Use of the left radial artery as vascular access for coronary angiography and as a bypass conduit: A clinical dilemma?

Eline H. Ploumen; Frank R. Halfwerk; Rachèl van der Kolk; Jan G. Grandjean; Clemens von Birgelen; Janine A. van Til

doi:10.1016/j.carrev.2021.01.014

Use of the left radial artery as vascular access for coronary angiography and as a bypass conduit: A clinical dilemma?

Eline H. Ploumen, Frank R. Halfwerk, Rachèl van der Kolk, Jan G. Grandjean, Clemens von Birgelen^*, Janine A. van Til

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

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.

Original language	English
Pages (from-to)	134-139
Number of pages	6
Journal	Cardiovascular Revascularization Medicine
Volume	34
Early online date	16 Jan 2021
DOIs	https://doi.org/10.1016/j.carrev.2021.01.014
Publication status	Published - 1 Jan 2022

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UT-Hybrid-D

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Innovations in cardio-thoracic surgery - State of the heart technology
Halfwerk, F. R. (Invited speaker)
21 Jun 2022
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Het hart: niet te missen | Medische Publieksacademie Twente
Halfwerk, F. R., ter Weeme, M., Stoel, M. G. & Hilderink, S.
8/07/21
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@article{3f2a60164ee3490799461e2a33e2fe6c,

title = "Use of the left radial artery as vascular access for coronary angiography and as a bypass conduit: A clinical dilemma?",

abstract = "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.",

keywords = "UT-Hybrid-D",

author = "Ploumen, {Eline H.} and Halfwerk, {Frank R.} and {van der Kolk}, Rach{\`e}l and Grandjean, {Jan G.} and {von Birgelen}, Clemens and {van Til}, {Janine A.}",

note = "Funding Information: There was no conflict of interest related to the present study. Outside this research, Thoraxcentrum Twente has received institutional research grants from Abbott Vascular, Biotronik, Boston Scientific and Medtronic. Publisher Copyright: {\textcopyright} 2021 The Authors",

year = "2022",

month = jan,

day = "1",

doi = "10.1016/j.carrev.2021.01.014",

language = "English",

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journal = "Cardiovascular Revascularization Medicine",

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T1 - Use of the left radial artery as vascular access for coronary angiography and as a bypass conduit

T2 - A clinical dilemma?

AU - Ploumen, Eline H.

AU - Halfwerk, Frank R.

AU - van der Kolk, Rachèl

AU - Grandjean, Jan G.

AU - von Birgelen, Clemens

AU - van Til, Janine A.

N1 - Funding Information: There was no conflict of interest related to the present study. Outside this research, Thoraxcentrum Twente has received institutional research grants from Abbott Vascular, Biotronik, Boston Scientific and Medtronic. Publisher Copyright: © 2021 The Authors

PY - 2022/1/1

Y1 - 2022/1/1

N2 - 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.

AB - 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.

KW - UT-Hybrid-D

U2 - 10.1016/j.carrev.2021.01.014

DO - 10.1016/j.carrev.2021.01.014

M3 - Article

SN - 1553-8389

VL - 34

SP - 134

EP - 139

JO - Cardiovascular Revascularization Medicine

JF - Cardiovascular Revascularization Medicine

ER -

Use of the left radial artery as vascular access for coronary angiography and as a bypass conduit: A clinical dilemma?

Abstract

Keywords

UN SDGs

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Innovations in cardio-thoracic surgery - State of the heart technology

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Het hart: niet te missen | Medische Publieksacademie Twente

Cite this