Radial versus Femoral Approach for Saphenous Vein Grafts Angiography and Interventions

Abstract

Aims
Coronary angiography and intervention to saphenous venous grafts (SVGs) remains challenging. This study aimed to investigate the feasibility and safety of the radial approach compared to femoral access in a large cohort of patients undergoing SVG angiography and intervention.

Methods and Results
Data from 1481 patients from Canada, United States and Spain who underwent procedures between 2010 and 2016 were collected. Patients must have undergone SVG coronary angiography and/or intervention. Demographics, procedural data and in-hospital complications were recorded. Procedures were undertaken by either the radial (n=863, 211 intervention) or femoral (n=618, 260 intervention) approach. The mean number of SVGs per-patient was similar between groups (radial 2.3±0.7 versus femoral 2.6±1.1, P=0.61) but the radial group required a fewer number of catheters (2.6±1.7 versus 4.1±1.1, P<0.001). Fluoroscopy time was comparable between groups, and there was a trend towards lower contrast volume in the radial group (P=0.045). In overall, the total dose of heparin was significantly higher in the radial group (P<0.001); however, radial patients experienced significantly less access-site bleeding complications (P<0.001). Outpatients undergoing radial SVG interventions had a higher likelihood of a same-day discharge home (P<0.001).

Conclusions
Radial access for SVG angiography and intervention is safe and feasible, without increasing fluoroscopy time. In experienced centers, radial access was associated with fewer catheters used, lower contrast volume, and lower rate of vascular access-site bleeding complications. Moreover, outpatients undergoing SVG-PCI though the radial approach had a higher likelihood of a same-day discharge home.