There are two methods of approach in the coronary angiography, which are femoral and brachial approaches. In Korea, femoral approach has been used routinely, but brachial approach is not sued widely compared to America, Europe and Japan, where
the
brachial approach is used more than 30% among the diagnostic coronary angiography, Recently, we have experienced coronary angiography by brachial artery puncture. And we will discuss about its usefulness.
Coronary antiography was done in 149 cases by femoral approach and 39 cases by brachial approach from Nov. 1992 to Oct. 1993. Unpaired t-test & χ2-test was used for comparison of each method about the procedure the total dose of contrast media
and
numbers of the used catheter.
@ES The results were as follows
@EN 1. In brachial approach group, mean procedure time was 25±12min, and the mean dose of contrast media was 147±37ml, which were not statistically significant compared with femoral approach group, 22±9min, and 138±37ml, each respectively.
Mean
numbers of the used catheter were 1.6 in brachial group and 3.6 in femoral group (p<0.05).
2. The percentage of incomplete engagement was 7.8%(3/39) in brachial group and 2.7%(4/149) in femoral group, which was significantly higher in brachial group(p<0.05). By the way, all 3 cases of incomplete engagement were left coronary artery in
brachial group, but there was same incidence between left and right coronary artery in femoral group.
3. Complications occurred 10.2(4/39) in brachial group, 3.3%(5/149) in femoral group(p<0.01), but most of them were minor.
4. We compared the total dose of contrast media and procedure time by 3 month and 6 month interval, The duration of procedure time was relatively constant in femoral group, but decreased in brachial group with time constant in femoral group, but
decreased in brachial group with time course(p<0.05). By 6 month interval, it was significantly shorter in femoral group compared with brachial group in the half(p<0.05), but there were no statistical significance between 2 groups in the 2nd half
of the
year. Also there were no significant differences in the total dose of contrast media between two groups.
We concluded that coronary angiography via brachial artery had similar result in the duration of procedure time, the total dose of contrast media, compared with femoral approach, Brachial approach is a useful method especially in the patient with
obstructive vascular lesion and on outpatient basis. We think it requires experience and discipline.
|