title: Comparison of the transradial and transfemoral approaches for coronary angiographic evaluation in patients with internal mammary artery grafts.
abstract: OBJECTIVE
  Transradial access for coronary angiography may offer some advantages in comparison with conventional transfemoral access in specific subgroups of patients. Therefore, the aim of this study was to compare the transradial and transfemoral approaches in patients with previous coronary artery bypass graft (CABG) surgery using the left internal mammary artery (IMA).
  
  
  METHODS
  The time to left IMA cannulation, the time needed for left IMA evaluation, and total procedure time were compared in 60 patients previously submitted to CABG surgery using the left IMA. The homolateral radial access was attempted in 20 consecutive patients (TR group), whereas the transfemoral approach was undertaken in 40 patients (2: 1, TF group), matched for age, sex and number of grafts.
  
  
  RESULTS
  In the TR group, the time to left IMA cannulation and the time needed for left IMA evaluation were 39% and 46%, respectively, lower than those in the TF group (P = 0.01 and P = 0.001, respectively), whereas total procedure time was similar. In the subgroup of patients with less than three saphenous vein grafts (n = 36), the time to left IMA cannulation, the time needed for left IMA evaluation as well as total procedure time were significantly reduced (P = 0.01, P = 0.001 and P = 0.004, respectively). The rate of ad-hoc coronary angioplasty procedures was unaffected by the access site (20% in the TR group and 27% in the TF group, P = 0.53).
  
  
  CONCLUSIONS
  The present study shows that the homolateral transradial approach facilitates left IMA evaluation in patients with previous CABG surgery undergoing coronary angiography, in particular in patients with a lower number of coronary artery bypass conduits, in the absence of an excess of periprocedural complications.
authors.affiliation: Institute of Cardiology, Catholic University, Rome, Italy. f.burzotta@eudoramail.com
authors.forename: Francesco
authors.initials: F
authors.lastname: Burzotta
authors.forename: Carlo
authors.initials: C
authors.lastname: Trani
authors.forename: Daniel
authors.initials: D
authors.lastname: Todaro
authors.forename: Enrico
authors.initials: E
authors.lastname: Romagnoli
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Niccoli
authors.forename: Floriana
authors.initials: F
authors.lastname: Ginnico
authors.forename: Giovanni Paolo
authors.initials: GP
authors.lastname: Talarico
authors.forename: Antonella
authors.initials: A
authors.lastname: Tommasino
authors.forename: Mario Attilio
authors.initials: MA
authors.lastname: Mazzari
authors.forename: Rocco
authors.initials: R
authors.lastname: Mongiardo
authors.forename: Giovanni
authors.initials: G
authors.lastname: Schiavoni
authors.forename: Filippo
authors.initials: F
authors.lastname: Crea
mesh_terms: D000368:Aged; D002406:Catheterization, Peripheral / Q000379:methods*; D017023:Coronary Angiography / Q000379:methods*; D001026:Coronary Artery Bypass / Q000379:methods*; D003327:Coronary Disease / Q000000981:diagnostic imaging* / Q000601:surgery; D005260:Female; D005263:Femoral Artery; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008323:Mammary Arteries / Q000637:transplantation*; D011184:Postoperative Period; D017534:Radial Artery; D015203:Reproducibility of Results