Use of the Left Radial Artery as Vascular Access for Coronary Angiography and as a Bypass Conduit: A Clinical Dilemma?
| Autor: | F.R. Halfwerk, Rachèl van der Kolk, Eline H. Ploumen, Clemens von Birgelen, Janine Astrid van Til, Jan G. Grandjean |
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| Přispěvatelé: | TechMed Centre, Health Technology & Services Research, Biomechanical Engineering |
| Rok vydání: | 2022 |
| Předmět: |
Coronary angiography
medicine.medical_specialty Left radial artery health care facilities manpower and services medicine.medical_treatment education UT-Hybrid-D Vascular access 030204 cardiovascular system & hematology 03 medical and health sciences 0302 clinical medicine medicine.artery Internal medicine medicine cardiovascular diseases 030212 general & internal medicine Radial artery health care economics and organizations business.industry Percutaneous coronary intervention General Medicine Guideline Dilemma medicine.anatomical_structure Cardiology Cardiology and Cardiovascular Medicine business Artery |
| Zdroj: | Cardiovascular Revascularization Medicine, 34, 134-139. Elsevier |
| ISSN: | 1553-8389 |
| Popis: | Purpose International coronary revascularization guidelines recommend both, transradial vascular access for coronary angiography/intervention and use of the radial artery as a conduit for coronary artery bypass grafting (CABG). These recommendations may pose a clinical dilemma, as transradial access exposes these arteries to vascular trauma which makes them potentially unsuitable as future grafts. In this study, we investigated the awareness and views of cardiologists on these guideline recommendations. Methods We performed semi-structured interviews with 50 cardiologists from 19 centers, who regularly perform coronary angiographies or interventions, and outlined clinical scenarios to evaluate their preference of vascular access. In addition, we assessed whether preference was related to sub-specialization. Results The interviewed cardiologists had 16 ± 9.3 years of professional experience. There were 23 (46%) cardiologists from 7 centers without percutaneous coronary intervention facilities, and 27 (56%) cardiologists from 12 interventional centers. All 50 (100%) cardiologists indicated familiarity with the guidelines, yet 28 (56%) said not to be familiar with the aforementioned dilemma, and 9 (18%) stated there was no dilemma at all. Responses did not differ significantly between interventional (n = 28) and non-interventional (n = 22) cardiologists; however, if the right radial artery was unavailable (e.g., occluded), interventional cardiologists more often said to prefer access via the left radial artery (18/28 (64%) vs. 5/22 (23%), p = 0.001). Conclusion More than half of the interviewed cardiologists indicated that they had not realized that left transradial access preceding CABG may preclude later use of this artery as a conduit. Notably, in case of unavailability of the right radial artery, interventional cardiologists preferred left transradial access more often than non-interventional cardiologists. |
| Databáze: | OpenAIRE |
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