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Review
. 2009 Oct;106(42):685-91.
doi: 10.3238/arztebl.2009.0685. Epub 2009 Oct 16.

Transcarpal cardiac catheterization

Torsten Schwalm  1
Affiliations
Review

Transcarpal cardiac catheterization

Torsten Schwalm. Dtsch Arztebl Int. 2009 Oct.

Abstract

Introduction: Even though the performance of coronary diagnostic and therapeutic procedures through the distal forearm arteries has become a well-established practice, only a small minority of procedures employ transcarpal approach. The aim of this review is to describe the state of art in cardiac catheterization through distal forearm arteries, to point out the advantages and disadvantages of this approach, and to discuss the specific aspects in which it differs from the transfemoral approach.

Methods: A Medline search up to January 2009 and the articles retrieved were selectively evaluated. Practical recommendations are given based on the authors' experience.

Results: The following advantages of the transcarpal approach to the coronary arteries, as compared to the transfemoral approach, were evident in 23 prospective randomized studies and registries: a lower risk of complications at the site of access (0.05% and 0.3% versus 2.3% and 2.8%), lower mortality (2.8% versus 3.9%), greater patient comfort, lower cost (14% and 15% lower), and a shorter hospital stay (1.5 days and 3 days versus 1.8 days and 4.5 days). Its disadvantages include the potential need for conversion to a transfemoral procedure, higher radiation exposure of the physician, and an extended learning curve, so that procedure times are longer and rates of technical failure are higher until about 400 procedures have been performed.

Conclusions: The current data give a favorable view of this procedure as long as its specific requirements in terms of pretreatment, choice of materials, technique, post-procedural care, and expertise of the physician are taken into account.

Keywords: angioplasty; coronary angiography; hemorrhage; learning curve; patient-oriented treatment.

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Figures

Figure 1
Figure 1
Positioning of the arm for a transcarpal study
Figure 2
Figure 2
Sideboards for arm positioning and for laterally extending the table as a positioning surface
Figure 3
Figure 3
Puncture of the ulnar artery with the Seldinger technique
Figure 4
Figure 4
Removal of a 5 French guide tube from the ulnar artery with simultaneous placement of a pressure cushion to serve as a transparent compression bandage
See this image and copyright information in PMC

Comment in

  • Transcarpal is the wrong term.
    Pabst R. Pabst R. Dtsch Arztebl Int. 2010 Mar;107(11):198; author reply 198. doi: 10.3238/arztebl.2010.0198a. Epub 2010 Mar 19. Dtsch Arztebl Int. 2010. PMID: 20386690 Free PMC article. No abstract available.

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  • Transcarpal is the wrong term.
    Pabst R. Pabst R. Dtsch Arztebl Int. 2010 Mar;107(11):198; author reply 198. doi: 10.3238/arztebl.2010.0198a. Epub 2010 Mar 19. Dtsch Arztebl Int. 2010. PMID: 20386690 Free PMC article. No abstract available.
  • Postoperative care and follow-up after coronary stenting.
    Rassaf T, Steiner S, Kelm M. Rassaf T, et al. Dtsch Arztebl Int. 2013 Feb;110(5):72-81; quiz 82. doi: 10.3238/arztebl.2013.0072. Epub 2013 Feb 1. Dtsch Arztebl Int. 2013. PMID: 23437032 Free PMC article. Review.

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