Comparison of Right Radial Artery with Femoral Artery Access for Patients with LIMA Grafts

Abstract

Background: Right Radial Angiography (RRA) is the preferred approach for invasive coronary angiography. Coronary artery bypass graft (CABG) patients with left internal mammary graft (LIMA) remain a technical challenge via this approach. Methods: A retrospective audit was carried out on all CABG patients with LIMA grafts who had diagnostic only angiography between December 2015 and December 2016 at North Shore Hospital. Right femoral artery (RFA) or RRA access (using a BartorelliCozzi catheter) was decided by the operator. Patient and procedural characteristics were compared with mean ± standard deviation and F-test statistical analysis (p < 0.05). Results: Thirty-one patients (72 ± 9 years, 90% male) underwent RFA approach and forty-four patients (70 ± 10 years, 75% male) underwent RRA approach. The procedure characteristics are presented in the table below:Tabled 1RFARRAp-valueProcedure duration (minutes)26 ± 935 ± 130.07Fluoroscopy time (minutes)11 ± 916 ± 80.43Dose Area Product (mGym2)4791 ± 25115926 ± 28620.46Contrast volume (mL)106 ± 51112 ± 420.29Procedural success (LIMA engaged)31/3142/44 Open table in a new tab The two conversions from RRA to RFA approach were due to not being able to pass a stented subclavian artery with glide wire and radial tortuosity prohibiting engagement of the ascending aortic grafts. One RFA patient had a large groin haematoma. Conclusion: LIMA angiography via the RRA appears feasible. There may be some resultant increase in procedural times that warrant further prospective study.