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Predictors of Conversion from Radial Into Femoral Access in Cardiac Catheterization
Maria Salomé Carvalho1, Rita Calé1, Pedro de Araújo Gonçalves1
1Hospital de Santa Cruz, Portugal.
Insights
The transradial approach for cardiac catheterization is highly successful, with a low conversion rate to femoral access. Predictors of conversion include female sex, older age, smaller body surface area, and percutaneous coronary intervention.
Area of Science:
- Cardiology
- Vascular Access Procedures
Background:
- Radial access is preferred for cardiac catheterization due to fewer bleeding risks and earlier ambulation.
- However, the transradial (TR) approach is not always successful, necessitating conversion to femoral access.
Purpose of the Study:
- To determine the conversion rate from radial to femoral access during cardiac catheterization.
- To identify independent predictors associated with this conversion.
Main Methods:
- A prospective dual-center registry of 7632 patients undergoing radial access cardiac catheterization.
- Logistic regression analysis was used to identify predictors of conversion to femoral access.
Main Results:
- The overall radial access failure rate requiring conversion was 5.8%.
- Key predictors for conversion included short introducer sheaths, percutaneous coronary intervention (PCI), female sex, multivessel disease, smaller body surface area (BSA), and older age (>66 years).
Conclusions:
- The transradial approach demonstrates a high success rate for cardiac catheterization.
- Factors such as female sex, advanced age, smaller BSA, specific procedural elements (short sheaths, PCI), and disease complexity (multivessel disease) predict the need for conversion to femoral access.
Background:
Fewer bleeding complications and early ambulation make radial access a privileged route for cardiac catheterization. However, transradial (TR) approach is not always successful, requiring its conversion into femoral access.
Objectives:
To evaluate the rate of conversion from radial into femoral access in cardiac catheterization and to identify its predictors.
Methods:
Prospective dual-center registry, including 7632 consecutive patients undergoing catheterization via the radial access between Jan/2009 and Oct/2012. We evaluated the incidence of conversion into femoral access and its predictors by logistic regression analysis.
Results:
The patients' mean age was 66 ± 11 years, and 32% were women. A total of 2969 procedures (38.4%) were percutaneous coronary interventions (PCI), and the most used first intention arterial access was the right radial artery (97.6%). Radial access failure rate was 5.8%. Independent predictors of conversion from radial into femoral access were the use of short introducer sheaths (OR 3.047, CI: 2.380-3.902; p < 0.001), PCI (OR 1.729, CI: 1.375-2.173; p < 0.001), female sex (OR 1.569, CI: 1.234-1.996; p < 0.001), multivessel disease (OR 1.457, CI: 1.167-1.819; p = 0.001), body surface area (BSA) ≤ 1.938 (OR 1.448, CI: 1.120-1.871; p = 0.005) and age > 66 years (OR 1.354, CI: 1.088-1.684; p = 0.007).
Conclusion:
Transradial approach for cardiac catheterization has a high success rate and the need for its conversion into femoral access in this cohort was low. Female sex, older age, smaller BSA, the use of short introducer sheaths, multivessel disease and PCI were independent predictors of conversion into femoral access.
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