Transradial access in a cath lab with moderate procedural volume: a single operator's experience.
OBJECTIVE
The transradial access (TRA) for cardiovascular interventions has become increasingly popular and was shown to be effective in many clinical settings, including acute coronary syndromes. Despite offering many advantages, such as a striking reduction in access site complications, the penetration of TRA in routine practice is still low. One reason for this could be that many studies about TRA were performed in high-volume centers by expert operators, making their results not fully applicable to the real world. In order to assess the efficacy of TRA, we retrospectively reviewed the caseload of a single operator working in a community hospital with moderate procedural volume.


METHODS
We considered 873 consecutive procedures, of which 406 percutaneous coronary interventions (PCI), performed by a single operator (S.R.) who had previously completed the learning curve in TRA at a high volume center.


RESULTS
TRA was selected in 48.3% of patients, transfemoral approach (TFA) in 50.9% and transbrachial approach in 0.8%. TFA was used more frequently in PCI (62.5% vs 37.5%; P<0.001), largely because it was the access of choice in primary PCI. The overall procedural success rate was 94% in TRA and 98% in TFA (P=0.035); access failure was more frequent in TRA (5.9% vs 1.1%; P<0.001), whereas an increased rate of access-related vascular complications was observed in TFA as compared to TRA (1.1% vs 0%; P=0.029).


CONCLUSIONS
After an adequate training period, the overall performance of TRA is good even in moderate-volume hospitals. Despite reducing access site complications, TRA is limited by a slightly higher rate of procedural failure as compared to TFA.
Rigattieri
S
S
Cardiology Department, Sandro Pertini Hospital, Rome, Italy. stefanorigattieri@yahoo.it
Ferraiuolo
G
G
Loschiavo
P
P
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D016507:Cardiology Service, Hospital; D002406:Catheterization, Peripheral; D017023:Coronary Angiography / Q000379:methods*; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D005260:Female; D005263:Femoral Artery / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D017534:Radial Artery / Q000601:surgery*; D012189:Retrospective Studies; D015607:Stents