• Ahmad Usman Department of Cardiology, Army Cardiac Center, Lahore
  • Fida Hussain Department of Cardiology, Army Cardiac Center, Lahore
  • Tahir Iqbal Department of Cardiology, Army Cardiac Center, Lahore
  • Farhan Tuyyab Department of Cardiology, Army Cardiac Center, Lahore


Background: Use of trans-radial route for cardiac catheterization is on the rise but is associated with increased radiation exposure to the operator. Our aim was to compare the radiation exposure, by taking fluoroscopy time (FT) as a surrogate of radiation exposure, to the operator with femoral and radial routes. Methods: This prospective observational study was carried out at Army Cardiac Center Lahore from 1st Jan to 1st June 2013. Mean fluoroscopy times via trans-radia (TR) and trans-femoral (TF) routes were compared. Procedure time was considered as time from sheath insertion to the finish of the diagnostic and interventional procedure. Descriptive statistics were used to explain the data. Chi square test was applied to compare qualitative variables between them. Results:A total of 1,110 diagnostic & PCI cases were performed out of which there were 850 diagnostic CA and 260 PCI cases. The mean procedure time & mean fluoroscopy time for TF-CA was 15.5±5.5 minutes and 4.3±3.2 minutes respectively in the current study while for TR-CA was 6.6±4.1. For TF-PCI, mean procedure time was 42.3±16.7 minutes, mean fluoroscopy time was 11.6±7.7 minutes & for TR-PCI it was 55.3±19.2 and 15.4±12.1.Conclusion: Radial route for cardiac catheterization procedures is associated with longer fluoroscopy time leading to increased radiation exposure to the operator along with an increased use of contrast.


Campeau L. Percutaneous radial artery approach for coronary angiography. Cathet Cardiovasc Diagn 1989;16(1):3–7.

Jolly SS, Amlani S, Hamon M, Yusuf S, Mehta SR. Radial versus femoral access for coronary angiography or intervention and the impact on major bleeding and ischemic events: a systematic review and meta-analysis of randomized trials, Am Heart J 2009;157(1):132–40.

Ziakas AG, Koskinas KC, Gavrilidis S, Giannoglou GD, Hadjimiltiades S, Gourassas I, et al. Radial versus femoral access for orally anticoagulated patients, Catheter Cardiovasc Interv 2010;76(4):493–9.

Yang YJ, Kandzari DE, Gao Z, Xu B, Chen JL, Qiao SB, et al. Transradial versus transfemoral method of percutaneous coronary revascularization for unprotected left main coronary artery disease: comparison of procedural and late-term outcomes,” JACC 2010;3(10)1035–42.

Nadarasa K, Robertson MC, Wong CK, Green BK, Chen VH, Wilkins GT, et al. Rapid cycle change to predominantly radial access coronary angiography and percutaneous coronary intervention: effect on vascular access site complications. Catheter Cardiovasc Interv 2012;79(4)589–94.

Neill J, Douglas H, Richardson G, Chew EW, Walsh S, Hanratty C, et al. Comparison of radiation dose and the effect of operator experience in femoral and radial arterial access for coronary procedures. Am J Cardiol 2010;106(7):936–40.

Mercuri M, Mehta S, Xie C, Valettas N, Velianou JL, Natarajan MK. Radial artery access as a predictor of increased radiation exposure during a diagnostic cardiac catheterization procedure. JACC Cardiovasc Interv 2011;4(3):347–52.

Kassam S, Cantor WJ, Patel D, Gilchrist IC, Winegard LD, Rea ME, et al. Radial versus femoral access for rescue percutaneous coronary intervention with adjuvant glycoprotein IIb/IIIa inhibitor use. Can J Cardiol 2004;20(14):1439–42.

Sandborg M, Fransson SG, Pettersson H. Evaluation of patient-absorbed doses during coronary angiography and intervention by femoral and radial artery access. Eur Radiol 2004;14(4):653–8.

Brasselet C, Blanpain T, Tassan-Mangina S, Deschildre A, Duval S, Vitry F, et al. Comparison of operator radiation exposure with optimized radiation protection devices during coronary angiograms and ad hoc percutaneous coronary interventions by radial and femoral routes. Eur Heart J 2008;29(1):63–70.

Bashore TM. Radiation safety in the cardiac catheterization laboratory. Am Heart J 2004;147(3):375–8.

Valentin J. Avoidance of radiation injuries from medical interventional procedures. Ann ACRP 2000;30(2):7–67.

Rao SV, Ou FS, Wang TY, Roe MT, Brindis R, Rumsfeld JS, et al. Trends in the prevalence and outcomes of radial and femoral approaches to percutaneous coronary intervention: a report from the National Cardiovascular Data Registry. JACC Cardiovasc Interv 2008;1(4):379–86.

Ball WT, Sharieff W, Jolly SS, Hong T, Kutryk MJ, Graham JJ, et al. Characterization of operator learning curve for transradial coronary interventions. Circ Cardiovasc Interv 2011;4(4):336–41.

Sciahbasi A, Romagnoli E, Burzotta F, Trani C, Sarandrea A, Summaria F, et al. Transradial approach (left vs. right) and procedural times during percutaneous coronary procedures: TALENT study. Am Heart J 2011;161(1):172–9.

Valsecchi O, Vassileva A, Musumeci G, Rossini R, Tespili M, Guagliumi G, et al. Failure of transradial approach during coronary interventions: anatomic considerations. Catheter Cardiovasc Interv 2006;67(6):870–8.

Pristipino C, Roncella A, Trani C, Nazzaro MS, Berni A, Di Sciascio G, et al. Identifying factors that predict the choice and success rate of radial artery catheterization in contemporary real world cardiology practice: a sub-analysis of the PREVAIL study data. Euro Interv 2010;6(2):240–6.

Louvard Y, Pezzano M, Scheers L, Koukoui F, Marien C, Benaim R, et al. Coronary angiography by a radial approach: feasibility, learning curve .One operator's experience. Arch Mal Coeur Vaiss 1998;91(2):209–15.

Louvard Y, Lefèvre T, Allain A, Morice M. Coronary angiography through the radial or the femoral approach: The CARAFE study. Catheter Cardiovasc Interv 2001;52:181–7.

Brueck M, Bandorski D, Kramer W, Wieczorek M, Höltgen R, Tillmanns H. A randomized comparison of transradial versus transfemoral approach for coronary angiography and angioplasty. JACC Cardiovasc Interv 2009;2(11):1047–54.

Hirshfeld JW Jr, Balter S, Brinker JA, Kern MJ, Klein LW, Lindsay BD, et al. ACCF/AHA/HRS/SCAI clinical competence statement on physician knowledge to optimize patient safety and image quality in fluoroscopically guided invasive cardiovascular procedures. A report of the American College of Cardiology Foundation/American Heart Association/American College of Physicians Task Force on Clinical Competence and Training. J Am Coll Cardiol 2004;44(11):2259–82.

Klein LW, Miller DL, Balter S, Laskey W, Haines D, Norbash A, et al. Occupational health hazards in the interventional laboratory: time for a safer environment. Catheter Cardiovasc Interv 2009;73(3):432–8.