title: Safety of transradial cardiac catheterization in patients with end-stage liver disease.
abstract: BACKGROUND
  Transradial access may be advantageous for patients with end-stage liver disease (ESLD) who need to undergo left heart catheterization (LHC). We aimed to assess the safety of transradial cardiac catheterization in patients listed for orthotopic liver transplantation.
  
  
  METHODS
  This is a retrospective analysis of consecutive adult patients with the diagnosis of ESLD, who underwent LHC via transradial access as part of a pre-operative liver transplantation evaluation. All the patients also underwent right heart catheterization (RHC) via brachial or femoral vein. The primary outcome measure was procedure-related major bleeding. Secondary outcomes included access site minor bleeding, in-hospital mortality, radial access failure, and acute kidney injury.
  
  
  RESULTS
  A total of 82 consecutive patients with ESLD, who underwent LHC via transradial access, were enrolled in the study. All patients also underwent RHC (n = 45 via brachial and n = 37 via femoral vein). The median age was 59 (54, 67) years old, and 58% were male. History of coronary artery disease or heart failure was present in 17% of patients. The median MELD score was 19 (13, 24.5), baseline hemoglobin was 10.5 mg/dL (9.4, 11.8), INR was 1.4 (1.2, 1.8) and platelets were 74,000 (53,000, 117,000)/mm(3) . The most common etiology of liver failure was viral hepatitis (51%), followed by alcoholic cirrhosis (24%) and non-alcoholic steatohepatitis (21%). Angiographically significant coronary artery disease was present in 17 (21%) patients. Major bleeding and acute kidney injury each occurred in two patients (2.4%). There were no instances of vascular complications. There were no deaths attributable to complications from cardiac catheterization.
  
  
  CONCLUSIONS
  Upper extremity right and left heart catheterization appears to be a safe method to evaluate coronary anatomy and hemodynamics in a severely ill population of patients with ESLD awaiting transplant.
authors.affiliation: From the Cardiovascular Division, Department of Medicine, and the Elaine and Sydney Sussman Cardiac Catheterization Laboratory, University of Miami Hospital, Miller School of Medicine, Miami, Florida.
authors.forename: Evan
authors.initials: E
authors.lastname: Jacobs
authors.forename: Vikas
authors.initials: V
authors.lastname: Singh
authors.forename: Abdulla
authors.initials: A
authors.lastname: Damluji
authors.forename: Neil R
authors.initials: NR
authors.lastname: Shah
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Warsch
authors.forename: Ravi
authors.initials: R
authors.lastname: Ghanta
authors.forename: Paul
authors.initials: P
authors.lastname: Martin
authors.forename: Carlos E
authors.initials: CE
authors.lastname: Alfonso
authors.forename: Claudia A
authors.initials: CA
authors.lastname: Martinez
authors.forename: Mauro
authors.initials: M
authors.lastname: Moscucci
authors.forename: Mauricio G
authors.initials: MG
authors.lastname: Cohen
mesh_terms: D000368:Aged; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology; D058625:End Stage Liver Disease / Q000150:complications* / Q000401:mortality / Q000601:surgery; D005260:Female; D006439:Hemodynamics; D006470:Hemorrhage / Q000209:etiology / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D018579:Patient Selection; D011300:Preoperative Care; D011677:Punctures; D017534:Radial Artery; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D014850:Waiting Lists
keywords: bleeding and transplant; cardiac catheterization; liver disease; transradial