Hildick-Smith David J R, Walsh John T, Lowe Martin D, Shapiro Leonard M, Petch Michael C
Department of Cardiology, Papworth Hospital, Cambridgeshire, United Kingdom.
Catheter Cardiovasc Interv. 2004 Jan;61(1):60-6. doi: 10.1002/ccd.10708.
The transradial approach to coronary angiography is considered by some to be a route of choice, by others to be a route that should be used only where there are relative contraindications to the femoral approach. We present the largest series to date of patients in whom transradial coronary angiography was undertaken specifically because of contraindications to the femoral approach. Since 1995, patients at this cardiothoracic center have been considered for a transradial approach to coronary angiography if there were relative contraindications to the femoral route. Data from 500 patients was prospectively collected. Patients were aged 66 +/- 9 years; 72% were male. Indications for the radial approach included peripheral vascular disease (305), therapeutic anticoagulation (77), musculoskeletal (59), and morbid obesity (32). Sixty-eight patients (14%) required a radial procedure following a failed femoral approach. Access was right radial 291 (58%), left radial 209 (42%). Eighteen operators were involved, but two operators undertook 355 (71%) of the cases. Catheter gauge was 6 Fr (n = 243; 49%), 5 Fr (219; 43%), and 4 Fr (29; 6%). The procedure was successful in 463 cases [92.6%; 88.2% for nonmajority vs. 94.4% (P < 0.05) for the two majority operators]. Success in males (93.6%) significantly exceeded that in females (90.1%; P < 0.05). In-catheter-laboratory duration was 45 +/- 17 min; fluoroscopy time, 7.5 +/- 6 min; radiation dose, 40 +/- 23 CGy. The procedure was without incident in 408 cases (82%). There were procedural difficulties in 18% of cases, including radial artery spasm (12%) and vasovagal response (5%). The incidence was higher with 6 Fr catheters (23%) than with 5/4 Fr (15%; P < 0.05). Major procedural complications occurred in three cases: brachial artery dissection in one and cardiac arrest in two. Postprocedure major vascular complications numbered three: claudicant pain on handgrip in one, ischemic index finger (with subsequent terminal phalanx amputation due to osteomyelitis) in one, and ischemic hand for 4 hr in one. Patients with contraindications to the femoral approach form a high-risk group. In these patients, transradial cardiac catheterization can be performed successfully and with a low risk of major complications. Minor adverse features remain frequent, occurring in one in five cases, though difficulties are minimized both with increasing operator experience and smaller sheath diameter.
一些人认为经桡动脉途径进行冠状动脉造影是一种首选途径，而另一些人则认为该途径仅应在存在股动脉途径相对禁忌证的情况下使用。我们展示了迄今为止因股动脉途径禁忌证而专门进行经桡动脉冠状动脉造影的患者的最大系列病例。自1995年以来，该心胸中心的患者如果存在股动脉途径的相对禁忌证，就会考虑采用经桡动脉途径进行冠状动脉造影。前瞻性收集了500例患者的数据。患者年龄为66±9岁；72%为男性。桡动脉途径的适应证包括外周血管疾病（305例）、治疗性抗凝（77例）、肌肉骨骼疾病（59例）和病态肥胖（32例）。68例患者（14%）在股动脉途径失败后需要进行桡动脉手术。入路为右侧桡动脉291例（58%），左侧桡动脉209例（42%）。有18名操作者参与，但两名操作者完成了355例（71%）病例。导管规格为6F（n = 243；49%）、5F（219；43%）和4F（29；6%）。该手术在463例中成功[92.6%；非主要操作者为88.2%，而两名主要操作者为94.4%（P < 0.05）]。男性的成功率（93.6%）显著高于女性（90.1%；P < 0.05）。导管室内停留时间为45±17分钟；透视时间为7.5±6分钟；辐射剂量为40±23 cGy。该手术在408例（82%）中无并发症发生。18%的病例存在手术困难，包括桡动脉痉挛（12%）和血管迷走反应（5%）。6F导管的发生率（23%）高于5/4F导管（15%；P < 0.05）。发生了3例主要手术并发症：1例肱动脉夹层和2例心脏骤停。术后主要血管并发症有3例：1例握力时出现跛行疼痛，1例示指缺血（因骨髓炎随后进行末节指骨截肢），1例手部缺血4小时。存在股动脉途径禁忌证 的患者构成一个高危组。在这些患者中，经桡动脉心脏导管插入术可以成功进行，且主要并发症风险较低。轻微不良特征仍然常见，每五例中就有一例发生，不过随着操作者经验的增加和鞘管直径的减小，困难会降至最低。
