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Will M, Weiss TW, Weber M, Kwok CS, Borovac JA, Lamm G, Unterdechler M, Aufhauser S, Nolan J, Mascherbauer J, Schwarz K. Left vs. right radial approach for coronary catheterization: Relation to age and severe aortic stenosis. Front Cardiovasc Med 2022; 9:1022415. [PMID: 36386308 PMCID: PMC9662167 DOI: 10.3389/fcvm.2022.1022415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 09/26/2022] [Indexed: 09/19/2023] Open
Abstract
Background Old age and the presence of aortic stenosis are associated with the unfolding of the intrathoracic aorta. This may result in increased difficulties navigating catheters from the right compared to the left radial approach. Objective To investigate whether increasing age or presence of severe aortic stenosis was associated with increased catheterization success rates from left (LRA) compared to right radial artery approach (RRA). Methods We compared coronary angiography success rates of RRA and LRA according to different age groups and in a subgroup of patients with severe aortic stenosis. Results A total of 21,259 coronary angiographies were evaluated. With increasing age, the first pass success rate from either radial access decreased significantly (p < 0.001). In patients aged <85 years, there was no difference between LRA and RRA. However, in patients aged ≥85 years, LRA was associated with significantly higher success rates compared to RRA (90.1 vs. 82.8%, p = 0.003). Patients aged ≥85 years received less contrast agent and had shorter fluoroscopy time when LRA was used [86.6 ± 41.1 vs. 99.6 ± 48.7 ml (p < 0.001) and 4.5 ± 4.1 min vs. 6.2 ± 5.7 min (p < 0.001), mean (±SD)]. In patients with severe aortic stenosis (n = 589) better first pass success rates were observed via LRA compared to the RRA route (91.9 vs. 85.1%, p = 0.037). Conclusion LRA, compared to RRA, is associated with a higher first-pass catheter success rate for coronary artery angiography in patients aged ≥85 years and those with severe aortic stenosis.
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Affiliation(s)
- Maximilian Will
- Department of Internal Medicine 3, University Hospital St. Pölten, Karl Landsteiner University of Health Sciences, Krems, Austria
- Karl Landsteiner Institute for Cardiometabolics, Karl Landsteiner Society, St. Pölten, Austria
| | - Thomas W. Weiss
- Karl Landsteiner Institute for Cardiometabolics, Karl Landsteiner Society, St. Pölten, Austria
- Medical School, Sigmund-Freud University, Vienna, Austria
| | - Michael Weber
- Division Biostatistics and Data Science, Department of General Health Studies, Karl Landsteiner University of Health Sciences, Krems, Austria
| | - Chun Shing Kwok
- Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom
- School of Medicine, Keele University, Keele, United Kingdom
| | - Josip A. Borovac
- Clinic for Heart and Vascular Diseases, University Hospital of Split, Split, Croatia
| | - Gudrun Lamm
- Department of Internal Medicine 3, University Hospital St. Pölten, Karl Landsteiner University of Health Sciences, Krems, Austria
| | | | - Simone Aufhauser
- Department of Internal Medicine 3, University Hospital St. Pölten, Karl Landsteiner University of Health Sciences, Krems, Austria
- Karl Landsteiner Institute for Cardiometabolics, Karl Landsteiner Society, St. Pölten, Austria
| | - Jim Nolan
- Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, United Kingdom
- School of Medicine, Keele University, Keele, United Kingdom
| | - Julia Mascherbauer
- Department of Internal Medicine 3, University Hospital St. Pölten, Karl Landsteiner University of Health Sciences, Krems, Austria
| | - Konstantin Schwarz
- Department of Internal Medicine 3, University Hospital St. Pölten, Karl Landsteiner University of Health Sciences, Krems, Austria
