Choice of access site
Coronary angiography and PCI can be done via three main routes. In the past the brachial artery was often used but nowadays most coronary angiographies and PCI procedures are performed via the trans-femoral or trans-radial approaches. The access site can be chosen depending on the patient, anatomy, operator experience and type of procedure.
Especially in europe, but recently also in the US transradial angiography and PCI are becomming increasingly popular. Recent studies show that procedural succes is just as high as with transfemoral approach. This has been shown for al subgroups including chronic total occlusions (CTO) and primary PCI. The advantages of the radial approach are fewer (hardly any) major and minor bleeds and that patients can remain ambulatory. Especially in primary or complex PCI were patient receive several anticoagulants the reduction in major and minor bleeds can be very important. Disadvantages of the radial approuch are spasm of the radial artery (especially in certain subsets of patients and with in experienced operators), difficult anatomy and the limitation of a maximum catheter size of 6-7F. This precludes bulkier devices like rotablators to be used via the radial artery.
For each access site we will describe the indications, contraindications and technique