Peripheral vascular access from the arms for electrophysiology
procedures using ultrasound guidance
Introduction Vascular access has traditionally been gained from the
femoral vessels, however, a ‘radial-first’ approach has become
increasingly popular and resulted in lower complication rates and
reduced healthcare costs. A “superior” approach has been reported for
electrophysiology (EP) studies but is associated with an increased risk.
To provide comprehensive anatomical evidence that the vessels of the
arms are suitable for use during EP procedures, as assessed by vascular
ultrasound. Methods A portable ultrasound device was used to measure the
diameter of the brachial artery, brachial, basilic & cephalic veins on
the left and right upper limbs of 63 healthy volunteers. A subgroup of
15 volunteers had additional measurements taken with a tourniquet.
Results The basilic vein had the largest diameter with a median of 4.6
mm and 4.5 mm (right and left diameter, respectively), followed by the
cephalic (median of 3.1 and 3.0 mm) and the brachial vein (median of 2.8
mm). 100% of volunteers had at least one vein that was equal to a 3 mm
diameter (which would allow for an 8F sheath), with 98% having 2
suitable veins and >80% having 3 suitable venous vessels.
More than 90 % had a suitable diameter for both the right and left
brachial artery. There was no correlation between BMI, height, weight,
but men had significantly larger basilic veins and brachial arteries
(p<0.05). Conclusion We demonstrate the anatomic evidence that
the vessels in the arm(s) are capable of housing the size of sheath
commonly used in the EP lab.