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
Publisher
University of Nairobi
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http://creativecommons.org/licenses/by-nc-nd/3.0/us/Collections
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