Transradial cardiac procedures: the state of the art.

Bethan Freestone, Jim Nolan, UK.

Since the first catheterisation of a human heart was performed by Werner Forssmann in 1929, access site practice has undergone considerable evolution and technical refinement. Early operators accessed the left side of the heart using a surgical technique to expose and cannulate the brachial artery in the antecubital fossa. Although expert operators can obtain excellent results with this technique, it requires considerable surgical expertise to identify, dissect out, cannulate, and repair the selected vessel.w1 Because of these issues, most cardiologists moved to the technically simpler percutaneous femoral access site. Performing cardiac procedures via a percutaneous approach to the femoral artery has important disadvantages related to its unfavourable neurovascular anatomy.w2 Because of this unfavourable neurovascular anatomy, femoral artery access site complications can have major life or limb threatening consequences. The risk of major femoral access site complications is substantially increased when intensive antithrombotic regimens are employed.w3 These femoral access site problems have not been solved by vascular access closure devices.w4

Radial artery access for coronary angiography was first described by Campeau in 1989, with coronary intervention performed by this route shortly after.1 Initial success rates with this access site were suboptimal. Improvements in technique and equipment have resolved this problem, and more recent success rates are comparable to those obtained via the transfemoral route.2 Radial operators have extended their practice, demonstrating that excellent results can be achieved by skilled operators in challenging patient subsets.w5 w6 Meta-analysis of randomised trials confirms that radial access is associated with a significant reduction in access site bleeding.3 Prevention of bleeding is of great clinical importance, and may explain the recent finding that radial access is associated with a reduction of mortality in angioplasty patients.4 Additional benefits of radial access include improved patient comfort, reduced nursing requirements, …

Heart 2010;96:883-891, Education in Heart.