Author + information
- Received May 28, 2013
- Revision received August 19, 2013
- Accepted August 26, 2013
- Published online November 1, 2013.
- Tesfaldet T. Michael, MD, MPH,
- Mohammed Alomar, MD,
- Aristotelis Papayannis, MD,
- Owen Mogabgab, MD,
- Vishal G. Patel, MD,
- Bavana V. Rangan, BDS, MPH,
- Michael Luna, MD,
- Jeffrey L. Hastings, MD,
- Jerrold Grodin, MD,
- Shuaib Abdullah, MD,
- Subhash Banerjee, MD and
- Emmanouil S. Brilakis, MD, PhD∗ ()
- ↵∗Reprint requests and correspondence:
Dr. Emmanouil S. Brilakis, Dallas VA Medical Center (111A), 4500 South Lancaster Road, Dallas, Texas 75216.
Objectives This study sought to compare and contrast use and radiation exposure using radial versus femoral access during cardiac catheterization of patients who had previously undergone coronary artery bypass graft (CABG) surgery.
Background Limited information is available on the relative merits of radial compared with femoral access for cardiac catheterization in patients who had previously undergone CABG surgery.
Methods Consecutive patients (N = 128) having previously undergone CABG surgery and referred for cardiac catheterization were randomized to radial or femoral access. The primary study endpoint was contrast volume. Secondary endpoints included fluoroscopy time, procedure time, patient and operator radiation exposure, vascular complications, and major adverse cardiac events. Analyses were by intention-to-treat.
Results Compared with femoral access, diagnostic coronary angiography via radial access was associated with a higher mean contrast volume (142 ± 39 ml vs. 171 ± 72 ml, p < 0.01), longer procedure time (21.9 ± 6.8 min vs. 34.2 ± 14.7 min, p < 0.01), greater patient air kerma (kinetic energy released per unit mass) radiation exposure (1.08 ± 0.54 Gy vs. 1.29 ± 0.67 Gy, p = 0.06), and higher operator radiation dose (first operator: 1.3 ± 1.0 mrem vs. 2.6 ± 1.7 mrem, p < 0.01; second operator 0.8 ± 1.1 mrem vs. 1.8 ± 2.1 mrem, p = 0.01). Fewer patients underwent ad hoc percutaneous coronary intervention (PCI) in the radial group (37.5% vs. 46.9%, p = 0.28) and radial PCI procedures were less complex. The incidences of the primary and secondary endpoints was similar with femoral and radial access among PCI patients. Access crossover was higher in the radial group (17.2% vs. 0.0%, p < 0.01) and vascular access site complications were similar in both groups (3.1%).
Conclusions In patients who had previously undergone CABG surgery, transradial diagnostic coronary angiography was associated with greater contrast use, longer procedure time, and greater access crossover and operator radiation exposure compared with transfemoral angiography. (RADIAL Versus Femoral Access for Coronary Artery Bypass Graft Angiography and Intervention [RADIAL-CABG] Trial; NCT01446263).
- coronary artery bypass graft surgery
- transfemoral approach
- transradial approach
Dr. Michael has received a cardiovascular training grant from the National Institutes of Health, Award Number T32HL007360. Dr. Banerjee is on the Speakers' Bureau of St. Jude Medical, Medtronic Corp., and Johnson & Johnson; is a consultant for Medtronic and Covidien; and has received a research grant from Boston Scientific and an institutional research grant from Gilead; his spouse has ownership of Mdcareglobal; and has intellectual property with HygeiaTel. Dr. Brilakis has received consulting fees/speaker honoraria from St. Jude Medical, Terumo, Janssen, sanofi-aventis, Asahi, Abbott Vascular and Bridgepoint Medical/Boston Scientific; and research support from Guerbet; and his spouse is an employee of Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received May 28, 2013.
- Revision received August 19, 2013.
- Accepted August 26, 2013.
- American College of Cardiology Foundation