Coronary angiography in the presence of peripheral vascular disease: Femoral or brachial/radial approach?

Peripheral vascular disease is considered a relative contraindication to th e femoral approach for coronary angiography, but no data exist comparing th e femoral and brachial/radial routes under these circumstances. We examined the influence of vascular approach on outcome. Two hundred and ninety-seve n patients, mean age 67.1 +/- 8.4 years, with clinical or radiographic evid ence of aortofemoral peripheral arterial disease underwent diagnostic coron ary angiography during a 3-year period at this cardiothoracic center. The a pproach was successful in 121 of 154 femoral cases (79%) compared with 130 of 143 brachial/radial cases (91%; P < 0.01). Of the 33 failed femoral case s, 15 were then approached from the other femoral artery, with success in 6 (40%), while 18 were approached from the arm, with success in all (100%; P < 0.01). Brachial/radial cases took significantly longer than femoral case s (51 +/- 19 vs. 42 +/- 22 mins; P < 0.01). In cases where the femoral puls e was considered normal, the femoral approach nonetheless failed in 19 of 9 5 (20%). Major vascular complications (e.g., pulseless limb, arterial disse ction, hemorrhage, or false aneurysm) occurred in nine femoral cases vs, ze ro brachial/radial cases (P < 0.01). Patients with peripheral vascular dise ase who undergo coronary angiography from the femoral artery have a 1-in-5 risk of procedural failure, necessitating use of an alternative vascular ap proach, and a 1-in-20 risk of a major vascular complication. Normality of f emoral arterial pulsation is not a good predictor of femoral success. Brach ial/radial approaches take longer, but succeed more frequently and have a n egligible major vascular complication rate. We believe that patients with p eripheral vascular disease should undergo coronary angiography via brachial or radial approach. (C) 2000 Wiley-Liss, Inc.