Zuo Yujie, Dong Hui, Li Hongwu, Ma Wentao, Zou Yubao, Jiang Xiongjing
Department of Cardiology, National Center for Cardiovascular Diseases and Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
J Clin Hypertens (Greenwich). 2024 Dec;26(12):1513-1520. doi: 10.1111/jch.14937. Epub 2024 Nov 17.
To evaluate the long-term efficacy and safety of transfemoral access (TFA) versus upper extremity access (UEA) for renal denervation (RDN) based on vascular morphology. This study retrospectively enrolled patients with resistant hypertension who underwent RDN treatment via TFA and UEA (brachial, radial, and ulnar artery) at the Fuwai Hospital between February 2012 and November 2019. Follow-up was conducted at 6 months, 1 year, and 3 years after RDN, and the last visit was June 2023. A total of 85 patients were enrolled, 58 (68.2%) of them were treated via TFA, and 27 patients (31.8%) via UEA. The fluoroscopy time was less in the TFA group (12.2 ± 5.7 min vs. 15.2 ± 7.2 min; p = 0.038). The procedure time (TFA group: 40.8 ± 14.9 min vs. UEA group: 38.6 ± 11.6 min; p = 0.506), contrast volume (TFA group: 78.2 ± 25.9 mL vs. UEA group: 91.9 ± 39.7 mL; p = 0.061) were similar between two groups, without procedure-related complications. Fifty-eight participants completed the last visit with a 3-12 year of follow-up (9.5 ± 1.3 years). Compared with baseline, there were no significant differences in the change of office systolic blood pressure (-12.6 ± 21.6 mmHg vs. -13.1 ± 22.8 mmHg; p = 0.933), 24-h mean systolic blood pressure (-11.9 ± 14.2 mmHg vs. -11.3 ± 15.3 mmHg; p = 0.899), the number of antihypertensive drugs, and renal function between two groups. There were three adverse events in the TFA group (3 of 58 patients, 5.2%) versus one (1 of 27 patients, 3.7%) in the UEA group, without a significant difference between the two groups. The study showed RDN via UEA was feasible using a special-designed catheter, particularly in patients with illegal vascular morphology via TFA.
基于血管形态评估经股动脉入路（TFA）与上肢入路（UEA）用于肾交感神经消融术（RDN）的长期疗效和安全性。本研究回顾性纳入了2012年2月至2019年11月期间在阜外医院接受经TFA和UEA（肱动脉、桡动脉和尺动脉）RDN治疗的难治性高血压患者。在RDN术后6个月、1年和3年进行随访，最后一次随访时间为2023年6月。共纳入85例患者，其中58例（68.2%）通过TFA治疗，27例（31.8%）通过UEA治疗。TFA组的透视时间较短（12.2±5.7分钟 vs. 15.2±7.2分钟；p = 0.038）。两组的手术时间（TFA组：40.8±14.9分钟 vs. UEA组：38.6±11.6分钟；p = 0.506）、造影剂用量（TFA组：78.2±25.9毫升 vs. UEA组：91.9±39.7毫升；p = 0.061）相似，且无手术相关并发症。58名参与者完成了最后一次随访，随访时间为3至12年（9.5±1.3年）。与基线相比，两组间诊室收缩压变化（-12.6±21.6 mmHg vs. -13.1±22.8 mmHg；p = 0.933）、24小时平均收缩压变化（-11.9±14.2 mmHg vs. -11.3±15.3 mmHg；p = 0.899）、降压药物数量及肾功能均无显著差异。TFA组有3例不良事件（58例患者中的3例，5.2%），UEA组有1例（27例患者中的1例，3.7%），两组间无显著差异。研究表明，使用特殊设计的导管经UEA进行RDN是可行的，尤其适用于经TFA存在血管形态异常的患者。
