BACKGROUND: The transradial approach is a more recent technique employed to perform diagnostic and therapeutic coronary procedures, which offers many advantages when compared to the femoral approach. Nevertheless, the radial access is routinely utilized in only a few catheterization laboratories in our country. OBJECTIVE: To determine the influence of the learning curve on the success rate and incidence of complications associated with performing diagnostic and therapeutic procedures using the radial approach METHODS: We analyzed 3,500 consecutive patients submitted to transradial procedures from April, 2000 through June, 2003. Patients with an abnormal Allen test, absent radial pulse, and those undergoing hemodialysis were excluded from this analysis. The effect of the learning curve on the success rate and on the occurrence of complications was evaluated by comparing the results obtained in the first 500 patients (Group I) to the results achieved in the remaining 3,000 patients (Group II). RESULTS: There were no differences identified between the groups in regard to gender, age and type of procedure performed (diagnostic catheterization or percutaneous intervention). The success rate was significantly higher (98.1% versus 95.2%, p<0.01) and the incidence of complications related to the vascular access site significantly smaller (2.4% versus 6.1%, p<0.01) in Group II. Additionally, a progressive increase in the success rate was observed with the greater experience using the technique. Therefore, the success rates in performing the procedure through the radial approach in the first 50, 100, 500 and 1,000 cases were, respectively, 88%, 94%, 97% and 98%. CONCLUSIONS: The transradial approach is associated with a long learning curve that exceeds the first 500 cases. The incidence of success increases and the occurrence of complications decreases significantly with the increase of the caseload.
Radial artery; Coronary disease; Angiography; Angioplasty; Coronary angiography, methods; Clinical competence; Learning; Catheterization, peripheral, methods
