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

To learn more about the Impella® platform of heart pumps, including important risk and safety information associated with the use of the devices, please visit: