title: Trans-radial versus trans-femoral access in patients with end-stage liver disease undergoing cardiac catheterization.
abstract: Cardiac catheterization has been increasingly utilized to evaluate coronary artery disease in patients with end stage liver disease (ESLD). It is known in other populations that radial access reduces access site complications;however, there is a paucity of data in ESLD patients. We investigated vascular and bleeding complications rates between trans-femoral and trans-radial cardiac catheterizations in this high risk population. In this retrospective cohort study, three hundred and thirty four ESLD patients were identified between August 2004 and December 2012 who had undergone trans-femoral (femoral group) or trans-radial (radial group) cardiac catheterizations at our institution. The radial group was not significantly different from the femoral group in age (p = 0.056), proportions of genders (p = 0.85), and weight (p = 0.19); however, compared to the femoral group, the radial group had significantly lower blood pressure (p < 0.0001), hemoglobin (10.4 ± 1.9 vs 11.1 ± 2.02 g/dL, p = 0.001), and hematocrit (30.3 ± 5.7% vs 32.6 ± 6.0%, p < 0.0006), and had a significantly higher INR (1.94 ± 1.16 vs 1.59 ± 0.62, p = 0.0001). In terms of vascular complications, the radial group had a significantly lower rate of pseudoaneurysms (0% vs 3.7%, p = 0.019) than the femoral group. While there were no bleeding complications in either group or differences in transfusion requirements, there was a significantly lower percentage drop in hematocrit in the radial group compared to the femoral group (5.4% vs 7.8%, p = 0.039). In conclusion, trans-radial catheterization is associated with lower rates of vascular access site complications compared to trans-femoral catheterization.
authors.affiliation: Department of Medicine, University of California San Francisco, USA.
authors.forename: Kent
authors.initials: K
authors.lastname: Feng
authors.affiliation: Department of Medicine, University of California San Francisco, USA.
authors.forename: Vipul
authors.initials: V
authors.lastname: Gupta
authors.affiliation: Department of Laboratory Medicine, University of California San Francisco, USA.
authors.forename: Enrique
authors.initials: E
authors.lastname: Terrazas
authors.affiliation: Department of Medicine, University of California San Francisco, USA.
authors.forename: Yerem
authors.initials: Y
authors.lastname: Yeghiazarians
authors.affiliation: Department of Medicine, University of California San Francisco, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Ports
authors.affiliation: Department of Medicine, University of California San Francisco, USA.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Gregoratos
authors.affiliation: Department of Surgery, University of California San Francisco, USA.
authors.forename: Mehdi
authors.initials: M
authors.lastname: Tavakol
authors.affiliation: Department of Surgery, University of California San Francisco, USA.
authors.forename: John Paul
authors.initials: JP
authors.lastname: Roberts
authors.affiliation: Department of Medicine, University of California San Francisco, USA ; University of Newcastle Australia ; John Hunter Hospital Newcastle, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Boyle
keywords: Cardiac catheterization; access site; end-stage liver disease