Arm Approach Safer for Cardiac Catheterization

Patients undergoing a coronary angiogram had a significantly lower risk of major bleeding and death when accessed through the arm rather than the groin, according to a new study.

Researchers at Erasmus University Medical Center (Rotterdam, The Netherlands) randomized more than 8,400 angiogram patients at 78 hospitals in four European countries to receive a percutaneous angiogram via the arm (radial approach) or the groin (femoral approach); all study participants suffered from acute coronary syndrome (ACS) or unstable angina. The primary endpoints were a composite rate of death, heart attack, or stroke 30 days after a catheterization procedure, as well as bleeding.

The results showed that patients receiving radial access suffered major bleeding, death, heart attack or stroke within 30 days in 9.8% of cases, as compared to 11.7% in those undergoing femoral access. The difference was attributed to major bleeding, which occurred in 1.6% of patients receiving radial access and 2.3% of patients receiving femoral access, and death, which occurred in 1.6% of patients receiving radial access and 2.2% of patients receiving femoral access. The increased risk of death was driven by increased bleeding complications. The study was presented at the American College of Cardiology (ACC) conference, held during March 2015 in San Diego (CA, USA).

“Interventional cardiologists who are experienced with the radial approach have nothing to lose and everything to gain. To build the level of experience necessary to maximize the benefits of the radial approach, a given surgeon should use the radial approach in at least 80% of cases,” said lead author interventional cardiologist Marco Valgimigli, MD, PhD. “However, the femoral approach is still appropriate for certain types of procedures that require the use of larger equipment, such as transcatheter aortic valve implantation.”

“I believe the evidence from our study should compel a switch to the radial approach as the preferred method,” added Dr. Valgimigli. “I hope that a new generation of interventional cardiologists will be specifically trained in the radial approach and that more medical centers will build up their expertise in this procedure.”

Interventional cardiologists have typically favored femoral catheter access because it involves a larger artery that is less prone to spasm, an event that can limit the ability to move medical devices through the catheter. Although the radial artery is closer to the surface and thus easier to access, it's smaller size makes the radial approach more technically difficult, and requires the use of smaller equipment.

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Erasmus University Medical Center