Transradial Access Catheter Procedures
Transradial access for percutaneous coronary diagnosis and intervention remains relatively rare in the United States (less than 2 percent of cases), 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.
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 Upon completion of angiogram, the catheter is withdrawn.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.
Transradial access reduces the risk of major bleeding by over 70 percent[5,6], even among high-risk groups.
Groin complications have been the most common peri-procedural complication of cardiac catheterization. Patients who experience bleeding complications and transfusions have a significantly increased risk of death.
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.
Click here to read a radial access case study.
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
Amoroso G, Laarman GJ, Kiemeneij F. Overview of the transradial approach in percutaneous coronary intervention. J Cardiovasc Med (Hagerstown) 2007;8:230-237
Cohen MG, Alfonso C. Starting a transradial vascular access program in the cardiac catheterization laboratory. J Invasive Cardiol 2009;21:Suppl A;11A-17A
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
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
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
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
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
Tremmel JA. Launching a successful transradial program. J Invasive Cardiol 2009;21:Suppl A;5A-10A