Antecubital vs Femoral Venous Access for Right Heart Catheterization: Benefits of a Flashback

Although rare, complications of right heart catheterization (RHC) are usually related to the access site. Antecubital venous access for RHC allows immediate ambulation and may reduce access-site complications, but data on this approach are scarce.

Our study prospectively collected comprehensive data from consecutive RHCs performed at our academic center between February 2010 and August 2013. Demographic, procedural, and in-hospital outcomes were compared between patient groups defined by antecubital and femoral approaches.

A total of 1007 RHC procedures was performed; 895 (88.9%) were performed through an antecubital approach and 112 (11.1%) were performed through a femoral approach. Antecubital attempts were successful in 92.8% of the clinically eligible patients. The antecubital approach was associated with a shorter procedure duration and fluoroscopy time as well as a lower radiation dose (P < 0.001 for all) compared with femoral access. Radiation dose and fluoroscopy time were significantly reduced (P < 0.001 for both) when antecubital procedures were performed by experienced operators compared with trainees. Periprocedural complications occurred in 8 patients (0.8%) (leading to prolonged hospitalization in only 1 patient in the femoral group). Access-site hematoma occurred more frequently in the femoral group (P < 0.001).

An antecubital venous approach is a feasible alternative to femoral venous access for RHC. Shorter fluoroscopy time, lower radiation dose, and fewer access-site hematomas with this approach argue for its preferential use when possible and performed in an experienced centre.