Langer Christoph, Prog Rostislav
Kardiologisch-Angiologische Praxis ● Herzzentrum Bremen, Senator-Weßling-Str 1a, 28277 Bremen, Germany.
Klinik für Innere Medizin und Kardiologie, Hospital zum Heiligen Geist, Akademisches Lehrkrankenhaus der Universität Düsseldorf, Von-Broichhausen-Allee 1, 47906 Kempen, Germany.
Rev Cardiovasc Med. 2022 Sep 28;23(10):331. doi: 10.31083/j.rcm2310331. eCollection 2022 Oct.
Arterial access in coronary angiography has always been an important issue. Convincing prognostic data from large randomized controlled trials (RCTs) in the first place but also safe performance of same-day-discharge after diagnostic and interventional procedures, improved patient comfort and cost-effectiveness led to a paradigm shift from the transfemoral approach (TFA) to the transradial approach (TRA) in several clinical situations. Consequently, today's relevant guidelines recommend a radial-first strategy as default approach. However, there is still strong controversy among interventional cardiologists resulting in delayed spread of the TRA causing significant regional differences. One major critics point is the rate of postprocedural radial artery occlusion (RAO) after using the traditional puncture site at the proximal radial artery (pTRA) which was registered too high in certain centers. A new access using the distal radial artery (dTRA) in the area of the snuff box (SB) and the dorsal box (DB) has been proven to minimize RAO and enabling even complex interventions using 7F guiding catheters. Although, dTRA seems to be an advantageous option, this approach is still not widely used. This review-addressed to beginners and even advanced interventionalists-presents all arterial access routes in interventional cardiology. It focusses on those to be routinely preferred and also on the possibility to guide the puncture with ultrasound. Thereby, the various approaches, including the transulnar (TRU) but also the still relevant TFA approach, are discussed in detail. Thereby, we introduce our philosophy of "radial freedom" and a new classification for TRA.
冠状动脉造影中的动脉入路一直是一个重要问题。首先，大型随机对照试验（RCT）提供了令人信服的预后数据，而且诊断和介入手术后当日出院的安全操作、患者舒适度的提高以及成本效益，在几种临床情况下导致了从经股动脉入路（TFA）到经桡动脉入路（TRA）的范式转变。因此，当今相关指南推荐首选桡动脉入路作为默认方法。然而，介入心脏病学家之间仍存在激烈争议，导致TRA的推广延迟，造成显著的地区差异。一个主要的批评点是在某些中心，使用桡动脉近端传统穿刺部位（pTRA）后，术后桡动脉闭塞（RAO）的发生率过高。一种在鼻烟壶（SB）和背侧盒（DB）区域使用桡动脉远端（dTRA）的新入路已被证明可将RAO降至最低，甚至能够使用7F引导导管进行复杂介入操作。尽管dTRA似乎是一个有利的选择，但这种方法仍未得到广泛应用。这篇综述面向初学者甚至高级介入专家，介绍了介入心脏病学中的所有动脉入路途径。它重点关注那些常规首选的入路，以及超声引导穿刺的可能性。由此，详细讨论了各种入路，包括经尺动脉入路（TRU）以及仍然相关的TFA入路。在此，我们介绍我们的“桡动脉自由”理念以及TRA的新分类。
