Comparative Analysis of Radial Versus Femoral Diagnostic Cardiac Catheterization Procedures in a Cardiology Training Program.
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This study was conducted to evaluate the differences in the procedural variables between transradial and transfemoral access for coronary angiography, with cardiology fellows as the primary operators.This was a retrospective study of 163 radial and 180 femoral access diagnostic cardiac catheterization procedures, and involved cardiology fellowship trainees as primary operators.The radial approach was associated with significantly higher fluoroscopy time (8.0 ± 6.97 min vs 4.25 ± 3.01 min; P<.001), dose area product (10775 ± 6724 μGy/m² vs 7952 ± 4236 μGy/m²; P<.001), procedure time (38.31 ± 12.25 min vs 27 ± 17.56 min; P<.001), procedure start to vascular access time (8.24 ± 6.31 min vs 5.31 ± 4.59 min; P<.001), and vascular access to procedure end time (30 ± 15.34 min vs 21.2 ± 9.57 min; P<.001). These differences persisted after adjusting for patients with bypass grafts and additional imaging (P<.001). The contrast amount was not significantly different between the two groups (P=.12). Procedure start to vascular access time improved significantly with fellowship training year in both the radial (9.57 ± 6.96 min vs 8.23 ± 6.08 min vs 5.57 ± 4.82 min) and femoral groups (6.17 ± 5.07 min vs 5.47 ± 4.75 min vs 4.01 ± 3.31 min). Fluoroscopy time showed significant difference in only the femoral access group (P=.01). Dose area product did not improve with training in either access group.Radial procedures were associated with higher radiation dose and longer procedure time. Despite decrease in total procedural time for radial cases with the level of training, total radiation dose did not decrease.Keywords:
Cardiac catheterization
Interventional cardiology
Cardiac catheterisation
Dose area product
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This study was conducted to evaluate the differences in the procedural variables between transradial and transfemoral access for coronary angiography, with cardiology fellows as the primary operators.This was a retrospective study of 163 radial and 180 femoral access diagnostic cardiac catheterization procedures, and involved cardiology fellowship trainees as primary operators.The radial approach was associated with significantly higher fluoroscopy time (8.0 ± 6.97 min vs 4.25 ± 3.01 min; P<.001), dose area product (10775 ± 6724 μGy/m² vs 7952 ± 4236 μGy/m²; P<.001), procedure time (38.31 ± 12.25 min vs 27 ± 17.56 min; P<.001), procedure start to vascular access time (8.24 ± 6.31 min vs 5.31 ± 4.59 min; P<.001), and vascular access to procedure end time (30 ± 15.34 min vs 21.2 ± 9.57 min; P<.001). These differences persisted after adjusting for patients with bypass grafts and additional imaging (P<.001). The contrast amount was not significantly different between the two groups (P=.12). Procedure start to vascular access time improved significantly with fellowship training year in both the radial (9.57 ± 6.96 min vs 8.23 ± 6.08 min vs 5.57 ± 4.82 min) and femoral groups (6.17 ± 5.07 min vs 5.47 ± 4.75 min vs 4.01 ± 3.31 min). Fluoroscopy time showed significant difference in only the femoral access group (P=.01). Dose area product did not improve with training in either access group.Radial procedures were associated with higher radiation dose and longer procedure time. Despite decrease in total procedural time for radial cases with the level of training, total radiation dose did not decrease.
