Feasibility and Safety of The Antecubital Venous Access for Right Heart Catheterization in Pulmonary Hypertension

Background: Right Heart Catheterization (RHC) usually done via proximal venous access (PVA) (internal jugular (IJV), femoral or subclavian). Although rare, complications of RHC are usually related to the access site. RHC via an antecubital venous approach (AVA) may reduce access-site complications by avoiding puncture of large vessels or organs. Moreover, AVA approach allows immediate ambulation and reduces anxiety and avoidance of the procedure by patients, but data on this approach are scarce.

Our objective is to determine feasibility and safety using AVA as compared to using the traditional approach of PVA for the evaluation of patients with Pulmonary Hypertension (PH).

Methods: Patients undergoing RHC for PH at a single large academic medical center were identified over a 1-year period (2014-2015). Medical records were retrospectively analyzed.

Results: A total of 61 RHC procedures were included: 41 (67%) were performed through AVA and 20 (33%) were performed through PVA. AVA was the preferred site and was obtained in all eligible patients using a Venflon cannula in the recovery room. PVA was obtained in the catheterization suite. Procedures done through cannulation of the IJV were guided by hand-handled pocket ultrasound. There were no failed procedures and catheterization of the pulmonary artery was achieved in all cases. Crossover to an alternate access to the original site was required in 24% in AVA group and in 10% in the PVA group. AVA access has not been achieved in most (75%) of the Scleroderma patients. Periprocedural complications occurred in 1 patient (0.01%), leading to hospitalization in only 1 patient in the PVA group.

Conclusion: RHC via the AVA is a feasible and safe alternative to PVA. Our experience supports the use of AVA as the access site of choice for evaluation of PH patients through RHC. Patients with Scleroderma might be an exception for this approach.