Barbosa Roberto R, De Barros Lucas, Sylvestre Rodolfo C, Belloti Vítor L, de Oliveira Guilherme F, Ferraz Rodrigo D, de Aragão Bruno P, Calil Osmar A, Serpa Renato, Barbosa Luiz Fernando M
Cardiology, Hospital Santa Casa de Misericórdia de Vitória, Vitória, BRA.
Cardiology, Instituto Dante Pazzanese de Cardiologia, São Paulo, BRA.
Cureus. 2024 Feb 25;16(2):e54878. doi: 10.7759/cureus.54878. eCollection 2024 Feb.
A novel arterial access distally on the radial artery through the anatomical snuffbox has been recently described for coronary interventional procedures. However, there is insufficient data comparing the advantages and limitations of distal transradial access (dTRA), conventional transradial access (TRA), and transfemoral access (TFA). The aim of this study was to compare the three access sites regarding local pain and complications during or after coronary interventional procedures.
This prospective observational single-center study included 211 patients undergoing cardiac catheterization or percutaneous coronary intervention, divided into three groups: dTRA (n=69), TRA (n=71), and TFA (n=71). The access site was chosen at the discretion of three operators. We administered a questionnaire to all patients, addressing local pain or discomfort during or after the procedure and the occurrence of possible complications such as distal pallor, local bleeding, and purple color on the access site.
Pain on the access site during the procedure was reported more frequently in the TRA group (dTRA 15.9% vs. TRA 32.4% vs. TFA 15.5%). There were no differences in the occurrence of local pain after the procedure in all three groups (29.6% in the dTRA group, 28.2% in the TRA group, and 26.8% in the TFA group). Pain intensity, when it occurred, was higher in the dTRA group (dTRA 5.8 vs. TRA 4.8 vs. TFA 4.6 on a 1-10 scale), as was its duration (dTRA 13.7 vs. TRA 7.6 vs. TFA 8.2 days). Only two local bleeding events were reported, both in the TFA group. No major complications were recorded.
The occurrence of local pain on the puncture site after coronary interventional procedures did not differ among the three groups. The dTRA group presented a lower incidence of pain during the procedure when compared to TRA and a lower incidence of purple color when compared to TFA. However, pain intensity and duration were higher in the dTRA group when pain was reported. Using dTRA for coronary procedures is a feasible and safe strategy in selected cases.
最近有报道称，一种通过解剖学鼻烟壶在桡动脉远端建立的新型动脉入路可用于冠状动脉介入手术。然而，比较远端桡动脉入路（dTRA）、传统桡动脉入路（TRA）和股动脉入路（TFA）的优缺点的数据并不充分。本研究的目的是比较这三种入路在冠状动脉介入手术期间或术后的局部疼痛和并发症情况。
这项前瞻性观察性单中心研究纳入了211例行心导管检查或经皮冠状动脉介入治疗的患者，分为三组：dTRA组（n = 69）、TRA组（n = 71）和TFA组（n = 71）。入路部位由三名操作者自行决定。我们向所有患者发放了一份问卷，询问手术期间或术后的局部疼痛或不适情况，以及是否发生远端苍白、局部出血和入路部位发紫等可能的并发症。
TRA组手术期间入路部位疼痛的报告频率更高（dTRA组为15.9%，TRA组为32.4%，TFA组为15.5%）。三组术后局部疼痛的发生率无差异（dTRA组为29.6%，TRA组为28.2%，TFA组为26.8%）。疼痛发生时，dTRA组的疼痛强度更高（1 - 10分制下，dTRA组为5.8，TRA组为4.8，TFA组为4.6），疼痛持续时间也更长（dTRA组为13.7天，TRA组为7.6天，TFA组为8.2天）。仅报告了两例局部出血事件，均发生在TFA组。未记录到重大并发症。
冠状动脉介入手术后穿刺部位局部疼痛的发生率在三组之间无差异。与TRA相比，dTRA组手术期间疼痛发生率较低；与TFA相比，dTRA组发紫发生率较低。然而，当报告疼痛时，dTRA组的疼痛强度和持续时间更高。在特定病例中，使用dTRA进行冠状动脉手术是一种可行且安全的策略。
