Ultrasound guidance for vascular access in patients undergoing coronary angiography via the transradial approach


BACKGROUND: We assessed the value of routine real-time ultrasound (RTUS) guidance to improve transradial access (TRA) for cardiac catheterization.

METHODS: A prospective, single-center descriptive observational study of patients presenting for cardiac catheterization via the transradial approach. The first phase of the study enrolled 100 consecutive patients who underwent TRA without the assistance of RTUS followed by 100 consecutive patients who underwent TRA using RTUS guidance. The primary outcome measure was time between needle attempts for arterial access and sheath insertion.

RESULTS: There were no statistically significant differences in any outcome measures. Median time between commencing needle attempts for arterial access to sheath insertion was 82.5 seconds (interquartile range [IQR], 64-161.5 seconds) with no RTUS guidance vs 84 seconds (IQR, 52.75-122.5 seconds) with RTUS; P=.19. Median number of needle passes through the skin required was 1 (IQR, 1-3) with no RTUS guidance vs 2 (IQR, 1-3) with RTUS; P=.25. Median number of arterial punctures was 1 (IQR, 1-1) with no RTUS guidance vs 1 (IQR, 1-1) with RTUS; P=.21.

CONCLUSION: Routine RTUS guidance to assist in TRA does not significantly improve parameters of successful vascular access among high-volume radial operators. However, RTUS guidance should still be considered in selected cases and among less experienced radial practitioners.

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J Invasive Cardiol. 2015;27:163-166.