Aptecar Eduardo, Pernes Jean-Marc, Chabane-Chaouch Mourad, Bussy Nicolas, Catarino Gino, Shahmir Ali, Bougrini Karim, Dupouy Patrick
Pôle Cardio-Vasculaire Interventionnel, Clinique Les Fontaines, Melun, France.
Catheter Cardiovasc Interv. 2006 May;67(5):711-20. doi: 10.1002/ccd.20679.
To compare in terms of efficacy and safety the transulnar to the transradial approach for coronary angiography and angioplasty.
Opposite to the transradial approach, which is now widely used in catheterization laboratories worldwide, the ulnar artery approach is rarely used for cardiac catheterization.
Diagnostic coronarography, followed or not by angioplasty, was performed by transulnar or transradial approach, chosen at random. A positive (normal) direct or reverse Allen's test was required before tempting the radial or the ulnar approach, respectively. MACE were recorded till 1-month follow-up. Doppler ultrasound assessment of the forearm vessels was scheduled for all the angioplastied patients.
Successful access was obtained in 93.1% of patients in the ulnar group (n = 216), and in 95.5% of patients in the radial group (n = 215), P = NS. One hundred and three and 105 angioplasty procedures were performed in 94 and 95 patients in ulnar and radial group, with success in 95.2% and 96.2% of procedures in ulnar and radial group, respectively (P = NS). Freedom from MACE at 1-month follow-up was observed in 93 patients in both groups (97.8% for ulnar group and 95.8% for radial group), P = NS. Asymptomatic access site artery occlusion occurred in 5.7% of patients after transulnar and in 4.7% of patients after transradial angioplasty. A big forearm hematoma, and a little A-V fistula were observed, each in one patient, in the ulnar group.
The transulnar approach for diagnostic and therapeutic coronary interventions is a safe and effective alternative to the transradial approach, as both techniques share a high success rate and an extremely low incidence of entry site complications. The transulnar approach has the potential to spare injury to the radial artery in anticipation of its use as a coronary bypass conduit.
比较经尺动脉途径与经桡动脉途径进行冠状动脉造影及血管成形术的有效性和安全性。
与目前在全球导管实验室广泛应用的经桡动脉途径相反，尺动脉途径很少用于心脏导管插入术。
随机选择经尺动脉或经桡动脉途径进行诊断性冠状动脉造影，造影后是否进行血管成形术视情况而定。在尝试经桡动脉或经尺动脉途径之前，分别需要直接或反向Allen试验呈阳性（正常）。记录直至1个月随访期的主要不良心血管事件（MACE）。对所有接受血管成形术的患者安排前臂血管的多普勒超声评估。
尺动脉组93.1%的患者（n = 216）成功建立通路，桡动脉组95.5%的患者（n = 215）成功建立通路，P = 无显著性差异。尺动脉组和桡动脉组分别有94例和95例患者进行了103例和105例血管成形术，尺动脉组和桡动脉组手术成功率分别为95.2%和96.2%（P = 无显著性差异）。两组均有93例患者在1个月随访时无MACE（尺动脉组为97.8%，桡动脉组为95.8%），P = 无显著性差异。经尺动脉血管成形术后5.7%的患者出现无症状的穿刺部位动脉闭塞，经桡动脉血管成形术后4.7%的患者出现这种情况。尺动脉组有1例患者出现较大的前臂血肿，1例患者出现小的动静脉瘘。
经尺动脉途径用于诊断和治疗性冠状动脉介入治疗是经桡动脉途径的一种安全有效的替代方法，因为这两种技术都具有高成功率和极低的穿刺部位并发症发生率。经尺动脉途径有可能避免桡动脉损伤，以便日后用作冠状动脉搭桥管道。
