Dharma Surya, Kedev Sasko, Patel Tejas, Gilchrist Ian C, Rao Sunil V
Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, Indonesian Cardiovascular Research Center, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia.
Department of Cardiology, Faculty of Medicine, University Clinic of Cardiology, University of St Cyril & Methodius, Vodnjanska 17, Skopje, Macedonia.
Cardiovasc Revasc Med. 2019 Aug;20(8):674-677. doi: 10.1016/j.carrev.2018.09.006. Epub 2018 Sep 11.
Although patients prefer radial over femoral approach, some develop post-procedural arm pain after transradial procedures. This complication has been poorly defined in prior studies. We evaluated the extent of non-ischemic arm pain after transradial arterial access and identify variables that may be associated with this complication.
We performed a retrospective analysis of a 1706 patient database on patients who underwent transradial catheterization at three experienced radial centers. Arm pain was assessed by adult visual analogue scale (score > 4) defined as moderate to severe pain at the accessed forearm not related to hand ischemia and was evaluated at one day after the procedure. Logistic regression was used to identify the predictors of post-procedural arm pain.
The overall incidence of post-procedural arm pain one day after a transradial procedure was 4.5%. Covariate associated with post-procedural arm pain were hemostasis compression >4 h (odds ratio (OR) = 29.47, p < 0.001), radial artery occlusion by Doppler evaluation (OR = 3.35, p < 0.001), radial artery diameter < 2.8 mm (OR = 2.66, p = 0.01), and multiple puncture attempts (OR = 2.31, p = 0.03).
Approximately 1 in 20 patients undergoing transradial procedure have post-procedural arm pain one day after the procedure. Predictors of this complication relate to radial hemostasis, radial artery occlusion, radial artery diameter, and number of access attempts.
尽管患者更喜欢经桡动脉途径而非股动脉途径，但一些患者在经桡动脉手术后会出现术后手臂疼痛。先前的研究对这种并发症的定义并不明确。我们评估了经桡动脉穿刺术后非缺血性手臂疼痛的程度，并确定了可能与这种并发症相关的变量。
我们对三个经验丰富的桡动脉中心进行经桡动脉导管插入术的1706例患者的数据库进行了回顾性分析。采用成人视觉模拟量表（评分>4）评估手臂疼痛，定义为穿刺侧前臂中度至重度疼痛，与手部缺血无关，并在术后一天进行评估。采用逻辑回归分析确定术后手臂疼痛的预测因素。
经桡动脉手术后一天，术后手臂疼痛的总体发生率为4.5%。与术后手臂疼痛相关的协变量包括止血压迫>4小时（比值比（OR）=29.47，p<0.001）、多普勒评估显示桡动脉闭塞（OR=3.35，p<0.001）、桡动脉直径<2.8mm（OR=2.66，p=0.01）和多次穿刺尝试（OR=2.31，p=0.03）。
大约每20例接受经桡动脉手术的患者中就有1例在术后一天出现术后手臂疼痛。这种并发症的预测因素与桡动脉止血、桡动脉闭塞、桡动脉直径和穿刺尝试次数有关。
