Original Title: 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. Reference: Lorenzo Azzalini et al. J Am Coll Cardiol Intv. 2015, ONLINE FIRST.
The aim of this study was to assess whether the benefit of the radial access is associated to the site per se or rather to an increase of femoral access complications from operators trained in the transradial approach.
The recent adoption of the radial access site in many centers has been associated to an increase in femoral access vascular complications.
Logistic regression was used to calculate the vascular complications rate in a contemporary cohort of consecutive patients (2006 to 2008); either the radial or the femoral access sites were used, which was then compared with the femoral access historical complications rate, from 1996 to 1998, when only the femoral approach was used.
The study included 17059 patients and, at population level, vascular complications were higher in the contemporary cohort over the historical one (adjusted risk 2.91% vs. 1.98%; p=0.001).
In the contemporary cohort, the use of the radial access site brought significantly less vascular complications than the femoral access site (adjusted risk 1.44% vs. 4.19%; p < 0.001).
A higher risk of vascular complications was observed with the femoral access in the contemporary cohort compared to the historical cohort (adjusted risk 4.19% vs. 1.98%; p < 0.001). These findings were consistent both with the diagnostic and therapeutic procedures.
Conclusion
In a contemporary populations where both the femoral and the radial access sites were used, the benefits of the radial access site are partly associated with an increase in femoral access site complications.
Editorial Comment
The radial era paradox, increased number of overall vascular complications (including all radial and the few femoral approach patients) could be explained by the scarce training in femoral access, or the lack of it, since young operators have not been part of the transition from one technique to the other. This is true not only for entering the needle, but also for removing the catheter.