How brachial access compares to femoral access for invasive cardiac angiography when radial access is not feasible: A meta-analysis

Background: Trans-radial access is considered the best approach for cardiac catheterization. The choice of an alternative access route may be complex and trans-femoral access (TFA) is generally preferred. However, trans-brachial approach (TBA) may represent another feasible alternative. We therefore aimed to compare TBA and TFA in terms of access site bleeding and complications in a meta-analysis study. Methods: We systematically searched principal databases for studies comparing femoral and brachial approach in terms of in-hospital vascular complications in patients undergoing cardiac catheterization (coronary angiography or percutaneous coronary intervention). Results: Five retrospective studies and one randomized study were identified for the meta-analysis; 2756 patients undergoing a TBA and 331.208 patients undergoing a TFA for cardiac catheterization were included in the final study. No significant differences between access routes were found in terms of risk of any vascular complications (relative risk 1.18; 95% CI: 0.91-1.53; p n.s.). Brachial access was associated with a significantly lower risk of access site bleeding (relative risk 0.46; 95% CI 0.24-0.88, p = 0.02). Conclusions: TBA for cardiac catheterization was associated with a lower risk of access site bleeding and a comparable risk of any vascular complications compared with TFA. TBA may be considered a reasonable alternative access route for cardiac catheterization, at least as femoral approach.