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Transradial Access Catheter Procedures

PictureTransradial access for percutaneous coronary diagnosis and intervention remains relatively rare in the United States (less than 2 percent of cases[1]), despite significantly lower bleeding complications, increased patient comfort and earlier ambulation compared with femoral access. The long learning curve involved in mastering the transradial approach has hindered domestic adoption of the technique[2,3]. However, the Oregon Cardiology team at Sacred Heart Medical Center has performed thousands of transradial access procedures over the past decade, with excellent outcomes and no serious complications. In the past five years, the team has completed 2,644 transradial procedures to great patient benefit.

How it Works

Entry point for procedures is in the radial artery of the wrist instead of the femoral artery. The superficial location of the radial artery makes it an ideal target for percutaneous arterial access. The collateralization of the radial artery decreases the risk of ischemia, and there is no major adjacent nerve, minimizing risk of nerve damage[4].

Once venous access is obtained, a diagnostic catheter is advanced into the brachial, axillary and subclavian arteries with use of a guide wire and fluoroscopic guidance. Upon completion of angiogram, the catheter is withdrawn. If further intervention is necessary, a catheter can often be reintroduced through the same access point.

Patients recover from the procedure in a recovery “lounge” furnished with comfortable recliner-type chairs. They can watch TV, visit with family or work on their laptops until discharge, which typically occurs in two to three hours. Cardiologists meet with patients in the recovery area prior to discharge to discuss findings and next steps.

Research/Efficacy

Transradial access reduces the risk of major bleeding by over 70 percent[5,6], even among high-risk groups[7].

Groin complications have been the most common peri-procedural complication of cardiac catheterization[8]. Patients who experience bleeding complications and transfusions have a significantly increased risk of death[9].

Among patients who have had both femoral and transradial approaches, 80 percent are more likely to prefer the transradial procedure, while only 2 percent prefer the femoral[10].

 Click here to read a radial access case study.

[1]Rao S, Ou FS, Wang TY, et al. Trends in the prevalence and outcomes of radial and femoral approaches to percutaneous coronary intervention. J Am Coll Cardiol Intv 2008;1:379-386
[2]Goldberg SL, Renslo R, Sinow R, French WJ. Learning curve in the use of the radial artery as vascular access in performance of percutaneous transluminal coronary angioplasty. Cathet Cardiovasc Diagn 1998;44:147-152
[3]Amoroso G, Laarman GJ, Kiemeneij F. Overview of the transradial approach in percutaneous coronary intervention. J Cardiovasc Med (Hagerstown) 2007;8:230-237
[4]Cohen MG, Alfonso C. Starting a transradial vascular access program in the cardiac catheterization laboratory. J Invasive Cardiol 2009;21:Suppl A;11A-17A
[5]Agostoni P, Biondi-Zoccai GG, de Benedictis ML, et al. Radial versus femoral approach for percutaneous coronary diagnostic and interventional procedures. J Am Coll Cardio 2004;44:349-356
[6]Jolly SS, Amlani S, Hamon M, et al. Radial versus femoral access for coronary angiography or intervention and the impact on major bleeding and ischemic events. Am Heart J 2009;157:132-140
[7]Rao S, Ou FS, Wang TY, et al. Trends in the prevalence and outcomes of radial and femoral approaches to percutaneous coronary intervention. J Am Coll Cardiol Intv 2008;1:379-386
[8]Berry C, Kelly J, Cobbe SN, Eteiba H. Comparison of femoral bleeding complications after coronary angiography versus coronary intervention. Am J Cardiol 2004;94:361-363
[9]Chase AJ, Fretz EB, Warburton WP, et al. The association of arterial access site at angioplasty with transfusion and mortality: The M.O.R.T.A.L. Study (Mortality benefit of reduced transfusion after PCI via the arm or leg). Heart 2008;94:1019-1025
[10]Tremmel JA. Launching a successful transradial program. J Invasive Cardiol 2009;21:Suppl A;5A-10A

Oregon Heart & Vascular Institute

3311 RiverBend Drive
Springfield OR 97477
Phone: (541) 222-7218
Toll free: (888) 240-6484

Physician Fact Sheet

Click here for a printable fact sheet about Transradial Access Catheter Procedures.

 

Patient Population

The transradial approach may be appropriate for a wider patient population, including:
  • Morbidly obese patients
  • Patients with severe peripheral vascular disease
  • Patients on oral anticoagulants
  • Elderly patients

Patient Benefits

  • Painless, minimally invasive procedure with excellent outcomes.
  • Increased patient safety due to substantial reduction in bleeding and vascular access complications.
  • Procedures can be performed on an out-patient basis, with discharge in two to three hours.
  • No need for immobilization, which can substantially reduce back pain.
  • Decreased time to ambulation.
  • Comfortable, lounge-like recovery area increases patient satisfaction.
 

 

 

 

 

 

 

 

 

 
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