Assessment Of Complications in Radial Versus Femoral Access-Site for Coronary Interventions: A Comparative Study

Abstract

Background: Trans radial access is becoming more popular internationally due to its decreased risk of access-site complications. However, many interventional cardiologists continue to choose the femoral route for coronary angiography and angioplasty in various coronary intervention procedures.

Objectives: To compare the overall rate of any access-site problems between radial and femoral methods.

Material and Methods: A prospective comparative cohort study was conducted from November 1^st, 2025, to April 30^th, 2026, at Rehman Medical Institute (RMI), a tertiary care cardiovascular hospital. In total, 132 adult subjects with either stable angina or acute coronary syndrome who needed coronary interventions for their complex coronary conditions were recruited and divided into two equal groups of radials (n=66) and femoral (n=66). Data were analyzed using the Chi-square test and the independent sample t-test.

Results: A total of 132 patients were analyzed (66 radial, 66 femoral). The two groups were comparable in mean age (57.93 ± 14.82 vs. 52.21 ± 23.97 years; p = 0.102). A highly significant association was found between access site and type of complication (χ² = 48.126, df = 8, p < 0.001). Overall, 22 radial patients (33.3%) and 38 femoral patients (57.5%) experienced at least one access-site complication, confirming a significantly higher complication burden in the femoral group. For the femoral cohort, hematoma constituted the most common problem (n = 24; 36.4%); on the other hand, radial artery spasm was the most common problem in the radial group (n = 14; 21.2%). Serious complications including retroperitoneal haemorrhage (n = 2), AV fistula (n = 2), and pseudoaneurysm (n = 4) occurred exclusively in the femoral group and were completely absent in the radial cohort.

Conclusion: Radial access is associated with significantly fewer and less severe access-site complications compared to femoral access in patients undergoing coronary interventions at tertiary care hospitals in Peshawar. The null hypothesis is rejected, confirming a statistically and clinically significant difference in complication profiles between the two access routes (χ² = 48.126, p < 0.001). The findings support consideration of a radial-first approach for interventional cardiology practice in this setting, supported by structured operator training in transradial technique across KPK cardiac centers.