I wish this discussion were required listening for all interventional cardiologists!

 I am a heart attack survivor; I had a stent implanted, 99% occluded LAD, May 6/08 by Dr. David Hilton in Victoria, BC Canada using trans radial access.  This appears to be the default access method here.

 I was able to walk around within an hour of being transferred back to CCU, and was home by that evening. No issues at all with bleeding, discomfort or complications after discharge from hospital. My right arm was put in a simple sling for 2-3 days, just to remind myself not to pick up anything heavy with that hand for the first while.

Five months after my heart attack, I attended the 'WomenHeart Science & Leadership Symposium for Women with Heart Disease' at Mayo Clinic in Rochester - the first Canadian ever invited to attend this annual five-day Symposium.  Out of the 45 heart attack survivors attending (women from all over the U.S. - except for me) I was the only one who had had a stent procedure done via radial access.  I heard many disturbing and distressing stories at Mayo, however, of severe complications from their femoral access angios ranging from excessive bleeding, infections, swelling, to extreme bruising and pain, or inability to get out of bed in some cases for a full day following the angio, etc. They couldn't believe it when I shared my radial access story.  Not one woman attending our Mayo Symposium had even heard of this procedure being done in her home community. This was not surprising, given the low 2-3% radial access procedure rate you mention!

There is another important advantage to radial access that was not mentioned by your panel: radial access can reduce costly hospital stays compared to femoral access.  In our own hospital, standard practice seems to be same day discharge post-radial angio.  This is not only great for us patients, but extremely cost-effective for hospital budgets.  I knew nothing of this at the time of course - I was just anxious to go home and sleep in my own bed, and I could almost tapdance out the hospital door!

Thanks so much for a very interesting discussion.  For your patients' sake, I hope radial access will become as common in your country as it is here.

Carolyn Thomas

http://www.myheartsisters.org  

Radial acess exposes the investigator to a much higher exposure rate to radiation - a higher risk of thrombosis of the atery - 5 max 6 F bares a higher risk of atery closure

the femoral atery is the better approach

- bleeding complication have to graded, no every bleeding is the same and the closure of the acess with e.g. angioseal is excellent - and mobilisation is not bad - the femoral approach is chossen in the light of pushing for a more ambulatory one day few hours investigation and money saving because of less postprocedure montorisation in beds....