Feasibility and Safety of Right and Left Heart Catheterization Via an Antecubital Fossa Vein and the Radial Artery in Patients With Heart Failure

Objectives. Heart failure is the leading cause of hospitalization among patients older than 65 years of age. A significant proportion of patients require heart catheterization for diagnostic, therapeutic, and prognostic purposes. To determine the feasibility and safety of full arm-arm catheterization access, we aimed to compare this approach with other established catheterization approaches. Methods and Results. In this retrospective cohort study, a total of 493 consecutive patients with heart failure requiring right and left heart catheterization were studied and analyzed. Subsequently, all patients were divided into three groups based on the catheterization approach used: arm-arm, hybrid femoral-arm, and femoral-femoral access. The three groups did not significantly differ in their baseline clinical, demographic, or risk factor characteristics. The full arm-arm catheterization procedures were significantly longer when compared with hybrid femoral-arm and femoral-femoral approach (73 min vs 68 min vs 67 min, respectively; P=.04), but remarkably provided significantly less fluoroscopy radiation dose (40,337 +/- 64,799 cG/cm(2) vs 62,270 +/- 120,420 cG/cm(2) vs 156077 +/- 566495 cG/cm(2), respectively; P=.04). Procedural complications were rare and occurred in 0.9% of the arm-arm group, 4.8% of the femoral-arm group, and 3.3% of the femoral-femoral group (P=.45). Finally, in arm-arm patients, a significantly earlier ambulation was achieved compared with the others groups (P=.02). Conclusion. Full arm-arm access for bilateral heart catheterization in patients with heart failure proved to be a safe and feasible approach, and was associated with lower radiation burden and early ambulation time when compared with hybrid arm-leg and full femoral catheterization approaches.