Radial versus Femoral Access for Primary Percutaneous Interventions in Acute Myocardial Infarction in Over 55 Years Old Patients

Abstract

he femoral artery is by far the most frequently used access for both peripheral and coronary angiography; however femoral access isn't always possible in all patients due to many reasons. TFA has been until presently the main-stay for arterial access PCI in the setting of acute STEMI, while the TRA is gaining ground in elective and to a lesser extent in primary procedures. The main complications of femoral artery access are local hematoma, arteriovenous fistula, arterial pseudo-aneurysm, and retroperitoneal hemorrhage. These complications are responsible for most of the bleeding that occurs in invasive procedures, especially in the setting of acute STEMI, and they are influenced by anatomic features, obesity, and puncture technique. Indeed, TRA has been shown to have several advantages over TFA. The radial artery is easily compressible, thus bleeding is controllable and hemorrhagic complications are reduced, moreover, no major nerves or veins are located near the artery, minimizing the risk of injury of those structures, finally, long post procedural bed rest is not required, permitting immediate ambulation, less hospital stay and early discharge and less costs.