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Updated: Jan 20, 2026
Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
Primary and Secondary Vascular Access Site Complications Associated With Percutaneous Coronary Intervention: Insights
David Kopin1, Milan Seth1, Devraj Sukul1
1Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan.
Objectives:
This study sought to describe the association between trends in primary and secondary vascular access sites and vascular access site complications (VASCs) among patients who underwent percutaneous coronary intervention (PCI) in Michigan.
Background:
The frequency of transradial PCI has increased. As a result, there is concern that operators may lose femoral-access proficiency resulting in a paradoxical increase in PCI complications. Anecdotally, an increase in secondary access use during PCI has also been observed.
Methods:
Data from the BMC2 (Blue Cross Blue Shield of Michigan Cardiovascular Consortium) registry was queried to evaluate the use of transradial and transfemoral PCI and their associated VASCs.
Results:
From 2013 to 2017, transradial PCI increased from 25.9% to 45.2% and the overall use of secondary vascular access increased from 4.9% to 8.7% with minimal change in overall VASCs (1.2% to 1.4%). The use of secondary vascular access was associated with increased VASCs (odds ratio [OR]: 5.82; 95% confidence interval [CI]: 5.26 to 6.43). Although, patients treated by operators in the highest tertile of radial use were more likely to experience femoral VASCs (adjusted OR: 1.51; 95% CI: 1.08 to 2.13), treatment by these operators was associated with an overall reduction in all VASCs (adjusted OR: 0.62; 95% CI: 0.46 to 0.83).
Conclusions:
Despite increased use of transradial PCI, there has been no significant decrease in VASCs. This is in part attributable to an increased incidence of femoral VASCs and increasing use of secondary vascular access. An overall reduction in VASCs was observed in the highest radial use operators. Further strategies are needed to reduce VASCs in the transradial era.
Insights
Transradial percutaneous coronary intervention (PCI) use increased, but vascular access site complications (VASCs) did not decrease. Higher radial use operators reduced overall VASCs, despite increased femoral complications.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Vascular Access
Background:
- Transradial percutaneous coronary intervention (PCI) use has risen, raising concerns about potential declines in femoral access proficiency and increased PCI complications.
- Anecdotal observations suggest a rise in the use of secondary vascular access during PCI procedures.
Purpose of the Study:
- To examine the association between trends in primary and secondary vascular access sites and vascular access site complications (VASCs).
- To evaluate the impact of increasing transradial PCI use on VASCs.
Main Methods:
- Utilized data from the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2) registry.
- Analyzed the utilization of transradial and transfemoral PCI and their associated VASCs from 2013 to 2017.
Main Results:
- Transradial PCI increased from 25.9% to 45.2%; secondary access use rose from 4.9% to 8.7%.
- Overall VASCs showed minimal change (1.2% to 1.4%), but secondary access use was linked to higher VASCs (OR: 5.82).
- Operators with the highest radial use demonstrated an overall reduction in VASCs (aOR: 0.62), despite a higher likelihood of femoral VASCs (aOR: 1.51).
Conclusions:
- Increased transradial PCI use has not led to a significant decrease in overall VASCs, partly due to increased femoral VASCs and secondary access use.
- High-volume radial operators achieved better overall VASC outcomes.
- Further strategies are necessary to mitigate VASCs in the context of widespread transradial PCI adoption.
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