Radial versus femoral artery approach for diagnostic coronary angiography – a comparative observational study

Background & Objective: The femoral artery has been the usual route of access for Coronary Angiography. In recent past some trials have suggested that radial artery as a route of access for Coronary Angiography reduces local vascular complications & bleeding as compared to femoral route. We present our study aimed to assess the two routes viz. a viz. complications & feasibility. Methods: Our study is of prospective comparative design, conducted in SMHS Hospital Srinagar, a tertiary care institute, associated hospital of Government Medical College Srinagar. A total of 400 patients were enrolled; 240 patients for radial and 160 patients for femoral approaches for Coronary Angiography. Patients fulfilling the inclusion and exclusion criteria were included in the tudy. Results: In our study we found that the access time was more with the radial compared to femoral approach (5.763+_3.101 min vs 3.11+_1.16 min, p <0.001). The total procedure time was also more in radial than femoral approach group (30.03+_6.728 vs 28.26+_10.637 min, p _0.06). Similarly the total fluoroscopic time was more in radial compared to femoral group (6.39+_2.89 vs 6.02+_1.53 min, p _ 0.09). The radial access had a strong trend towards more ontrast volume use as compared to femoral access (54.58+_25.919 ml & 52.06+_18.053 ml, p _0.252). The post procedure complications were more common in the femoral compared to radial group. The common complications were puncture site ecchymosis (p<0.05), thrombophelibitis (p<0.05), local site hematoma (p <0.001) & access site bleeding (p<0.05). Patient comfort was higher in the radial (4.2±0.6) than in the femoral group (4.1± 0.7) (p_0.03)). The patients who would undergo CAG via radial group would spend 3.85±2.6 hours in the hospital whereas the femoral group would need 7.15±2.2 hours hospitalization (p_0.001). Interpretation & Conclusion: The radial approach for Diagnostic Coronary Angiography is more favourable than femoral approach. However, the same needs longer learning curve, has increased access failure and crossover.