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Radial approach in high-risk older patients reduced vascular complications
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Compared with the femoral approach, radial access PCI, although taking longer, significantly reduced vascular complication rates in high-risk patients aged 80 years and older, according to study findings published in the Journal of Interventional Cardiology.
For the study, researchers included 268 patients aged 80 to 97 years who underwent elective PCI from May 2003 to May 2007. Of these patients, 156 underwent a femoral approach and 112 underwent a radial approach.
There was a more than 95% success rate for both groups, yet the radial approach was seen as an independent negative predictor of post-procedural vascular complications (OR=0.25; 95% CI, 0.09-0.75).
Overall, the radial approach was associated with a significantly reduced ambulation time (5 ± 2 hours vs. 20 ± 4 hours; P<.001), access site bleeding (2.7% vs. 9.6%; P=.004), hematoma (4.5% vs. 10.9%; P=.006) or any vascular complication (7.1% vs. 23.7%; P<.001) than the femoral approach.
However, radial access PCI required longer cannulation (3 ± 2.8 minutes vs. 2 ± 1.9 minutes; P<.001), fluoroscopy time (23 ± 15 minutes vs. 19 ± 12 minutes; P=.03) and a higher rate of crossover to an alternative access site (9.8% vs. 3.8%; P=.02) compared with the femoral approach.
Researchers wrote that the radial approach is more technically demanding and requires more nephrotoxic contrast medium, but there were two cases of retroperitoneal hematoma in the femoral approach group in this study that lengthened hospitalization.
“Therefore, pre-procedural evaluation of the structure of radial, brachial and upper arch arteries is particularly important because it not only reduces pain but also avoids vascular complications,” they wrote.
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