Zaremski Lynn, Quesada Ramon, Kovacs Margaret, Schernthaner Melanie, Uthoff Heiko
Department of Angiology, University Hospital Basel Petersgraben 4, 4031 Basel, Switzerland.
J Invasive Cardiol. 2013 Oct;25(10):538-42.
Radial access is increasingly used for both diagnostic and interventional cardiac procedures. Prospective data comparing ultrasound- versus palpation-guided radial catheterization are largely lacking.
In this prospective, single-center study, a total of 183 consecutive patients scheduled for transradial cardiac catheterization by an experienced interventionalist were assigned 1:1 to either palpation- or ultrasound-guided radial access. Demographic and procedure parameters were prospectively recorded.
Baseline demographic and clinical parameters did not differ significantly between the ultrasound group (n = 92) and palpation group (n = 91). The initial radial catheterization success rate (87% vs 86.8%; P=.999) and time to access (47 seconds [interquartile range (IQR), 20-90 seconds] versus 31 seconds [IQR, 20-75 seconds]; P=.179) did not differ between the ultrasound and palpation groups, respectively. Pulse quality (absent, weak, strong) was independently associated with access failure in both groups (P<.001). Obesity was associated with access failure in the palpation group (P=.005), but not in the ultrasound group (P=.544). In 3/12 cases (25%) in the ultrasound group and 2/6 cases (33%) in the palpation group, the operator was able to establish radial access using the alternative method (P=.710). If palpation-guided radial access failed, an additional ultrasound-guided attempt before crossover to femoral access was associated with a shorter overall time to access (525 seconds [IQR, 462-567 seconds] versus 744 seconds [IQR, 722-788 seconds]; P=.016).
Ultrasound-guided radial access seems to provide no substantial additional benefit over palpation-guided access alone. Attempting the alternative guiding methods to establish radial access before crossover to femoral access seems to be a reasonable approach.
桡动脉入路越来越多地用于心脏诊断和介入手术。目前很大程度上缺乏比较超声引导与触诊引导桡动脉置管的前瞻性数据。
在这项前瞻性单中心研究中，共有183例连续接受经验丰富的介入专家进行经桡动脉心脏导管插入术的患者，按1:1比例分配至触诊引导或超声引导桡动脉入路组。前瞻性记录人口统计学和手术参数。
超声组（n = 92）和触诊组（n = 91）的基线人口统计学和临床参数无显著差异。超声组和触诊组的初始桡动脉置管成功率（87%对86.8%；P = 0.999）和穿刺时间（47秒[四分位间距（IQR），20 - 90秒]对31秒[IQR，20 - 75秒]；P = 0.179）分别无差异。两组中脉搏质量（无、弱、强）均与穿刺失败独立相关（P < 0.001）。肥胖在触诊组与穿刺失败相关（P = 0.005），但在超声组无相关性（P = 0.544）。超声组12例中有3例（25%）、触诊组6例中有2例（33%），术者能够使用替代方法建立桡动脉入路（P = 0.710）。如果触诊引导的桡动脉入路失败，在转为股动脉入路之前额外进行超声引导尝试与缩短总体穿刺时间相关（525秒[IQR，462 - 567秒]对744秒[IQR，722 - 788秒]；P = 0.016）。
超声引导桡动脉入路似乎并不比单纯触诊引导入路提供实质性的额外益处。在转为股动脉入路之前尝试替代引导方法来建立桡动脉入路似乎是一种合理的方法。
