for coronary bypass surgery. Twelve patients underwent successful follow-on intervention including the insertion of 9 intracoronary stents. Adequate haemostasis was achieved within 20 min after diagnostic angiography and 60 min after interventional procedures. One patient had a forearm haematoma with paraesthesia of the hand which settled with conservative treatment. At 4-6 weeks, all patients had normal hand sensation and function (100%) with a palpable pulse present in 59/62 (96%). All patients undergoing diagnostic angiography were discharged on the same day, and patients undergoing intervention were discharged the following day.
Conclusions:
Transradial coronary investigation and intervention can be performed with a high degree of success and a low complication rate with early mobilization and discharge in patients with severe peripheral vascular disease. We suggest that the percutaneous transradial technique should be considered as an alternative to the Sones' technique in these patients.