Transcarpal cardiac catheterization

Even though the performance of coronary diagnostic and therapeutic procedures through the distal forearm arteries has become a well-established practice, only a small minority of procedures employ transcarpal approach. The aim of this review is to describe the state of art in cardiac catheterization through distal forearm arteries, to point out the advantages and disadvantages of this approach, and to discuss the specific aspects in which it differs from the transfemoral approach.

A Medline search up to January 2009 and the articles retrieved were selectively evaluated. Practical recommendations are given based on the authors' experience.

The following advantages of the transcarpal approach to the coronary arteries, as compared to the transfemoral approach, were evident in 23 prospective randomized studies and registries: a lower risk of complications at the site of access (0.05% and 0.3% versus 2.3% and 2.8%), lower mortality (2.8% versus 3.9%), greater patient comfort, lower cost (14% and 15% lower), and a shorter hospital stay (1.5 days and 3 days versus 1.8 days and 4.5 days). Its disadvantages include the potential need for conversion to a transfemoral procedure, higher radiation exposure of the physician, and an extended learning curve, so that procedure times are longer and rates of technical failure are higher until about 400 procedures have been performed.

The current data give a favorable view of this procedure as long as its specific requirements in terms of pretreatment, choice of materials, technique, post-procedural care, and expertise of the physician are taken into account.