Current Cardiology Reports

, Volume 11, Issue 5, pp 391–397 | Cite as

Transradial versus transfemoral approach for percutaneous coronary procedures

  • Elena Franchi
  • Paolo Marino
  • Giuseppe G. Biondi-Zoccai
  • Giuseppe De Luca
  • Corrado Vassanelli
  • Pierfrancesco AgostoniEmail author


Selective coronary angiography was originally performed through open brachial arteriotomy. Thereafter, the percutaneous Seldinger technique and the use of preformed Judkins-type catheters popularized the femoral approach. More recently, after the first report of successful coronary angiography by the transradial approach in 1989, the radial artery has been increasingly used as an alternative access site. The main advantage offered by the transradial approach is represented by the very low (< 1%) incidence of relevant vascular access site complications, which on the contrary occur in about 3% to 7% of patients undergoing procedures through the femoral route. The main disadvantage is a higher incidence of procedural failure that leads to a crossover to the femoral route. In this review, we examine the available evidence on transradial and transfemoral approach advantages, disadvantages, and complications in coronary angiography and intervention. Their use in the acute myocardial infarction setting and other situations is described. Vascular closure device usefulness is also considered.


Percutaneous Coronary Intervention Acute Coronary Syndrome Abciximab Primary Percutaneous Coronary Intervention Femoral Approach 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References and Recommended Reading

