title: Comparison Between Radial Approach and Femoral Approach With Vascular Closure Devices on the Occurrence of Access-Site Complications and Periprocedural Bleeding After Percutaneous Coronary Procedures: A Systematic Review and Meta-Analysis.
abstract: OBJECTIVE
  Periprocedural bleedings, often related to vascular access site, represent an important drawback of percutaneous coronary procedures and are associated with worse outcomes. Radial access (RA) and, potentially, femoral access (FA) with vascular closure device (VCD) are useful strategies in order to mitigate periprocedural bleedings; nevertheless, their relative efficacy is largely undetermined. We aimed to perform a systematic review and meta-analysis of available studies comparing the efficacy of RA and FA with hemostasis by VCD (FA + VCD) on the reduction of access-site complications and/or periprocedural bleedings.
  
  
  METHODS
  Published studies reporting outcomes on access-site complications and periprocedural bleedings were included in the analysis. Data were extracted by two independent reviewers; odds ratio (OR) and 95% confidence interval (CI) were calculated by random-effects model and were used as summary statistics.
  
  
  RESULTS
  We included in the analysis 13 studies, of which 5 were randomized. Access-site complications were reported by 11 studies, amounting to 157,031 patients (77,713 in the RA group and 79,318 in the FA + VCD group), whereas periprocedural bleedings were reported by 12 studies, amounting to 600,196 patients (137,277 in the RA group and 462,919 in the FA + VCD group). RA was associated with a significant reduction in access-site complications (OR, 0.25; 95% CI ,0.21-0.31; P<.001) and periprocedural bleedings (OR, 0.40; 95% CI, 0.34-0.48; P<.001) as compared with FA + VCD; the results were consistent among randomized and observational studies.
  
  
  CONCLUSIONS
  This meta-analysis shows that RA is superior to FA + VCD in the reduction of access-site complications and periprocedural bleedings.
authors.affiliation: Interventional Cardiology Unit and Emergency Department, Sandro Pertini Hospital, Via dei Monti Tiburtini 385, 00157, Rome, Italy. stefanorigattieri@yahoo.it.
authors.forename: Stefano
authors.initials: S
authors.lastname: Rigattieri
authors.forename: Alessandro
authors.initials: A
authors.lastname: Sciahbasi
authors.forename: Karim
authors.initials: K
authors.lastname: Ratib
authors.forename: Alessandro
authors.initials: A
authors.lastname: Alonzo
authors.forename: Nicholas
authors.initials: N
authors.lastname: Cox
authors.forename: Piotr
authors.initials: P
authors.lastname: Chodór
authors.forename: Andrea
authors.initials: A
authors.lastname: Berni
authors.forename: Silvio
authors.initials: S
authors.lastname: Fedele
authors.forename: Francesco R
authors.initials: FR
authors.lastname: Pugliese
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Cooper
authors.forename: Yves
authors.initials: Y
authors.lastname: Louvard
authors.forename: James
authors.initials: J
authors.lastname: Nolan
authors.forename: Sunil V
authors.initials: SV
authors.lastname: Rao
mesh_terms: D006328:Cardiac Catheterization / Q000379:methods*; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000379:methods; D057186:Comparative Effectiveness Research; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000601:surgery; D006470:Hemorrhage / Q000209:etiology / Q000601:surgery; D006488:Hemostasis, Surgical / Q000295:instrumentation / Q000379:methods; D006801:Humans; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D017534:Radial Artery / Q000000981:diagnostic imaging / Q000601:surgery; D065506:Vascular Closure Devices