非选择性患者经尺动脉与经桡动脉途径行冠状动脉导管插入术的安全性和可行性

Safety and feasibility of transulnar versus transradial artery approach for coronary catheterization in non-selective patients.

作者信息

Geng Wei, Fu Xianghua, Gu Xinshun, Jiang Yunfa, Fan Weize, Wang Yanbo, Li Wei, Xing Kun, Liu Chen

机构信息

Department of Cardiology, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, China.

Department of Cardiology, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, China. Email:

出版信息

Chin Med J (Engl). 2014;127(7):1222-8.

PMID:24709170

Abstract

BACKGROUND

Transradial approach catheterization is now widely used in coronary angiography and angioplasty. The ulnar artery, which is one of the two terminal branches of the brachial artery, may be a potential approach for cardiac catheterization. The aim of this study was to evaluate the safety and feasibility of a transulnar approach for coronary catheterization in non-selective patients.

METHODS

A total of 535 consecutive patients were randomly assigned to transulnar approach (TUA) group (n = 271) or transradial approach (TRA) group (n = 264) upon arrival at the catheterization laboratory. Allen's test and inverse Allen's test were not routinely performed. Ultrasound-Doppler assessment of the forearm artery was performed before the procedure, two days after the procedure, and 30 days after the procedure. The primary endpoints of study were the rate of successful artery cannulation and the access-site related complications. The secondary endpoints included the number of needle punctures, total time for the procedure, and major adverse cardiac events (MACE).

RESULTS

Successful puncture of the objective artery was obtained in 91.5% of the patients in the TUA group, and 95.1% of the patients in the TRA group (P > 0.05). There was no significant difference in hematoma complications between the two groups (7.7% vs. 4.2%, P = 0.100). A motor abnormality of the hand was observed in one patient in the TUA group. There were no arteriovenous fistula or pseudoaneurysm observed in our study. Three (1.1%) patients in the TUA group and 8 (3.0%) patients in the TRA group had occlusion of the access artery (P = 0.137), but none of the patients had symptoms or signs of hand ischemia. There were no significant differences in MACE between the two groups during follow-up.

CONCLUSION

The transulnar approach is an effective and safe technique for coronary catheterization in non-selective patients.

摘要

背景

经桡动脉途径导管插入术目前广泛应用于冠状动脉造影和血管成形术。尺动脉是肱动脉的两个终末分支之一，可能是心脏导管插入术的一种潜在途径。本研究的目的是评估经尺动脉途径在非选择性患者中进行冠状动脉导管插入术的安全性和可行性。

方法

共有535例连续患者在抵达导管室时被随机分配至经尺动脉途径（TUA）组（n = 271）或经桡动脉途径（TRA）组（n = 264）。未常规进行艾伦试验和反向艾伦试验。在术前、术后两天和术后30天对前臂动脉进行超声多普勒评估。研究的主要终点是动脉穿刺成功率和与穿刺部位相关的并发症。次要终点包括穿刺次数、手术总时间和主要不良心脏事件（MACE）。

结果

TUA组91.5%的患者成功穿刺目标动脉，TRA组为95.1%的患者（P>0.05）。两组血肿并发症无显著差异（7.7%对4.2%，P = 0.100）。TUA组有1例患者出现手部运动异常。本研究中未观察到动静脉瘘或假性动脉瘤。TUA组有3例（1.1%）患者和TRA组有8例（3.0%）患者出现穿刺动脉闭塞（P = 0.137），但所有患者均无手部缺血的症状或体征。随访期间两组MACE无显著差异。