Interventional Cardiology, Fortis Escorts Heart Institute, New Delhi, India.
Catheter Cardiovasc Interv. 2013 Jul 1;82(1):64-73. doi: 10.1002/ccd.24585. Epub 2013 Feb 26.
To assess feasibility and utility of imaging of both arms using ultrasound to facilitate transradial (TR) and transulnar (TU) coronary angiograms (CA) and intervention.
Despite well recognized advantages, transradial approach (TRA) has challenges that reduce procedural success including small arterial size, anatomical variations, and anomalies of radial artery (RA). The utility of routine pre-procedural ultrasound of the arm arteries (PPUAA) in facilitating TRA has not been previously studied.
To determine the role of PPUAA, we performed a single center registry of consecutive patients undergoing diagnostic and interventional procedures between 2006 and 2011. All patients underwent PPUAA of the right and left radial, ulnar (UA), as well as the brachial arteries (BA) in the antecubital fossa using a linear probe. End-points assessed included the incidence and correlates of arterial sizes, vascular anomalies, procedure success, and fluoroscopy as well as ultrasound assessment times. RA occlusion rates were studied in the last 10 months of the study period.
Complete data on radial (mean 1.9 mm (male);1.7 mm (female)) and ulnar artery size (mean 1.8 mm (male); 1.6 mm (female)) and data on brachial branching anatomy were available in 2,344 patients; 1,872 of whom underwent a TR or TU procedure. The mean time to perform bilateral PPUAA was 6.4 min ± 1.8 min. The incidence of arterial abnormalities was 9.8% in PPUAA. Procedure success was 98.7% for CA and 97.5% for percutaneous coronary intervention. Outcomes were better in this cohort compared with remaining 3,781 patients in whom PPUAA data were not available.
This single center prospective registry shows that PPUAA is feasible, requires minimum time, and provides anatomical information that may improve procedure success while reducing patient discomfort, arterial spasm, and fluoroscopy time. These findings should be confirmed in a randomized trial.
评估使用超声对双臂成像以促进经桡动脉（TR）和经尺动脉（TU）冠状动脉造影（CA）和介入的可行性和实用性。
尽管经桡动脉入路（TRA）具有公认的优势，但仍存在一些挑战，包括动脉尺寸小、解剖变异和桡动脉（RA）异常等，这降低了手术成功率。以前尚未研究过在 TRA 中常规进行术前手臂动脉超声检查（PPUAA）的作用。
为了确定 PPUAA 的作用，我们对 2006 年至 2011 年间连续进行诊断和介入治疗的患者进行了单中心登记。所有患者均在肘前窝使用线性探头进行双侧桡动脉、尺动脉（UA）和肱动脉（BA）的 PPUAA。评估的终点包括动脉尺寸、血管异常、手术成功率、透视以及超声评估时间的发生率和相关因素。在研究期间的最后 10 个月研究了 RA 闭塞率。
在 2344 例患者中获得了桡动脉（男性平均 1.9mm；女性平均 1.7mm）和尺动脉大小以及肱动脉分支解剖数据的完整资料，其中 1872 例患者进行了 TR 或 TU 手术。双侧 PPUAA 的平均时间为 6.4 分钟±1.8 分钟。PPUAA 的动脉异常发生率为 9.8%。CA 的手术成功率为 98.7%，经皮冠状动脉介入治疗的成功率为 97.5%。与未进行 PPUAA 数据的其余 3781 例患者相比，该队列的结果更好。
这项单中心前瞻性登记研究表明，PPUAA 是可行的，所需时间最短，并提供解剖学信息，这可能有助于提高手术成功率，同时减少患者不适、动脉痉挛和透视时间。这些发现应在随机试验中得到证实。
