Kuno Toshiki, Hirano Keita, Imaeda Syohei, Hashimoto Kenji, Ryuzaki Toshinobu, Saito Tetsuya, Yamazaki Hiroyuki, Tabei Ryota, Kodaira Masaki, Numasawa Yohei
Department of Cardiology, Japanese Red Cross Ashikaga Hospital, 284-1 Yobe-cho, Ashikaga, Japan.
J Invasive Cardiol. 2018 Jun;30(6):212-217. Epub 2018 Jan 15.
Periprocedural bleeding is associated with increased risk of early mortality during percutaneous coronary intervention (PCI), especially in patients on dialysis. A transradial approach (TRA) should be considered for these patients; however, PCI operators avoid this approach because of the risk of radial artery occlusion (RAO). The aim of this study is to construct a TRA system and clarify its safety in patients on dialysis.
Eighty-eight consecutive patients on dialysis who underwent cardiac catheterization were prospectively included in this study and divided according to the access site into either the TRA group or the transfemoral approach (TFA) group. Radial access was limited in the opposite side of arteriovenous fistula. The study endpoints were in-hospital and 30-day mortality rates, puncture-site related bleeding complications, and other complications. The study safety endpoints were procedure success rate and RAO rate in the TRA group.
Mean patient age was 70.4 ± 8.5 years. PCI was performed in 43 patients (48.9%). The TRA and TFA groups included 62 patients (70.5%) and 26 patients (29.5%), respectively. In-hospital and 30-day mortality rates were 0.0% in both groups. Puncture-site bleeding rates were 3.8% in the TFA group and 0.0% in the TRA group (P=.12). Procedural success rate in the TRA group was 98.4%. Crossover to TFA was necessary in 1 patient due to radial artery spasm. RAO occurred in 4 patients (6.5%).
Constructed TRA can be safely used in patients on dialysis. Our study could lead to an increase in TRA in these patients, which would lead to better prognosis and patient comfort.
围手术期出血与经皮冠状动脉介入治疗（PCI）期间早期死亡风险增加相关，尤其是在透析患者中。对于这些患者应考虑采用经桡动脉途径（TRA）；然而，PCI操作人员因桡动脉闭塞（RAO）风险而避免采用这种途径。本研究的目的是构建一个TRA系统并阐明其在透析患者中的安全性。
连续88例接受心脏导管插入术的透析患者前瞻性纳入本研究，并根据穿刺部位分为TRA组或经股动脉途径（TFA）组。桡动脉穿刺限于动静脉内瘘对侧。研究终点为住院和30天死亡率、穿刺部位相关出血并发症及其他并发症。研究安全终点为TRA组的手术成功率和RAO发生率。
患者平均年龄为70.4±8.5岁。43例患者（48.9%）接受了PCI。TRA组和TFA组分别包括62例患者（70.5%）和26例患者（29.5%）。两组的住院和30天死亡率均为0.0%。TFA组穿刺部位出血率为3.8%，TRA组为0.0%（P = 0.12）。TRA组的手术成功率为98.4%。1例患者因桡动脉痉挛需要转为TFA。4例患者（6.5%）发生RAO。
构建的TRA可安全用于透析患者。我们的研究可能会增加这些患者TRA的使用，这将带来更好的预后和患者舒适度。
