Coronary angiography in the presence of peripheral vascular disease: femoral or brachial/radial approach?
Peripheral vascular disease is considered a relative contraindication to the femoral approach for coronary angiography, but no data exist comparing the femoral and brachial/radial routes under these circumstances. We examined the influence of vascular approach on outcome. Two hundred and ninety-seven patients, mean age 67.1 +/- 8.4 years, with clinical or radiographic evidence of aortofemoral peripheral arterial disease underwent diagnostic coronary angiography during a 3-year period at this cardiothoracic center. The approach was successful in 121 of 154 femoral cases (79%) compared with 130 of 143 brachial/radial cases (91%; P < 0.01). Of the 33 failed femoral cases, 15 were then approached from the other femoral artery, with success in 6 (40%), while 18 were approached from the arm, with success in all (100%; P < 0.01). Brachial/radial cases took significantly longer than femoral cases (51 +/- 19 vs. 42 +/- 22 mins; P < 0.01). In cases where the femoral pulse was considered normal, the femoral approach nonetheless failed in 19 of 95 (20%). Major vascular complications (e.g., pulseless limb, arterial dissection, hemorrhage, or false aneurysm) occurred in nine femoral cases vs. zero brachial/radial cases (P < 0.01). Patients with peripheral vascular disease who undergo coronary angiography from the femoral artery have a 1-in-5 risk of procedural failure, necessitating use of an alternative vascular approach, and a 1-in-20 risk of a major vascular complication. Normality of femoral arterial pulsation is not a good predictor of femoral success. Brachial/radial approaches take longer, but succeed more frequently and have a negligible major vascular complication rate. We believe that patients with peripheral vascular disease should undergo coronary angiography via brachial or radial approach. Cathet. Cardiovasc. Intervent. 49:32-37, 2000.
Hildick-Smith
D J
DJ
Department of Cardiology, Papworth Hospital, Cambridgeshire, United Kingdom. david.hildick-smith@papworth-tr.anglox.nhs.uk
Walsh
J T
JT
Lowe
M D
MD
Stone
D L
DL
Schofield
P M
PM
Shapiro
L M
LM
Petch
M C
MC
D000368:Aged; D001916:Brachial Artery; D002406:Catheterization, Peripheral / Q000009:adverse effects; D017023:Coronary Angiography / Q000009:adverse effects / Q000379:methods*; D003327:Coronary Disease / Q000150:complications / Q000000981:diagnostic imaging; D005260:Female; D005263:Femoral Artery; D006801:Humans; D008297:Male; D016491:Peripheral Vascular Diseases / Q000150:complications; D017534:Radial Artery; D012189:Retrospective Studies