Ruiz-Salmerón Rafael J, Mora Ramón, Vélez-Gimón Manuel, Ortiz José, Fernández Carlos, Vidal Bárbara, Masotti Mónica, Betriu Amadeo
Departamento de Hemodinámica y Cardiología Intervencionista, Hospital Clínic, Barcelona, España.
Rev Esp Cardiol. 2005 May;58(5):504-11.
Radial artery spasm is the most frequent complication of transradial cardiac catheterization. It causes patient discomfort and reduces the procedure's success rate. The aims of this study were to identify variables associated with this complication, such as clinical parameters, angiographic characteristics of the radial artery and factors related to the procedure, and to analyze the clinical consequences of spasm, both generally and for radial artery patency, during follow-up.
The study included 637 patients who were undergoing transradial cardiac catheterization. Radial artery spasm was recorded using a scale that reflected the presence of pain and the technical difficulty of the procedure.
Radial artery spasm was reported in 127 patients (20.2%). Multivariate analysis showed that the variables associated with radial artery spasm were radial artery anatomical anomalies (odds ratio [OR]=5.1; 95% confidence interval [95% CI]: 2.1-11.4), use of >size-3 catheters (OR=3.0; 95% CI: 1.9-4.7), moderate-to-severe pain during radial artery cannulation (OR=2.6; 95% CI: 1.4-4.9), the use of phentolamine as a spasmolytic (OR=1.8; 95% CI: 1.1-2.9), and postvasodilation radial artery diameter (OR=0.98; 95% CI: 0.98-0.99). At follow-up [20 (18) days], severe pain in the forearm was more frequent in patients who presented with radial artery spasm (12.4% vs 5.3%), but there was no significant difference in the radial artery occlusion rate (4.5% vs 2.2%).
Radial artery spasm during transradial catheterization mainly depends on radial artery characteristics and procedural variables. At follow-up, radial artery spasm was associated with more frequent severe pain in the forearm, but the radial artery occlusion rate was not increased.
桡动脉痉挛是经桡动脉心脏导管插入术最常见的并发症。它会引起患者不适并降低手术成功率。本研究的目的是确定与该并发症相关的变量，如临床参数、桡动脉的血管造影特征以及与手术相关的因素，并分析痉挛在随访期间的临床后果，包括总体情况以及对桡动脉通畅性的影响。
该研究纳入了637例行经桡动脉心脏导管插入术的患者。使用反映疼痛程度和手术技术难度的量表记录桡动脉痉挛情况。
127例患者（20.2%）出现桡动脉痉挛。多因素分析显示，与桡动脉痉挛相关的变量有桡动脉解剖异常（比值比[OR]=5.1；95%置信区间[95%CI]：2.1 - 11.4）、使用大于3号的导管（OR=3.0；95%CI：1.9 - 4.7）、桡动脉插管时中度至重度疼痛（OR=2.6；95%CI：1.4 - 4.9）、使用酚妥拉明作为解痉剂（OR=1.8；95%CI：1.1 - 2.9）以及血管扩张后桡动脉直径（OR=0.98；95%CI：0.98 - 0.99）。在随访[20（18）天]时，出现桡动脉痉挛的患者前臂严重疼痛更为常见（12.4%对5.3%），但桡动脉闭塞率无显著差异（4.5%对2.2%）。
经桡动脉导管插入术期间的桡动脉痉挛主要取决于桡动脉特征和手术变量。在随访中，桡动脉痉挛与前臂更频繁的严重疼痛相关，但桡动脉闭塞率并未增加。
