Wang Xinsen, Xian Lei, Zhang Wenlei, Xu Yang, Zhao Delong, Wang Xue
Department of Interventional Therapy, the First Hospital of Jilin University, Changchun, China.
Department of Oncology, Huadian People's Hospital, Huadian, China.
Transl Cancer Res. 2024 Aug 31;13(8):4500-4506. doi: 10.21037/tcr-24-1231. Epub 2024 Aug 26.
The femoral artery is the standard route for transarterial chemoembolization (TACE); however, it is negatively associated with the quality of life of patients, and carries an increased risk of deep vein thrombosis in the lower limbs. We employed the distal radial approach to TACE to assess its feasibility and safety.
We conducted a retrospective study at the First Hospital of Jilin University from August 1, 2020 to October 31, 2023. To be eligible for inclusion in the study, the patients had to meet the following main inclusion criteria: (I) have undergone a preoperative imaging (abdominal computed tomography enhancement or magnetic resonance dynamic enhancement) examination, or have a pathologically confirmed diagnosis of primary liver cancer, and a Child-Pugh score of A or B; and (II) have undergone distal radial artery puncture. The primary endpoint of this study was the success rate of distal radial artery puncture. The secondary endpoints were complications and the duration of the puncture.
Among the 343 patients with primary liver cancer (of whom 236 were male and 107 were female), a total of 1,315 distal radial artery punctures were attempted. The success rate was remarkably high at 95.13% (1,251/1,315), with only 64 cases requiring an alternative approach due to failed puncture. The average puncture duration was 20±7.43 minutes. No bleeding and hematoma, no arterial dissection and pseudoaneurysm formation were observed on ultrasound, and the radial pulse was palpable in all patients, highlighting the safety of the procedure. Further, no adverse events of vascular occlusion were observed among the 12 patients who received 6 or more punctures, indicating the sustainability of the distal radial artery access under the premise of adequate vascular protection. The development of this technique requires a learning curve of at least 50 cases to break through the learning baseline and be proficient in distal radial artery blind puncture. This may be the reason why many interventional physicians are reluctant to perform this procedure, adapting to the femoral approach with a shorter learning curve.
The distal radial artery approach is feasible and safe in hepatic arterial chemoembolization, and should be widely promoted in TACE.
股动脉是经动脉化疗栓塞术（TACE）的标准入路；然而，它与患者的生活质量呈负相关，且下肢深静脉血栓形成风险增加。我们采用桡动脉远端入路进行TACE，以评估其可行性和安全性。
我们于2020年8月1日至2023年10月31日在吉林大学第一医院进行了一项回顾性研究。符合纳入本研究条件的患者必须满足以下主要纳入标准：（I）已接受术前影像学检查（腹部计算机断层扫描增强或磁共振动态增强），或经病理确诊为原发性肝癌，且Child-Pugh评分为A或B；（II）已接受桡动脉远端穿刺。本研究的主要终点是桡动脉远端穿刺成功率。次要终点是并发症和穿刺持续时间。
在343例原发性肝癌患者中（其中男性236例，女性107例），共尝试进行了1315次桡动脉远端穿刺。成功率高达95.13%（1251/1315），仅64例因穿刺失败而需采用其他入路。平均穿刺持续时间为20±7.43分钟。超声检查未发现出血和血肿、动脉夹层及假性动脉瘤形成，所有患者桡动脉搏动可触及，突出了该操作的安全性。此外，在接受6次或更多次穿刺的12例患者中未观察到血管闭塞不良事件，表明在充分血管保护的前提下，桡动脉远端入路具有可持续性。该技术的发展需要至少50例的学习曲线才能突破学习基线并熟练掌握桡动脉远端盲穿。这可能是许多介入医师不愿进行该操作，而选择学习曲线较短的股动脉入路的原因。
桡动脉远端入路在肝动脉化疗栓塞术中可行且安全，应在TACE中广泛推广。
