More Radial Access Means More Complications When Femoral Access Is Required

MedicalResearch.com Interview with:
Lorenzo Azzalini, MD PhD MSc
Marc Jolicoeur, MD MSc MHS
Montreal Heart Institute, Université de Montréal
Montreal Health Innovations Coordinating Center
Montréal, Québec, Canada

MedicalResearch: What is the background for this study? What are the main findings?

Response: The femoral arterial puncture is a tactful intervention that requires knowledge, skills and practice. Following the relatively recent widespread adoption of radial access, the femoral route is now used less frequently, typically in challenging clinical scenarios, due to either patient- and procedure-related factors. This situation becomes synergistically problematic when poorly trained operators attempt challenging femoral accesses.

We compared an historical cohort where only femoral access was used, with a contemporary cohort where both femoral and radial access were used, in order to assess whether the benefits conferred by radial access at an individual level are offset by a proportionally greater incidence of vascular access site complications (VASC) that would be anticipated at a population level if only femoral access was performed.

We have observed an increase in the rate of VASC when femoral access is used, which in turn has offset the benefit conferred by radial access at a population level. In other words, the lucky patients who undergo radial access will likely have a lower risk of getting a vascular access site complications; however, if femoral access is needed for any reason, this risk will increase substantially as compared to when radial access was not regularly performed and femoral access was the default approach. Our findings were supported by adjusted analyses and were consistent in several stratified sub-analyses.

MedicalResearch: What should clinicians and patients take away from your report?

Response: We call this phenomenon “The Campeau Radial Paradox”, which we named after Montreal cardiologist Lucien Campeau, who pioneered the radial access for coronary angiography and intervention in 1989.

We believe that educational programs for trainees and young interventional cardiologists should take into consideration the existence of this radial paradox in such a way to maximize exposure to optimal femoral access technique. Such programs could include formal teaching, focused workshops and simulators, as is currently done for radial access. Additionally, fluoroscopy- and ultrasound-guided femoral puncture, bivalirudin and vascular closure devices appear to be feasible and effective strategies. Finally, maintaining a minimal femoral access volume could also be recommended.

MedicalResearch: What recommendations do you have for future research as a result of this study?

Response: Additional studies should propose and test effective measures to improve femoral access technique and minimize complication rate, thus improving patient clinical outcomes.

Large continuous registries from everyday clinical practice are also needed to track the implementation of these measures, since randomized clinical trials do not mirror closely “real-world” experience with femoral access.

Citation:

Azzalini L, Tosin K, Chabot-Blanchet M, et al. The Benefits Conferred by Radial Access for Cardiac Catheterization Are Offset by a Paradoxical Increase in the Rate of Vascular Access Site Complications With Femoral Access: The Campeau Radial Paradox. J Am Coll Cardiol Intv. 2015;():. doi:10.1016/j.jcin.2015.07.029.

 

 

Lorenzo Azzalini, MD PhD MSc, & Marc Jolicoeur, MD MSc MHS (2015). More Radial Access Means More Complications When Femoral Access Is Required MedicalResearch.com