Cardiac catheterization
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We evaluated the efficacy of low-dose (LD) radiation (≤7.5 frames/second [f/s]) compared with standard-dose (SD) radiation (≥10 f/s) in cardiac catheterization (CC) and percutaneous coronary intervention (PCI). Patients undergoing CC with LD vs SD radiation have not been previously studied.We performed an observational study of 452 consecutive patients (61 ± 12 years) who had coronary angiography or PCI from September 2016 to September 2017. Patients were divided into an LD radiation group (n = 136) consisting of 0.5 f/s and 1 f/s (n = 73), 4 f/s (n = 40), or 7.5 f/s fluoroscopy (n = 23) with 7.5 f/s cine angiography vs an SD group (n = 316) consisting of 10 f/s (n = 250), 15 f/s (n = 64), or 30 f/s fluoroscopy (n = 2) and 10-30 f/s cine angiography. Primary endpoints included air kerma, dose area product (DAP), fluoroscopy time, and contrast use.Compared with SD radiation, LD radiation was associated with a significant reduction in air kerma (100.70 mGy [IQR, 46.42-233.35 mGy] vs 660.96 mGy [IQR, 362.78-1373.65 mGy]; P<.001), DAP (723.60 μGy•m² [IQR, 313.09-2328.22 μGy•m²] vs 5203.40 μGy•m² [IQR, 2743.55-10064.71 μGy•m²]; P<.001), and contrast use (100 mL [IQR, 60-150 mL] vs 115 mL [IQR, 80-180 mL]; P<.03). No difference in fluoroscopy time was noted (13.33 min [IQR, 6.93-25.55 min] vs 12.75 min [IQR, 7.75-22.55 min]; P=.95).LD radiation in CC was efficacious, with significant radiation reduction and without an increase in fluoroscopy time or contrast utilization. All patients underwent successful LD radiation catheterization without conversion to SD.
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Cardiac catheterization
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Objective To explore the X-ray radiation dose to patients from different cardiovascular interventional procedures and analyze the dose-affecting factors.Methods In accordance with the A,B,C operators,442 patients undergoing cardiovascular interventional procedures were collected,including single coronary angiography (CAG),percutaneous coronary intervention ( PCI ),radiofrequency catheter ablation (RFCA),congenital heart disease intervention (CHD) and permanent cardiac pacemaker implantation (PCPI),to observe dose area product (DAP),cumulative radiation dose (CD),fluoroscopy time.Results CD values of patients in groups of CAG,PCI,RFCA,CHD,PCPI were (0.34 ±0.23),(1.33 ±0.76),(0.71 ±0.43),(0.27 ±0.22) and (0.92±0.42) Gy and DAP values were (34.18 ±23.33),(135.92 ±81.14),(79.79 ±50.66),(27.93 ±23.66),and (94.60 ±48.11 ) Gy·cm2,respectively.Fluoroscopy time were (4.82 ±3.73),( 16.64 ±9.01 ),( 17.04 ± 15.29),(9.60 ±5.97)and (7.31 ±6.45) min.DAP values and fluoroscopy time were highly correlated (r =0.84,P ＜ 0.05 ).Conclusions There is significant difference in radiation dose for cardiovascular interventional procedures.Radiation dose and fluoroscopy time are directly related to surgeons' proficiency in operations.Improvement of operation proficiency should be carried out to reduce the patients' radiation dose.
Key words:
Cumulative radiation dose; Dose area product; Fluoroscopy time; X-rays; Cardiovascular intervention
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Interventional cardiology
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Kerma
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Background and Aim. The aim of study was to evaluate safety, feasibility, and procedural variables of transradial approach compared with transfemoral approach in a standard population of patients undergoing coronary catheterization as one of the major criticisms of the transradial approach is that it takes longer overall procedure and fluoroscopy time, thereby causing more radiation exposure. Method. Between January 2015 and December 2015, a total of 1,997 patients in LPS Institute of Cardiology, GSVM Medical College, Kanpur, UP, India, undergoing coronary catheterization were randomly assigned to the transradial or transfemoral approach. Result. Successful catheterization was achieved in 1045 of 1076 patients (97.1%) in the transradial group and in 918 of 921 patients (99.7%) in the transfemoral group (p = 0.001 2.46 ± 1.22 2.83 ± 1.31 p = 0.32 8.89 ± 2.72 9.33 ± 2.82 p = 0.56 67.52 ± 22.54 71.63 ± 25.41 p = 0.32 24.2 ± 4.21 22.3 ± 3.46 p = 0 . 43 6 ± 4.5 8 ± 2.6 p = 0.41 p = 0.04
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