National Audit of Angioplasty Procedures - HQIP

7Arterial access routeWhen performing coronary interventioncatheters are introduced to the patient’sarterial system so the coronary arteriescan be reached and treated. Initialaccess to the coronary arteries wastraditionally achieved using the femoralartery at the top of the leg. However,some of the commonest complicationsafter PCI relate to the difficulty in stoppingthis artery from bleeding after removing theequipment at the end of the procedure.As PCI equipment has become smaller,it has been possible to perform almostall PCI from the radial artery at the wrist.Robust data shows this is associated witha reduction in complication rate; it is easierto stop any bleeding, and there are fewernearby structures that can be damaged.There are particular methods needed touse the radial artery. Therefore, training isneeded for those only familiar with the femoralapproach. Nevertheless there has been anincreasing adoption of this method which isnow used for more than half of all proceduresas can be seen from figure 10. The hoped forreduction in complication rates does appearto be borne out (figure 11).100% cases using radial accessFigure 10The increasing adoption ofthe radial artery as accesssite for PCI in the UK80604020050.942.834.6128.121.315.710.22004 2005 2006 2007 2008 2009 20101.21.01.10.90.971Access site complications assessed up to time of discharge:• False aneurysm• Haemorrhage (retroperitoneal, delay discharge, surgery)• Arterial occlusion/dissection• Any need for surgery0.8% of all cases0.60.40.60.50.430.43Figure 11Access site complicationrates in PCI using femoralaccess versus radial access0.202007 2008 2009 2010 2007 2008 2009 2010FemoralRadial15