الفهرس 
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Abstract
The obesity epidemic is expected to increase dramatically. As numerous studies link the degree of obesity to cardiovascular risk factors as well as overall morbidity and mortality, it is projected that coronary artery disease prevalence will continue to climb.
The radial approach has been increasingly used as an alternative to femoral access as it improves patients comfort; associated with less access site complications (local ischemia, large hematomas, minor or major hemorrhagic complications) and permits earlier ambulation and discharge. Our aim was to assess the feasibility and safety of transradial approach (TRA) versus transfemoral approach (TFA) for diagnostic coronary angiography and percutaneous coronary intervention in obese patients especially the high risk group with BMI level≥40kg/m2.
Aim of the work:
To compare trans-radial and trans-femoral approaches for coronary procedures in obese patients with BMI ≥ 30 kg/m2 in terms of vascular complications (Bleeding and Access site complications).
Patients and Methods:
The study included 80 patients in the radial group and 80 patients in the femoral group.
Exclusion criteria:
1-Non-palpable radial artery.
2-Abnormal Modified Allen test result.
3-Chronic renal failure patients with arteriovenous fistula or those patients who have the potential of having arteriovenous fistula.
4- Patients with small calcified radial artery.
5- Peripheral vascular disease.
6-History of prior vascular surgery for lower limbs.
7-Patient with very high risk of bleeding complications.
Results:
● Femoral approach had significantly more access site complications (local hematomas, pseudoaneursym & artery dissection) compared to radial approach, most of cases with local vascular complications belonged to patients with BMI level ≥35kg/m2.
● Radial access was associated with higher rate of procedural failure; crossover occurred in 5 patients (3.1%) compared to 2 patients (1.25%) in the femoral group, however this wasn’t statistically significant.
● Hospital length of stay was significantly reduced in the radial group and this is of paramount importance in an overcrowded hospital. .
● Total procedure time was longer in radial approach which consumed more time and more Fluoro.time compared to femoral approach ; time 28.83±7.54 minutes in radial group and 26.15±9.15 minutes in femoral group and Fluoro.time; 6.43±3.42 in radial and 4.71±3.32 in femoral .
●Major adverse cardiac events wasn’t statistically significant when comparing both groups , however sub analysis showed that when BMI level is above 40kg/m2, mortality and morbidity from cardiovascular related events may increase with using femoral approach in these patients.
Conclusion:
Our analysis suggests that a transradial approach for coronary angiography and PCI in obese patients especially those with extreme obesity can markedly reduce vascular access complications, provides higher patient satisfaction, and potentially lower overall costs compared to transfemoral access. The femoral approach is the standard access site for coronary angiography; however, interventional cardiologists should acquire experience in the radial approach as an alternative in this high risk group.