  1. 1.
    Waksman R, King SB, Douglas JS, et al.: Predictors of groin complications after balloon and new-device coronary intervention. Am J Cardiol 1995, 26:922–930.CrossRefGoogle Scholar
  2. 2.
    Hamon M, Nolan J: Should radial artery access be the “gold standard” for PCI? Heart 2008, 94:1530–1532.PubMedCrossRefGoogle Scholar
  3. 3.
    Eikelboom JW, Mehta SR, Anand SS, et al.: Adverse impact of bleeding on prognosis in patients with acute coronary syndromes. Circulation 2006, 114:774–782.PubMedCrossRefGoogle Scholar
  4. 4.
    Steinhubl SR, Kastrati A, Berger PB: Variation in the definitions of bleeding in clinical trials of patients with acute coronary syndromes and undergoing percutaneous coronary interventions and its impact on the apparent safety of antithrombotic drugs. Am Heart J 2007, 154:3–11.PubMedCrossRefGoogle Scholar
  5. 5.
    Rao SV, O’Grady K, Pieper KS, et al.: Impact of bleeding severity on clinical outcomes among patients with acute coronary syndromes. Am J Cardiol 2005, 96:1200–1206.PubMedCrossRefGoogle Scholar
  6. 6.
    Yusuf S, Mehta SR, Chrolavicius S, et al.: Comparison of fondaparinux and enoxaparin in acute coronary syndromes. N Engl J Med 2006, 354:1464–1476.PubMedCrossRefGoogle Scholar
  7. 7.
    Manoukian S, Feit F, Mehran R, et al.: Impact of major bleeding on 30-day mortality and clinical outcomes in patients with acute coronary syndromes. An analysis from the ACUITY trial. J Am Coll Cardiol 2007, 49:1362–1368.PubMedCrossRefGoogle Scholar
  8. 8.
    Yoo BS, Lee SH, Ko JY, et al.: Procedural outcomes of repeated transradial coronary procedure. Cathet Cardiovasc Interv 2003, 58:301–304.CrossRefGoogle Scholar
  9. 9.
    Grinfeld L, Berrocal D, Rojas Matas C, et al.: What is the most effective vascular approach for a diagnostic cardiac catheterization? A randomized trial using the femoral, brachial or radial approaches [abstract]. J Am Coll Cardiol 1996, 27(Suppl):A901.Google Scholar
  10. 10.
    Kiemeneij F, Laarman GJ, Odekerken D, et al.: A randomized comparison of percutaneous transluminal coronary angioplasty by the radial, brachial and femoral approach: the ACCESS study. J Am Coll Cardiol 1997, 29:1269–1275.PubMedCrossRefGoogle Scholar
  11. 11.
    Cooper CJ, El-Shiekh RA, Cohen DJ, et al.: Effect of transradial access on quality of life and cost of cardiac catheterization: a randomized comparison. Am Heart J 1999, 138:430–436.PubMedCrossRefGoogle Scholar
  12. 12.
    Louvard Y, Lefevre T, Allain A, et al.: Coronary angiography through the radial or the femoral approach: the CARAFE study. Catheter Cardiovasc Interv 2001, 52:181–187.PubMedCrossRefGoogle Scholar
  13. 13.
    Louvard Y, Benamer H, Garot P, et al.; for the OCTOPLUS Study Group: Comparison of transradial and transfemoral approaches for coronary angiography and angioplasty in octogenarians (the OCTOPLUS Study). Am J Cardiol 2004, 94:1177–1180.PubMedCrossRefGoogle Scholar
  14. 14.
    Chase AJ, Fretz EB, Warburton WP, et al.: Association of the arterial access site at angioplasty with transfusion and mortality: the M.O.R.T.A.L study (Mortality benefit Of Reduced Transfusion after percutaneous coronary intervention via the Arm or Leg). Heart 2008, 94:1019–1025.PubMedCrossRefGoogle Scholar
  15. 15.
    Montalescot G, Ongen Z, Guindy R, et al.: Predictors of outcome in patients undergoing PCI. Results of the RIVIERA study. Int J Cardiol 2007 Dec 3 (Epub ahead of print).Google Scholar
  16. 16.
    Roberts EB, Rathore S, Beaumont A, et al.: Lesion complexity and angiographic outcomes in radial access percutaneous coronary intervention. J Interv Cardiol 2008, 21:555–561.PubMedCrossRefGoogle Scholar
  17. 17.
    Jaffe R, Hong T, Sharieff W, et al.: Comparison of radial versus femoral approach for percutaneous coronary interventions in octogenarians. Catheter Cardiovasc Interv 2007, 69:815–820.PubMedCrossRefGoogle Scholar
  18. 18.
    Yang YJ, Xu B, Chen JL, et al.: Comparison of immediate and follow-up results between transradial and transfemoral approach for percutaneous coronary intervention in true bifurcational lesions. Chin Med J (Engl) 2007, 120:539–544.Google Scholar
  19. 19.
    Hsueh SK, Hsieh YK, Wu CJ, et al.: Immediate results of percutaneous coronary intervention for unprotected left main coronary artery stenoses: transradial versus transfemoral approach. Chang Gung Med J 2008, 31:190–200.PubMedGoogle Scholar
  20. 20.
    Ziakas A, Klinke P, Mildenberger R, et al.: Comparison of the radial and femoral approaches in left main PCI: a retrospective study. J Invasive Cardiol 2004, 16:129–132.PubMedGoogle Scholar
  21. 21.
    Ziakas A, Klinke P, Mildenberger R, et al.: A comparison of the radial and the femoral approach in vein graft PCI. A retrospective study. Int J Cardiovasc Intervent 2005, 7:93–96.PubMedCrossRefGoogle Scholar
  22. 22.
    Wiper A, Kumar S, MacDonald J, et al.: Day case transradial coronary angioplasty: a four-year single-center experience. Catheter Cardiovasc Interv 2006, 68:549–553.PubMedCrossRefGoogle Scholar
  23. 23.
    Agostoni P, Biondi-Zoccai GG, de Benedictis ML, et al.: Radial versus femoral approach for percutaneous coronary diagnostic and interventional procedures; systematic overview and meta-analysis of randomized trials. J Am Coll Cardiol 2004, 44:349–356.PubMedCrossRefGoogle Scholar
  24. 24.
    Biondi-Zoccai GG, Abbate A, Agostoni P, et al.: Long-term benefits of an early invasive management in acute coronary syndromes depend on intracoronary stenting and aggressive antiplatelet treatment: a metaregression. Am Heart J 2005, 149:504–511.PubMedCrossRefGoogle Scholar
  25. 25.
    Jolly SS, Amlani S, Hamon M, et al.: Radial versus femoral access for coronary angiography or intervention and the impact on major bleeding and ischemic events: a systematic review and meta-analysis of randomized trials. Am Heart J 2009, 157:132–140.PubMedCrossRefGoogle Scholar
  26. 26.
    Ochiai M, Isshiki T, Toyoizumi H, et al.: Efficacy of transradial primary stenting in patients with acute myocardial infarction. Am J Cardiol 1999, 83:966–968.PubMedCrossRefGoogle Scholar
  27. 27.
    Saito S, Hosokawa G, Miyake S: Successful reperfusion with transradial angioplasty safely results in early ambulation and shorter hospital stay in a selected subgroup of acute myocardial infarction. The results of Kamakura PASTA trial [abstract]. J Am Coll Cardiol 1997, 29(Suppl A):235.Google Scholar
  28. 28.
    Mathias DW, Bigler L: Transradial coronary angioplasty and stent implantation in acute myocardial infarction: initial experience. J Invasive Cardiol 2000, 12:547–549.PubMedGoogle Scholar
  29. 29.
    Delarche N, Idir M, Estrade G, et al.: Direct angioplasty for acute myocardial infarction in elderly patients using transradial approach. Am J Geriatr Cardiol 1999, 8:32–35.PubMedGoogle Scholar
  30. 30.
    Brasselet C, Tassan S, Nazeyrollas P, et al.: Randomised comparison of femoral versus radial approach for percutaneous coronary intervention using abciximab in acute myocardial infarction: results of the FARMI trial. Heart 2007, 93:1556–1561.PubMedCrossRefGoogle Scholar
  31. 31.
    Ziakas A, Gomma A, McDonald J, et al.: A comparison of the radial and the femoral approaches in primary or rescue percutaneous coronary intervention for acute myocardial infarction in the elderly. Acute Card Care 2007, 9:93–96.PubMedCrossRefGoogle Scholar
  32. 32.
    Cantor WJ, Mahaffey KW, Huang Z, et al.: Bleeding complications in patients with acute coronary syndrome undergoing early invasive management can be reduced with radial access, smaller sheath sizes, and timely sheath removal. Catheter Cardiovasc Interv 2007, 69:73–83.PubMedCrossRefGoogle Scholar
  33. 33.
    Mann T, Cowper PA, Peterson ED, et al.: Transradial coronary stenting: comparison with femoral access closed with an arterial suture device. Catheter Cardiovasc Interv 2000, 49:157–159.CrossRefGoogle Scholar
  34. 34.
    Nikolsky E, Mehran R, Halkin A, et al.: Vascular complications associated with arteriotomy closure devices in patients undergoing percutaneous coronary procedures: a metaanalysis. J Am Coll Cardiol 2004, 44:1200–1209.PubMedGoogle Scholar
  35. 35.
    Koreny M, Riedmuller E, Nikfardjam M, et al.: Arterial puncture closing devices compared with standard manual compression after cardiac catheterization: systematic review and meta-analysis. JAMA 2004, 291:350–357.PubMedCrossRefGoogle Scholar

Copyright information

© Current Medicine Group, LLC 2009

Authors and Affiliations

  • Elena Franchi
  • Paolo Marino
  • Giuseppe G. Biondi-Zoccai
  • Giuseppe De Luca
  • Corrado Vassanelli
  • Pierfrancesco Agostoni
    • 1
    Email author
  1. 1.Department of CardiologyUniversity Medical Center UtrechtUtrechtThe Netherlands

Personalised recommendations