Outcomes of Transradial Approach to Percutaneous Coronary Intervention in End-Stage Renal Disease Patients on Dialysis

Background: Percutaneous coronary intervention (PCI) is increasingly performed in patients with chronic kidney disease (CKD), including in end-stage renal disease (ESRD), however studies on vascular access are limited.

Objective: We sought to describe vascular access choice and outcomes of PCI from transfemoral (TFA) compared to transradial access (TRA) in ESRD patients on dialysis.

Methods: Patients with ESRD on dialysis undergoing PCI from October 2010 to January 2017 at two hospitals in a health system reporting to the National Cardiovascular Data Registry (NCDR) CathPCI registry as well as their respective electronic medical records (Epic) were analyzed. Baseline characteristics, procedural and in-hospital outcomes were compared according to access site, TFA versus TRA.

Results: There were 270 patients with ESRD on dialysis who underwent PCI, 234 via the TFA and 36 via the TRA. Mean age of the patients was 67 and 67.4% were male. The TFA patients had a lower body-mass-index (BMI) (P < 0.001) and were more likely to have prior coronary artery bypass graft (CABG) (P < 0.001) and PCI of the left main coronary artery (LM) (P = 0.04). Access site cross over only occurred in one patient in each group. Bleeding within 72 h was seen in 3.8% of the TFA group and in 2.8% of the TRA group (P = 0.75).

Conclusion: Use of TRA is uncommon in patients with ESRD on dialysis, but is feasible and associated with low complication rates, similar to TF.

Summary for the annotated table of contents: While PCI is being increasingly performed in patients with end-stage renal disease, there are is a lack of data on vascular access for this group. This study shows that while a transradial approach TRA is less common than transfemoral (TFA), it is still a feasible option and is associated with low complications similar to TFA.