Department of Cardiology, Beijing Anzhen Hospital of Capital Medical University, Beijing 100029, China.
Chin Med J (Engl). 2010 Jul;123(13):1774-9.
Transradial approach, which is now widely used in coronary angiography and intervention, may be advantageous with respect to the femoral access due to the lower incidence of vascular complications. Transulnar approach has been proposed for elective procedures in patients not suitable for transradial approach. The objective of this study was to evaluate the safety and efficacy of the transulnar approach versus the transradial approach for coronary angiography and intervention.
Two hundred and forty patients undergoing coronary angiography, followed or not by intervention, were randomized to transulnar (TUA) or transradial approach (TRA). Doppler ultrasound assessments of the forearm vessels were scheduled for all patients before procedures, 1 day and 30 days after procedures. The primary end point was access site vascular complications during hospitalization and 30 days follow-up. Major adverse cardiac events (MACE) as secondary end point was recorded till 30 days follow-up.
Successful puncture was achieved in 98.3% (118/120) of patients in the TUA group, and in 100% (120/120) of patients in the TRA group. Coronary angiographies were performed in 40 and 39 patients in TUA and TRA group. Intervention procedures were performed in 78 and 83 patients in TUA and TRA group, respectively. The incidence of artery stenosis 1 day and 30 days after procedures was 11.0% vs.12.3% and 5.1% vs. 6.6% in TUA and TRA group, respectively. Asymptomatic access site artery occlusion occurred in 5.1% vs.1.7% of patients 1 day and 30 days after transulnar angioplasty, and in 6.6% vs. 4.9% of patients 1 day and 30 days after transradial angioplasty. Minor bleeding was still observed at the moment of the ultrasound assessment in 5.9% and 5.7% of patients in TUA and TRA group, respectively (P = 0.949). No big forearm hematoma, and A-V fistula were observed in both groups. Freedom from MACE at 30 days follow-up was observed in all patients.
The transulnar approach is as safe and effective as the transradial approach for coronary angiography and intervention. It is an attractive opinion for experienced operators who are skilled in this technique, particularly in cases of anatomic variations of the radial artery, radial artery small-caliber or thin radial pulse.
经桡动脉入路现已广泛应用于冠状动脉造影和介入治疗，其血管并发症的发生率较低，优于股动脉入路。对于不适合经桡动脉入路的患者，可选择经尺动脉入路进行选择性操作。本研究旨在评估经尺动脉入路（TUA）与经桡动脉入路（TRA）在冠状动脉造影和介入治疗中的安全性和疗效。
240 例接受冠状动脉造影，随后行或不行介入治疗的患者被随机分为经尺动脉（TUA）或经桡动脉（TRA）入路组。所有患者在术前、术后 1 天和 30 天均行前臂血管多普勒超声检查。主要终点为住院期间及 30 天随访期间的血管穿刺部位并发症。次要终点为 30 天随访期间的主要不良心脏事件（MACE）。
TUA 组 98.3%（118/120）的患者穿刺成功，TRA 组 100%（120/120）的患者穿刺成功。TUA 组和 TRA 组分别有 40 例和 39 例患者进行冠状动脉造影，78 例和 83 例患者进行介入治疗。术后 1 天和 30 天，动脉狭窄发生率分别为 TUA 组 11.0%和 5.1%，TRA 组 12.3%和 6.6%。术后 1 天和 30 天，TUA 组和 TRA 组分别有 5.1%和 1.7%的患者出现无症状穿刺部位动脉闭塞，分别有 6.6%和 4.9%的患者出现穿刺部位动脉闭塞。术后即刻，TUA 组和 TRA 组分别有 5.9%和 5.7%的患者出现轻微出血（P=0.949）。两组均未发生大前臂血肿和动静脉瘘。30 天随访时，所有患者均无 MACE。
经尺动脉入路与经桡动脉入路行冠状动脉造影和介入治疗同样安全有效。对于经验丰富且熟练掌握该技术的术者而言，该入路具有吸引力，尤其适用于桡动脉解剖变异、桡动脉细或桡动脉搏动微弱的患者。
