Department of Cardiovascular Medicine, Assiut University Hospital, Egypt.
Department of Cardiovascular Medicine, Assiut University Hospital, Egypt.
Int J Cardiol. 2022 Sep 15;363:23-29. doi: 10.1016/j.ijcard.2022.06.041. Epub 2022 Jun 14.
There might be a beneficial effect of transient ulnar artery compression in prevention of radial artery occlusion (RAO) after trans-radial catheterization.
The objective of this study was to assess, by Duplex ultrasound, the efficacy of simultaneous ulnar and radial artery compression (SURC), in prevention of RAO, compared to conventional and patent hemostasis techniques.
Four hundred and fifty consecutive patients undergoing elective trans-radial catheterization were enrolled. Patients were randomized in 1:1:1 fashion into 3 groups; conventional hemostasis (Group A, n = 150 patients), patent hemostasis (Group B, n = 150 patients), and SURC technique (Group C, n = 150 patients). RAO was assessed by duplex ultrasound at 1-h post TR band removal (primary endpoint), and at 1-month.
The primary endpoint, RAO 1-h post TR-band removal, was significantly lower among patients of group C as compared to those of group A and B (1.3%, 6.7%, and 7.3%, respectively -p = 0.03). This was still consistent at 1-month (0.7%, 8%, and 6%, respectively -p = 0.03). Multiple regression analyses revealed that lower radial artery diameter (RAD) after flow-mediated dilatation (FMD) independently predicted RAO at 1-h, while RAD at 1-h post-TR band removal was the only independent predictor of RAO at 1-month. Receiver operator characteristic (ROC) analysis showed that RAD at 1-h post-TR band removal at cut-off ≤1.75 mm could predict RAO at 1-month with high accuracy (AUC = 0.9, CI = 0.8-1.0, p < 0.001-86% sensitivity, and 95% specificity).
A technique of SURC is associated with less incidence of early and late RAO compared to conventional hemostasis techniques.
桡动脉压迫（Trans-radial catheterization）后，短暂压迫尺动脉可能对预防桡动脉闭塞（Radial artery occlusion，RAO）有有益影响。
本研究旨在通过超声双功检查评估尺桡动脉同时压迫（Simultaneous ulnar and radial artery compression，SURC）与常规和专利止血技术相比预防 RAO 的效果。
连续纳入 450 例行择期经桡动脉导管插入术的患者。患者以 1:1:1 的比例随机分为 3 组：常规止血组（A 组，n=150 例）、专利止血组（B 组，n=150 例）和 SURC 技术组（C 组，n=150 例）。TR 带去除后 1 小时（主要终点）和 1 个月时通过超声双功检查评估 RAO。
与 A 组和 B 组相比，C 组患者 1 小时后 TR 带去除时 RAO 的发生率显著降低（分别为 1.3%、6.7%和 7.3%，p=0.03）。这在 1 个月时仍然一致（分别为 0.7%、8%和 6%，p=0.03）。多变量回归分析显示，血流介导的扩张（Flow-mediated dilatation，FMD）后桡动脉直径（Radial artery diameter，RAD）较小与 1 小时时 RAO 独立相关，而 TR 带去除后 1 小时的 RAD 是 1 个月时 RAO 的唯一独立预测因素。受试者工作特征（Receiver operating characteristic，ROC）分析显示，TR 带去除后 1 小时 RAD 截断值≤1.75mm 可高度准确地预测 1 个月时的 RAO（AUC=0.9，CI=0.8-1.0，p<0.001-86%的敏感性和 95%的特异性）。
与常规止血技术相比，SURC 技术可降低早期和晚期 RAO 的发生率。
