Ronald James, Durocher Nicholas, Martin Jonathan G., Smith Tony P., Kim Charles Y., Sag Alan A.
Division of Vascular - Interventional Radiology, Department of Radiology, Duke University Medical Center, Durham, North Carolina, USA.
Diagn Interv Radiol. 2021 Sep;27(5):639-643. doi: 10.5152/dir.2021.20375.
There is increasing interest in the distal radial artery in the anatomic snuffbox as an alternative arterial access point, but the durability of the distal radial artery to support repetitive accesses over multiple procedures is not well established. The purpose of this study was therefore to evaluate success rates for repeated left-sided distal transradial access (ldTRA) in the anatomic snuffbox.
In this single institution retrospective study, all patients undergoing radioembolization treatments from January 1st, 2019 to May 1st, 2020 were prospectively evaluated for ldTRA. ldTRA was performed by 15 different operators. Exclusion criteria were a left radiocephalic hemodialysis fistula, inability to properly position the arm, Barbeau D waveform, or failed prior ldTRA due to tortuosity. Barbeau patterns, arterial sizes, and success rates at the first, second, and third ldTRA were compared.
Fifty patients were evaluated for ldTRA and 44, 39, and 10 underwent one, two, and three ldTRA attempts for a total of 93 procedures. There was no significant change in Barbeau patterns between the first and second (p = 0.13) or first and third (p = 1.0) ldTRA. There was no significant change in artery size between the first (mean, 2.3 mm; range, 1.5-3.4 mm) and second (mean, 2.3 mm; range, 1.6-3.3 mm) (p = 0.59) and first and third (mean, 2.4 mm; range, 1.9-3.3) (p = 0.45) ldTRA. The success rate was not significantly different between the first (93%, 41/44, 95% CI 81%-99%), second (95%, 37/39, 95% CI 83%-99%), and third (100%, 10/10, 95% CI 69%-100%) procedure (p = 1.0). The asymptomatic occlusion rate was 4.1% (2/49, 95% CI 0%-14%), and subsequent ldTRA was successfully completed in both patients with occlusions. There were no hemorrhagic or ischemic complications.
Success rates are indistinguishable among first, second, and third time ldTRA suggesting that this is a durable access point.
作为一种替代的动脉穿刺点，解剖鼻烟壶处的桡动脉远端越来越受到关注，但桡动脉远端支持多次手术重复穿刺的耐用性尚未得到充分证实。因此，本研究的目的是评估解剖鼻烟壶处左侧桡动脉远端重复穿刺（ldTRA）的成功率。
在这项单机构回顾性研究中，对2019年1月1日至2020年5月1日期间所有接受放射性栓塞治疗的患者进行ldTRA的前瞻性评估。ldTRA由15名不同的操作人员进行操作.排除标准为左侧头静脉血液透析瘘、无法正确摆放手臂、Barbeau D波形或因血管迂曲导致先前ldTRA失败。比较Barbeau分型、动脉大小以及首次、第二次和第三次ldTRA的成功率。
对50例患者进行ldTRA评估，其中44例、39例和10例分别接受了1次、2次和3次ldTRA尝试.共进行了93例手术.首次与第二次（p = 0.13）或首次与第三次（p = 1.0）ldTRA之间的Barbeau分型无显著变化。首次（平均2.3mm；范围1.5 - 3.4mm）与第二次（平均2.3mm；范围1.6 - 3.3mm）（p = 0.59）以及首次与第三次（平均2.4mm；范围1.9 - 3.3）（p = 0.45）ldTRA之间动脉大小无显著变化。第一次（93%，41/44，95%CI 81% - 99%）、第二次（95%，37/39，95%CI 83% - 99%）和第三次（100%，10/10，95%CI 69% - 100%）手术的成功率无显著差异（p = 1.0）。无症状闭塞率为4.1%（2/49，95%CI 0% - 14%），两名闭塞患者均成功完成了后续的ldTRA。无出血或缺血性并发症。
首次、第二次和第三次ldTRA的成功率无差异，表明这是一个耐用的穿刺点。
