2(nd) Department of Internal Medicine, Division of Invasive Cardiology, University of Szeged, Szeged, Hungary; Medicala 1 Invasive Cardiology Department, University of Medicine and Pharmacy "Iuliu Hatieganu", Cluj-Napoca, Romania.
2(nd) Department of Internal Medicine, Division of Invasive Cardiology, University of Szeged, Szeged, Hungary.
Cardiovasc Revasc Med. 2022 Jul;40:152-157. doi: 10.1016/j.carrev.2021.11.021. Epub 2021 Nov 22.
Although not yet recommended by the guidelines, distal radial access, a new site for cardiovascular interventions, has been rapidly acknowledged and adopted by many centers due to its high rate of success, safety and fewer complications. We present our experience using secondary distal radial access during transcatheter aortic valve implantation (TAVI), proposing a new, even more minimal approach.
As of November 2020, a systematic distal radial approach as secondary access site for TAVI was adopted in our center. Primary endpoints were technical success and major adverse events (MAEs). Secondary endpoints: the access site complication rate, hemodynamic and clinical results of the intervention, procedural related factors, crossover rate to the femoral access site, and hospitalization duration (in days).
From November 2020, 41 patients underwent TAVI using this strategy. Patients had a mean age of 76 ± 11.2 years, 41% were male. Six (14.63%) patients received a balloon-expandable valve and 35 (85.37%) received a self-expandable valve. TAVI was successful in all cases. No complications occurred due to transradial access. Puncture success, defined as completed sheath placement was maximum (N = 41/41,100%) and emergent transfemoral secondary access was not required in any case. Primary transfemoral vascular access site complications occurred in 7 cases (17%) of which 4 (13.63%) were resolved through distal radial access: one occlusion, two flow-limiting stenoses and four perforations of the common femoral artery. There were no additional major vascular complications at 30 days. Overall MACE rate was 2.4%.
The use of the distal radial approach for secondary access in TAVI is safe, feasible and has several advantages over old access sites.
尽管远端桡动脉入路（心血管介入的新部位）尚未被指南推荐，但由于其成功率高、安全性好、并发症少，许多中心已迅速认可并采用了这种方法。我们介绍了在经导管主动脉瓣植入术（TAVI）中使用辅助远端桡动脉入路的经验，并提出了一种新的、更微创的方法。
截至 2020 年 11 月，我们中心采用了一种系统的远端桡动脉作为 TAVI 的辅助入路方法。主要终点是技术成功率和主要不良事件（MAE）。次要终点：入路部位并发症发生率、介入的血流动力学和临床结果、介入相关因素、股动脉入路的交叉率以及住院时间（以天计）。
从 2020 年 11 月开始，有 41 例患者采用这种策略接受了 TAVI。患者平均年龄为 76±11.2 岁，41%为男性。6 例（14.63%）患者接受了球囊扩张瓣，35 例（85.37%）接受了自膨式瓣膜。所有病例 TAVI 均成功。无因经桡动脉入路引起的并发症。穿刺成功率（定义为完成鞘管置入）最高（N=41/41，100%），无紧急股动脉辅助入路。7 例（17%）出现原发性股动脉血管入路并发症，其中 4 例（13.63%）通过远端桡动脉入路解决：1 例闭塞，2 例血流受限狭窄，4 例股总动脉穿孔。30 天内无其他主要血管并发症。总体 MACE 发生率为 2.4%。
在 TAVI 中使用远端桡动脉入路作为辅助入路是安全、可行的，并且与旧入路相比具有多个优势。
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