title: Comparison of Brachial Vein Versus Internal Jugular Vein Approach for Access to the Right Side of the Heart With or Without Myocardial Biopsy.
abstract: Right heart catheterization (RHC) and endomyocardial biopsy are mainstay procedures for patients with heart failure and heart transplantation. Approaches are predominantly neck (internal jugular) or leg (femoral vein). We describe a novel arm (brachial/basilica vein) approach. Over 5.5 years, 1,130 right-sided cardiac procedures in 276 patients were analyzed retrospectively and divided into either neck or arm approach. Comparative analyses of procedural success, time, safety, efficacy, and cost were performed. Patient preference was assessed for those who had both neck and arm approaches. In patients receiving RHC (174 neck and 121 arm cases) and in those receiving RHC + biopsy (594 neck and 141 arm cases), mean elapsed and fluoroscopic times (minutes), respectively, were 60 ± 20 versus 62 ± 19 and 3.43 ± 3.8 versus 4.99 ± 5.2 (RHC neck vs arm, respectively), and 55 ± 19 versus 63 ± 17 and 4.14 ± 3.4 versus 5.22 ± 2.6 (RHC + biopsy neck vs arm, respectively). Procedural complications were low (n = 7, 0.6%) and restricted to the neck approach. Patients surveyed preferred the arm approach. In conclusion, RHC and endomyocardial biopsy through the brachial vein can be performed safely, timely, effectively, and at equivalent cost compared with a neck approach. We advocate that an arm approach be the preferred method for these procedures.
authors.affiliation: Department of Cardiology, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina.
authors.forename: Neha
authors.initials: N
authors.lastname: Harwani
authors.affiliation: Department of Cardiology, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina.
authors.forename: Ebere
authors.initials: E
authors.lastname: Chukwu
authors.affiliation: Department of Cardiology, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina.
authors.forename: Manrique
authors.initials: M
authors.lastname: Alvarez
authors.affiliation: Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Milwaukee, Wisconsin. Electronic address: publishing112@aurora.org.
authors.forename: Vinay
authors.initials: V
authors.lastname: Thohan
mesh_terms: D001706:Biopsy / Q000379:methods*; D016121:Brachiocephalic Veins; D006328:Cardiac Catheterization / Q000379:methods*; D002405:Catheterization, Central Venous / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000175:diagnosis*; D006333:Heart Failure / Q000175:diagnosis*; D016027:Heart Transplantation; D006801:Humans; D007601:Jugular Veins; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013997:Time Factors