Burstein Jason M, Gidrewicz Dominica, Hutchison Stuart J, Holmes Kate, Jolly Sanjit, Cantor Warren J
Department of Cardiology, Rouge Valley Ajax and Pickering Hospital, Ajax, Canada.
Am J Cardiol. 2007 Feb 15;99(4):457-9. doi: 10.1016/j.amjcard.2006.08.055. Epub 2006 Dec 20.
The radial artery is commonly used as a conduit in coronary artery bypass grafting. No data exist on the effects of radial sheath insertion on radial artery function. Because many patients considered for coronary artery bypass grafting have had previous radial procedures, it is important to understand any effects radial sheath insertion may have on radial artery function. Twenty-two patients who underwent elective coronary angiography or angioplasty with a 6Fr sheath through the right radial artery were studied. Radial artery function was assessed using ultrasound to measure flow-mediated dilation (FMD). Reactive hyperemia was produced by 5-minute cuff inflation on the arm to suprasystolic pressures. Radial artery diameter was measured at rest and 1 minute after cuff deflation. FMD was expressed as percent change in radial diameter compared with at rest. In all cases, the left radial artery was studied as a control. Patients were studied before sheath insertion, immediately after sheath insertion, and 6 weeks after sheath insertion. The FMD of the cannulated arm was 13.2% before sheath insertion versus 3.6% immediately after sheath insertion (p <0.01) and 0.2% (p <0.01) 9 weeks after sheath insertion. In contrast, there were no significant changes in the noncannulated arm at either time point. In conclusion, radial artery sheath insertion for coronary angiography or angioplasty results in immediate and persistent blunting of FMD, suggesting severe vasomotor dysfunction. Radial artery sheath insertion has important effects on radial artery function that must be considered when selecting radial conduits for coronary artery bypass grafting.
桡动脉常用于冠状动脉旁路移植术中作为血管通道。目前尚无关于桡动脉鞘管插入对桡动脉功能影响的数据。由于许多考虑进行冠状动脉旁路移植术的患者之前已接受过桡动脉相关操作，了解桡动脉鞘管插入可能对桡动脉功能产生的任何影响非常重要。对22例通过右桡动脉使用6Fr鞘管进行择期冠状动脉造影或血管成形术的患者进行了研究。使用超声测量血流介导的血管舒张（FMD）来评估桡动脉功能。通过在上臂将袖带充气5分钟至收缩压以上来产生反应性充血。在静息状态和袖带放气后1分钟测量桡动脉直径。FMD表示为与静息状态相比桡动脉直径的百分比变化。在所有病例中，对左侧桡动脉作为对照进行研究。在鞘管插入前、插入后即刻以及插入后6周对患者进行研究。插管侧手臂的FMD在鞘管插入前为13.2%，插入后即刻为3.6%（p<0.01），插入后9周为0.2%（p<0.01）。相比之下，未插管侧手臂在两个时间点均无显著变化。总之，用于冠状动脉造影或血管成形术的桡动脉鞘管插入会导致FMD立即且持续减弱，提示严重的血管舒缩功能障碍。桡动脉鞘管插入对桡动脉功能有重要影响，在选择用于冠状动脉旁路移植术的桡动脉血管通道时必须予以考虑。
