Advantages of transradial cardiac catheterization regarding complications (bleeding and hematomas), care, and hospital stay over the femoral techniques

Abstract

Background In the hands of experienced operators and high-volume transradial catheterization centers, transradial coronary angiography and intervention offers improved patient comfort, decreased access-site complications, and decreased costs without compromising procedural success or long-term outcomes. Patients presenting with ST-elevation myocardial infarction, in particular, benefit from a transradial approach to coronary intervention. Transradial access has become the default mode of catheterization for a growing number of cardiologists and will undoubtedly continue to be increasingly performed. Objective This was a retrograde study in 100 patients who were involved in coronary angiography whether as emergency acute coronary syndrome or elective cases. The patients were divided into two equal groups that used radial or femoral techniques to assess the advantage of radial over femoral approach regarding complications, care, and hospital stay. All patients were subjected to the usual investigations before the procedure, and strict precautions were taken. The complications of both groups were compared together, and statistical data were done beside the hospital stay and the need for medical care. Patients and methods A nonrandomized study was done on 100 cases comprising 34 females and 66 males with mean age of 50 ± 14 years, with youngest being 39 years old and eldest being 77 years old, referred with suspected Ischemic heart disease (IHD) and coronary angiography. All patients were analyzed for clinical problems, namely, chest pain or dyspnea, and patients with atrial fibrillation were excluded from the study. Transthoracic echocardiography was used to assess wall motion abnormality by apical 4 chamber, apical 2 chamber, parasternal, and subcostal views, and blood flow by Doppler across the mitral and aortic valves was analyzed. A 12-lead ECG was used to prove the presence of ischemic changes. Myocardial perfusion images and computed tomography scanning were done for some patients. Results The incidence of vascular complications, namely, bleeding and hematomas, was much less compared with those using the femoral technique. The incidence of vascular complications was less in the elective cases than patients with acute coronary syndrome. All patients with transradial technique had mean hospital stay of 2 ± 1.22 h compared with femoral technique of 6 ± 3.34 h. The need of medical care in the first group regarding compression after catheterization, dressing, bandage, ICU transfer, and lower limb care is markedly different than the femoral technique. Conclusion Transradial catheterization also has the potential to reduce procedural costs. Fewer complications equate to shorter hospital stays. Additionally, less staffing is needed to care for patients following transradial catheterization. Furthermore, same-day discharge is feasible after coronary intervention, which shortens stays and significantly reduces costs. One study showed percutaneous coronary intervention with transradial access was associated with cost savings per patient relative to transfemoral access.

Keywords

• bleeding and haematomas
• emergency acute coronary syndrome
• transradial catheterization