Amro Ahmed, Mansoor Kanaan, Amro Mohammad, Hirzallah Hisham, Sobeih Amal, Kusmic Damir, Abuhelwa Ziad, Kanbour Majd, Elhamdani Adee, Aqtash Obadah, Elhamdani Mehiar
Cardiology, Marshall University, Huntington, USA.
Internal Medicine, Marshall University Joan C. Edwards School of Medicine, Huntington, USA.
Cureus. 2020 Jan 28;12(1):e6797. doi: 10.7759/cureus.6797.
Background Multiple studies have shown that trans-radial access (TRA) for women undergoing coronary angiography/intervention (CA/I) has a lower risk of vascular access site complications as compared with trans-femoral access (TFA). In patients who had previously undergone coronary artery bypass grafting (CABG), studies also showed no significant difference between TRA and TFA in terms of contrast amount (CA), procedure time (PT), and fluoroscopy time (FT). However, those studies mainly included men. Limited information is available on the relative merits of TRA as compared with TFA for cardiac catheterization in females who previously undergone CABG. The purpose of this study was to determine the efficacy and safety of TRA versus TFA in women with prior CABG surgery who are undergoing CA/I in regard to CA, PT, and FT. Methods In this single-center retrospective cohort study, females with a history of CABG who underwent CA/I in the period from January 2013 to September 2016 were included. A total of 584 patients were included and divided into two groups: TRA group (49 patients) and TFA group (535 patients). The primary endpoints were CA, PT, and FT. The means for the primary outcomes were compared between the two using the independent t-score test. Results A total of 584 female patients with a history of CABG had cardiac catheterization from January 2013 to September 2016 at our center. Trans-femoral access accounted for 91.6% (n=535) of the patients while trans-radial access accounted for 8.4% (n=49) of the patients. A comparison of procedural variables between TRA and TFA revealed that there was no statistical significance in procedure time, fluoroscopy time, or the contrast volume. The access site crossover rate was 6.12% (n=3) from radial to femoral while there was a 0% rate in the femoral to radial access. Conclusion The key findings of this study suggest that in female patients with a prior history of CABG, TRA is an equally reliable and efficacious approach for both diagnostic angiography and intervention compared to TFA.
多项研究表明，与经股动脉入路（TFA）相比，接受冠状动脉造影/介入治疗（CA/I）的女性采用经桡动脉入路（TRA）时血管入路部位并发症的风险较低。在既往接受过冠状动脉旁路移植术（CABG）的患者中，研究还表明，在造影剂用量（CA）、手术时间（PT）和透视时间（FT）方面，TRA与TFA之间无显著差异。然而，这些研究主要纳入的是男性。关于既往接受过CABG的女性在心脏导管插入术中TRA与TFA相比较的相对优势，可用信息有限。本研究的目的是确定在接受CA/I的既往有CABG手术史的女性中，TRA与TFA在CA、PT和FT方面的有效性和安全性。方法：在这项单中心回顾性队列研究中，纳入了2013年1月至2016年9月期间接受CA/I且有CABG病史的女性。共纳入584例患者，分为两组：TRA组（49例患者）和TFA组（535例患者）。主要终点为CA、PT和FT。使用独立t检验比较两组的主要结局均值。结果：2013年1月至2016年9月，共有584例有CABG病史的女性患者在本中心接受了心脏导管插入术。经股动脉入路的患者占91.6%（n = 535），经桡动脉入路的患者占8.4%（n = 49）。TRA与TFA之间手术变量的比较显示，手术时间、透视时间或造影剂用量无统计学意义。从桡动脉到股动脉的入路部位交叉率为6.12%（n = 3），而从股动脉到桡动脉的入路部位交叉率为0%。结论：本研究的主要发现表明，在既往有CABG病史的女性患者中，与TFA相比，TRA对于诊断性血管造影和介入治疗而言同样可靠且有效。
