1. RADIAL OR BUST The only choice for vascular access
Jim Nolan
University Hospital of North Staffordshire
United Kingdom

2. CONFLICTS OF INTEREST

3. ARTERIAL ACCESS – WHY AM I INTERESTED (Heart 1995, Am Heart J 1997)%
Major Vasacular Complications % %

4. BRACHIAL CUT DOWN COMPLICATIONS

5. NEURO-ANATOMY OF THE FEMORAL TRIANGLE

6. FEMORAL ACCESS PRACTICE Two weeks at UHNS

7. FEMORAL ACCESS COMPLICATIONS

8. ACTIVE RETROPERITONEAL BLEED

9. FEMORAL VASCULAR COMPLICATIONS IN CONTEMPORARY UK PRACTICE (Berry et-al, AJC 2004, n = 311)

10. MAJOR VASCULAR COMPLICATIONS
1 RPH, 3 Pseudo-aneurysms
3 GA emergency surgery
13 units of blood
Total of 61 extra days in hospital

11. ANTITHROMBOTIC THERAPY AND FEMORAL COMPLICATIONS
17.5 %
5.9
2.2
1.1
DIAGNOSTIC
POPULATION
Berry 2004
ANGINA PCI
POPULATION
Moutralescot 2005
MI/REO-PRO
PCI POPULATION
Otavio 2004
RESCUE PCI
Dauermau 2000

12. VACD – DEVICE FAILURE RATE (Sesana et-al, JIC 2000, n = 827)

13. VCD META ANALYSIS – RANDOMISED + OBSERVATIONAL
(Nikolsky et-al, JACC 2004, n = 37,066)

14. DOES IT ALL MATTER? COMPLICATIONS OF PCI IN CONTEMPORARY PRACTICE (Heart 2005, n = 3071)%

15. DOES IT ALL MATTER? MEDICO-LEGAL CASES ARISING FROM CARDIAC CATHETERISATION PROCEDURES ( MDU)

16. NEURO-ANATOMY OF THE WRIST

17. VASCULAR COMPLICATIONS (uhns transradial programme) Heart 2003
RADIAL FEMORAL
(n=1000) (n=727)
TRANSFUSION (0%) (0.6%)
VASCULAR INTERVENTION 1 (0.1%) (0.8%)
INFECTION (0.2%) (0.3%)
3 (0.3%) 12 (1.7%)

18. RADIAL VS FEMORAL ACCESS – RCT meta analysis (Agostoni et-al JACC 2004)
number
279
152
600
112
142
200
210
420
371
149
Grinfield Mann ACCESS BRAFE Mann Cooper CARAFE Gorge Moriyama OCTOPLUS TEMPURA
MACE
Procedural success
Procedural success
Access site complications

19. ARE RADIAL CASES TOO HARD TO DO (Rao et al, JACCI 2008)

20. DOES EVERYBODY BENEFIT FROM RADIAL ACCESS (Rao et-al JACCI 2008)

21. DOES EVERYBODY BENEFIT FROM RADIAL ACCESS (Rao et-al JACCI 2008)

22. DOES EVERYBODY BENEFIT FROM RADIAL ACCESS (Rao et-al JACCI 2008)

23. IS PCI RELATED BLEEDING A BAD THING (MORTAL study, Heart 2008, n=38,872)

24. DOES PREVENTION OF ACCESS SITE BLEEDING IMPROVE OUTCOME (MORTAL study, Heart 2008, n=38,872)

25. VASCULAR COMPLICATIONS – ECONOMIC IMPACT (Nowamagbe et-al, JACC 1995, n = 1,012 CAVEAT-1)
LENGTH OF STAY
HOSPITAL COSTS
COST ($)
LOS (DAYS)

26. TRANSRADIAL APPROACH PATIENT PREFERENCE

27. TRANSRADIAL APPROACH NURSING PREFERENCE (Amoroso, EJCVN, 2005, n = 260)
Cath lab
Ward
Femoral
Radial
Femoral
Radial

28. RADIATION EXPOSURE IS IMPORTANT Skin injury due to cardiac intervention

29. RADIATION EXPOSURE IS IMPORTANT Accessory pathway ablation
3 weeks
5 months
6.5 months

30. OPERATORS ALSO GET RADIATION INDUCED SKIN INJURY

31. UHNS RADIATION EXPOSURE STUDY Mean fluoroscopy time and patient and operator radiation doses (Heart 2007)
P=NS
P=NS
P<0.05

32. UHNS RADIATION EXPOSURE STUDY Mean procedure duration (min) and time to ambulation (min) (Heart 2007)
P<0.0001
P<0.005

33. PCI OPERATIVE RADIATION EXPOSURE 2003 – 2004 TLD BADGE READINGS - UHNS

34. Mont Blanc Summit Ridge September 2007

35. TRANSRADIAL APPROACH THE LEARNING CURVE
Lefevre TCT 2003
Puncture failure, spasm, different guide manipulation

36. “…the radial approach has become increasingly popular with the potential advantage of a greater opportunity for same day discharge”
“…shorter bed rest and hospital stay when the radial approach is used”
“…the use of the radial approach is likely to increase”

37. RADIAL Vs FEMORAL PCI (BCIS DATABASE)

38. THE RADIAL ARTERY Reduces access site bleeding Impact on mortality
Efficient
Preferred by patients
Endorsed by BCIS
Taken up by increasing numbers of UK interventionists
THE ONLY CHOICE FOR VASCULAR ACCESS

39. THANKS TO MARK GUNNING