A randomized study of sheaths versus guidewires for arterial access during elective cardiac catheterization

The aim of this study was to compare the ease and safety of intravascular sheaths versus guidewires for maintaining arterial access during cardiac catheterization.

Two hundred patients with normal coagulation status undergoing routine diagnostic cardiac catheterization were randomized to intravascular sheath access versus guidewire access groups. Procedure times and difficulties were recorded during the procedure. Patients were asked to evaluate groin discomfort immediately after the procedure and two weeks later. Complications including groin hematoma, vascular damage, and stroke were assessed at the end of the procedure and the following morning.

There were no differences between the sheath and guidewire groups in patient discomfort, procedural time or difficulty, or total complications. Hematomas occurred in 18% of patients (sheath 16% vs. guidewire 20%, p = NS) and were more often large in the guidewire group (5% vs. 0%, p = .05). None required vascular repair. Oozing around the catheter was more frequent in the guidewire group (6% vs. 0%, p = .03) but did not lead to any significant complications.

We conclude that using guidewires for arterial access during cardiac catheterization leads to more large hematomas and more access site oozing during the procedure. However, there were no differences in patient comfort, overall procedural difficulty, or total complications between sheath and guidewire techniques.