Vascular Access Methods and Their Pattern of Evolution for Left Heart Catheterization at Two Tertiary Medical Centers in Nairobi: A Retrospective Chart Analysis

Abstract

Background: Cardiac catheterization is an invasive procedure done by cardiologists (using specialized equipment) for diagnostic and /or interventional purposes for a wide range of cardiac diseases. Left heart 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. Indications for cardiac catheterization majorly include evaluation and treatment of coronary artery disease, facilitate interventional procedures in valvulopathies, access congenital heart diseases prior to surgery and assessment of myocardial as well as pericardial diseases.

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: A 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: A total of 384 files from the two hospitals: 106 from KNH and 278 from KR were analyzed. Files that were not well documented and files of patients that had had a right heart catheterization procedure were excluded. 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 the year 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 the acute peri-procedural complications (for example anaphylactic shock, cardiogenic shock, bleeding necessitating blood transfusion), it was 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. Twenty four (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: Majority of the left heart catheterization procedures were done via the femoral access in Nairobi. The procedures done were safe with minimal complications. Over the study period, there has been a progressive shift to radial access in line with global trends.