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Ong CW, Yong E, Hong Q, Chandrasekar S, Quek LHH, Pua U, Tan GWL, Lo ZJ. Transradial access for arteriovenous fistuloplasty in Singapore. J Vasc Access 2020; 22:555-560. [PMID: 32847465 DOI: 10.1177/1129729820946643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Endovascular balloon angioplasty is standard therapy for dysfunctional arteriovenous fistula in end-stage renal failure patients on hemodialysis. Venous antegrade or retrograde puncture of the fistula is typically performed to gain access for fistuloplasty. Transradial approach for brachiocephalic or brachiobasilic arteriovenous fistulas offers an alternative method of access with the advantage of addressing multi-focal juxta-anastomotic and venous stenosis from the same approach. We aim to review the efficacy, outcomes and complication rates of transradial access for arteriovenous fistuloplasty among patients in Singapore. METHODS A retrospective review of 195 endovascular fistuloplasties from September 2017 to August 2019, at a tertiary university hospital Vascular Surgery unit. RESULTS Of 195 fistuloplasties, 43 (22%) were transradial approach (23 brachiocephalic arteriovenous fistulas, 20 brachiobasilic arteriovenous fistulas) in 33 patients (67% male and mean age = 65 years). Of these 43 procedures, 11 (26%) were performed as balloon-assisted maturation fistuloplasties while 32 (74%) were performed for mature arteriovenous fistulas with multi-focal juxta-anastomosis and venous stenosis. Technical success rate was 95% with mean procedure duration at 43.5 ± 14.6 min. Mean pre- and post-fistuloplasty dialysis access flow rates increased from 502 to 952 ml/min (p < 0.001). Post-intervention primary patency was 100%, 66% and 20% at 1, 6 and 12 months, respectively. There were four patients with non-limb-threatening radial artery thrombosis (9.3%) while there was no radial artery pseudoaneurysm or post-procedural bleeding. CONCLUSION Transradial approach for arteriovenous fistuloplasty is a safe and feasible option in patients requiring balloon-assisted maturation or with multi-focal juxta-anastomotic and venous stenosis.
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Affiliation(s)
- Chee Wui Ong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Enming Yong
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Qiantai Hong
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Sadhana Chandrasekar
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | | | - Uei Pua
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore
| | - Glenn Wei Leong Tan
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | - Zhiwen Joseph Lo
- Vascular Surgery Service, Department of General Surgery, Tan Tock Seng Hospital, Singapore
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Abstract
BACKGROUND AND OBJECTIVE Transradial access is an attractive approach for angiography or percutaneous coronary intervention. Different devices have been used to apply pressure locally at the site of arterial entry for achieving hemostasis. The aim of this study was to evaluate the effect of 2 different hemostatic devices on radial artery outcomes after transradial coronary intervention. SUBJECTS AND METHODS This study included 600 patients who had undergone transradial coronary intervention who were randomized into 2 groups after the procedure: 300 were treated with a radial compression device (TR Band, Terumo Medical, Tokyo, Japan) (CD group) and the other 300 patients were treated using a chitosan-based pad (Anscare, Daxon, Taoyuan, Taiwan) (CS group). Compression time, major and minor access site bleeding complications, and incidence of radial artery occlusion were recorded. RESULTS There were no statistical differences in the baseline clinical characteristics of the patients between the 2 groups. Compression time in the CS group was significantly shorter than that in the CD group (P < .001). Although no major access site bleeding complications were observed in either group, 6 patients in each group experienced minor access site bleeding complications. At the same time, 61 patients in the CD group and 21 patients in the CS group experienced errhysis (20% vs 7%, respectively; P < .001). Early radial artery occlusion (24 hours) occurred in 11.7% of the patients in the CD group and 5.4% of the patients in the CS group (P < .05). Chronic radial artery occlusion (30 days) occurred in 10% of the patients in the CD group and 5% of the patients in the CS group (P < .05). CONCLUSION The application of the chitosan-based pad showed better hemostatic efficacy and a lower incidence of radial artery occlusion after transradial coronary intervention compared with the compression device.
