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ABSTRACT: The transradial approach for left heart catheterization has become increasingly popular recently because of its clinical benefits. We examined the safety and feasibility of a transforearm approach for bilateral cardiac catheterizations, using the radial artery and a superficial forearm vein (the cephalic, basilic, or median antecubital vein). Between August 2002 and October 2003, 296 right heart catheterizations were performed in our hospital. A superficial forearm vein was used in one group of 101 patients, of which 98 had a concomitant left heart catheterization through the radial artery. The femoral vein was used for right heart catheterization in the second group of 195 patients. Of these patients, 37 underwent left heart catheterization through the radial artery and 157 through the femoral artery. All instances of bilateral catheterizations were successful except for one complication of pseudoaneurysm occurring in the transfemoral group. The procedure time for right heart catheterization was significantly less in the forearm group than the femoral group. The transforearm group had a larger proportion of males and of patients undergoing diagnostic right heart catheterization for congestive heart failure, dilated cardiomyopathy, and ischemic cardiomyopathy. Patients with aortic stenosis (AS), atrial septal defect (ASD), and mitral stenosis (MS) were mainly restricted to the transfemoral approach. We conclude that the transradial artery and superficial forearm venous approach for bilateral cardiac catheterizations is a safe and feasible alternative to the femoral approach in a wide range of patients, with the exception of patients with AS, ASD, or MS.
International Heart Journal 02/2006; 47(1):21-7. · 1.16 Impact Factor
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ABSTRACT: Cutting balloon angioplasty can reduce the restenosis rate more than conventional balloon angioplasty, but is traditionally performed through a femoral artery. However, it is not clear how useful a transradial approach would be for cutting balloon angioplasty. This study was conducted to examine the safety, feasibility, and limitations of transradial as opposed to transfemoral cutting balloon angioplasty. From November 1999 to August 2001, 177 patients underwent cutting balloon coronary angioplasty. We compared the success rate, angiographic results, and complication rates of two groups of patients, those undergoing transradial (168 lesions from 153 patients) and those undergoing transfemoral (24 lesions from 24 patients) cutting balloon angioplasty. In both groups of patients who had similar clinical and target lesion characteristics. the percentage of lesions that required balloon predilation (27.4% vs 29.2%). stenting (7.7% vs 4.2%), and adjunct balloon dilation (28.0% vs 33.3%) due to dissection (35.7% vs 33.3%) or suboptimal results were comparable. Both approaches achieved a 100% primary success rate with similar acute gain (2.02 +/- 0.68 mm vs 1.94 +/- 0.70 mm), residual (luminal) diameter stenosis (19.2 +/- 11.7% vs 17.0 +/- 12.7%). proportion of lesions that achieved TIMI 3 flow (98.8% vs 100%), and clinical success rate (98.8% vs 95.8%). However, patients undergoing transradial cutting balloon angioplasty had earlier ambulation and a significantly shorter hospital stay than those undergoing a transfemoral approach (2.80 +/- 2.67 days vs 4.75 +/- 5.44 days, P = 0.005). We conclude that the transradial approach is a feasible and safe alternative to the transfemoral approach for cutting balloon angioplasty. In addition, it offers patients early ambulation and a short hospital stay.
Japanese Heart Journal 02/2003; 44(1):51-60. · 0.40 Impact Factor
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ABSTRACT: The transradial approach for cardiac catheterization has become popular; however, its application in percutaneous coronary intervention (PCI) for chronic total occlusion (CTO) has rarely been reported. This study examines the feasibility and safety of this approach for performing PCI for CTO lesions.
We retrospectively evaluated 419 consecutive patients who underwent PCI for CTO lesions between February 1998 and December 2003 in our hospital; a transradial artery approach was used in 400 patients and a transfemoral artery approach in 19.
The baseline clinical characteristics were similar in the 2 patient groups. The transradial group had more de novo lesions (76% vs 47.37%, p = 0.012), fewer in-stent restenotic lesions (11.75% vs 36.84%, p = 0.006) and smaller guiding catheters (p < 0.001) than the transfemoral group. There was no statistical difference in the procedure success rates (69.25% and 78.95%, p = 0.369) between the 2 groups. The incidence of major complications, including death, Q wave myocardial infarction, and emergency coronary artery bypass surgery, was similar in the 2 groups.
The transradial approach for PCI can be a feasible choice for a CTO lesion. If this approach fails because of poor back up support from the guiding catheter, the transfemoral approach can be attempted with a larger guiding catheter.
Chang Gung medical journal 33(6):639-45.
