Predictors of conversion from radial to femoral access in cardiac catheterization

Abstract

Aims: To study the prevalence of conversion from Radial (RA) to Femoral Access (FA) in cardiac catheterization and identify its clinical and demographic predictors. Methods and results: Prospective multicentre registry, including 7664 consecutive pts undergoing catheterization via RA between Jan/2009 and Out/2012 (66±11 years, 32% female). A total of 2982 procedures (38.9%) were PCIs and the most used route was the right RA (97.6%). We evaluated the incidence of conversion to FA and its predictors by logistic regression analysis. RA failure rate was 6.2%, with conversion to FA in most cases (93.9%). The need for conversion was more frequent in older pts (mean age 69±12 yrs vs 65±11 yrs, p<0.001), women (8.6% vs 4.5%, p <0.001) and in pts with a smaller body surface area (mean BSA 1.82±0.18 vs 1.87±0.20, p<0.001). Smoking was associated with lower RA failure (4.2% vs 7.0%, p <0.001). Conversion rate to FA was more frequent in PCIs (7.4%) than in diagnostic catheterizations (4.8%), p<0.001. Conversion rate was also higher when shorter introducer were used compared to the longer ones (8.0% vs 3.6%, p <0.001), but less with 6F caliber introducer compared to 4F or 5F introducers (5.5% vs 7.6%, p = 0.009). Independent predictors of conversion from RA to FA are shown in the graph. ![Figure][1] Conclusion: Transradial approach for cardiac catheterization was associated with a high success rate. The need for conversion to FA was very low, especially when long introducers were used. Some demographic predictors of conversion were identified (female gender, older age and smaller BSA), which could be taken in consideration when choosing the vascular access. [1]: pending:yes