Choosing Radial Over Femoral: Single-Center Study Tackles Questions of When and Why


CHICAGO, IL—With mounting safety evidence supporting the use of radial over femoral access for catheterization, a high-volume South Dakota center taking a closer look at all of its procedures over the past 5 years found that physicians are less likely to use a transradial approach in younger and smaller patients, those with STEMI, and those undergoing CABG.

Box. Choosing Radial Over Femoral: Single-Center Study Tackles Questions of When and Why If given the choice, patients strongly prefer transradial over transfemoral procedures purely from a comfort standpoint. Those who receive radial access are also able to walk more quickly than patients treated femorally, and they generally have shorter lengths of stay—reducing hospital costs. More importantly, studies like RIVAL, RIFLE-STEACS, and MATRIX have all shown strong safety signals favoring radial access.

The Sanford Heart Center (SHC) at the University of South Dakota in Sioux Falls is unusual in that upwards of three-quarters of its patients are cathed radially, and that proportion is growing, lead author and SHC Fellow Jimmy Yee, MD, told TCTMD during a poster session at the American College of Cardiology 2016 Scientific Sessions.

Yee and colleagues looked at 10,143 consecutive procedures conducted between 2011 and 2015 at their institution. Overall, 74.8% of patients were treated radially, and 61.3% were men.

Factors associated with radial access were aortic valve stenosis, dyslipidemia, elective procedures, unstable angina, NSTEMI, older age, and higher BMI. Conversely, older patients and those with cerebrovascular disease, CABG, STEMI or other emergency procedures, and lower BMIs were more likely to be treated transfemorally.

Table. Choosing Radial Over Femoral: Single-Center Study Tackles Questions of When and Why

Given that the data date back to 2011, Yee said the results are “a little bit delayed. I think if we [redid the analysis] from 2014 to 2015, it would be more shifted toward radial.”

He conjectured that femoral access appears to be favored in STEMI because many of these patients start with radial but are converted to femoral after access issues. After practicing in South Dakota for a year, Yee added, “I swear we do a lot more radials [in STEMI] than this shows.” Another puzzling finding was the preference to treat the youngest patients with femoral, he said. “That doesn’t make sense to me.”

The findings might also be skewed by the fact that the study includes diagnostic procedures performed by general cardiologists who “are probably not as comfortable with radial as an interventionalist would be,” Yee added.

Besides the hard clinical factors, he guessed that much of what goes into the decision of radial versus femoral is physician preference and “what they’re comfortable with.” While no guidelines currently exist governing when each access method should be used, Yee said he would not want to see one, at least for a while. Interventional cardiology is part skill and part “finesse,” he said. “So to tell someone who does not feel comfortable with radial to do radial, [would not make sense].”



Source:
  • Yee J. Current trend of factors influencing physician preference in radial vs. femoral access in angiography: a real world experience. Presented at: American College Cardiology 2016 Scientific Sessions. April 2, 2016. Chicago, IL.

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Disclosures
  • Yee reports no relevant conflicts of interest.

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