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Transradial approaches in women and the elderly: deciphering the challenges and opportunities

O Mirza, K Challa, S Yallapragada, P Banankhah & A Shroff

Transradial versus transfemoral approach: complications • The transition from the classic transfemoral (TF) approach to a transradial (TR) approach is notable for a dramatic reduction of access-associated complications (AAC) including decreased medical costs, hospitalization fees and length of stay. • Despite the improvement in vascular access closure devices and the use of safer anticoagulants, the relative risk for AAC remains higher in both female patients and elderly patients regardless of method of entry. Complications in females • There is a significantly increased risk for vascular complications in females using the TF approach. • Specific complications include entry site bleeding, hematoma, and pseudoaneurysm formation. • The relative risk for access complications in females is augmented with larger sheath sizes. • Bleeding and complication rates in females for diagnostic and interventional procedures combined are significantly lower using the TR versus the TF approach. Age-related impact on complications • Elderly populations who are post cardiac intervention have increased in-hospital mortality and morbidity related to vascular complications and bleeding. • The etiology of increased vascular complications is related to alteration in vascular anatomy and calcification. • There is a significant decrease in vascular complications when utilizing the TR approach versus the TF approach. Reconciling the challenges in TR approach in women & the elderly • Despite a proven decrease in vascular complications in women and elderly undergoing TR versus TF catheterization, there is still unwillingness for many operators to adopt TR catheterization into their practices, likely due to concerns regarding excess procedural and fluoroscopy times. • Upper extremity complications associated with the TR approach including perforations, forearm hematomas, and compartment syndromes are not conditions commonly faced by the interventional cardiology community and this likely augments the disproportionate anxiety level in operators. Conclusion • The benefits of TR over TF catheterization in female and elderly patient populations continue to outweigh the AAC in either group. • With increased emphasis on improved patient-centered outcomes, a TR option should be integrated into every institution’s cardiac catheterization program.