You review a patient in clinic who has previously had bypass surgery and a recurrence of angina. They have three grafts (LIMA to LAD, vein graft to OM, and vein graft to RCA). You recommend a coronary angiogram. The patient asks you if the procedure will be carried out from the wrist or the leg as they have had vascular procedure to both groins. You can see bilateral inguinal scars, but the procedures were carried out at another hospital.
What do you advise?
A. The left wrist would be the preferred route hereAlthough, based on the vascular procedure, it is often possible to access the femoral arteries, this is obviously best avoided as there is a greater risk of complications. The left radial will give direct access to the LIMA (comes off the left subclavian artery) and would be the route of choice. The right radial will not allow simple or safe access to the left subclavian artery. If the left radial has been harvested as a graft, then the femoral arteries may have to be considered.