title: Real-time ultrasound guidance facilitates transradial access: RAUST (Radial Artery access with Ultrasound Trial).
abstract: OBJECTIVE
  This study sought to assess the utility of ultrasound (US) guidance for transradial arterial access.
  
  
  BACKGROUND
  US guidance has been demonstrated to facilitate vascular access, but has not been tested in a multicenter randomized fashion for transradial cardiac catheterization.
  
  
  METHODS
  We conducted a prospective multicenter randomized controlled trial of 698 patients undergoing transradial cardiac catheterization. Patients were randomized to needle insertion with either palpation or real-time US guidance (351 palpation, 347 US). Primary endpoints were the number of forward attempts required for access, first-pass success rate, and time to access.
  
  
  RESULTS
  The number of attempts was reduced with US guidance [mean: 1.65 ± 1.2 vs. 3.05 ± 3.4, p < 0.0001; median: 1 (interquartile range [IQR]: 1 to 2) vs. 2 (1 to 3), p < 0.0001] and the first-pass success rate improved (64.8% vs. 43.9%, p < 0.0001). The time to access was reduced (88 ± 78 s vs. 108 ± 112 s, p = 0.006; median: 64 [IQR: 45 to 94] s vs. 74 [IQR: 49 to 120] s, p = 0.01). Ten patients in the control group required crossover to US guidance after 5 min of failed palpation attempts with 8 of 10 (80%) having successful sheath insertion with US. The number of difficult access procedures was decreased with US guidance (2.4% vs. 18.6% for ≥5 attempts, p < 0.001; 3.7% vs. 6.8% for ≥5min, p = 0.07). No significant differences were observed in the rate of operator-reported spasm, patient pain scores following the procedure, or bleeding complications.
  
  
  CONCLUSIONS
  Ultrasound guidance improves the success and efficiency of radial artery cannulation in patients presenting for transradial catheterization. (Radial Artery Access With Ultrasound Trial [RAUST]; NCT01605292).
authors.affiliation: Division of Cardiology, Department of Medicine, Long Beach Veterans Affairs Medical Center, Long Beach, California; Division of Cardiology, Department of Medicine, University of California, Irvine Medical Center, Orange, California. Electronic address: arnoldseto@yahoo.com.
authors.forename: Arnold H
authors.initials: AH
authors.lastname: Seto
authors.affiliation: Baptist Cardiac and Vascular Institute, Baptist Hospital of Miami, Miami, Florida.
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Roberts
authors.affiliation: Cardiovascular Section, Department of Medicine, Veterans Affairs Medical Center and University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
authors.forename: Mazen S
authors.initials: MS
authors.lastname: Abu-Fadel
authors.affiliation: Lenox Hill Heart and Vascular Institute of New York, North Shore LIJ Lenox Hill Hospital, New York, New York.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Czak
authors.affiliation: Cardiovascular Section, Department of Medicine, Veterans Affairs Medical Center and University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
authors.forename: Faisal
authors.initials: F
authors.lastname: Latif
authors.affiliation: Lenox Hill Heart and Vascular Institute of New York, North Shore LIJ Lenox Hill Hospital, New York, New York; Jamaica Hospital Medical Center, New York, New York.
authors.forename: Suresh P
authors.initials: SP
authors.lastname: Jain
authors.affiliation: Lenox Hill Heart and Vascular Institute of New York, North Shore LIJ Lenox Hill Hospital, New York, New York; Jamaica Hospital Medical Center, New York, New York.
authors.forename: Jaffar A
authors.initials: JA
authors.lastname: Raza
authors.affiliation: Lenox Hill Heart and Vascular Institute of New York, North Shore LIJ Lenox Hill Hospital, New York, New York; Jamaica Hospital Medical Center, New York, New York.
authors.forename: Aditya
authors.initials: A
authors.lastname: Mangla
authors.affiliation: Lenox Hill Heart and Vascular Institute of New York, North Shore LIJ Lenox Hill Hospital, New York, New York.
authors.forename: Georgia
authors.initials: G
authors.lastname: Panagopoulos
authors.affiliation: Division of Cardiology, Department of Medicine, University of California, Irvine Medical Center, Orange, California.
authors.forename: Pranav M
authors.initials: PM
authors.lastname: Patel
authors.affiliation: Division of Cardiology, Department of Medicine, Long Beach Veterans Affairs Medical Center, Long Beach, California; Division of Cardiology, Department of Medicine, University of California, Irvine Medical Center, Orange, California.
authors.forename: Morton J
authors.initials: MJ
authors.lastname: Kern
authors.affiliation: Lenox Hill Heart and Vascular Institute of New York, North Shore LIJ Lenox Hill Hospital, New York, New York; Jamaica Hospital Medical Center, New York, New York.
authors.forename: Zoran
authors.initials: Z
authors.lastname: Lasic
mesh_terms: D006328:Cardiac Catheterization / Q000379:methods*; D005260:Female; D006489:Hemostatic Techniques; D006801:Humans; D008297:Male; D008875:Middle Aged; D010173:Palpation; D011446:Prospective Studies; D017534:Radial Artery; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
keywords: radial artery spasm; transradial cardiac catheterization; ultrasound guidance; vascular access