Coronary interventions

Standard versus ultrasound-guided radial and femoral access in coronary angiography and intervention (SURF): a randomised controlled trial

EuroIntervention 2019;15:e522-e530. DOI: 10.4244/EIJ-D-19-00336

Phong Nguyen
Phong Nguyen1,2,3,4, MBBS, FRACP; Angela Makris2,3,4, PhD, FRACP, MBBS; Annemarie Hennessy1,2,3, MBBS, FRACP, PhD; Sumedh Jayanti2,4, Ms; Alexandra Wang2,4, MBBS; Kevin Park2,4, MBBS; Vanessa Chen4, MBBS; Tram Nguyen2,4, MBBS; Sidney Lo2,4, MBBS, FRACP; Wei Xuan4,5, MSc, MAppStat; Melissa Leung2,4,5, PhD, MBBS, MBiostat; Craig Juergens2,4, MBBS, FRACP, DMedSc
1. Campbelltown Hospital, Campbelltown, NSW, Australia; 2. Liverpool Hospital, Liverpool, NSW, Australia; 3. Western Sydney University, Campbelltown, NSW, Australia; 4. University of New South Wales, Liverpool, NSW, Australia; 5. Ingham Institute, Liverpool, NSW, Australia

Aims: This study aimed to compare outcomes in unselected patients undergoing cardiac catheterisation via transradial versus transfemoral access and standard versus ultrasound-guided arterial access.

Methods and results: This was a prospective, randomised (radial vs. femoral and standard vs. ultrasound), 2x2 factorial trial of 1,388 patients undergoing coronary angiography and percutaneous coronary intervention. The primary outcome was a composite of ACUITY (Acute Catheterization and Urgent Intervention Triage strategY) major bleeding, MACE (death, stroke, myocardial infarction or urgent target lesion revascularisation) and vascular complications at 30 days. Transradial access reduced the primary outcome (RR 0.37, 95% CI: 0.17-0.81; p=0.013), mostly driven by ACUITY major bleeding (RR 0.343, 95% CI: 0.123-0.959; p=0.041) when compared with the transfemoral approach. There was no difference in the primary outcome between standard and ultrasound guidance (p=0.76). Ultrasound guidance, however, reduced mean access time (93 sec vs. 111 sec; p=0.009), attempts (1.47 vs. 1.9; p<0.0001), difficult accesses (4.5% vs. 9.2%; p=0.0007), venepuncture (4.1% vs. 9.2%; p<0.0001) and improved first-pass success (73% vs. 59.7%; p<0.0001).

Conclusions: Transradial access significantly reduced the composite outcome compared to transfemoral access. Ultrasound guidance did not reduce the primary outcome compared to the standard technique, but significantly improved the efficiency and overall success rate of arterial access.

Sign in to read and download the full article

Forgot your password?

No account yet?
Sign up for free!

Create my pcr account

Join us for free and access thousands of articles from EuroIntervention, as well as presentations, videos, cases from

access siteradialfemoral
Read next article
Does an occluded RCA affect prognosis in patients undergoing PCI or CABG for left main coronary artery disease? Analysis from the EXCEL trial

Latest news