Excellent femoral outcomes when all access attempts and closure devices are performed by experienced cardiologists

DOI: 10.4236/wjcd.2013.39089   PDF   HTML     2,915 Downloads   4,211 Views  


Femoral access is considered less safe for access site complications than the radial access. Cardiovascular procedures have not been studied taking operator experience, defined as American Board of Internal Medicine, Interventional Cardiology certification or equivalent qualification in another country, into account. We hypothesize that the procedural results are operator dependent and excellent results are obtained when procedures are performed by experienced operators. Femoral access is higher risk than radial access based on American College of Cardiology (ACC) guidelines. Femoral access is less forgiving, as opposed to radial, as it is an end-artery, lacks easy compressibility and is more likely to cause morbidity when injured. Hence, radial is recommended over the femoral approach according to ACC practice guidelines. These guidelines are often based on the randomized studies from academic centers where trainees, with variable arterial access experience, perform the initial access stick and arterial closure device deployment. Methods: We performed a single center retrospective review of 32,446 consecutive patients undergoing invasive cardiovascular procedures done from the femoral approach using American College of Cardiology/National Cardiovascular Data Registry (ACC/NCDR) from January 1, 2006 to June 30, 2013. Only experienced operators performed the actual access site stick and the reminder of the invasive procedure. Results: Total bleeding and vascular complications were less than 1%. We define outcomes as excellent if the total bleeding and vascular complication risk is less than 1% based on previous studies discussed in the ACC guidelines. Conclusion: Excellent outcomes can be obtained from the femoral access if experienced cardiologists perform the procedure. Hence, radial arterial access over the femoral access may be selectively rather than universally recommended considering the possibility of varying level of femoral access expertise of different practices.


Share and Cite:

Kang, K. , Orlando, Q. , Maholic, R. , Petrella, R. and Kang, G. (2013) Excellent femoral outcomes when all access attempts and closure devices are performed by experienced cardiologists. World Journal of Cardiovascular Diseases, 3, 569-572. doi: 10.4236/wjcd.2013.39089.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Gruentzig, A. (1978) Transluminal dilatation of coronary-artery stenosis. Lancet, 1, 263.
[2] Doyle, B.J., Rihal, C.S., Gastineau, D.A. and Holmes, D.R., Jr. (2009) Bleeding, blood transfusion, and increased mortality after percutaneous coronary intervenetion: implications for contemporary practice. Journal of the American College of Cardiology, 53, 2019-2027.
[3] Jolly, S.S., Yusuf, S., Cairns, J., et al. (2011) RIVAL trial group. Radial versus femoral access for coronary angiography and intervention in patients with acute coronary syndromes (RIVAL): A randomized, parallel group, multicenter trial. Lancet, 377, 1409-1420.
[4] Levine, G.N., Bates, E.R., Blankenship, J.C., et al. (2011) ACCF/AHA/SCAI Guideline for percutaneous coronary intervention: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. Journal of the American College of Cardiology, 58, e44-e122.
[5] Jolly, S.S., Cairns, J., Niemela, K., et al. (2013) Effect of radial versus femoral access on radiation dose and the importance of procedural volume: A substudy of the multicenter randomized RIVAL trial. JACC: Cardiovascular Interventions, 6, 258-266.
[6] Biondi-Zoccai, G., Sciahbasi, A., Bodí, V., FernándezPortales, J., et al. (2013) Right versus left radial artery access for coronary procedures: An international collaborative systematic review and meta-analysis including 5 randomized trials and 3210 patients. International Journal of Cardiology, 166, 621-626.
[7] Gray, W.A., Rosenfield, K.A., Jaff, M.R., et al. (2011) Influence of site and operator characteristics on carotid artery stent outcomes: Analysis of the CAPTURE 2 (Carotid Acculink/Accunet Post Approval Trial to Uncover Rare Events)clinical study. Journal of the American College of Cardiology, 4, 235-246.
[8] Kastrati, A., Neumann, F.J. and Schomig, A. (1998) Operator volume and outcome of patients undergoing coronary stent placement. Journal of the American College of Cardiology, 32, 970-976.
[9] Nicholas, R., Balaji, P. and Shah, B. (2011) Radial artery catheterization. American Heart Association, 124, e407-e408.
[10] Rao, S.V., Ou, F.S., Wang, T.Y., et al. (2008) Trends in the prevalence and outcomes of radial and femoral approaches to percutaneous coronary intervention: A report from the National Cardio-vascular Data Registry. JACC: Cardiovascular Interventions, 1, 379-386.
[11] Kiran, R.P., Ahmed Ali, U., Coffey, J.C., et al. (2012) Impact of resident participation in surgical operations on postoperative outcomes: National surgical quality improvement program. Annals of Surgery, 256, 469-475.

comments powered by Disqus

Copyright © 2020 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.