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Utility of Long Radial Artery Sheaths for Left Heart Catheterization
Aarash Roshandel1, Danielle Shields1, Ehab Abaza1
1Department of Internal Medicine, NYU Langone Health, New York, USA.
Insights
Longer hydrophilic sheaths can help avoid femoral access crossover during transradial procedures in patients with vessel tortuosity. This technique successfully engaged coronaries in 87% of cases without complications.
Area of Science:
- Cardiovascular Interventions
- Vascular Access Techniques
- Interventional Cardiology
Background:
- Vessel tortuosity can complicate transradial procedures.
- Longer hydrophilic sheaths offer an alternative to femoral access crossover.
Purpose of the Study:
- To evaluate the efficacy of long hydrophilic sheaths in transradial left heart catheterization.
- To determine if these sheaths can avoid femoral access crossover in tortuous vasculature.
Main Methods:
- Retrospective study of 71 patients undergoing left heart catheterization.
- Utilized 75 cm long thin-walled, hydrophilic sheaths.
- Collected data on patient and procedural characteristics, including complications.
Main Results:
- 87% of cases successfully engaged coronaries using the long sheath.
- Reasons for sheath use included tortuosity (86%) and radial spasm (14%).
- No procedural complications were reported.
Conclusions:
- Long thin-walled, hydrophilic radial sheaths can be effective in avoiding femoral access crossover.
- This approach is beneficial in selected cases with challenging anatomy.
Background:
Increased vessel tortuosity may hinder the success of transradial procedures. Longer thin-walled, hydrophilic sheaths ≥ 75 cm can be placed into the ascending aorta and have the potential to avoid femoral access crossover.
Methods:
We studied consecutive cases of patients undergoing left heart catheterization (LHC) where a 75 cm long thin-walled, hydrophilic sheath was used from 1/1/22 to 9/30/24. Patient and procedural characteristics were collected. Procedural data included indication, contrast load, radiation dose, procedural time, procedural complications, and the need to convert to femoral access.
Results:
Our study sample included 71 patients (mean age 69, 45% male). Comorbidities included hypertension (82%), hyperlipidemia (76%), and congestive heart failure (30%). Previous coronary artery disease was present in 31% of patients, and 20% of patients had undergone previous percutaneous coronary intervention (PCI). Indications for LHC included symptoms of stable ischemic heart disease (21%), abnormal non-invasive ischemic testing (52%), acute coronary syndrome (18%), and pre-operative evaluation for surgery (8%). The reason to switch to the long thin-walled, hydrophilic sheath was inability to engage the coronaries due to subclavian/brachiocephalic artery tortuosity (86%) or radial artery spasm (14%). After switching to the long thin-walled, hydrophilic sheath, 62/71 (87%) cases successfully engaged the coronaries without converting to femoral access. The mean procedure time was 36 min for diagnostic LHC cases (n = 46) and 72 min for PCI cases (n = 25). No procedural complications occurred.
Conclusion:
This case series suggests that use of the long thin-walled, hydrophilic radial sheaths can avoid femoral access crossover in selected cases.
Related Concept Videos
01:24Cardiac Catheterization III: Left Heart Catheterization
01:21Cardiac Catheterization II: Right Heart Catheterization
01:12Arteries of the Upper Limbs
01:28Cardiac Catheterization I: Pre-Procedure Overview
01:11Assessment of radial pulse
The radial pulse, located at the wrist, is often the preferred site for assessing peripheral pulse because of its accessibility and dependability. The process of determining the radial pulse involves several steps:
01:25Assessment of apical radial pulse
The A-R pulse assessment involves simultaneous evaluation of the apical and radial pulses. When the apical and radial pulse rates vary, this assessment helps identify a pulse deficit.
Pre-Procedural Preparation