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Published byDaniela Bradley Modified over 9 years ago
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RADIAL ARTERY The route for the unwary
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Uptake of New Procedures Volume Time
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Esprit Trial Femoral % Radial % P Death/MI 8% 10.4%.326 Any bleed 17.9% 11.8%.05 Access site bleed 14.2% 6.3%.003 Access site complication 6.6% 0.7%.001
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Femoral Artery Occlusion
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Compartmental Syndrome
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Leeches Patient
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Internuclear Ophthalmoplegia
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Radial Artery Perforation
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Trapped Guide Wire
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Why the Femoral Artery? 1. Preserve the Radial Artery 2. Arm Access not possible
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Radial Artery Loop
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Why the Femoral Artery? 1. IABP 2. TAVI (PAVR) 3. Valvuloplasty 4. Complex PCI - ?Rotablation ? Double balloon PCI ? Distal protection
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Why the Femoral Artery? Operator Radiation Exposure
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Brasselet et al Europ Ht J 2008 Operator radiation exposure significantly higher from radial route compared to femoral route.
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Brasslelet et al Europ Ht J 2008 Radial route indication should be promptly reconsidered in the light of these findings
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Adverse Effects of Radiation First reported 1902 – Solid Tumour Stochastic – even smallest radiation exposure gives rise to finite risk of premature death
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Johnson et al (1990) Interventional cardiologists approach current annual dose limit of 20 mSv Classified as approaching 3/10 of a stochastic dose limit if doing 50 PCI/yr or 100 diagnostic/yr
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Complex Procedures: Longer Procedures 1. Multi vessel PCI 2. TAVI 3. CTO
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Risks of Radiation Skin Cataracts Leukaemia Thyroid Cancer Solid Tumours
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Sources of Radiation Natural (82%)- Radon 55% -Inside Human body 11% -Rocks and Soil 8% -Cosmic Rays 8%
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Sources of Radiation Man Made (18%)- Medical X-Ray 11% -Nuclear Medicine 4% -Consumer Products 3% -Fall out from Nuclear Missiles <.3% -Nuclear Power.1% -Miscellaneous.1%
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Avoiding Over-exposure 1. Scrupulous Radiation Protection 2. Avoid the Radial Route 3. Reduce the number of procedures per operator 4. Get a fat assistant between you and the image intensifier
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Why the Femoral Route? 1. Image Quality 2. Full Portfolio of procedures 3. You will live longer
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