Comparison between Ultrasound-Guided and Traditional Palpatory Approaches of Proximal Transradial Access for Coronary Angiography and Intervention

Objectives: To compare the efficacy and safety of ultrasound-guided versus traditional palpatory approaches of proximal transradial access (TRA) for coronary angiography and intervention. Methodology: This cross-sectional analytical study was carried out from September 2023 to February 2024 at the Cardiology Department of Fauji Foundation Hospital, Rawalpindi after ethical approval. After obtaining informed consent, 75 patients who presented with ischemic heart disease and underwent coronary angiography and /or percutaneous primary coronary intervention with proximal TRA were included by convenient sampling. In 37 patients of Group I, the traditional palpatory technique was used whereas, in 38 patients of Group II, the ultrasound-guided technique was used. The Statistical Package for the Social Sciences (SPSS) version 25 was used for data analysis. Results: The first pass success rate was 92.1% in Group II versus 75.7% in Group I with statistical significance. The mean cannulation time was greater in Group I than in Group II (p-value = 0.001).  The switchover to another procedure was 35.1% in Group I and 0% in Group II. Hematoma formation occurred in 24.3% of patients in Group I and 10.5% of patients in Group II but was not significant. Loss of radial pulse at 2 months was reported in 5.4% and 2.6% of the patients in Group I and Group II, respectively (p-value=0.53). Conclusion: Ultrasound-guided transradial access is associated with improved patient outcomes as compared to traditional approach. It has a higher first-pass success rate, reduced mean cannulation time, and lower frequency of switchover procedure. However, the difference in hematoma formation and loss of radial pulse between the two groups is not significant