Vascular complications and access crossover in 10,676 transradial percutaneous coronary procedures.
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.
Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy. f.burzotta@rm.unicatt.it
Francesco
F
Burzotta
Carlo
C
Trani
Mario Attilio
MA
Mazzari
Antonella
A
Tommasino
Giampaolo
G
Niccoli
Italo
I
Porto
Antonio Maria
AM
Leone
Giovanni
G
Tinelli
Valentina
V
Coluccia
Maria
M
De Vita
Marta
M
Brancati
Rocco
R
Mongiardo
Giovanni
G
Schiavoni
Filippo
F
Crea
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000379:methods; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D009203:Myocardial Infarction / Q000628:therapy*; D011446:Prospective Studies; D017534:Radial Artery; D012307:Risk Factors; D014652:Vascular Diseases / Q000453:epidemiology / Q000209:etiology*