Al-Azizi Karim M, Lotfi Amir S
Baystate Medical Center - University of Massachusetts Medical School, 759 Chestnut Street, S4 661, Springfield, MA 01199, United States.
Cardiovasc Revasc Med. 2018 Dec;19(8S):35-40. doi: 10.1016/j.carrev.2018.03.020. Epub 2018 Mar 26.
Patients' intra and post procedural comfort, quick recovery, as well as procedure success, are key elements for choosing the right arterial access site. Radial artery access has been of increasing interest since it was first described. Advanced treatments of coronary lesions, from primary percutaneous interventions during ST elevation myocardial infarction cases to chronic total occlusion cases, have been increasingly done through the radial access. Distal left trans radial artery (dlTRA) is a new technique first described by Kiemineij. We report the first documented US experience of the left distal radial artery access for coronary angiography and interventions.
dlTRA was attempted on 22 consecutive patients, consented for a cardiac catheterization. 7 patients underwent percutaneous coronary intervention. The left hand is prepped in the usual fashion, exposing the anatomical snuff box. Under ultrasound guidance, the artery is punctured and the sheath is inserted carefully. The cardiac catheterization is completed using standard diagnostic and guiding catheters, that are typically chosen for femoral artery access. Hemostasis was achieved with a radial band. Patients had the ability to use the right hand as well as bend their left wrist post procedure.
dlTRA was successful in all 22 patients. 7 patients underwent PCI through this approach. Two patients required a multivessel complex PCI with multiple stents and additional equipment. There were no conversions to the right radial or femoral approach. All patients had excellent hemostasis with a radial band, with no complications. Pre discharge radial pulses were intact in the wrist as well as in the anatomical snuff box.
Distal left trans radial access is feasible and safe in patients that are carefully selected and are deemed good candidates. There is a learning curve for developing such program, as is the case with conventional radial access.
患者术中及术后的舒适度、快速康复以及手术成功率是选择合适动脉穿刺部位的关键因素。自首次被描述以来，桡动脉穿刺越来越受到关注。从ST段抬高型心肌梗死病例的直接经皮介入治疗到慢性完全闭塞病例，冠状动脉病变的高级治疗越来越多地通过桡动脉穿刺进行。左桡动脉远端穿刺（dlTRA）是Kiemineij首次描述的新技术。我们报告了美国首例有记录的经左桡动脉远端穿刺进行冠状动脉造影和介入治疗的经验。
对22例连续同意进行心导管检查的患者尝试进行dlTRA。7例患者接受了经皮冠状动脉介入治疗。以常规方式准备左手，暴露解剖鼻烟壶。在超声引导下，穿刺动脉并小心插入鞘管。使用通常用于股动脉穿刺的标准诊断和引导导管完成心导管检查。用桡动脉压迫带止血。术后患者能够使用右手并弯曲左手腕。
22例患者的dlTRA均成功。7例患者通过该方法接受了PCI。2例患者需要进行多支血管复杂PCI，使用多个支架和额外设备。没有转为右桡动脉或股动脉穿刺。所有患者使用桡动脉压迫带止血效果良好，无并发症。出院前手腕及解剖鼻烟壶处桡动脉搏动正常。
对于经过仔细筛选且被认为是合适候选人的患者，左桡动脉远端穿刺是可行且安全的。与传统桡动脉穿刺一样，开展此类项目存在学习曲线。
