Kuroda Koji, Murakami Ayaka, Todoroki Takafumi, Iwasaki Masamichi, Imanishi Junichi, Yamashita Souichiro, Fujimoto Wataru, Takemoto Makoto, Okuda Masanori
Department of Cardiology, Hyogo Prefectural Awaji Medical Center, 1-1-137 Shioya, Sumoto, Hyogo, 656-0021, Japan.
Cardiovasc Interv Ther. 2025 May 4. doi: 10.1007/s12928-025-01127-4.
Distal radial access (DRA) has emerged as an alternative approach to reduce the risk of radial artery occlusion in coronary angiography. Vascular access intervention therapy (VAIVT) is traditionally used to treat arteriovenous fistula stenosis. However, the feasibility and safety of DRA for VAIVT have not been established. This study aimed to evaluate the feasibility and safety of using DRA for VAIVT. We included 421 consecutive VAIVT procedures for upper limb arteriovenous fistulas retrospectively. DRA for VAIVT was performed in 181 procedures (DRA group), and the remaining procedures were approached through the brachial artery or vein (SA group: standard access group). Clinical follow-up was performed to evaluate the incidence of hematoma and dialysis access-associated steal syndrome (DASS). The mean follow-up duration following VAIVT was 24.0 months. The VAIVT success rate did not differ significantly between the groups (DRA: 97.8% vs. SA: 98.3%; P = 0.73), neither did the incidence of puncture site hematoma (DRA: 0.0% vs. SA: 0.8%; P = 0.51). There were no complications with DASS symptoms in the DRA group during the clinical follow-up. In the DRA group, 90 patients underwent a subsequent VAIVT procedure, and 85 patients (94.4%) underwent a subsequent VAIVT by DRA. DRA is a feasible and safe strategy for VAIVT and could be considered an option for VAIVT.
桡动脉远端入路（DRA）已成为一种可降低冠状动脉造影时桡动脉闭塞风险的替代方法。血管通路介入治疗（VAIVT）传统上用于治疗动静脉内瘘狭窄。然而，DRA用于VAIVT的可行性和安全性尚未明确。本研究旨在评估DRA用于VAIVT的可行性和安全性。我们回顾性纳入了421例连续的上肢动静脉内瘘VAIVT手术。181例手术采用DRA进行VAIVT（DRA组），其余手术通过肱动脉或静脉入路（SA组：标准入路组）。进行临床随访以评估血肿和透析通路相关窃血综合征（DASS）的发生率。VAIVT后的平均随访时间为24.0个月。两组间VAIVT成功率无显著差异（DRA组：97.8% vs. SA组：98.3%；P = 0.73），穿刺部位血肿发生率也无显著差异（DRA组：0.0% vs. SA组：0.8%；P = 0.51）。临床随访期间DRA组未出现有DASS症状的并发症。在DRA组中，90例患者接受了后续的VAIVT手术，其中85例患者（94.4%）通过DRA接受了后续的VAIVT手术。DRA是一种用于VAIVT的可行且安全的策略，可被视为VAIVT的一种选择。
