title: Evolving Techniques to Improve Radial/Ulnar Artery Access: Crossover Rate of 0.3% in 1,000 Consecutive Patients Undergoing Cardiac Catheterization and/or Percutaneous Coronary Intervention via the Wrist.
abstract: OBJECTIVE
  To evaluate several techniques to reduce crossover rates in wrist artery access in patients undergoing cardiac catheterization (CC)/percutaneous coronary intervention (PCI).
  
  
  BACKGROUND
  Palpation-guided radial artery (RA) access for CC/PCI is associated with a crossover rate to femoral artery (FA) access in up to 7.6%.
  
  
  METHODS
  A retrospective analysis of a single-center consecutive series of patients undergoing CC/PCI was performed. After one 0.4 mg sublingual NTG tablet, the RA and UA were assessed by intraprocedural ultrasound imaging to select the more suitable artery for ultrasound-guided access. A tight "knuckle wire" technique using a 0.014 inch Prowater® coronary wire was used to negotiate RA, UA, and brachial loops when a standard wire would not easily cross. Crossover was defined as any reason requiring secondary arterial access from the contralateral arm or FA.
  
  
  RESULTS
  A total of 1,162 consecutive patients treated from January 2012 to April 2014 were evaluated. Primary arterial access from the wrist (RA/UA) was performed in 1,000 (86.1%, RA: 977, UA 23) and planned FA access in 162 patients (13.9%). The overall crossover rate from the wrist was 0.3% as a result of 3/1,000 patients requiring crossover to the contralateral arm (radial loop: n = 1, brachial loop: n = 1, vessel injury: n = 1). No crossover to the FA was necessary. All primary FA access sites were successful.
  
  
  CONCLUSIONS
  Crossover rates of primary wrist artery access to alternative arterial access for CC/PCI can be reduced to less than 1% applying the aforementioned techniques.
authors.affiliation: Miami Cardiac & Vascular Institute, Miami, Florida.
authors.forename: Frederic
authors.initials: F
authors.lastname: Baumann
authors.affiliation: Memorial Cardiac & Vascular Institute, Hollywood, Florida.
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Roberts
mesh_terms: D000368:Aged; D006328:Cardiac Catheterization / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D005996:Nitroglycerin / Q000008:administration & dosage; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D017534:Radial Artery / Q000000981:diagnostic imaging*; D012189:Retrospective Studies; D017535:Ulnar Artery / Q000000981:diagnostic imaging*; D018084:Ultrasonography, Interventional; D014665:Vasodilator Agents / Q000008:administration & dosage; D014953:Wrist
chemical_list: D014665:Vasodilator Agents; D005996:Nitroglycerin