Predictors of Conversion from Radial Into Femoral Access in Cardiac Catheterization

Background

Fewer bleeding complications and early ambulation make radial access a privilegedroute for cardiac catheterization. However, transradial (TR) approach is notalways successful, requiring its conversion into femoral access.

Objectives

To evaluate the rate of conversion from radial into femoral access in cardiaccatheterization and to identify its predictors.

Methods

Prospective dual-center registry, including 7632 consecutive patients undergoingcatheterization via the radial access between Jan/2009 and Oct/2012. We evaluatedthe incidence of conversion into femoral access and its predictors by logisticregression analysis.

Results

The patients’ mean age was 66 ± 11 years, and 32% were women. A total of2969 procedures (38.4%) were percutaneous coronary interventions (PCI), and themost used first intention arterial access was the right radial artery (97.6%).Radial access failure rate was 5.8%. Independent predictors of conversion fromradial 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), femalesex (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).

Conclusion

Transradial approach for cardiac catheterization has a high success rate and theneed for its conversion into femoral access in this cohort was low. Female sex,older age, smaller BSA, the use of short introducer sheaths, multivessel diseaseand PCI were independent predictors of conversion into femoral access.