Ghanem Islam, Mesbah Mohamed, Refaat Hesham
Cardiology Department, Zagazig University, Zagazig, Egypt.
Egypt Heart J. 2024 Mar 26;76(1):36. doi: 10.1186/s43044-024-00466-6.
There are many percutaneous coronary approaches. The most commonly used one is the radial artery because of its lowest risk of adverse vascular events. However, it could not be an option in some situations as congenital radial artery hypoplasia and spasm. In these cases, the second most common access is the femoral artery. The current literature over the brachial artery access is controversial. Thus, the aim of this study was to verify the brachial artery approach's effectiveness and safety.
We studied 300 patients who underwent elective coronary angiography and angioplasty in our institution with failed radial access between August 2022 and February 2023. They were classified into two groups; 150 patients with brachial access and 150 with femoral access. Access, procedural and fluoroscopy times were recorded. All patients were examined carefully immediately after the procedure and before discharge to assess any complications. Left brachial access was used more frequently than left femoral access (32.7% vs. 22.7%, P = 0.05), but no significant difference noted regarding right sided or bilateral access. Procedure time, fluoroscopy time, and contrast volume did not significantly differ (P = 0.19, 0.06 and 0.1 respectively). However, brachial group had shorter access time (2.6 ± 1.1 vs. 3.4 ± 0.7 min, P = 0.05) and hospital stay (3.5 ± 1.1 vs. 5.9 ± 1.3 days, P < 0.001). Regarding major and minor complications (especially hematomas), they were significantly less in the brachial arm (P = 0.04 and P = 0.05, respectively).
Brachial access is a safe, efficient and non-inferior to the femoral route for coronary intervention whenever radial access is not an option.
经皮冠状动脉介入途径有多种。最常用的是桡动脉，因为其发生不良血管事件的风险最低。然而，在某些情况下，如先天性桡动脉发育不全和痉挛，它并非可行选择。在这些情况下，第二常见的入路是股动脉。目前关于肱动脉入路的文献存在争议。因此，本研究的目的是验证肱动脉入路的有效性和安全性。
我们研究了2022年8月至2023年2月在我院因桡动脉穿刺失败而接受择期冠状动脉造影和血管成形术的300例患者。他们被分为两组；150例采用肱动脉入路，150例采用股动脉入路。记录穿刺、手术和透视时间。所有患者在术后立即和出院前均进行仔细检查，以评估是否有任何并发症。左肱动脉入路的使用频率高于左股动脉入路（32.7%对22.7%，P = 0.05），但右侧或双侧入路方面未观察到显著差异。手术时间、透视时间和造影剂用量无显著差异（分别为P = 0.19、0.06和0.1）。然而，肱动脉组的穿刺时间较短（2.6±1.1对3.4±0.7分钟，P = 0.05），住院时间也较短（3.5±1.1对5.9±1.3天，P < 0.001）。关于主要和次要并发症（尤其是血肿），肱动脉组明显较少（分别为P = 0.04和P = 0.05）。
当桡动脉入路不可行时，肱动脉入路对于冠状动脉介入治疗是安全、有效的，且不劣于股动脉途径。
