Author + information
- Brahim Harbaoui, MD, MS∗ (, )
- Nicolas Girerd, MD, PhD,
- Pierre-Yves Courand, MD, PhD and
- Pierre Lantelme, MD, PhD
- ↵∗Cardiology Department, Hôpital de la Croix-Rousse, 103 Grande Rue de la Croix-Rousse, 69004 Lyon, France
In the past decade, many centers have switched to radial access (RA) to perform cardiac catheterization on the grounds that it would reduce local vascular access site complications (VASC) and favor fast track patient management. However, its use remains highly variable. The study by Azzalini et al. (1) raises an unforeseen drawback of RA, which is a paradoxical increase in VASC risk with the femoral access (FA) when it is still used; this questions the net benefit of the RA over the classic FA approach. In their carefully designed study, they addressed several potential confounders of the FA paradox such as the severity of illness of the patients in whom the FA has been used, the progressive loss of skills when the physician changes from the FA to the RA, and new anticoagulant therapies. Yet, 1 crucial point is omitted in estimating the real benefit of switching to the RA in the cath lab, which is the rate of RA use. In their report, their contemporary cohort encompasses a rate of RA of only 46%, which is much lower than the rate of a center accustomed to using, by default, the RA (2). Based on the VASC risk reported by Azzalini et al. (1) (i.e., 2.9% for the historical FA cohort, 4.7% for the contemporary FA cohort, and 1.4% for the RA cohort), RA use >60% will overcome the paradoxical increased VASC related to FA use (2.9% > 4.7% × 0.4 + 1.4% × 0.6) (Figure 1). Thus, albeit, we do not intend to question the reality of this paradoxical increase in VASC with the FA, we would like to emphasize the need to switch more widely to the RA approach when this route is used in the cath lab. This condition is probably the best way to minimize VASC in the modern era. Indeed, even if the risk of complications increased with the residual use of FA, having very little FA will translate into low overall VASC because of the lower risk associated with changing to the RA. In a way, the simplest and almost trivial message of the paper by Azzalini et al. (1), rather than questioning its advantage, is to favor the RA in most cases, which is currently largely feasible.
Please note: The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- American College of Cardiology Foundation
- Azzalini L.,
- Tosin K.,
- Chabot-Blanchet M.,
- et al.
- Johnman C.,
- Pell J.P.,
- Mackay D.F.,
- et al.