Effectiveness of radial approach in coronary angiographies : in adult patients undergoing coronary angiography, is a radial approach more effective in improving patient outcomes when compared to femoral approach?

Abstract

Coronary angiography and angioplasty are generally performed using the femoral access. The femoral approach has the disadvantages of longer bed rest required, loss of patient compliance, longer hospital stay and increase in hospital costs. An alternative to the femoral approach is the radial approach that was initially introduced by Campeau et al. in 1989 and eventually improved in 1993 by Kiemeneij and Laarman when angioplasty and stenting were also performed. This approach enables a significant lower rate of vascular access site complications compared to femoral approach while allowing an earlier and immediate mobilisation post angiography or angiogplasty (Manu et al. 1998; Saito et al. 2003; Agostoni et al. 2004; Brueck et al. 2009; Chodor et al. 2009; Hetherington et a;. 2009; Jolly et al. 2009; Sallam et al. 2009; Jolly et al. 2011). Several studies were found after the PICO question was formulated in order to confirm which approach is best when comparing the radial and femoral in angiography and angioplasty. Population/Patient- Adult patients undergoing coronary angiography Intervention- Coronary angiography Comparison- Radial approach compared to femoral approach Outcome- Does the radial approach improve patients' outcomes when compared to femoral approach? The PICO question formulated is: 'In adult patients undergoing coronary angiography/angioplasty, is a radial approach more effective in improving patient outcomes when compared to femoral approach?' PubMed, Google Scholar, Medline, Cinahl Plus and Metasearch were used to find relevant studies that fit the inclusion and exclusion criteria. Search keywords used were "radial", "femoral", "approach", "stenting", "angiography" and "angioplasty". Studies included were only comparing radial and femoral approach, English Language only, worldwide publications, adult age groups, both sexes, data from 1998 onwards and patients with cardiovascular disease requiring coronary angiography/ angioplasty. Studies excluded were those comparing the radial, brachial and femoral approach, patients who had thrombolytic therapy before or after angiography, comparative studies between the left and right radial artery, patients having vascular complications, studies comparing radial versus femoral in relation to radiation exposure or studies comparing radial versus femoral in relation to fluoroscopy time in coronary angiography. The CASP and the CONSORT were the tools used to critically analyse the studies found. The results of these studies discussed an array of outcomes. In relation to fluoroscopy time and contrast the femoral approach seems to be a safer alternative to the radial approach, but femoral approach increases the risk for vascular site complication and the inability to mobilize immediately after the procedure as opposed to radial approach (Mann et al. 1998; Saito et al. 2003; Agostoni et al. 2004; Brueck et al. 2009; Chodor et al. 2009; Hetherington et a;. 2009; Jolly et al. 2009; Sallam et al. 2009; Jolly et al. 2011 ). Radial approach requires more expertise than the femoral; therefore the femoral approach provides a higher procedural success rate (Mann et al. 1998; Saito et al. 2003; Agostoni et al. 2004; Brueck et al. 2009; Chodor et al. 2009; Hetherington et a;. 2009; Jolly et al. 2009; Sallam et al. 2009; Jolly et al. 2011). This confirms that the radial approach requires a larger learning curve therefore if it used more frequently technique can be learnt easily. In fact, this is what every author recommended, apart from the need of more studies. Studies from Malta can also help to decide which approach provides more advantages for the patient. Guidelines might also be helpful to nursing staff in order to provide guide nurses and also doctors. This study might also provide a step forward to practice if discussed with cardiologists and the management, due to the fact that in Malta no such study was ever performed; therefore, this study can aid to resole or reduce bed state problem.