Nagai S, Abe S, Sato T, Hozawa K, Yuki K, Hanashima K, Tomoike H
Division of Internal Medicine, Yamagata Prefectural Shinjo Hospital, Japan.
Am J Cardiol. 1999 Jan 15;83(2):180-6. doi: 10.1016/s0002-9149(98)00821-2.
The transradial approach has currently been accepted as an alternative entry method for coronary angiography and angioplasty. Vascular complications of this method were evaluated by 2-dimensional echo and color Doppler ultrasonic studies in 162 patients before, early (2+/-2 [mean+/-SD] days), and late (95+/-29 days) after catheterization. Mean age was 64+/-10 years, and 103 were men. Coronary angioplasty was performed in 59 patients (79 lesions) with angiographic success in 92%. Early after the procedure, segmental stenosis was noted in 35 patients (22%) and no flow in 15 patients (9%). Late after the procedure, segmental stenosis was noted in 2, diffuse stenosis in 36 (22%), and no flow in 8 (5%) patients. The cessation of radial artery pulse was unpalpable in only 2% of cases, whereas radial flow by color Doppler was undetectable in 9% early after the procedure. Late after the procedure, recanalization was observed in 60% of these occluded cases. Thirty-three of 86 patients (38%) with no flow or diffuse stenosis had radial artery diameters smaller than the sheath diameter, and 11 of 76 patients (14%) had radial artery diameters larger than the sheath diameter (p <0.01). Multivariate analysis revealed risk factors for vascular complications: (1) Radial artery diameter before the procedure was one of the significant and independent determinants of no flow both early (p = 0.06) and late (p = 0.004) after the procedure. (2) The difference in radial artery diameter and sheath size was related to the occurrence of diffuse stenosis late after the procedure (p = 0.003). (3) Diabetes mellitus was related to no flow (p = 0.05) or diffuse stenosis (p = 0.11) late after the procedure. Thus, ultrasonic evaluation of the radial artery was useful in selecting both an access route and an appropriate size of the sheath to determine early and late vascular complications.
目前，经桡动脉途径已被公认为是冠状动脉造影和血管成形术的一种替代入路方法。通过二维超声心动图和彩色多普勒超声研究，对162例患者在导管插入术前、术后早期（2±2[均值±标准差]天）和晚期（95±29天）的该方法血管并发症进行了评估。平均年龄为64±10岁，男性103例。59例患者（79处病变）接受了冠状动脉血管成形术，血管造影成功率为92%。术后早期，35例患者（22%）出现节段性狭窄，15例患者（9%）血流中断。术后晚期，2例出现节段性狭窄，36例（22%）出现弥漫性狭窄，8例（5%）患者血流中断。仅2%的病例触诊不到桡动脉搏动，而术后早期9%的病例彩色多普勒显示桡动脉血流无法检测到。术后晚期，这些闭塞病例中有60%观察到再通。86例无血流或弥漫性狭窄的患者中有33例（38%）桡动脉直径小于鞘管直径，76例患者中有11例（14%）桡动脉直径大于鞘管直径（p<0.01）。多因素分析揭示了血管并发症的危险因素：（1）术前桡动脉直径是术后早期（p=0.06）和晚期（p=0.004）血流中断的重要且独立的决定因素之一。（2）桡动脉直径与鞘管尺寸的差异与术后晚期弥漫性狭窄的发生有关（p=0.003）。（3）糖尿病与术后晚期血流中断（p=0.05）或弥漫性狭窄（p=0.11）有关。因此，桡动脉的超声评估有助于选择入路途径和合适尺寸的鞘管，以确定早期和晚期血管并发症。
