Total wrist access for angiography and interventions: Procedural success and access site crossover in a high volume transradial center

To assess the crossover rate from primarily chosen transradial access (TRA) in a high volume transradial center. All consecutive 30,848 patients, that underwent diagnostic angiography and/or intervention in the period from 2010 until 2015 were examined. Preprocedural radial artery angiography was performed in all patients since 2011. Clinical and procedure characteristics, reason for crossover and its direction were analyzed. Primary end-point of the study was the occurrence of TRA failure and need to crossover to another approach to finish the procedure. Procedural success of primarily chosen TRA was 94% (n = 28,988). Crossover to other access sites was 6% (n = 1860). Most common reason for crossover was inability to puncture the right radial artery in 4,1%, presence of radial artery anomalies (0,3%), high grade spasm (0,1%), or radial artery occlusion (1,2%). Crossover direction was primarily through the ipsilateral transulnar access (TUA) 3,8%, left radial access (LRA) 1,5% and in only 0,6% (n = 189) of patients to transfemoral access (TFA). Access site bleeding complications were present in 5,1% (n 1579). Total wrist access is feasible and safe with low rate of access site complications and crossovers, especially when performed in experienced high volume transradial center. •Total wrist access can be implemented safely in experienced transradial centers.•This is an observational study with a large patient cohort.•Failure of transradial access is caused by failure to puncture, presence of RA anomalies, high grade spasm or RA occlusion.•Pre-procedural radial artery angiography provides a roadmap for successful arterial access.•Total wrist access is feasible and safe with low percentage of access site complications