Key result
Right forearm access linked to ~2.5-fold higher risk of difficult vascular anatomy vs. left access.
Why the study?
Difficult vascular anatomy (DVA) poses a threat to procedural success in forearm artery access for cardiac catheterization, but its prevalence and predictors are not well defined.
Observational (n=1,108)
No
Odds Ratio: 2.52 (95% CI 1.72–3.69)
p-value: p=<0.001
Right forearm access may raise SIAR difficulty risk; leaves open optimal side selection pending prospective trials.
Transradial access has established as preferred access for cardiac catheterization. Difficult vascular anatomy (DVA) is a noticeable threat to procedural success. We retrospectively analyzed 1397 consecutive cardiac catheterizations to estimate prevalence and identify predictors of DVA. In the subclavian-innominate-aortic-region (SIAR), DVA was causing failure in 2.4% during right-sided vs. 0.7% in left-sided forearm-artery-access (FAA) attempts (χ2 = 5.1, p = 0.023). Independent predictors were advanced age [odds ratio (OR) 1.44 per 10-year increase, 95% confidence interval (CI) 1.15 to 1.80, p = 0.001] and right FAA (OR 2.52, 95% CI 1.72 to 3.69, p < 0.001). In the radial-ulnar-brachial region (RUBR), DVA was causing failure in 2.5% during right-sided vs. 1.7% in left-sided FAA (χ2 = 0.77, p = 0.38). Independent predictors were age (OR 1.28 per 10-year increase, 95% CI 1.01 to 1.61, p = 0.04), lower height (OR 1.56 per 10-cm decrease, 95% CI 1.13 to 2.15, p = 0.008) and left FAA (OR 2.15, 95% CI 1.45 to 3.18, p < 0.001). Bilateral DVA was causing procedural failure in 0.9% of patients. The prevalence of bilateral DVA was rare. Predictors in SIAR were right FAA and advanced age and in RUBR, left FAA, advanced age and lower height. Gender, arterial hypertension, body mass, STEMI and smoking were not associated with DVA.
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Roeschl et al. (2022) conducted an observational in Coronary artery disease or acute coronary syndrome requiring coronary angiography or PCI (n=1,108). Right forearm artery access vs. Left forearm artery access was evaluated on Difficult vascular anatomy (DVA) in the subclavian-innominate-aortic-region (SIAR) (OR 2.52, 95% CI 1.72 to 3.69, p=<0.001). Right forearm artery access was an independent predictor of difficult vascular anatomy in the subclavian-innominate-aortic region compared to left access (OR 2.52).
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