Vascular Access Methods and Their Pattern of Evolution for Left Heart Catheterization at the Kenyatta National and Karen Hospitals: a Retrospective Audit (2015-2020)

Abstract

Background: Cardiac catheterization is an invasive procedure that is used for diagnostic and /or interventional purposes for a wide range of cardiac diseases. Left heart cardiac catheterization entails insertion of a fine bore catheter via a peripheral vascular access into the aorta, coronary arteries and/or left heart chambers. The brachial, femoral, radial and/or ulnar arteries are used as peripheral arterial access routes. The increased utilization of trans-radial approach has led to lower rates of major bleeding and vascular complications. Trans-femoral arterial access approach is still used by many operators due to its ease of use and feasibility. Objectives: To describe the vascular access methods for left heart catheterization and their associated complications at the Kenyatta National Hospital (KNH) and Karen Hospital (KR). Methodology: Cross sectional retrospective audit that examined health records of cardiac catheterization laboratories at KNH and KR over a 6-year period (1st January 2015 to 31st December 2020). Results: We analyzed a total of 384 files from the two hospitals: 106 from KNH and 278 from KR. Of the total number of procedures done 62.1 % were via the trans-femoral arterial access while 32.7 % were via the trans-radial arterial access. Most of the procedures done at the KNH were via the trans- femoral access with the adoption of the trans-radial access noted from 2017 and steadily increasing till 2020. The use of trans-femoral in KR was also high but KR had a markedly increasing trend in adoption and incorporation of the use of the trans-radial arterial access over the entire study period. For patients with STEMI AND NSTEMI, the use of the transfemoral access was still higher at 66.2% and 66.7 % respectively. Looking at complications associated with cardiac catheterization (which include anaphylactic shock, bleeding, hematoma formation, pain/arterial spasm, acute kidney injury, acute arterial occlusion, infection, myocardial infarction, stroke/transient ischemia, iatrogenic coronary dissection, cardiac arrythmias, hypotension, cardiogenic shock, pericardial, bleeding necessitating blood transfusion) we noted that 39 (10.7%) patients experienced one or more of the complications, with about 19 (48.7%) of them having severe pain at puncture site. 24 (10.6%) had had a common femoral arterial access. On the length of hospital stay, most patients (50.3%) either stayed for a day or were discharged the same day followed by those that stayed between 2-5 days (32.1%). Conclusion: Over the entire study period, the use of the trans-femoral arterial access for cardiac catheterization was higher compared to the use of the trans-radial for both KNH and KR. From 2016, there has been a progressive adoption and incorporation of the trans-radial arterial access. The procedures done had minimal complications and a majority of the patients stayed for less than a day in the hospital after undergoing the procedure