Safety of transradial cardiac catheterization in patients with end-stage liver disease

Catheter Cardiovasc Interv. 2014 Feb 15;83(3):360-6. doi: 10.1002/ccd.25043. Epub 2013 Jul 3.

Abstract

Background: Transradial access may be advantageous for patients with end-stage liver disease (ESLD) who need to undergo left heart catheterization (LHC). We aimed to assess the safety of transradial cardiac catheterization in patients listed for orthotopic liver transplantation.

Methods: This is a retrospective analysis of consecutive adult patients with the diagnosis of ESLD, who underwent LHC via transradial access as part of a pre-operative liver transplantation evaluation. All the patients also underwent right heart catheterization (RHC) via brachial or femoral vein. The primary outcome measure was procedure-related major bleeding. Secondary outcomes included access site minor bleeding, in-hospital mortality, radial access failure, and acute kidney injury.

Results: A total of 82 consecutive patients with ESLD, who underwent LHC via transradial access, were enrolled in the study. All patients also underwent RHC (n = 45 via brachial and n = 37 via femoral vein). The median age was 59 (54, 67) years old, and 58% were male. History of coronary artery disease or heart failure was present in 17% of patients. The median MELD score was 19 (13, 24.5), baseline hemoglobin was 10.5 mg/dL (9.4, 11.8), INR was 1.4 (1.2, 1.8) and platelets were 74,000 (53,000, 117,000)/mm(3) . The most common etiology of liver failure was viral hepatitis (51%), followed by alcoholic cirrhosis (24%) and non-alcoholic steatohepatitis (21%). Angiographically significant coronary artery disease was present in 17 (21%) patients. Major bleeding and acute kidney injury each occurred in two patients (2.4%). There were no instances of vascular complications. There were no deaths attributable to complications from cardiac catheterization.

Conclusion: Upper extremity right and left heart catheterization appears to be a safe method to evaluate coronary anatomy and hemodynamics in a severely ill population of patients with ESLD awaiting transplant.

Keywords: bleeding and transplant; cardiac catheterization; liver disease; transradial.

Publication types

  • Observational Study

MeSH terms

  • Aged
  • Cardiac Catheterization / adverse effects
  • Cardiac Catheterization / methods*
  • Cardiac Catheterization / mortality
  • Coronary Angiography
  • Coronary Artery Disease / complications
  • Coronary Artery Disease / diagnosis*
  • Coronary Artery Disease / mortality
  • Coronary Artery Disease / physiopathology
  • End Stage Liver Disease / complications*
  • End Stage Liver Disease / mortality
  • End Stage Liver Disease / surgery
  • Female
  • Hemodynamics
  • Hemorrhage / etiology
  • Hemorrhage / mortality
  • Hospital Mortality
  • Humans
  • Liver Transplantation
  • Male
  • Middle Aged
  • Patient Safety
  • Patient Selection
  • Preoperative Care
  • Punctures
  • Radial Artery*
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Severity of Illness Index
  • Time Factors
  • Waiting Lists