Kashiwagi Manabu, Tanimoto Takashi, Kitabata Hironori, Arita Yu, Yamamoto Yasunori, Mori Kazuya, Terada Kosei, Nishiguchi Tsuyoshi, Taruya Akira, Kubo Takashi, Tanaka Atsushi, Akasaka Takashi
Department of Cardiology, Shingu Municipal Medical Center, Japan.
Department of Cardiology, Shingu Municipal Medical Center, Japan.
Cardiovasc Revasc Med. 2019 Apr;20(4):311-315. doi: 10.1016/j.carrev.2018.07.004. Epub 2018 Jul 5.
Transradial cardiac catheterization reduces access site complications and is more comfortable for patients than the transfemoral approach. However, failure of the transradial approach is more common than the transfemoral approach. This study aimed to investigate whether ultrasound-guided rescue could facilitate transradial cardiac catheterization.
We retrospectively analyzed 592 consecutive patients who underwent coronary angiography and/or percutaneous coronary intervention. Patients were divided into 2 groups: the palpation technique (PT) (n = 280) and the ultrasound guidance (UG) available group (n = 312). The application and the timing of introduction of ultrasound guidance in the UG group were at the discretion of the individual operators.
Real-time ultrasound guidance was used in 98 patients (31.4%) in the UG group. No statistically significant intergroup differences were observed in the incidence of hematoma (6.8% vs. 5.8%, p = 0.62). Although the procedural time in the UG group was longer than that in the PT group (303 s vs. 357 s, p < 0.01), the success rate of sheath insertion was significantly higher in the UG group (97% vs. 92%, p < 0.01). Multivariate analysis revealed that the availability of UG was the only independent predictor of success of sheath insertion (odds ratio 2.79, 95% confidence interval 1.24-6.31, p = 0.01).
Although UG maneuvers require additional procedural time for setting up systems, UG rescue was effective for successful transradial cardiac catheterization.
经桡动脉心脏导管插入术可减少穿刺部位并发症，且相较于经股动脉途径，患者感觉更舒适。然而，经桡动脉途径失败的情况比经股动脉途径更为常见。本研究旨在探讨超声引导下的补救措施是否有助于经桡动脉心脏导管插入术。
我们回顾性分析了592例连续接受冠状动脉造影和/或经皮冠状动脉介入治疗的患者。患者被分为两组：触诊技术组（PT）（n = 280）和可使用超声引导组（UG）（n = 312）。UG组中超声引导的应用及引入时机由各操作者自行决定。
UG组中有98例患者（31.4%）使用了实时超声引导。两组间血肿发生率无统计学显著差异（6.8%对5.8%，p = 0.62）。尽管UG组的操作时间比PT组长（303秒对357秒，p < 0.01），但UG组鞘管插入成功率显著更高（97%对92%，p < 0.01）。多因素分析显示，UG的可用性是鞘管插入成功的唯一独立预测因素（比值比2.79，95%置信区间1.24 - 6.31，p = 0.01）。
尽管UG操作需要额外的操作时间来设置系统，但UG补救措施对经桡动脉心脏导管插入术的成功是有效的。
