Comparison between femoral and radial approach in invasive coronary procedures after coronary artery bypass grafting

Background

Invasive coronary procedures are common in patients with previous coronary artery bypass graft surgery. Data on the actual role and possible limitations of the radial approach in this subgroup of patients are sparse. The objective of this study was to evaluate the feasibility and safety of radial access in patients surgically revascularized and who underwent subsequent invasive diagnostic or therapeutic coronary procedures, comparing it to the femoral access.

Methods

Between May 2008 and November 2014, 959 procedures were included; 539 performed by radial access and 420 by femoral access. All operators were familiar with both vascular accesses, and the final decision on the route to be used was left to the operators discretion.

Results

The failure rate was 6.1% vs. 0.5% (p < 0.0001), favoring the femoral approach. Major adverse cardiac events (0.4% vs. 0.7%) and vascular complications (1.5% vs. 1.9%) rates were low, with no difference between groups. The choice of the radial approach resulted in greater fluoroscopy time and crossover rate between access routes, especially in diagnostic procedures.

Conclusions

The radial approach was a safe and effective option for invasive coronary procedures in post- coronary artery bypass graft patients, especially for therapeutic procedures.