Comparison of Radial with Femoral Access Coronary Angiography in Patients with Previous Coronary Artery Bypass Surgery

Background: There is uncertainty over the efficacy and safety of radial compared with femoral access coronary angiography in patients with previous coronary artery bypass graft surgery (CABG).

Methods: Hospital records of consecutive patients undergoing coronary angiography (September 2016 to September 2017) at a London cardiac center were examined to identify patients with previous CABG undergoing the procedure by the radial or femoral vascular access routes. We compared clinical characteristics, procedural efficacy and complications up to 30-days, adjusting for significant baseline differences by logistic regression.

Results: Among 5993 patients undergoing angiography 471 (8%) had previous CABG; 164 (35%) had angiography by the radial and 307 (65%) by the femoral artery access routes. Procedural efficacy was lower in the radial than femoral groups; 28/164 (17%) versus 2/307 (1%) patients required access site cross-over (p<0.001) and 257/347 (74%) vs 496/594 (84%) bypass grafts were successfully identified (p=0.008), respectively. Fluoroscopy time was 20% greater in the radial than femoral groups (18 minutes vs 15 minutes, p= 0.045). Minor access-site bleeding requiring compression affected 1/164 (0.6%) in the radial group and 12/307 (3.9%) in the femoral group (p=0.04 for difference) with no significant differences in major complications including myocardial infarction, stroke or death between the two groups.

Conclusions: In patients with previous CABG undergoing coronary angiography the femoral access route was associated with greater procedural success and less radiation, benefits that need to be balanced against an increase in minor bleeding complications.