Mattea Violeta, Salomon Carsten, Menck Niels, Lauten Philipp, Malur Frank Michael, Schade Anja, Steinborn Frank, Costello-Boerrigter Lisa, Neumeister Axel, Lapp Harald
HELIOS Klinikum Erfurt, Department of Internal Medicine III, Nordhäuser Straße 74, 99089, Erfurt, Germany.
HELIOS Klinikum Erfurt, Department of Angiology, Nordhäuser Straße 74, 99089, Erfurt, Germany.
Int J Cardiol Heart Vasc. 2016 Dec 29;14:46-52. doi: 10.1016/j.ijcha.2016.12.003. eCollection 2017 Mar.
Transradial artery (TRA) left heart catheterization is an increasingly used technique for both diagnostic and interventional coronary procedures. This study evaluates the incidence of access site complications in the current interventional era.
A total of 507 procedures were performed under standardized conditions. Each procedure was performed using high levels of anticoagulation, hydrophilic sheaths, and short post-procedural compression times. Vascular complications were assessed one day after TRA catheterization using Duplex sonography and classified according to the necessity of additional medical intervention. A simple questionnaire helped identifying upper extremity neurologic or motor complications. Vascular complications were detected in 12 patients (2.36%): radial artery occlusion was detected in 9 patients (1.77%), 1 patient developed an AV-fistula (0.19%), and 2 patients had pseudoaneurysms (0.38%). None of the patients required specialized medical or surgical intervention. Under our procedural conditions, small radial artery diameter was the only significant predictor for the development of post-procedural vascular complications (2.11 ± 0.42 mm vs 2.52 ± 0.39 mm, = 0.001). None of the previously reported risk factors, namely, advanced renal failure, diabetes, acuteness/complexity of procedure, or sheath and catheter size significantly influenced the rate of vascular complications. No major hematoma or local neurologic or motor complications were identified.
Using current techniques and materials, we report a very low rate of local complications associated with TRA catheterization.
经桡动脉左心导管插入术在诊断性和介入性冠状动脉手术中越来越常用。本研究评估了当前介入时代穿刺部位并发症的发生率。
在标准化条件下共进行了507例手术。每例手术均采用高剂量抗凝、亲水鞘管及术后短时间压迫。在经桡动脉导管插入术后一天，使用双功超声评估血管并发症，并根据是否需要额外的医疗干预进行分类。一份简单的问卷有助于识别上肢神经或运动并发症。12例患者（2.36%）检测到血管并发症：9例患者（1.77%）检测到桡动脉闭塞，1例患者发生动静脉瘘（0.19%），2例患者出现假性动脉瘤（0.38%）。所有患者均无需特殊医疗或手术干预。在我们的手术条件下，桡动脉直径较小是术后血管并发症发生的唯一显著预测因素（2.11±0.42mm对2.52±0.39mm，P=0.001）。既往报道的危险因素，即晚期肾衰竭、糖尿病、手术的急性程度/复杂性或鞘管及导管尺寸，均未显著影响血管并发症的发生率。未发现重大血肿或局部神经或运动并发症。
使用当前的技术和材料，我们报道经桡动脉导管插入术相关的局部并发症发生率非常低。
