Systematic use of transradial approach or suture of the femoral artery after angioplasty: Attempt at achieving zero access site complications

Access site complications occur in 5-15% of cases according to the various series. The predictive factors most often reported in the literature are th e size of the puncture site and the intensity of the antiplatelet or antico agulant treatment associated with the angioplasty procedure. Six senior car diologists in a high volume Cardiology center (>1,500 procedures a year) wi th an individual experience >500 procedures in either the radial approach o r the percutaneous suture of the femoral artery with the Techstar/ Prostar system, conducted a prospective study from January 1 to December 31, 1999. The aim of this study was to eliminate the occurrence of access site compli cations by using either one of two techniques that were at the operator's d iscretion, i.e., systematic radial approach, or percutaneous suture of the femoral artery. A total of 956 patients were included over the study period ; 60.7% of these patients had percutaneous arterial closure of the femoral artery and the remaining 39.3% were treated via the radial approach; 88.7% were stented. The patients were administered a mean 9,000 IU of heparin dur ing the procedure; 1.9% had been fibrinolyzed and Reopro was used in 5.9%. No complications were documented in the radial group. Of the 580 patients i n the femoral suture group, 96.9% had femoral suture, immediately effective in 508 cases (90.4%). Only 3 patients required additional prolonged compre ssion. One significant hematoma (0.2%) necessitating blood transfusion was reported in the femoral group. Infection at the puncture site with subseque nt antibiotic treatment was reported in 2 patients (0.3%). No further acces s site complications were observed at one-month follow-up. After completion of the learning curve, the two techniques (radial approach and percutaneou s arterial suture) permit the almost total elimination of access site compl ications. Cathet. Cardiovasc. Intervent 51:417-421, 2000. (C) 2000 Wiley-Li ss, Inc.