comparison of brachial versus femoral approach for coronary angiography in coronary artery disease [CAD] patients with peripheral vascular disease [PVD]

ABSTRACT

Diagnostic left heart catheterization [LHC] and coronary angiography via Brachial Seldinger technique was compared to Femoral Seldinger technique with a view to determine its feasibility, efficacy and safety. 22 patients in the brachial group [Br] and 20 matched patients in femoral group [Fe] were retrospectively reviewed. The sources of information included hospital records of the patients [medical and nursing] and catheter laboratory data. The two groups were compared with respect to patient tolerance of the procedure, complications, time for radiation exposure, hemostasis, ambulation and procedure. The mean age of patients was 65.8 +/- 11.4 yrs. The reasons for performing LHC via brachial approach included known Peripheral Vascular Disease [PVD] in 72.7 percent, difficult access due to previously unrecognized aorto-iliac disease in 22.7 percent and tight coractation of aorta in 4.6 percent. Mean procedure time for Br group was 31.6 + 33.0 min and for Fe group was 12.6 + 5.2 [p = 0.004]. Mean ambulation time for Br pts was 2 hrs and that for Fe patients was 4.3 hrs + 0.9 hrs [p < 0.001]. The mean time to discharge for Br patients was 6.0 +/- 0.2 hrs and for Fe patients 7.6 +/- 0.9 hrs [p <0.001]. Br group was complicated by one significant hematoma [4.8 percent] and one arterial spasm [4.8 percent]. No complications occurred in Fe group. There was no significant difference between Fe and Br patients as far as tolerability was concerned. Hemoastasis time was significantly lower in patients who underwent Br angiography compared to Fe group [p-value = 0.003]. Conclusion we conclude that brachial approach for LHC is a very safe and equally effective alternative to femoral approach and even more so in patients with PVD. Br approach was similar to Fe in terms of tolerance, complication profile and technical feasibility but required longer laboratory time. Its advantages include lesser time for hemostasis, ambulation and discharge