A randomized study of sheaths versus guidewires for arterial access during elective cardiac catheterization.

PURPOSE: The aim of this study was to compare the ease and safety of intravascular sheaths versus guidewires for maintaining arterial access during cardiac catheterization. METHODS: Two hundred patients with normal coagulation status undergoing routine diagnostic cardiac catheterization were randomized to intravascular sheath access versus guidewire access groups. Procedure times and difficulties were recorded during the procedure. Patients were asked to evaluate groin discomfort immediately after the procedure and two weeks later. Complications including groin hematoma, vascular damage, and stroke were assessed at the end of the procedure and the following morning. RESULTS: There were no differences between the sheath and guidewire groups in patient discomfort, procedural time or difficulty, or total complications. Hematomas occurred in 18% of patients (sheath 16% vs. guidewire 20%, p = NS) and were more often large in the guidewire group (5% vs. 0%, p = .05). None required vascular repair. Oozing around the catheter was more frequent in the guidewire group (6% vs. 0%, p = .03) but did not lead to any significant complications. CONCLUSIONS: We conclude that using guidewires for arterial access during cardiac catheterization leads to more large hematomas and more access site oozing during the procedure. However, there were no differences in patient comfort, overall procedural difficulty, or total complications between sheath and guidewire techniques.

Results of coronary artery bypass grafting using multiple arterial conduits.

Between January 1991 and June 1993, a total of 128 patients underwent coronary artery bypass grafting employing multiple autologous arterial conduits, including 157 internal mammary arteries, 69 inferior epigastric arteries, 44 gastroepiploic arteries, and 72 radial artery grafts. Their mean age was 61.4 years (range 29 to 82 years). The patients were divided into 2 groups: group A, consisted of 69 patients (mean age 60.3 years), in whom multiple arterial conduits were used exclusively (no vein grafts); group B, included 59 patients (mean age 62.7 years) in whom, in addition to multiple arterial conduits, 89 saphenous vein grafts were used concomitantly. The mean number of grafts was 3.1 and 3.7, for groups A and B, respectively. The preoperative left ventricular function, and the prevalence of unstable angina, a recent myocardial infarction, and diabetes, were not significantly different between both groups. Our series included 11 "redo" operations (8 in group A, and 3 in group B). There were 6 early deaths (4.7% mortality) (1 in group A, and 5 in group B), and 4 perioperative myocardial infarctions (1 in group A, 3 in group B). During a mean follow-up of 12.9 months (range 1 to 28 months) there were no late deaths or reoperations in any group. All patients in group A are free of symptoms. In group B, 2 patients have recurrent angina, and 1 had a late myocardial infarction, in the distribution of a vein graft. A myocardial SPECT scan with exercise revealed new perfusion defects in 4 of 49 patients (1 in group A, 3 in group B), studied 1 year after surgery.(ABSTRACT TRUNCATED AT 250 WORDS)