Vlachadis Castles Anastasia, Asrar Ul Haq Muhammad, Barlis Peter, Ponnuthurai Francis A, Lim Chris C S, Mehta Nilesh, van Gaal William J
Cardiology Department, The Northern Hospital, Epping, Victoria, Australia; Radiology Department, The Northern Hospital, Epping, Victoria, Australia.
Cardiology Department, The Northern Hospital, Epping, Victoria, Australia; University of Melbourne, Parkville, Victoria, Australia.
Heart Lung Circ. 2014 Aug;23(8):751-7. doi: 10.1016/j.hlc.2014.02.019. Epub 2014 Mar 12.
Use of the radial approach for coronary angiography and percutaneous coronary intervention (PCI) is known to improve many patient outcome measures. However, there is some concern that it may be associated with increased patient radiation exposure. This study explores radiation exposure with the radial approach compared with the femoral approach in a centre previously performing purely femoral approach.
Data was collected retrospectively for all patients undergoing diagnostic coronary angiography over a six month period. PCIs and procedures with inherent technical difficulty or use of additional techniques (graft studies, optical coherence tomography, fractional flow reserve) were excluded. Dose area product (DAP) and fluoroscopy time (FT) were analysed for all remaining procedures (n=389), comparing radial (n=109) and femoral (n=280) approaches.
The overall mean FT for transradial cases (7.45 mins) was significantly higher than for transfemoral cases (4.59 mins; p<0.001). The overall mean DAP for transradial cases (95.64 G Gycm(2)) was significantly higher than for transfemoral cases (70.25 Gycm(2), p<0.05)). Neither the FT nor the DAP decreased over the six month period.
The radial approach was associated with significantly higher DAP and FT compared to the femoral approach during an initial introductory phase which was likely insufficient to develop radial proficiency. The results of this study are consistent with previous studies and may influence choice of access for non-emergent diagnostic coronary angiography before radial proficiency has been established, particularly for patients more susceptible to radiation risks.
冠状动脉造影和经皮冠状动脉介入治疗（PCI）采用桡动脉入路已知可改善许多患者的预后指标。然而，有人担心这可能会增加患者的辐射暴露。本研究探讨了在一个先前仅采用股动脉入路的中心，将桡动脉入路与股动脉入路的辐射暴露情况进行比较。
回顾性收集了六个月内所有接受诊断性冠状动脉造影的患者的数据。排除了PCI以及存在固有技术难度或使用额外技术（移植物研究、光学相干断层扫描、血流储备分数）的手术。对所有剩余手术（n = 389）的剂量面积乘积（DAP）和透视时间（FT）进行分析，比较桡动脉入路（n = 109）和股动脉入路（n = 280）。
经桡动脉病例的总体平均FT（7.45分钟）显著高于经股动脉病例（4.59分钟；p < 0.001）。经桡动脉病例的总体平均DAP（95.64 Gycm²）显著高于经股动脉病例（70.25 Gycm²，p < 0.05）。在六个月期间，FT和DAP均未下降。
在最初的引入阶段，桡动脉入路与股动脉入路相比，DAP和FT显著更高，这可能是因为尚未充分掌握桡动脉入路技术。本研究结果与先前研究一致，可能会影响在尚未建立桡动脉入路熟练程度之前进行非紧急诊断性冠状动脉造影的入路选择，特别是对于更容易受到辐射风险影响的患者。
