The Campeau Radial Paradox: Radial vs. Femoral Access [JACC]

May 12, 2016

A 2015 paper on the Campeau Radial Paradox in JACC Cardiovasc Interventions highlights the issue of access: radial vs. femoral access. This topic is often debated between physicians who are femoral versus radial operators. The radial enthusiasts believe their procedure is superior for both patient comfort and safety, and highlight the mortality benefit of a radial approach. Femoral operators point out that a femoral procedure is equally good in skilled hands, and may sometimes need to be used.  For example, the use of the Impella® requires a femoral-based approach.

Azzalini et al. “investigated the effects of the radial approach on the occurrence of vascular access site complications in a contemporary cohort of patients receiving both radial and femoral approaches compared with a historical cohort that only used the femoral approach. The authors found the rate of vascular complications was higher in the contemporary cohort compared with the historical cohort because of the higher rate of complications in femoral patients.”

The main point of the Campeau Radial Paradox is that the less frequently a procedure is conducted, such as a femoral catheterization, the less skilled the physician is at performing that procedure. Current interventional cardiologists should receive training for both femoral and radial approaches, because all procedures cannot be done radially. Once physicians know both approaches, they may take a radial-first approach because patients prefer it, or they are comfortable with it, and like it. But cardiologists will also need to maintain their femoral skills to be able to treat more complex patients, such as those undergoing Protected PCI.

Next Steps:

  1. Read the original paper by Azzalini et al. 2015
  2. Learn more about the use of Impella 2.5 for PCI


About Impella

The Impella 2.5 system is a temporary (<6 hours) ventricular support device indicated for use during high risk percutaneous coronary interventions (PCI) performed in elective or urgent, hemodynamically stable patients with severe coronary artery disease and depressed left ventricular ejection fraction, when a heart team, including a cardiac surgeon, has determined high risk PCI is the appropriate therapeutic option. Use of the Impella 2.5 in these patients may prevent hemodynamic instability which can result from repeat episodes of reversible myocardial ischemia that occur during planned temporary coronary occlusions and may reduce peri- and post-procedural adverse events.

Protected PCI and use of the Impella 2.5 is not right for every patient. Patients may not be able to be treated with Impella if they have certain pre-existing conditions, which a cardiologist can determine, such as: severe narrowing of the heart valve, severe peripheral artery disease, clots in blood vessels, or a replacement heart valve or certain heart valve deficiencies. Additionally, use of Impella has been associated with risks, including, but not limited to valvular and vascular injury, bleeding, and limb ischemia in certain patients. Learn more about the Impella devices’ approved indications for use, as well as important safety and risk information at