Transradial right and left heart catheterizations: A comparison to traditional femoral approach

Upper extremity transvenous access for neuroendovascular procedures: an international multicenter case series

BACKGROUND

Radial artery access for transarterial procedures has gained recent traction in neurointerventional due to decreased patient morbidity, technical feasibility, and improved patient satisfaction. Upper extremity transvenous access (UETV) has recently emerged as an alternative strategy for the neurointerventionalist, but data are limited. Our objective was to quantify the use of UETV access in neurointerventions and to measure failure and complication rates.

METHODS

An international multicenter retrospective review of medical records for patients undergoing UETV neurointerventions or diagnostic procedures was performed. We also present our institutional protocol for obtaining UETV and review the existing literature.

RESULTS

One hundred and thirteen patients underwent a total of 147 attempted UETV procedures at 13 centers. The most common site of entry was the right basilic vein. There were 21 repeat puncture events into the same vein following the primary diagnostic procedure for secondary interventional procedures without difficulty. There were two minor complications (1.4%) and five failures (ie, conversion to femoral vein access) (3.4%).

CONCLUSIONS

UETV is safe and technically feasible for diagnostic and neurointerventional procedures. Further studies are needed to determine the benefit over alternative venous access sites and the effect on patient satisfaction.

Single arm access venous sinus stenting (SAVeS) technique: Technical note

Intracranial venous sinus stenting is gaining acceptance as an effective treatment for idiopathic intracranial hypertension (IIH). The typical approach is via femoral venous and arterial access for transvenous stenting with simultaneous angiography. These patients are at an above average risk for groin complications considering obesity is typically associated with IIH and the need for heparinization and dual antiplatelet therapy. Here, we describe cerebral venography, angiography, and venous sinus stenting via a single upper extremity. We utilize a transradial approach for angiography and a venous access via the brachial or basilic vein. Over a series of 28 consecutive procedures, we were able to successfully access the intracranial venous sinuses via the arm without access site complications. This method offers the advantages of immediate patient mobilization after the procedure and more easily monitored and compressible access sites for easier post-procedural care.

Ultrasound-guided antecubital vein approach for right heart catheterisation in a Brazilian tertiary centre

Objective

As a parallel to the radial approach for left heart catheterisation, forearm veins may be considered for the performance of right heart catheterisation. However, data regarding the application of this technique under ultrasound guidance are scarce. The current study aims to demonstrate the feasibility of right heart catheterisation through ultrasound-guided antecubital venous approach in the highly heterogeneous population usually referred for right heart catheterisation.

Methods

Data from consecutive right heart catheterisations performed at an academic centre in Brazil, between January 2016 and March 2017 were prospectively collected.

Results

Among 152 performed right heart catheterisations, ultrasound-guided antecubital venous approach was attempted in 127 (84%) cases and it was made feasible in 92.1% of those. Yet, there was no immediate vascular complication with the antecubital venous approach in this prospective series.

Conclusions

Ultrasound-guided antecubital venous approach for the performance of right heart catheterisation was feasible in the vast majority of cases in our study, without occurrence of vascular complications.

RadialFirst in CHIP and Cardiogenic Shock

This article highlights the advantages and disadvantages of transradial arterial (TRA) access for a variety of presentations including acute coronary syndromes; cardiogenic shock; unprotected left main, heavily calcified coronaries; bifurcations; and chronic total occlusions. It includes techniques for overcoming challenges of using TRA access, including spasm and the need for larger bore guides. In addition, the authors review the use of ultrasound for access, percutaneous hemodynamic support via axillary approach, and tips and tricks to performing right heart catheterizations from the antecubital vein.

Right Cardiac Catheterization Using the Antecubital Fossa Vein in Korean Patients

Background and Objectives

Right heart catheterization is traditionally performed using a femoral vein approach that involves admission, bed rest, and risks of bleeding and hematoma. Recent studies have confirmed safety of the use of forearm vein for right cardiac catheterization. In the present study, we evaluated the feasibility of right cardiac catheterization via the antecubital fossa vein in Korean patients.

Subjects and Methods

The medical records of all patients who underwent right heart catheterization at our hospital between January 2003 and December 2014 were reviewed retrospectively. Right cardiac catheterizations via the antecubital fossa vein and the femoral vein were compared in terms of demographic data (age, sex, weight, height, and body mass index), indications for right cardiac catheterization, and procedural and outcome data (initial success rate, procedure time, compression to ambulation time, and complications).

Results

We reviewed 132 cases (antecubital fossa vein approach, n=37; femoral vein approach, n=95). The demographic data, initial success rate (100% vs. 100%) and procedure time (21.6±16.8 min vs. 25.6±12.6 min, p=0.14) were similar in both groups. The antecubital fossa vein group had a shorter mean compression to ambulation time than the femoral vein group (0.0 min vs. 201.2±48.1 min, p<0.01). No complications were observed in either group.

Conclusion

Our study indicated the ease of performance of right cardiac catheterization via the antecubital fossa vein. Thus, the antecubital fossa vein can be an alternative access site for right cardiac catheterization in Korean patients.

Comparison of door-to-balloon times for primary PCI using transradial versus transfemoral approach

OBJECTIVES

The objective of this study was to compare door-to-balloon times and other variables in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI) using transfemoral or transradial approaches.

BACKGROUND

Transradial PCI has been shown to lower the risk of access site complications but the procedure is not applied to STEMI patients, due to concerns of procedural complexity adversely affecting prompt reperfusion. There is paucity of real-world data comparing TRI with TFI in patients with STEMI.

METHODS

Three hundred sixteen consecutive patients with STEMI undergoing primary PCI were studied. Patients were divided in two groups, Group I (n = 204) undergoing PCI transfemorally and Group II (n = 109) patients transradially. Demographic data, door-to-balloon times, procedural variables, predischarge adverse events, access site complications, and 1 year follow-up major adverse cardiac events (MACE) were recorded.

RESULTS

Door-to-balloon time was 72 +/- 14 min in Group I compared with 70 +/- 17 min in Group II, the difference was not statistically significant (t = 1.096, P > 0.27). Group II patients had significantly fewer access site complications compared with Group I (20 vs. 1 patient, chi(2) = 10.8, P < 0.05). Demographics, predischarge adverse events, and MACE at 1 year follow-up were comparable between the two groups.

CONCLUSIONS

Transradial approach to primary PCI provides similar door-to-balloon times to transfemoral approach, and significantly lowers access site related complications, in patients presenting with STEMI.