TITLE:
Excellent femoral outcomes when all access attempts and closure devices are performed by experienced cardiologists
AUTHORS:
Kevin S. Kang, Quentin Orlando, Robert Maholic, Richard Petrella, Gurjaipal S. Kang
KEYWORDS:
Operators; Access; Complications
JOURNAL NAME:
World Journal of Cardiovascular Diseases,
Vol.3 No.9,
December
23,
2013
ABSTRACT: 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.