title: Transradial access compared with femoral puncture closure devices in percutaneous coronary procedures.
abstract: BACKGROUND
  Transradial access (RA) is associated with less complications and is preferred by patients. Vascular closure devices (VCDs) may improve discomfort and may reduce complications associated with transfemoral access. Aim was to evaluate complications and discomfort associated with percutaneous coronary procedures employing RA or VCDs.
  
  
  METHODS
  We enrolled 1492 consecutive patients who underwent percutaneous coronary procedures with RA (604 procedures), femoral approach with manual compression (MC) (276 procedures), or with either Angioseal (311 procedures) or Starclose (301 procedures) closure device. Discomfort was assessed using procedure-specific questions. Major vascular complications were evaluated during hospitalization.
  
  
  RESULTS
  RA significantly reduced major complications (0.7%) compared to either the MC (2.9%, p=0.03) or the VCDs (Starclose 2.7%, Angioseal 3.9%, p=0.003). There were no significant differences in major complications between MC and either the Angioseal or the Starclose. At multivariate analysis the RA was predictor of reduced complications (OR 0.26, 95% CI 0.08-0.85, p=0.03 vs MC, and OR 0.19, 95% CI 0.07-0.57, p=0.003 vs VCDs). The RA was associated with a significant reduction in procedural discomfort with 44.2% of patients referring no discomfort (p<0.0001). Starclose and Angioseal were better tolerated than MC (27.8%, 29.3% and 8.9% patients respectively without discomfort, p<0.0001).
  
  
  CONCLUSIONS
  RA is associated with a significant reduction in major vascular complications compared to femoral approach even if two different VCDs are employed. VCDs are better tolerated than MC but the RA was associated with the lowest discomfort.
authors.affiliation: U.O. Cardiologia, Policlinico Casilino, ASL RMB, Rome, Italy. alessandro.sciahbasi@fastwebnet.it
authors.forename: Alessandro
authors.initials: A
authors.lastname: Sciahbasi
authors.forename: Dionigi
authors.initials: D
authors.lastname: Fischetti
authors.forename: Amedeo
authors.initials: A
authors.lastname: Picciolo
authors.forename: Roberto
authors.initials: R
authors.lastname: Patrizi
authors.forename: Isabella
authors.initials: I
authors.lastname: Sperduti
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Colonna
authors.forename: Francesco
authors.initials: F
authors.lastname: Summaria
authors.forename: Antonio
authors.initials: A
authors.lastname: Montinaro
authors.forename: Ernesto
authors.initials: E
authors.lastname: Lioy
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D006328:Cardiac Catheterization / Q000295:instrumentation*; D016009:Chi-Square Distribution; D005260:Female; D005263:Femoral Artery; D006489:Hemostatic Techniques / Q000295:instrumentation*; D006801:Humans; D007558:Italy; D016015:Logistic Models; D008297:Male; D010147:Pain Measurement; D011183:Postoperative Complications; D011446:Prospective Studies; D011677:Punctures; D011788:Quality of Life; D017534:Radial Artery; D016896:Treatment Outcome