Djr. Hildick-smith et al., Coronary angiography in the presence of peripheral vascular disease: Femoral or brachial/radial approach?, CATHET C IN, 49(1), 2000, pp. 32-37
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.