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Vascular Access in Cardiac Catheterization and Intervention

Background

Cardiac catheterization is performed for both therapeutic and diagnostic reasons.
Like any invasive procedure, cardiac catheterization is associated with complications, so the decision to undertake the procedure should be based on the risks and benefits.

More than a million cardiac catheterizations are performed each year in the United States. Several approaches to cardiac catheterization have been developed over the past 40 years. The three most widely used techniques for cardiac catheterization involve access through the femoral, radial, or brachial artery, with access to the brachial artery usually obtained by a cutdown approach and the others via a percutaneous approach.

Traditionally, the heart has been accessed via the femoral artery; however, in the last decade, the radial artery has been more widely used, since it (1) is readily accessible (even in obese individuals), (2) is the preferred site of access by many patients, (3) is associated with a lower incidence of hemorrhage, and (4) allows earlier ambulation of the patient following the procedure than a femoral catheterization. Since the radial artery is of a smaller caliber than the femoral artery, the radial artery cannot accommodate large-size catheters, spasms in some cases (thereby preventing catheter passage), and occludes in 5%-10% of patients postprocedure, although this seldom causes symptoms.

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