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Radial Angiography Experience in a Regional Centre
Abstracts CSANZ Abstracts 2011
incomplete (abbreviation only 16%, undated 16%, without signature 2%). One hundred percent of consent forms written by consultants were complete (n = 6). Fifty-two percent of consent forms completed by interventional fellows were complete (n = 25), while all of registrar written consents were incomplete (n = 19). Conclusion: This audit highlights the need for education and training of the consenting process, particularly for time poor junior medical staff. Monitoring of the consenting process is crucial and should be audited regularly for centres undertaking day case procedures. doi:10.1016/j.hlc.2011.05.356 354 Radial Angiography Experience in a Regional Centre R. Szirt ∗ , M. Premaratne, D. Brillante, A. Lee, D. Owensby, B. McKenzie, N. Dang, E. Vogl, A. Yeung, J. Gohil, M. Dennis, L. Garg, P. Shetty Wollongong Hospital, Australia Introduction: Wollongong Hospital is a regional tertiary referral hospital that performs 1600 coronary angiography and interventions via femoral approach annually. Radial approach was commenced in March 2010. When compared to the femoral approach complications including bleeding are significantly lower. Despite the benefits of radial approach, operator uptake has been consistently low worldwide. Our aim is to show that experienced femoral operators can successfully implement radial angiography and show demonstrable improvement. Methods: Data was collected from the radial angiography database maintained in the cardiac catheterisation laboratory from March 2010 to December 2010. The first 50 patients were compared to the second 50 patients using the variables of; fluoroscopy time, catheter type, contrast volume, procedural success rate and complications. Results: Between March and December 2010, 100 patients underwent angiogram via radial approach.
Sheath size Catheter type Drug cocktails
First 50
Second 50
5F TIG 73%
6F Judkins 26%
Average Fluoroscopy (mins) Contrast volume (ml) Procedural success Major complication
17.8 102 84% 3%
First 50 22.5 103 82% 6%
Second 50 11.8 101 86% 0%
Most common reason for failure was vasospasm. Major complication included stroke (2%) and dissection (1%). No major bleeding was observed however there was one instance of minor bleeding.
S143
Conclusion: Wollongong Hospital successfully introduced diagnostic radial angiography with minimal complications and demonstrable improvement. Plans include expanding our scope to percutaneous coronary intervention via the radial approach. The steep curve to mastering radial angiography should not be a barrier for experienced femoral operators. doi:10.1016/j.hlc.2011.05.357 355 Reduced Radiation Dose and Contrast Use with Dual Axis Rotational Coronary Angiography S. Sahay ∗ , A. Farshid, A. Mishra, S. O’ Connor, R. Tan, M. Rahman, C. Allada, D. McGill, G. Bright, A. Balwin The Canberra Hospital, Australia Background: Dual Axis Rotational Coronary Angiography (DARCA) is a novel acquisition technique whereby the gantry rotation occurs in a trajectory incorporating LAO, RAO and cranio-caudal orientations. Diagnostic accuracy of DARCA has been shown to be as good as that of standard coronary angiography (SCA) with increased number of images in different angles to assess the coronary vasculature. There is limited data on the practical application of this technique for general use in the cath lab. Objective: To compare DARCA and SCA with regards to contrast volume usage, radiation exposure and procedure time. Methods: Twenty-six patients were assigned to either DARCA or SCA as preferred by individual operators. Information collected included radiation exposure, volume of contrast used and procedure time. Patients with acute myocardial infarction and prior CABG were excluded from the study. Results: Mean age of patients was 61 years and 69% were male. Indication for angiography was NSTEMI in 20%, unstable angina in 20%, chest pain for investigation in 55% and other indications in 5%. Mean Air Kerma (radiation energy per unit mass) was 242.81mGy for DARCA vs. 350.54 mGy for SCA (p = 0.0279). Contrast volume in DARCA was 23.5 ml vs. 39.4 ml for SCA (p < 0.0001). There was no significant difference in Fluoroscopy or procedure time. Full results of this ongoing study will be available in August 2011. Conclusion: DARCA is associated with 40% reduction in contrast use and 31% reduction in radiation dose as compared to SCA and may increase the safety of angiography in certain high-risk groups. doi:10.1016/j.hlc.2011.05.358
