1. RADIAL ARTERY The route for the unwary

4. Uptake of New Procedures Volume Time

9. 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

10. Femoral Artery Occlusion

12. Compartmental Syndrome

14. Leeches Patient

15. Internuclear Ophthalmoplegia

16. Radial Artery Perforation

17. Trapped Guide Wire

18. Why the Femoral Artery? 1. Preserve the Radial Artery 2. Arm Access not possible

19. Radial Artery Loop

20. Why the Femoral Artery? 1. IABP 2. TAVI (PAVR) 3. Valvuloplasty 4. Complex PCI - ?Rotablation ? Double balloon PCI ? Distal protection

23. Why the Femoral Artery? Operator Radiation Exposure

24. Brasselet et al Europ Ht J 2008 Operator radiation exposure significantly higher from radial route compared to femoral route.

25. Brasslelet et al Europ Ht J 2008 Radial route indication should be promptly reconsidered in the light of these findings

26. Adverse Effects of Radiation First reported 1902 – Solid Tumour Stochastic – even smallest radiation exposure gives rise to finite risk of premature death

28. 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

29. Complex Procedures: Longer Procedures 1. Multi vessel PCI 2. TAVI 3. CTO

30. Risks of Radiation  Skin  Cataracts  Leukaemia  Thyroid Cancer  Solid Tumours

31. Sources of Radiation Natural (82%)- Radon 55% -Inside Human body 11% -Rocks and Soil 8% -Cosmic Rays 8%

32. 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%

33. 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

35. Why the Femoral Route? 1. Image Quality 2. Full Portfolio of procedures 3. You will live longer