Transradial coronary angiography in patients with contraindications to the femoral approach: an analysis of 500 cases.

The transradial approach to coronary angiography is considered by some to be a route of choice, by others to be a route that should be used only where there are relative contraindications to the femoral approach. We present the largest series to date of patients in whom transradial coronary angiography was undertaken specifically because of contraindications to the femoral approach. Since 1995, patients at this cardiothoracic center have been considered for a transradial approach to coronary angiography if there were relative contraindications to the femoral route.

Permanent pacemakers: should straightened atrial leads be repositioned?

The aim of this study was to assess if atrial leads whose "J" configuration has straightened significantly on the postprocedural chest X ray should be repositioned. Between January 1996 and December 1997, 445 patients underwent dual chamber pacemaker implantation at the Papworth Hospital. Postprocedural chest X rays were available in 410 of these.

Coronary angiography in the fully anticoagulated patient: the transradial route is successful and safe.

The radial approach to coronary angiography is intuitively attractive for fully anticoagulated patients (INR > 2) but no data exist concerning efficacy or safety of this procedure. The consensus view is that the femoral approach is contraindicated in fully anticoagulated patients, and though some operators undertake femoral catheterization in such patients and use closure devices, there are no data to suggest that it is safe to do so. At our institution, the radial approach for coronary angiography is reserved for patients in whom there is a relative contraindication to the femoral route.

Occasional-operator percutaneous brachial coronary angiography: first, do no arm.

The percutaneous brachial approach to coronary angiography is perceived, rightly or wrongly, to be the easiest of the arm approaches. Predominantly femoral operators may therefore be encouraged to use the percutaneous brachial approach as an occasional procedure. We decided to investigate prospectively whether this was a reasonable strategy by examining outcome in patients who underwent percutaneous brachial cardiac catheterization by occasional brachial operators.