title: Right and left heart catheterization via an antecubital fossa vein and the radial artery--a prospective study.
abstract: Right heart catheterization has been described via the arm but previous reports have been retrospective, performed for limited indications, and may not give an accurate assessment of the success rate or safety of this technique. We sought to prospectively examine the feasibility and safety of left and right heart catheterization entirely via the arm using the radial artery and an antecubital fossa vein for a broad range of indications. Fifty-eight consecutive procedures were included. Transradial arterial access was successful in 57 patients (98%), right heart catheterization via the antecubital fossa vein was successful in 54 patients (93%) and bilateral catheterization from the arm was achieved in 53 patients (91%). Standard diagnostic catheterization was the most frequent procedure (59%), although thermodilution (6.9%), percutaneous coronary intervention (33%), and coronary sinus sampling (16%) were also performed in selected cases. Compared to a historical cohort of patients undergoing right and left heart catheterization via femoral access, mean procedural time (38 vs 47 minutes; P=.03) and screening time (8.1 vs 11.2 minutes; P<.001) were significantly reduced. There was 1 venous forearm hematoma that was managed conservatively. Right and left heart catheterization can be performed routinely via the arm in a broad range of patients and is associated with reduced procedural and fluoroscopy time as compared to femoral access. This approach can be considered for all patients in whom right and left heart catheterization is planned.
authors.affiliation: James Cook University Hospital, Marton Road, Middlesbrough, United Kingdom TS4 3BW. dr.pdwilliams@gmail.com.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Williams
authors.forename: Sonny
authors.initials: S
authors.lastname: Palmer
authors.forename: Chris
authors.initials: C
authors.lastname: Judkins
authors.forename: Jack
authors.initials: J
authors.lastname: Gutman
authors.forename: Rob
authors.initials: R
authors.lastname: Whitbourn
authors.forename: Andrew
authors.initials: A
authors.lastname: MacIsaac
authors.forename: Bo
authors.initials: B
authors.lastname: Xu
authors.forename: Andrew
authors.initials: A
authors.lastname: Burns
authors.forename: Andrew
authors.initials: A
authors.lastname: Wilson
mesh_terms: D000368:Aged; D000792:Angiography; D006328:Cardiac Catheterization / Q000379:methods*; D005260:Female; D005542:Forearm / Q000098:blood supply*; D006352:Heart Ventricles; D006801:Humans; D008297:Male; D008722:Methods; D008875:Middle Aged; D011446:Prospective Studies; D017534:Radial Artery; D014680:Veins