Kyriakopoulos Vassileios, Xanthopoulos Andrew, Papamichalis Michail, Skoularigkis Spyridon, Tzavara Chara, Papadakis Emmanouil, Patsilinakos Sotirios, Triposkiadis Filippos, Skoularigis John
Department of Cardiology, Konstantopoulio General Hospital, Athens 14233, Greece.
Department of Cardiology, University Hospital of Larissa, Larissa 41110, Greece.
World J Cardiol. 2021 Oct 26;13(10):574-584. doi: 10.4330/wjc.v13.i10.574.
Radial artery obstruction is the most common complication of coronary angiography performed transradial access. Patent hemostasis can significantly reduce the risk of radial artery occlusion. Previous studies utilized sophisticated methods to evaluate radial artery patency. Simplified and easily applicable methods for successful patent hemostasis are currently lacking.
To determine which method (pulse oximeter the traditional radial artery palpation) is better to achieve patent hemostasis.
This prospective, single center study included 299 consecutive patients who underwent coronary angiography or percutaneous coronary intervention between November 2017 and July 2019. Patients less than 18 years old, with a history of radial artery disease, or no palpable artery pulse were excluded from the study. Patients were randomly assigned to two groups. In the first group, radial artery flow was assessed by palpation of the artery during hemostasis (traditional method). In the second group, radial artery patency was estimated with the use of a pulse oximeter. Two different compression devices were used for hemostasis (air chamber and pressure valve). The primary study endpoint was the achievement of successful patent hemostasis.
The two groups (pulse oximeter artery palpation) had no significant differences in age, sex, body mass index, risk factors, or comorbidities except for supraventricular arrhythmias. The percentage of patients with successful patent hemostasis was significantly higher in the pulse oximeter group (82.2% 68.1%, = 0.005). A lower percentage of patients with spasm was recorded in the pulse oximeter group (9.9% 19.0%, = 0.024). The incidence of local complications, edema, bleeding, hematoma, vagotonia, or pain did not differ between the two groups. In the multivariate analysis, the use of a pulse oximeter (OR: 2.35, 95%CI: 1.34-4.13, = 0.003) and advanced age (OR: 1.04, 95%CI: 1.01-1.07, = 0.006), were independently associated with an increased probability of successful patent hemostasis. The type of hemostatic device did not affect patent hemostasis ( = 0.450).
Patent hemostasis with the use of pulse oximeter is a simple, efficient, and safe method that is worthy of further investigation. Larger randomized studies are required to consider its clinical implications.
桡动脉闭塞是经桡动脉途径进行冠状动脉造影最常见的并发症。有效的止血可显著降低桡动脉闭塞的风险。以往的研究采用复杂的方法来评估桡动脉通畅情况。目前缺乏简单且易于应用的实现有效止血的方法。
确定哪种方法（脉搏血氧仪或传统的桡动脉触诊）更有利于实现有效止血。
这项前瞻性单中心研究纳入了2017年11月至2019年7月期间连续接受冠状动脉造影或经皮冠状动脉介入治疗的299例患者。年龄小于18岁、有桡动脉疾病史或无法触及动脉搏动的患者被排除在研究之外。患者被随机分为两组。第一组在止血过程中通过触诊动脉评估桡动脉血流（传统方法）。第二组使用脉搏血氧仪评估桡动脉通畅情况。使用两种不同的压迫装置进行止血（气室和压力阀）。主要研究终点是实现有效的止血。
除室上性心律失常外，两组（脉搏血氧仪组和动脉触诊组）在年龄、性别、体重指数、危险因素或合并症方面无显著差异。脉搏血氧仪组有效止血的患者百分比显著更高（82.2%对68.1%，P = 0.005）。脉搏血氧仪组记录到痉挛的患者百分比更低（9.9%对19.0%，P = 0.024）。两组局部并发症、水肿、出血、血肿、血管迷走神经反应或疼痛的发生率无差异。在多变量分析中，使用脉搏血氧仪（OR：2.35，95%CI：1.34–4.13，P = 0.003）和高龄（OR：1.04，95%CI：1.01–1.07，P = 0.006）与有效止血概率增加独立相关。止血装置的类型不影响止血效果（P = 0.450）。
使用脉搏血氧仪进行有效止血是一种简单、有效且安全的方法，值得进一步研究。需要更大规模的随机研究来考量其临床意义。
