Predictors of Conversion from Radial into Femoral Access in Cardiac Catheterization

Abstract

BackgroundFewer 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.ObjectivesTo evaluate the rate of conversion from radial into femoral access in cardiac catheterization and to identify its predictors.MethodsProspective 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.ResultsThe 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).ConclusionTransradial 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.

Elaboração e validação de um manual informativo sobre cateterismo cardíaco

“…(25) There is consensus that educational material must be written in a simple way that precisely communicates information. (18) Regarding the characteristics of patients undergoing cardiac catheterization, studies reported a mean patient age of 57 to 63 years, primarily men with a low educational level; (26,27) these findings agree with those reported in our study.…”

Lower Patient Height and Weight Are Predisposing Factors for Complex Radial Arterial Catheterization

“…In accordance with our data, the results from Kotowycz et al revealed that lower patient height, weight, BMI and BSA, together with other physiognomical parameters such as wrist circumference or shoe size, predict reduced radial artery size in patients undergoing cardiac catheterization [ 17 ]. Consequently, difficulties encountered during radial cannulation leading to conversion into femoral access were similarly shown to be associated with reduced patient height and body surface area [ 18 , 19 ]. This is somewhat surprising since radial catheterization is usually thought to be particularly challenging in obese patients [ 20 ].…”

Perfil dos pacientes submetidos ao cateterismo cardí­aco

“…A escolha da via se justifica pela maior facilidade para manipulação do profissional e por exigir menor treinamento do mesmo e maior rapidez no procedimento (26) . Entretanto, foi evidenciado por outros estudos (27,28) que o acesso radial tem benefícios mais expressivos que o femoral, incluindo menor tempo de internação hospitalar, ausência de restrição da deambulação, menor ocorrência de complicações vasculares e menor custo.…”