title: A randomized comparison of the transradial and transfemoral approaches for coronary artery bypass graft angiography and intervention: the RADIAL-CABG Trial (RADIAL Versus Femoral Access for Coronary Artery Bypass Graft Angiography and Intervention).
abstract: OBJECTIVE
  This study sought to compare and contrast use and radiation exposure using radial versus femoral access during cardiac catheterization of patients who had previously undergone coronary artery bypass graft (CABG) surgery.
  
  
  BACKGROUND
  Limited information is available on the relative merits of radial compared with femoral access for cardiac catheterization in patients who had previously undergone CABG surgery.
  
  
  METHODS
  Consecutive patients (N = 128) having previously undergone CABG surgery and referred for cardiac catheterization were randomized to radial or femoral access. The primary study endpoint was contrast volume. Secondary endpoints included fluoroscopy time, procedure time, patient and operator radiation exposure, vascular complications, and major adverse cardiac events. Analyses were by intention-to-treat.
  
  
  RESULTS
  Compared with femoral access, diagnostic coronary angiography via radial access was associated with a higher mean contrast volume (142 ± 39 ml vs. 171 ± 72 ml, p < 0.01), longer procedure time (21.9 ± 6.8 min vs. 34.2 ± 14.7 min, p < 0.01), greater patient air kerma (kinetic energy released per unit mass) radiation exposure (1.08 ± 0.54 Gy vs. 1.29 ± 0.67 Gy, p = 0.06), and higher operator radiation dose (first operator: 1.3 ± 1.0 mrem vs. 2.6 ± 1.7 mrem, p < 0.01; second operator 0.8 ± 1.1 mrem vs. 1.8 ± 2.1 mrem, p = 0.01). Fewer patients underwent ad hoc percutaneous coronary intervention (PCI) in the radial group (37.5% vs. 46.9%, p = 0.28) and radial PCI procedures were less complex. The incidences of the primary and secondary endpoints was similar with femoral and radial access among PCI patients. Access crossover was higher in the radial group (17.2% vs. 0.0%, p < 0.01) and vascular access site complications were similar in both groups (3.1%).
  
  
  CONCLUSIONS
  In patients who had previously undergone CABG surgery, transradial diagnostic coronary angiography was associated with greater contrast use, longer procedure time, and greater access crossover and operator radiation exposure compared with transfemoral angiography. (RADIAL Versus Femoral Access for Coronary Artery Bypass Graft Angiography and Intervention [RADIAL-CABG] Trial; NCT01446263).
authors.affiliation: VA North Texas Healthcare System and University of Texas Southwestern Medical Center, Dallas, Texas.
authors.forename: Tesfaldet T
authors.initials: TT
authors.lastname: Michael
authors.forename: Mohammed
authors.initials: M
authors.lastname: Alomar
authors.forename: Aristotelis
authors.initials: A
authors.lastname: Papayannis
authors.forename: Owen
authors.initials: O
authors.lastname: Mogabgab
authors.forename: Vishal G
authors.initials: VG
authors.lastname: Patel
authors.forename: Bavana V
authors.initials: BV
authors.lastname: Rangan
authors.forename: Michael
authors.initials: M
authors.lastname: Luna
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Hastings
authors.forename: Jerrold
authors.initials: J
authors.lastname: Grodin
authors.forename: Shuaib
authors.initials: S
authors.lastname: Abdullah
authors.forename: Subhash
authors.initials: S
authors.lastname: Banerjee
authors.forename: Emmanouil S
authors.initials: ES
authors.lastname: Brilakis
mesh_terms: D000368:Aged; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000379:methods*; D003287:Contrast Media; D017023:Coronary Angiography / Q000009:adverse effects / Q000379:methods*; D001026:Coronary Artery Bypass; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000601:surgery*; D005260:Female; D005263:Femoral Artery; D006801:Humans; D057194:Intention to Treat Analysis; D008297:Male; D008875:Middle Aged; D016273:Occupational Exposure; D011237:Predictive Value of Tests; D011446:Prospective Studies; D017534:Radial Artery; D011829:Radiation Dosage; D012307:Risk Factors; D013781:Texas; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media
keywords: CABG; MACE; PCI; TF; TR; contrast; coronary artery bypass graft; coronary artery bypass graft surgery; major adverse cardiac event(s); percutaneous coronary intervention; radiation; transfemoral; transfemoral approach; transradial; transradial approach; utilization