Abstract：
OBJECTIVE: In the trans-radial era, arm venous access for right heart catheterization (RHC) is rising. Procedural success is affected by many factors, including subclavian/innominate vein stenosis (SVS) and pre-existing wires or catheters. In a study published previously by the same authors, 2% of cases had unsuccessful RHC through the arm, predominantly due to SVS. Since that study, techniques to improve RHC success rates have been developed, including crossing the stenosis with a coronary guidewire, followed by balloon dilatation. We aimed to determine whether subclavian/innominate venoplasty allows successful RHC in patients with SVS.
METHODS: Our retrospective study included patients who had RHC from the arm between November 1, 2019, and December 31, 2022 that was unsuccessful due to the inability to pass a catheter through the SVS, and then underwent balloon venoplasty. The success rate of completed RHC was then assessed.
RESULTS: Out of 2506 RHCs via arm access, 2488 were successful with a catheter alone or over a guidewire. In 18 patients, venoplasty was needed for catheter passage over a guidewire. Post-dilatation, all 18 cases (100%) had successful RHC with a mean procedural time of 35.2 (SD = 15.5) minutes. The most common stenosis site was the subclavian vein in 13 patients (72.2%), and 12 patients (66.7%) had pacemaker/ implantable cardioverter defibrillator wires present.
CONCLUSIONS: Balloon dilatation of SVS is an efficacious method to improve the success rate of RHC from the arm. It is a safe technique that may prevent cross-over to a different access site, thereby improving patient satisfaction and reducing the possibility of alternate site complications.
METHODS: Our retrospective study included patients who had RHC from the arm between November 1, 2019, and December 31, 2022 that was unsuccessful due to the inability to pass a catheter through the SVS, and then underwent balloon venoplasty. The success rate of completed RHC was then assessed.
RESULTS: Out of 2506 RHCs via arm access, 2488 were successful with a catheter alone or over a guidewire. In 18 patients, venoplasty was needed for catheter passage over a guidewire. Post-dilatation, all 18 cases (100%) had successful RHC with a mean procedural time of 35.2 (SD = 15.5) minutes. The most common stenosis site was the subclavian vein in 13 patients (72.2%), and 12 patients (66.7%) had pacemaker/ implantable cardioverter defibrillator wires present.
CONCLUSIONS: Balloon dilatation of SVS is an efficacious method to improve the success rate of RHC from the arm. It is a safe technique that may prevent cross-over to a different access site, thereby improving patient satisfaction and reducing the possibility of alternate site complications.
摘要：
目标：在跨radial时代，右心导管插入术（RHC）的手臂静脉通路正在上升。程序成功受许多因素的影响，包括锁骨下/无名静脉狭窄（SVS）和预先存在的导线或导管。在同一作者先前发表的一项研究中，2%的病例通过手臂进行RHC不成功，主要是由于SVS。自从这项研究以来，已经开发了提高RHC成功率的技术，包括用冠状动脉导丝穿过狭窄，接着是气球扩张。我们旨在确定锁骨下/无名静脉成形术是否可以成功治疗SVS患者的RHC。
方法：我们的回顾性研究包括在2019年11月1日至2022年12月31日之间从手臂接受RHC的患者，由于无法通过导管穿过SVS，然后做了气囊静脉成形术.然后评估完成的RHC的成功率。
结果：在2506个通过手臂进入的RHC中，2488只使用导管或在导丝上成功。在18名患者中，导管通过导丝需要进行静脉成形术.后扩张，所有18例(100%)均成功进行RHC,平均手术时间为35.2分钟(SD=15.5分钟).13例(72.2%)患者中最常见的狭窄部位是锁骨下静脉,12例患者(66.7%)存在起搏器/植入式心律转复除颤器导线。
结论：球囊扩张SVS是提高手臂RHC成功率的有效方法。这是一种安全的技术，可以防止交叉到不同的访问站点，从而提高患者满意度并减少替代部位并发症的可能性。
方法：我们的回顾性研究包括在2019年11月1日至2022年12月31日之间从手臂接受RHC的患者，由于无法通过导管穿过SVS，然后做了气囊静脉成形术.然后评估完成的RHC的成功率。
结果：在2506个通过手臂进入的RHC中，2488只使用导管或在导丝上成功。在18名患者中，导管通过导丝需要进行静脉成形术.后扩张，所有18例(100%)均成功进行RHC,平均手术时间为35.2分钟(SD=15.5分钟).13例(72.2%)患者中最常见的狭窄部位是锁骨下静脉,12例患者(66.7%)存在起搏器/植入式心律转复除颤器导线。
结论：球囊扩张SVS是提高手臂RHC成功率的有效方法。这是一种安全的技术，可以防止交叉到不同的访问站点，从而提高患者满意度并减少替代部位并发症的可能性。
