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JACC Cardiovasc Interv. 2015 Feb;8(2):283-291. doi: 10.1016/j.jcin.2014.05.036. Epub 2015 Jan 14.

Real-time ultrasound guidance facilitates transradial access: RAUST (Radial Artery access with Ultrasound Trial).

Author information

1
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. Electronic address: arnoldseto@yahoo.com.
2
Baptist Cardiac and Vascular Institute, Baptist Hospital of Miami, Miami, Florida.
3
Cardiovascular Section, Department of Medicine, Veterans Affairs Medical Center and University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
4
Lenox Hill Heart and Vascular Institute of New York, North Shore LIJ Lenox Hill Hospital, New York, New York.
5
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.
6
Division of Cardiology, Department of Medicine, University of California, Irvine Medical Center, Orange, California.
7
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.

Abstract

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).

KEYWORDS:

radial artery spasm; transradial cardiac catheterization; ultrasound guidance; vascular access

PMID:
25596790
DOI:
10.1016/j.jcin.2014.05.036
[Indexed for MEDLINE]
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