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Transradial vs. Femoral Access
Blog By: Kenneth A. Gorski RN RCIS RCSA FSICP
Transradial coronary angiography and PCI seems to be everywhere these days. Pick up a cardiac journal, visit various cath-related websites, and you cannot escape being inundated with industry ads, articles on technique, and workshops offered at various conferences.
Data from the American College of Cardiology’s National Cardiovascular Data Registry (NCDR) shows that currently, radial access is extremely rare in United States practice (1.32% of procedures done through the radial artery). However, in many European countries (such as France, Italy, and Spain) radial access is not only common, it is becoming the preferred route, not just when femoral arterial disease and obesity hinder vascular access. Just to our north, it is estimated that nearly 50% of cases are done radially in Canada; Norway and China are leading the way with 80-90% radial access.
There are many pluses and minuses to either femoral or radial access. One is that radial access may limit specialty device selections for complex disease. Radial access allows for immediate sheath removal, diagnostic or PCI, no matter what anticoagulation regimen was used.
Is this another passing fad, or the next “revolution” in our practice? I know if I was the patient, I would be much more comfortable with a needle to my wrist than to my groin.
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Posted by admin on January 21, 2010 at 6:01 pm
(Reposted) from Cath Lab Digest's Facebook page:
We have a "new to us" doc that is from Brazil but trained at UCSD. He is doing a lot of radials lately. He said in Brazil they did EVERY pt radially unless acute MI or other reason. So, we're just trying to get into the swing of it, the more we do, the better it gets...go New Mexico! Proud of us that we're getting on the bandwagon.
- Cassidy Lilienthal
Posted by Anonymous on January 26, 2010 at 12:01 am
HI, my name is Orlando Marrero RCIS at Winter Haven Hospital, Florida. We are a site that trains MD and technologistand nurse in the art of TR approach and we are a adovacate of the radial access for all procedures to include ACS. We love it and dislike the groin and the patient satidfaction and outcomes are beeter than trans femoral. I beleive every hospital should be a TR center of excellence.
We have courses every month and we are willing to educate anyone who is willing to change. TR is the future.
Posted by Anonymous on January 26, 2010 at 11:01 am
We have been performing Transradial approach for the last 17 months, both diagnostic and intervention. The approach is a little different and there is a slight learning curve, but our practitioner was taught in Canada and is very talented. We are very lucky to have him here.
The patients who have had the femoral approach prefer the radial by far. Potential complications are minimized. Approximately 60% of our procedures are RA. We have done a few acutes throught the TRA, but the femoral still offers better access in unknown acute situations as well as IAB and Temp wire access. I think our ICU appreciates this approach as well as it minimizes some of the direct hands on of the nursing staff (Pulling lines etc.)We are a small rural program and I feel that we offer an exceptional product to our patients.
Rick Upshaw
Posted by Anonymous on January 26, 2010 at 1:01 pm
Our facility does not do any interventions via the radial artery. We do have one MD relatively new who has done one pt via the radial artery. I am not sure why this is but I agree that using the radial artery does limit the devices you might be able to use when treating complex lesions. I think also that many of our MD's have not been trained to do interventions via the radial and therefore they are more comfortable doing procedures the way they have always done them. Maybe as the next generation of interventional cardiologists start to practice in hospital settings the use of radial artery access will increase.
Annie Ruppert RN, BSN
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