Radial Uptake and Femoral Complications
Is increased uptake of radial access (RA) offset by a greater incidence of vascular access site complications among patients undergoing femoral access (FA)?
The authors calculated the adjusted vascular complication (VC) rate in a cohort of consecutive patients (2006-2008) where both RA and FA were used, and compared it with the adjusted VC rate observed in a historical control cohort (1996-1998) where only FA was used.
The study population was comprised of 17,059 patients. The VC rate was higher in the overall contemporary cohort compared with the historical cohort (adjusted rates: 2.91% vs. 1.98%; odds ratio [OR], 1.48; 95% confidence interval [CI], 1.17-1.89; p = 0.001). In the contemporary cohort, radial access was associated with fewer VCs compared with femoral access (adjusted rates: 1.44% vs. 4.19%; OR, 0.33; 95% CI, 0.23-0.48; p < 0.001). There was a higher likelihood of VCs in association with FA in the contemporary cohort compared with the historical cohort (adjusted rates: 4.19% vs. 1.98%; OR, 2.16; 95% CI, 1.67-2.81; p < 0.001). This finding was consistent for both diagnostic and therapeutic catheterizations separately.
The increased uptake of RA is associated with an increased VC rate among patients undergoing FA.
RA is associated with a very low VC rate, but as this study (and prior work) allude to, the increased uptake of RA is associated with an increase in complications in patients undergoing FA. This is not surprising since a reduction in femoral route is probably accompanied by a reduction in proficiency with obtaining FA as well as in managing FA site after sheath removal. As RA becomes more widely adopted, it is important for operators and institutions to maintain competency in obtaining FA and in the post-access management of these patients.
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