Department of Internal Medicine/Cardiology, Heart Centre, University of Leipzig, Leipzig, Germany.
JACC Cardiovasc Interv. 2012 Jan;5(1):36-43. doi: 10.1016/j.jcin.2011.08.011.
This study investigated the impact of sheath size on the rate of radial artery occlusions (RAO) (primary objective) and other access site complications (hemorrhage, pseudoaneurysm, arteriovenous fistula) as secondary objectives after transradial coronary catheterization.
The number of vascular access complications in the published data ranges from 5% to 38% after transradial catheterization.
Between November 2009 and August 2010, 455 patients 65.3 ± 10.9 years of age (62.2% male) with transradial access with 5-F (n = 153) or 6-F (n = 302) arterial sheaths were prospectively recruited. Duplex sonography was obtained in each patient before discharge. Patients with symptomatic RAO were treated with low-molecular-weight heparin (LMWH), and a follow-up was performed.
The incidence of access site complications was 14.4% with 5-F sheaths compared with 33.1% with 6-F sheaths (p < 0.001). Radial artery occlusion occurred in 13.7% with 5-F sheaths compared with 30.5% with 6-F sheaths (p < 0.001). There was no difference between groups with regard to hemorrhage, pseudoaneurysms, or arteriovenous fistulas. Female sex, larger sheath size, peripheral arterial occlusive disease, and younger age independently predicted RAO in multivariate analysis. In total, 42.5% of patients with RAO were immediately symptomatic; another 7% became symptomatic within a mean of 4 days. Of patients with RAO, 59% were treated with LMWH. The recanalization rates were significantly higher in patients receiving LMWH compared with conventional therapy (55.6% vs. 13.5%, p < 0.001) after a mean of 14 days.
The incidence of RAO by vascular ultrasound was higher than expected from previous data, especially in patients who underwent the procedure with larger sheaths.
本研究旨在探讨鞘管大小对经桡动脉冠状动脉介入治疗后桡动脉闭塞（RAO）发生率（主要目标）和其他入路并发症（出血、假性动脉瘤、动静脉瘘）的影响，并将其作为次要目标。
在经桡动脉入路的已发表数据中，血管入路并发症的发生率为 5%至 38%。
2009 年 11 月至 2010 年 8 月，前瞻性纳入 455 例年龄 65.3±10.9 岁（62.2%为男性）的经桡动脉入路患者，其中 5-F 动脉鞘（n=153）和 6-F 动脉鞘（n=302）各 153 例。每位患者在出院前均行超声检查。对于有症状的 RAO 患者，给予低分子肝素（LMWH）治疗，并进行随访。
5-F 鞘组的入路并发症发生率为 14.4%，6-F 鞘组为 33.1%（p<0.001）。5-F 鞘组的 RAO 发生率为 13.7%，6-F 鞘组为 30.5%（p<0.001）。两组间出血、假性动脉瘤或动静脉瘘的发生率无差异。多因素分析显示，女性、鞘管较大、外周动脉闭塞性疾病和年龄较小是 RAO 的独立预测因素。共有 42.5%的 RAO 患者有立即症状，另有 7%的患者在平均 4 天内出现症状。RAO 患者中有 59%接受了 LMWH 治疗。与常规治疗相比，接受 LMWH 治疗的患者再通率明显更高（55.6%比 13.5%，p<0.001），平均时间为 14 天。
通过血管超声检测到的 RAO 发生率高于以往数据，尤其是在使用较大鞘管的患者中。
