Clinic of Cardiology and Angiology, Klinikum Neumarkt, Neumarkt, Germany.
Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany.
Sci Rep. 2022 Jul 29;12(1):13060. doi: 10.1038/s41598-022-17435-1.
Transradial access has established as preferred access for cardiac catheterization. Difficult vascular anatomy (DVA) is a noticeable threat to procedural success. We retrospectively analyzed 1397 consecutive cardiac catheterizations to estimate prevalence and identify predictors of DVA. In the subclavian-innominate-aortic-region (SIAR), DVA was causing failure in 2.4% during right-sided vs. 0.7% in left-sided forearm-artery-access (FAA) attempts (χ = 5.1, p = 0.023). Independent predictors were advanced age [odds ratio (OR) 1.44 per 10-year increase, 95% confidence interval (CI) 1.15 to 1.80, p = 0.001] and right FAA (OR 2.52, 95% CI 1.72 to 3.69, p < 0.001). In the radial-ulnar-brachial region (RUBR), DVA was causing failure in 2.5% during right-sided vs. 1.7% in left-sided FAA (χ = 0.77, p = 0.38). Independent predictors were age (OR 1.28 per 10-year increase, 95% CI 1.01 to 1.61, p = 0.04), lower height (OR 1.56 per 10-cm decrease, 95% CI 1.13 to 2.15, p = 0.008) and left FAA (OR 2.15, 95% CI 1.45 to 3.18, p < 0.001). Bilateral DVA was causing procedural failure in 0.9% of patients. The prevalence of bilateral DVA was rare. Predictors in SIAR were right FAA and advanced age and in RUBR, left FAA, advanced age and lower height. Gender, arterial hypertension, body mass, STEMI and smoking were not associated with DVA.
经桡动脉入路已成为心脏导管插入术的首选入路。血管解剖困难（DVA）是程序成功的显著威胁。我们回顾性分析了 1397 例连续心脏导管插入术，以估计 DVA 的患病率并确定其预测因素。在锁骨下动脉-无名动脉-主动脉区域（SIAR），右侧桡动脉-肱动脉（FAA）入路中 DVA 导致失败的比例为 2.4%，而左侧为 0.7%（χ²=5.1，p=0.023）。独立预测因素为高龄[每增加 10 岁，优势比（OR）为 1.44，95%置信区间（CI）为 1.15 至 1.80，p=0.001]和右侧 FAA（OR 2.52，95%CI 为 1.72 至 3.69，p<0.001）。在桡动脉-尺动脉-肱动脉区域（RUBR），右侧桡动脉-肱动脉入路中 DVA 导致失败的比例为 2.5%，而左侧为 1.7%（χ²=0.77，p=0.38）。独立预测因素为年龄（每增加 10 岁，OR 为 1.28，95%CI 为 1.01 至 1.61，p=0.04）、较低的身高（每降低 10cm，OR 为 1.56，95%CI 为 1.13 至 2.15，p=0.008）和左侧 FAA（OR 2.15，95%CI 为 1.45 至 3.18，p<0.001）。双侧 DVA 导致程序失败的比例为 0.9%。双侧 DVA 的患病率罕见。SIAR 中的预测因素为右侧 FAA 和高龄，RUBR 中的预测因素为左侧 FAA、高龄和较低的身高。性别、动脉高血压、体重、STEMI 和吸烟与 DVA 无关。
