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Angiography of the heart is generally performed via artery of upper thigh, the femoral artery. This artery is larger and easier to access but patient has to remain lying down for a few hours after the procedure.

In recent years, artery at the wrist (radial artery) is being used to perform cardiac or coronary angiography. Here, the patient can be made mobile (sit up and walk) soon after the procedure. The complications may be lesser with radial artery route, but if they occur, they affect hand as compared to involvement of thigh or leg with femoral route.

What are the most common factors that affect the choice of the route, and are there any studies on the effectiveness/outcomes from one versus the other? Thanks for your responses.

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Talking to a cardiologist at my hospital he said now almost all percutaneous coronary interventions can be done through radial access. He mentioned that he does still do certain procedures (valve repair, right heart ablations, etc.) through femoral access. His reasoning was that femoral access can be faster for certain procedures vs radial and this means that less x-rays will be used and less exposure to the patient. He did mention that most cardiologists have developed their own preferences for when to still use femoral access (some even choosing not to do them at all).

Radial seems to have become the main method because of decreased risk of bleeding and complications. This also allows patients to be ambulatory in less time than with femoral access, resulting in lower costs both to the hospital and the patient. However, the development of vascular closure devices (VCD's) have reduced the bleeding risks associated with femoral access.

This study did show no significant difference in death, myocardial infarction, and stroke between access sites.

Gersh, B.j. "Radial versus Femoral Access for Coronary Angiography and Intervention in Patients with Acute Coronary Syndromes (RIVAL): A Randomised, Parallel Group, Multicentre Trial." Yearbook of Cardiology 2012 (2012): 235-38. Web.

In a large (8404) multicenter, randomized, superiority study, patients with radial access had less incidence of major adverse cardiovascular events: 8.8% radial vs 10.3% femoral (not significant)

In the same study, radial access had less "net adverse clinical events": 9.8% radial vs 11.7% femoral (significant)

The study concluded:

In patients with acute coronary syndrome undergoing invasive management, radial as compared with femoral access reduces net adverse clinical events, through a reduction in major bleeding and all-cause mortality.

Femoral access review

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    I do agree with your answer. However, I have two points: 1. your link "femoral access review" doesn't work (I think you should edit it, as there is a double http://). 2. I would also consider adding at least two other reviews, published recently (2015, 2016) in two high impact journals (Lancet and Am. J. Cardiology) on this topic (doi: 10.1016/S0140-6736(15)60292-6 and doi: 10.1016/j.amjcard.2015.10.039). Thank you. Best regards. M. Arrowsmith – M. Arrowsmith Aug 25 '16 at 7:42

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