ABSTRACTS
Heart, Lung and Circulation 2011;20S:S1–S155
incomplete (abbreviation only 16%, undated 16%, without signature 2%). One hundred percent of consent forms written by consultants were complete (n = 6). Fifty-two percent of consent forms completed by interventional fellows were complete (n = 25), while all of registrar written consents were incomplete (n = 19). Conclusion: This audit highlights the need for education and training of the consenting process, particularly for time poor junior medical staff. Monitoring of the consenting process is crucial and should be audited regularly for centres undertaking day case procedures. doi:10.1016/j.hlc.2011.05.356 354 Radial Angiography Experience in a Regional Centre R. Szirt ∗ , M. Premaratne, D. Brillante, A. Lee, D. Owensby, B. McKenzie, N. Dang, E. Vogl, A. Yeung, J. Gohil, M. Dennis, L. Garg, P. Shetty Wollongong Hospital, Australia Introduction: Wollongong Hospital is a regional tertiary referral hospital that performs 1600 coronary angiography and interventions via femoral approach annually. Radial approach was commenced in March 2010. When compared to the femoral approach complications including bleeding are significantly lower. Despite the benefits of radial approach, operator uptake has been consistently low worldwide. Our aim is to show that experienced femoral operators can successfully implement radial angiography and show demonstrable improvement. Methods: Data was collected from the radial angiography database maintained in the cardiac catheterisation laboratory from March 2010 to December 2010. The first 50 patients were compared to the second 50 patients using the variables of; fluoroscopy time, catheter type, contrast volume, procedural success rate and complications. Results: Between March and December 2010, 100 patients underwent angiogram via radial approach.
Sheath size Catheter type Drug cocktails
First 50
Second 50
5F TIG 73%
6F Judkins 26%
Average Fluoroscopy (mins) Contrast volume (ml) Procedural success Major complication
17.8 102 84% 3%
First 50 22.5 103 82% 6%
Second 50 11.8 101 86% 0%
Most common reason for failure was vasospasm. Major complication included stroke (2%) and dissection (1%). No major bleeding was observed however there was one instance of minor bleeding.
S143
Conclusion: Wollongong Hospital successfully introduced diagnostic radial angiography with minimal complications and demonstrable improvement. Plans include expanding our scope to percutaneous coronary intervention via the radial approach. The steep curve to mastering radial angiography should not be a barrier for experienced femoral operators. doi:10.1016/j.hlc.2011.05.357 355 Reduced Radiation Dose and Contrast Use with Dual Axis Rotational Coronary Angiography S. Sahay ∗ , A. Farshid, A. Mishra, S. O’ Connor, R. Tan, M. Rahman, C. Allada, D. McGill, G. Bright, A. Balwin The Canberra Hospital, Australia Background: Dual Axis Rotational Coronary Angiography (DARCA) is a novel acquisition technique whereby the gantry rotation occurs in a trajectory incorporating LAO, RAO and cranio-caudal orientations. Diagnostic accuracy of DARCA has been shown to be as good as that of standard coronary angiography (SCA) with increased number of images in different angles to assess the coronary vasculature. There is limited data on the practical application of this technique for general use in the cath lab. Objective: To compare DARCA and SCA with regards to contrast volume usage, radiation exposure and procedure time. Methods: Twenty-six patients were assigned to either DARCA or SCA as preferred by individual operators. Information collected included radiation exposure, volume of contrast used and procedure time. Patients with acute myocardial infarction and prior CABG were excluded from the study. Results: Mean age of patients was 61 years and 69% were male. Indication for angiography was NSTEMI in 20%, unstable angina in 20%, chest pain for investigation in 55% and other indications in 5%. Mean Air Kerma (radiation energy per unit mass) was 242.81mGy for DARCA vs. 350.54 mGy for SCA (p = 0.0279). Contrast volume in DARCA was 23.5 ml vs. 39.4 ml for SCA (p < 0.0001). There was no significant difference in Fluoroscopy or procedure time. Full results of this ongoing study will be available in August 2011. Conclusion: DARCA is associated with 40% reduction in contrast use and 31% reduction in radiation dose as compared to SCA and may increase the safety of angiography in certain high-risk groups. doi:10.1016/j.hlc.2011.05.358
ABSTRACTS
Heart, Lung and Circulation 2011;20S:S1–S155