Author + information
- Received February 24, 2014
- Revision received April 25, 2014
- Accepted May 8, 2014
- Published online February 1, 2015.
- Arnold H. Seto, MD, MPA∗,†∗ (, )
- Jonathan S. Roberts, MD‡,
- Mazen S. Abu-Fadel, MD§,
- Steven J. Czak, DO∥,
- Faisal Latif, MD§,
- Suresh P. Jain, MD∥,¶,
- Jaffar A. Raza, MD∥,¶,
- Aditya Mangla, DO∥,¶,
- Georgia Panagopoulos, PhD∥,
- Pranav M. Patel, MD†,
- Morton J. Kern, MD∗,† and
- Zoran Lasic, MD∥,¶
- ∗Division of Cardiology, Department of Medicine, Long Beach Veterans Affairs Medical Center, Long Beach, California
- †Division of Cardiology, Department of Medicine, University of California, Irvine Medical Center, Orange, California
- ‡Baptist Cardiac and Vascular Institute, Baptist Hospital of Miami, Miami, Florida
- §Cardiovascular Section, Department of Medicine, Veterans Affairs Medical Center and University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
- ∥Lenox Hill Heart and Vascular Institute of New York, North Shore LIJ Lenox Hill Hospital, New York, New York
- ¶Jamaica Hospital Medical Center, New York, New York
- ↵∗Reprint requests and correspondence:
Dr. Arnold H. Seto, Long Beach Veterans Administration Medical Center, 5901 East 7th Street, 111C, Long Beach, California 90822.
Objectives This study sought to assess the utility of ultrasound (US) guidance for transradial arterial access.
Background US guidance has been demonstrated to facilitate vascular access, but has not been tested in a multicenter randomized fashion for transradial cardiac catheterization.
Methods We conducted a prospective multicenter randomized controlled trial of 698 patients undergoing transradial cardiac catheterization. Patients were randomized to needle insertion with either palpation or real-time US guidance (351 palpation, 347 US). Primary endpoints were the number of forward attempts required for access, first-pass success rate, and time to access.
Results The number of attempts was reduced with US guidance [mean: 1.65 ± 1.2 vs. 3.05 ± 3.4, p < 0.0001; median: 1 (interquartile range [IQR]: 1 to 2) vs. 2 (1 to 3), p < 0.0001] and the first-pass success rate improved (64.8% vs. 43.9%, p < 0.0001). The time to access was reduced (88 ± 78 s vs. 108 ± 112 s, p = 0.006; median: 64 [IQR: 45 to 94] s vs. 74 [IQR: 49 to 120] s, p = 0.01). Ten patients in the control group required crossover to US guidance after 5 min of failed palpation attempts with 8 of 10 (80%) having successful sheath insertion with US. The number of difficult access procedures was decreased with US guidance (2.4% vs. 18.6% for ≥5 attempts, p < 0.001; 3.7% vs. 6.8% for ≥5min, p = 0.07). No significant differences were observed in the rate of operator-reported spasm, patient pain scores following the procedure, or bleeding complications.
Conclusions Ultrasound guidance improves the success and efficiency of radial artery cannulation in patients presenting for transradial catheterization. (Radial Artery Access With Ultrasound Trial [RAUST]; NCT01605292)
Dr. Abu-Fadel serves on the Speakers Bureau of Abbott Vascular. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received February 24, 2014.
- Revision received April 25, 2014.
- Accepted May 8, 2014.
- 2015 American College of Cardiology Foundation