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Vascular complications and access crossover in 10,676 transradial percutaneous coronary procedures
Francesco Burzotta1, Carlo Trani, Mario Attilio Mazzari
1Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy. f.burzotta@rm.unicatt.it
Insights
The transradial approach for coronary procedures has a very low and stable rate of vascular complications (VCs). Access crossover rates decreased over time, influenced by operator experience.
Area of Science:
- Interventional Cardiology
- Vascular Access Techniques
- Percutaneous Coronary Interventions
Background:
- Transradial approach reduces vascular complications compared to transfemoral in select patients.
- However, radial access can lead to access-site VCs and higher failure rates.
Purpose of the Study:
- To prospectively assess vascular complications (VCs) and outcomes associated with the transradial approach.
- To investigate the rate and predictors of access crossover during transradial percutaneous coronary procedures.
Main Methods:
- Prospective assessment of 10,676 transradial procedures (May 2005-May 2010).
- Classification of VCs as radial-related or nonradial-related (access crossover).
- Categorization of VCs as major (requiring surgery/transfusion) or minor.
Main Results:
- A total of 53 VCs (0.5%) were observed, with 83% being radial-related.
- Major VCs occurred in 0.2% of patients.
- Access crossover rate was 4.9%, decreasing over time and varying with operator experience.
Conclusions:
- Transradial approach demonstrates a very low and stable rate of vascular complications in high-volume centers.
- Access crossover rates significantly decrease with operator experience and over time.
Background:
Randomized trials have shown that transradial approach, compared with transfemoral, reduces vascular complications (VCs) of coronary procedures in selected patients. Yet, radial approach is associated to a variety of access-site VC as well as to a higher failure rate compared with femoral access.
Methods:
At our institution, from May 2005 to May 2010, we prospectively assessed the occurrence and outcome of VC in consecutive patients undergoing transradial percutaneous coronary procedures performed by trained radial operators. The need of access crossover to complete the procedure was also prospectively investigated. Vascular complications were classified as "radial related" or "nonradial related" (in the case of access crossover). Vascular complications were also classified "major" if requiring surgery and/or blood transfusions or causing hemoglobin drop >3 g/dL.
Results:
Ten thousand six hundred seventy-six procedures were performed using a right radial (87.5%), left radial (12.4%), or ulnar (0.1%) artery as primary access. A total of 53 VCs (0.5%) were observed: 44 (83%) radial related and 9 (17%) nonradial related. Major VCs occurred in 16 patients only (0.2%) and were radial related in 10 (62.5%) and nonradial related in 6 (37.5%) patients. Vascular complications rate was stable during the study and independent of operator's experience. Access crossover rate was 4.9%, differed according to the operator radial experience and significantly decreased over time.
Conclusions:
The present study, conducted in a center with high volume of radial procedures, shows that transradial approach is associated with a very low rate of VC, which is stable over time. On the contrary, access crossover rate decreased over time and differed according to operator (radial) experience.
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