title: The Benefits Conferred by Radial Access for Cardiac Catheterization Are Offset by a Paradoxical Increase in the Rate of Vascular Access Site Complications With Femoral Access: The Campeau Radial Paradox.
abstract: OBJECTIVE
  The purpose of this study was to assess whether the benefits conferred by radial access (RA) at an individual level are offset by a proportionally greater incidence of vascular access site complications (VASC) at a population level when femoral access (FA) is performed.
  
  
  BACKGROUND
  The recent widespread adoption of RA for cardiac catheterization has been associated with increased rates of VASCs when FA is attempted.
  
  
  METHODS
  Logistic regression was used to calculate the adjusted VASC rate in a contemporary cohort of consecutive patients (2006 to 2008) where both RA and FA were used, and compared it with the adjusted VASC rate observed in a historical control cohort (1996 to 1998) where only FA was used. We calculated the adjusted attributable risk to estimate the proportion of VASC attributable to the introduction of RA in FA patients of the contemporary cohort.
  
  
  RESULTS
  A total of 17,059 patients were included. At a population level, the VASC rate was higher in the overall contemporary cohort compared with the historical cohort (adjusted rates: 2.91% vs. 1.98%; odds ratio [OR]: 1.48, 95% confidence interval [CI]: 1.17 to 1.89; p = 0.001). In the contemporary cohort, RA patients experienced fewer VASC than FA patients (adjusted rates: 1.44% vs. 4.19%; OR: 0.33, 95% CI: 0.23 to 0.48; p < 0.001). We observed a higher VASC rate in FA patients in the contemporary cohort compared with the historical cohort (adjusted rates: 4.19% vs. 1.98%; OR: 2.16, 95% CI: 1.67 to 2.81; p < 0.001). This finding was consistent for both diagnostic and therapeutic catheterizations separately. The proportion of VASCs attributable to RA in the contemporary FA patients was estimated at 52.7%.
  
  
  CONCLUSIONS
  In a contemporary population where both RA and FA were used, the safety benefit associated with RA is offset by a paradoxical increase in VASCs among FA patients. The existence of this radial paradox should be taken into consideration, especially among trainees and default radial operators.
authors.affiliation: Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Azzalini
authors.affiliation: Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada.
authors.forename: Kunle
authors.initials: K
authors.lastname: Tosin
authors.affiliation: Montreal Health Innovations Coordinating Center, Montréal, Québec, Canada.
authors.forename: Malorie
authors.initials: M
authors.lastname: Chabot-Blanchet
authors.affiliation: Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada.
authors.forename: Robert
authors.initials: R
authors.lastname: Avram
authors.affiliation: Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada.
authors.forename: Hung Q
authors.initials: HQ
authors.lastname: Ly
authors.affiliation: Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada.
authors.forename: Benoit
authors.initials: B
authors.lastname: Gaudet
authors.affiliation: Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada.
authors.forename: Richard
authors.initials: R
authors.lastname: Gallo
authors.affiliation: Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada.
authors.forename: Serge
authors.initials: S
authors.lastname: Doucet
authors.affiliation: Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Tanguay
authors.affiliation: Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada.
authors.forename: Réda
authors.initials: R
authors.lastname: Ibrahim
authors.affiliation: Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada.
authors.forename: Jean C
authors.initials: JC
authors.lastname: Grégoire
authors.affiliation: Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada.
authors.forename: Jacques
authors.initials: J
authors.lastname: Crépeau
authors.affiliation: Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada.
authors.forename: Raoul
authors.initials: R
authors.lastname: Bonan
authors.affiliation: Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada.
authors.forename: Pierre
authors.initials: P
authors.lastname: de Guise
authors.affiliation: Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Nosair
authors.affiliation: Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Dorval
authors.affiliation: Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada.
authors.forename: Gilbert
authors.initials: G
authors.lastname: Gosselin
authors.affiliation: Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada.
authors.forename: Philippe L
authors.initials: PL
authors.lastname: L'Allier
authors.affiliation: Montreal Health Innovations Coordinating Center, Montréal, Québec, Canada.
authors.forename: Marie-Claude
authors.initials: MC
authors.lastname: Guertin
authors.affiliation: Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada.
authors.forename: Anita W
authors.initials: AW
authors.lastname: Asgar
authors.affiliation: Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada. Electronic address: marc.jolicoeur@icm-mhi.org.
authors.forename: E Marc
authors.initials: EM
authors.lastname: Jolicœur
mesh_terms: D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000379:methods; D003324:Coronary Artery Disease / Q000601:surgery*; D005260:Female; D005263:Femoral Artery; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects* / Q000379:methods; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D011792:Quebec / Q000453:epidemiology; D017534:Radial Artery; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D062666:Vascular Access Devices / Q000009:adverse effects*
keywords: access site; cardiac catheterization; percutaneous coronary intervention; vascular complications