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Therapeutic Considerations with Revascularization in Chronic Kidney Disease: Radial Versus Femoral Arterial Access

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Kidney Disease in the Cardiac Catheterization Laboratory

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Abstract

The radial artery is a safe and feasible access site to perform cardiac catheterization and percutaneous coronary intervention (PCI) in stable and unstable settings. Recent evidence suggests potential nephroprotective benefits of the radial approach over the femoral route toward both short- and long-term kidney injury preventions. Acute kidney injury (AKI) after cardiac catheterization remains a major issue in hospitalized patients and is associated with worse clinical outcomes. Patients with chronic kidney disease (CKD) are more prone to AKI after cardiac catheterization, requiring careful management to prevent further decline in renal function. The transradial approach (TRA) provides several advantages for renal safety compared to the transfemoral approach (TFA) which include less access site-related bleeding and the avoidance of manipulation of the atheromatous aorta, thus limiting renal atheroembolic events. On the other hand, the extensive use of TRA in patients with advanced CKD has been questioned, raising concerns about the use of previously cannulated radial arteries for the creation of future autogenous radial-cephalic fistulae for hemodialysis access. Several studies have reported conflicting data regarding the use of contrast-associated AKI with TRA, possibly counterbalancing the potential benefits of this approach. In this chapter, we discuss benefits and limits of the transradial strategy in patients undergoing cardiac catheterization, with emphasis on patients with CKD and data on renal safety with this approach.

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Abbreviations

AKI:

Acute kidney injury

AV:

Arteriovenous

CI:

Confidence interval

CABG:

Coronary artery bypass grafting

CIN:

Contrast-induced nephropathy

CKD:

Chronic kidney disease

eGFR:

Estimated glomerular filtration rate

MATRIX:

Minimizing Adverse Haemorrhagic Events by Transradial Access Site and Systemic Implementation of AngioX

PCI:

Percutaneous coronary intervention

sCr:

Serum creatinine

TFA:

Transfemoral approach

TRA:

Transradial approach

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Authors and Affiliations

  1. Azienda Ospedaliera Universitaria Policlinico “Gaetano Martino”, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy

    Giuseppe Andò

  2. Division of Clinical Cardiology, A.O.R.N. Sant’Anna e San Sebastiano, Caserta, Italy

    Felice Gragnano & Paolo Calabrò

  3. Department of Cardiothoracic and Respiratory Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy

    Felice Gragnano & Paolo Calabrò

  4. Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland

    Marco Valgimigli

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  1. Giuseppe Andò
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  2. Felice Gragnano
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  3. Paolo Calabrò
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  4. Marco Valgimigli
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Correspondence to Marco Valgimigli .

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Editors and Affiliations

  1. Einstein Medical Center/Thomas Jefferson University, Department of Medicine/Nephrology, Philadelphia, PA, USA

    Janani Rangaswami

  2. UIC/Advocate Christ Medical Center, Department of Medicine, Chicago, Il, USA

    Edgar V. Lerma

  3. Baylor University Medical Center, Baylor Heart and Vascular Hospital, Department of Internal Medicine, Texas A & M College of Medicine, Division of Cardiology, Dallas, TX, USA

    Peter A. McCullough

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Andò, G., Gragnano, F., Calabrò, P., Valgimigli, M. (2020). Therapeutic Considerations with Revascularization in Chronic Kidney Disease: Radial Versus Femoral Arterial Access. In: Rangaswami, J., Lerma, E., McCullough, P. (eds) Kidney Disease in the Cardiac Catheterization Laboratory . Springer, Cham. https://doi.org/10.1007/978-3-030-45414-2_5

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  • DOI: https://doi.org/10.1007/978-3-030-45414-2_5

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