RADIAL ARTERY

The route for the unwary

Uptake of New ProceduresVolume

Time

Esprit TrialFemoral

%

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

Femoral Artery Occlusion

Compartmental Syndrome

Compartmental Syndrome

Leeches Patient

Internuclear Ophthalmoplegia

Radial Artery Perforation

Trapped Guide Wire

Why the Femoral Artery?

1. Preserve the Radial Artery

2. Arm Access not possible

Radial Artery Loop

Why the Femoral Artery?

1. IABP

2. TAVI (PAVR)

3. Valvuloplasty

4. Complex PCI - ?Rotablation

? Double balloon PCI

? Distal protection

Why the Femoral Artery?

Operator Radiation

Exposure

Brasselet et al Europ Ht J 2008

Operator radiation exposure significantly higher from radial route compared to femoral route.

Brasslelet et al Europ Ht J 2008

Radial route indication should be promptly reconsidered in the light of these findings

Adverse Effects of Radiation

First reported 1902 – Solid Tumour

Stochastic – even smallest radiation exposure gives rise to finite risk of premature death

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

Complex Procedures: Longer Procedures

1. Multi vessel PCI

2. TAVI

3. CTO

Risks of Radiation

Skin Cataracts Leukaemia Thyroid Cancer Solid Tumours

Sources of RadiationNatural

(82%) - Radon 55%

- Inside Human body 11%

- Rocks and Soil 8%

- Cosmic Rays 8%

Sources of Radiation

Man Made(18%) - Medical X-Ray 11%

- Nuclear Medicine 4%- Consumer Products 3%- Fall out from NuclearMissiles <.3%- Nuclear Power .1%- Miscellaneous .1%

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

Why the Femoral Route?

1. Image Quality

2. Full Portfolio of procedures

3. You will live longer