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Transradial right and left heart catheterizations: a comparison to traditional femoral approach
Ian C Gilchrist1, Carey D Moyer, Joseph A Gascho
1Penn State Heart and Vascular Institute, Hershey Medical Center, Hershey, Pennsylvania 17033-0850, USA. icg1@psu.edu
Insights
Transradial catheterization combined with forearm venous access is safer and faster than the transfemoral approach for bilateral heart catheterization, with fewer access site complications.
Area of Science:
- Cardiovascular Interventions
- Vascular Access Techniques
- Diagnostic Cardiology
Background:
- Central venous access via peripheral veins is a valuable technique.
- Historically, right-heart catheterization was an exclusion criterion for transradial approaches.
- This study explored combining radial arterial access with forearm venous access for bilateral heart catheterization.
Purpose of the Study:
- To compare the safety and efficacy of transradial versus transfemoral approaches for combined right- and left-heart catheterization.
- To evaluate the feasibility of using forearm venous access in conjunction with transradial arterial access.
- To assess postprocedural complications associated with each approach.
Main Methods:
- Retrospective review of 175 transfemoral and 105 transradial cases over 18 months.
- Exclusion of salvage, mixed-site, and biopsy procedures.
- Comparison of demographics, procedural duration, and access site complications between radial and femoral groups.
Main Results:
- Procedural duration was shorter in the transradial group (70 min) compared to the transfemoral group (75 min).
- Access site complications occurred in 12 femoral patients but in zero radial patients.
- Crossover rates were low, with radial failure attributed to prior shoulder trauma and femoral crossover due to arterial access difficulties.
Conclusions:
- Forearm venous access for central venous access appears safer than using femoral vessels.
- Transradial catheterization, when combined with forearm venous access, offers excellent results and improved patient safety for bilateral heart catheterization.
Objectives:
This study compares the transradial versus transfemoral approach to combined right- and left-heart catheterization.
Background:
Central venous access from peripheral veins has been a historically useful technique. Although the need for right-heart catheterization has been considered an exclusion for transradial catheterization, we have combined a peripheral approach to the central venous system with radial arterial access which permits bilateral heart catheterization using a transradial approach.
Methods:
Over an 18-month period all right-heart catheterizations done in conjunction with arterial access were reviewed. Salvage procedures, mixed site access, and biopsy procedures were excluded. Radial procedures were performed using radial artery access and a forearm vein. Femoral procedures used femoral artery/vein. Demographics, procedural information, and postprocedural complications including those requiring vascular ultrasound or transfusion were recorded and used for comparison between groups.
Results:
Total of 175 femoral/105 radial cases done by 4 operators met criteria for comparison. Both groups had similar procedural indications and age. Procedural durations were shorter (P < .01) with radial 70 +/- 5.0 min (+/-95% CI) vs. femoral 75 +/- 5.4 min (+/-95% CI). Crossover was noted in several patients from both groups; radial procedures (n = 2) failed due to previous shoulder trauma. Femoral crossover to radial involved difficult arterial access. Complications related to access site occurred in 12 femoral and 0 radial patients.
Conclusions:
Using the forearm for central venous access appears safer than using the femoral vessels. Transradial catheterizations can be done in combination with forearm venous access procedures with excellent results and enhanced patient safety.
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