Cardiac Catheterization Department, Cardiovascular Institute, The Medical City Hospital, Pasig City, Philippines.
Catheter Cardiovasc Interv. 2024 Apr;103(5):722-730. doi: 10.1002/ccd.31005. Epub 2024 Mar 12.
The radial first approach in cardiac catheterization is preferred for its benefits in patient comfort and recovery time. Yet, challenges persist due to characteristics like small, deep, calcified, and mobile radial arteries. Utilizing ultrasound before and during procedures can improve success rates. However, the adoption of its use is still limited and subject to debate.
To utilize routine preprocedural ultrasound (US) and compare US guided with palpation guided radial access, focusing on operator efficiency and outcomes.
Consenting adult patients undergoing elective radial cardiac catheterization were divided into palpation and US groups. Routine preprocedural assessment of radial artery characteristics was performed using handheld US. Baseline data, US findings, procedural outcomes, and clinical outcomes were compared in 182 participants (91 in each group). US guided radial access had significantly higher first pass success rates (76.92% vs. 49.45%, p 0.0001), fewer number of attempts (1.46 ± 1 vs. 1.99 ± 1.46, p 0.004), and shorter amount of time (93.62 ± 44.04 vs. 120.44 ± 67.1, p 0.002) compared with palpation guidance. The palpation group had significantly higher incidence of spasm (15.38% vs. 3.3%, p 0.0052). Subgroup analysis indicated consistent benefits of US guidance, especially in calcified radial arteries.
This prospective, nonrandomized, single-center study demonstrated that real-time procedural US improved the operator's time and effort and enhanced patient comfort compared with palpation. US guidance use was particularly favorable in the presence of calcifications observed on baseline preoperative US.
经桡动脉入路行心脏导管术具有患者舒适度高、恢复时间短等优势，因此受到青睐。然而，由于桡动脉细小、位置深、存在钙化、走行迂曲等特点，操作仍存在一定难度。术前及术中超声检查可提高成功率，但目前其使用率仍较低，且存在一定争议。
探讨常规术前超声（US）在桡动脉入路中的应用价值，并比较 US 引导与触诊引导桡动脉入路的效果，重点关注术者操作效率和临床结局。
连续纳入行择期经桡动脉心脏导管术的成年患者，根据入路方式分为触诊组和 US 组。术前采用手持 US 对桡动脉特征进行常规评估。比较两组基线资料、US 检查结果、操作相关指标及临床结局。共纳入 182 例患者（每组 91 例）。US 组首次穿刺成功率明显高于触诊组（76.92% vs. 49.45%，p 0.0001），穿刺次数更少（1.46±1 次 vs. 1.99±1.46 次，p 0.004），用时更短（93.62±44.04 s vs. 120.44±67.1 s，p 0.002）。触诊组桡动脉痉挛发生率明显更高（15.38% vs. 3.3%，p 0.0052）。亚组分析显示，US 组在桡动脉存在钙化时优势更为明显。
与触诊引导相比，实时超声引导可改善术者操作时间和体验，减轻患者痛苦，提高舒适度。对于术前 US 显示存在钙化的患者，US 引导更具优势。
