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Alternative access site choice after initial radial access site failure for coronary angiography and intervention
Dionysios Gatzopoulos1, Aggeliki Rigatou1, Eleftherios Kontopodis1
1The Second Department of Cardiology, Hellenic Red Cross Hospital of Athens, Athens, Greece.
Insights
Transradial access for cardiac catheterization can fail. Alternative forearm arteries, like the ulnar artery, offer successful access when radial artery cannulation is unsuccessful, reducing femoral approach use.
Area of Science:
- Cardiology
- Vascular Access
- Interventional Cardiology
Background:
- Transradial access for coronary catheterization presents technical challenges compared to the transfemoral approach.
- Radial access failure is a recognized complication during cardiac catheterization procedures.
Purpose of the Study:
- To describe alternative access strategies following initial radial access failure.
- To evaluate the utility of forearm arteries as secondary access sites in cardiac catheterization.
Main Methods:
- Retrospective analysis of coronary catheterizations performed between January 2016 and December 2016.
- Focus on arterial access sites, including radial, ulnar, and femoral approaches.
- Evaluation of initial access success rates and alternative site utilization after failure.
Main Results:
- Out of 1346 procedures, initial radial access was used in 87.1%.
- Radial artery cannulation failure occurred in 2.9% of radial attempts.
- Alternative forearm access (contralateral radial, ipsilateral ulnar, contralateral ulnar) was successful in reducing femoral artery use.
Conclusions:
- Forearm arteries serve as viable alternative access sites after initial radial approach failure.
- Utilizing forearm arteries can effectively minimize the need for the transfemoral approach during cardiac catheterization.
Background:
Transradial access for coronary catheterization is more technically challenging compared to the traditional transfemoral approach and radial access failure is quite common. The aim of this study is to describe the additional steps after initial radial access site failure in a high specialized forearm approach center.
Methods:
A retrospective evaluation of all coronary catheterizations performed in our Department between January 2016 and December 2016 was performed, with focus on arterial access.
Results:
One thousand three hundred forty six procedures were evaluated. The initial access site used was right radial [1173 procedures (87.1%)], left radial [120 procedures (8.9%)], right ulnar [7 procedures (0.5%)], left ulnar [40 procedures (2.9%)] and femoral approach [6 procedures (0.4%)]. Radial artery cannulation failure was observed in 37 procedures (2.9% of 1293 procedures with initial radial approach). Failure of procedure completion after successful radial sheath insertion was observed in 46 procedures (3.6%). The alternative access site after initial radial approach failure was contralateral radial [43 procedures (51.8%)], ipsilateral ulnar [22 procedures (26.5%), contralateral ulnar [12 patients (14.5%)] and femoral approach [6 procedures (7.2%)].
Conclusion:
Forearm arteries can be used as alternative access site after initial radial approach failure in order to reduce the use of femoral approach during cardiac catheterization.
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