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TATLI ERSAN, BUTURAK ALI, CAKAR AKIF, VATAN BULENTM, DEGIRMENCIOGLU ALEKS, AGAC TARM, KILIC HARUN, GUNDUZ HUSEYIN, AKDEMIR RAMAZAN. Unusual Vascular Complications Associated with Transradial Coronary Procedures Among 10,324 Patients: Case Based Experience and Treatment Options. J Interv Cardiol 2015; 28:305-12. [DOI: 10.1111/joic.12206] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- ERSAN TATLI
- Department of Cardiology; Sakarya University School of Medicine; Sakarya Turkey
| | - ALI BUTURAK
- Department of Cardiology; Acibadem University School of Medicine; Istanbul Turkey
| | - AKIF CAKAR
- Department of Cardiology; Sakarya University School of Medicine; Sakarya Turkey
| | - BULENT M. VATAN
- Department of Cardiology; Sakarya University School of Medicine; Sakarya Turkey
| | - ALEKS DEGIRMENCIOGLU
- Department of Cardiology; Acibadem University School of Medicine; Istanbul Turkey
| | - TARıK M. AGAC
- Department of Cardiology; Sakarya University School of Medicine; Sakarya Turkey
| | - HARUN KILIC
- Department of Cardiology; Sakarya University School of Medicine; Sakarya Turkey
| | - HUSEYIN GUNDUZ
- Department of Cardiology; Sakarya University School of Medicine; Sakarya Turkey
| | - RAMAZAN AKDEMIR
- Department of Cardiology; Sakarya University School of Medicine; Sakarya Turkey
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Hsieh V, Jolly S. Comparing radial and femoral access for coronary angiography and interventions. J Comp Eff Res 2013; 2:151-8. [PMID: 24236557 DOI: 10.2217/cer.12.79] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Cardiac catheterization and coronary intervention via the radial approach is increasingly adopted as the preferred vascular access to avoid transfemoral vascular complications. Recent clinical trials have confirmed that radial access reduces vascular complications and local bleeding with similar procedural efficacy. Transradial access has inherent technical challenges, including smaller vessel size of the radial artery, arterial spasm and tortuosity involving the radial and subclavian arteries, which may undermine the procedural success of this approach. A number of strategies have been reported to minimize complications of radial access, including the use of hydrophilic introducer sheaths and smaller sheath sizes, administration of nitroglycerin and unfractionated heparin during the procedure, patent hemostasis of the radial artery and careful patient selection. Operators experienced in transradial percutaneous coronary intervention can achieve comparable clinical outcomes to the transfemoral approach and minimize vascular complications. Radial artery access is likely to become widely accepted as the preferred percutaneous coronary intervention approach.
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Affiliation(s)
- Victar Hsieh
- McMaster University, 237 Barton Street East, Hamilton, ON, L8L 2X2, Canada
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Bagur R, Bertrand OF, Rodés-Cabau J, Rinfret S, Larose É, Tizón-Marcos H, Gleeton O, Nguyen CM, Roy L, Costerousse O, De Larochellière R. Comparison of outcomes in patients > or =70 years versus <70 years after transradial coronary stenting with maximal antiplatelet therapy for acute coronary syndrome. Am J Cardiol 2009; 104:624-9. [PMID: 19699334 DOI: 10.1016/j.amjcard.2009.04.050] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2009] [Revised: 04/26/2009] [Accepted: 04/26/2009] [Indexed: 10/20/2022]
Abstract
Elderly patients are at a higher risk for complications after percutaneous coronary intervention (PCI) when performed through the femoral approach. The impact of age on complications in patients treated using the transradial approach is not known. The bleeding and ischemic outcomes at 30 days, 6 months, 1 year, and 3 years after transradial PCI and maximal antiplatelet therapy were compared in 1,348 patients aged <70 or > or =70 years with acute coronary syndromes. All patients received aspirin and clopidogrel before catheterization, followed by abciximab at the time of PCI. Patients aged > or =70 years (n = 259 [19%]) had more hypertension, dyslipidemia, family histories, and previous coronary artery bypass grafting. Older patients had lower baseline hemoglobin, platelet, and creatinine clearance values, and they also more often had 2- or 3-vessel syndrome (p = 0.001), as well as longer procedure durations (p = 0.024). At 30 days, the rates of major adverse cardiac events and major bleeding were similar in older and younger patients. Only the incidence of gastrointestinal bleeding (p = 0.021) and mild to moderate access-site hematoma were higher in older patients (p = 0.036). The rates of major adverse cardiac events were also similar in the 2 age groups at 6 months (6% vs 9%, p = 0.08), 1 year (10% vs 13%, p = 0.22), and 3 years (19% vs 20%, p = 0.73), but mortality was significantly higher at 3 years in patients aged > or =70 years (p = 0.0031). In conclusion, age per se is not a predictor of major adverse cardiac events or major bleeding after transradial PCI with maximal antiplatelet therapy. However, older patients remain more prone to gastrointestinal bleeding and local hematoma compared to younger patients, and preventive measures need to be further investigated.
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