Markovic Sinisa, Imhof Armin, Kunze Markus, Rottbauer Wolfgang, Wöhrle Jochen
Department of Internal Medicine II, University of Ulm, Ulm, Germany.
Coron Artery Dis. 2015 Jan;26(1):56-9. doi: 10.1097/MCA.0000000000000166.
The aim of this study was to evaluate the occurrence of complications by Doppler sonography after radial access for cardiac catheterization in a prospective observational registry.
The radial approach for cardiac catheterization is being used with increasing frequency. In randomized trials, the risk of bleeding was lower with radial access compared with femoral access. However, there are still concerns in terms of the radial access because of reported high rates of radial artery occlusion (RAO) up to 30%.
In this prospective observational registry, a total of 369 procedures were performed using a standardized radial approach in terms of sheath size, anticoagulation, and postinterventional hemostasis. The rates of RAO, hematoma, and vascular complications were assessed the day after catheterization.
A diagnostic procedure was performed in 25.7% and a coronary intervention in 74.3% of patients. Sheath size was 5 Fr in 12.2% (N=45) or 6 Fr in 87.8% (N=324). Doppler sonography showed RAO in 3.8% (N=14/369), with no difference between the 5- and the 6-Fr sheath (2.2 vs. 4.0%, P=0.56). A hematoma of 5 cm or more was documented after two (0.5%) procedures. There was no need for any blood transfusion or surgery. A small hematoma (every hematoma <5 cm) was observed in 16.0% (N=59). There was no statistical difference in the frequency of RAO, hematoma, or vascular complications between procedures performed with 5-Fr or less or 6-Fr sheaths and the use of dual antiplatelet therapy or oral anticoagulation.
Radial access for coronary catheterization is effective and safe. With a standardized approach, the rates of bleeding events and RAOs are low.
本研究旨在通过前瞻性观察登记系统评估经桡动脉途径进行心脏导管插入术后多普勒超声检查并发症的发生情况。
心脏导管插入术的桡动脉途径使用频率日益增加。在随机试验中，与股动脉途径相比，桡动脉途径的出血风险更低。然而，由于报道的桡动脉闭塞（RAO）发生率高达30%，桡动脉途径仍存在一些问题。
在这个前瞻性观察登记系统中，总共369例手术采用了标准化的桡动脉途径，包括鞘管尺寸、抗凝和介入后止血。在导管插入术后第二天评估RAO、血肿和血管并发症的发生率。
25.7%的患者进行了诊断性手术，74.3%的患者进行了冠状动脉介入治疗。鞘管尺寸为5 Fr的占12.2%（N = 45），6 Fr的占87.8%（N = 324）。多普勒超声显示RAO发生率为3.8%（N = 14/369），5 Fr和6 Fr鞘管之间无差异（2.2%对4.0%，P = 0.56）。2例（0.5%）手术后记录到5 cm或更大的血肿。无需任何输血或手术。观察到16.0%（N = 59）的患者有小血肿（每个血肿<5 cm）。5 Fr及以下或6 Fr鞘管手术以及使用双联抗血小板治疗或口服抗凝治疗之间，RAO、血肿或血管并发症的发生率无统计学差异。
冠状动脉导管插入术的桡动脉途径有效且安全。采用标准化方法，出血事件和RAO的发生率较低。
