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介入心脏病学中的桡动脉远端入路：技术、陷阱与建议。

Distal radial access in interventional cardiology: technique, pitfalls and recommendations.

作者信息

Rivera Kristian, Fernández-Rodríguez Diego, Ferreiro José Luis

机构信息

Department of Cardiology, Arnau de Vilanova University Hospital, Lleida, Spain.

Grup de Fisiologia i Patologia Cardíaca, Institut de Recerca Biomèdica de Lleida Fundació Dr. Pifarré, IRBLleida, Lleida, Spain.

出版信息

Cardiovasc Diagn Ther. 2025 Jun 30;15(3):665-683. doi: 10.21037/cdt-2025-66. Epub 2025 Jun 26.

DOI:10.21037/cdt-2025-66
PMID:40656779
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12246993/
Abstract

Distal radial access (DRA) is a relatively novel approach in interventional cardiology and represents an evolution of transradial techniques. This approach involves accessing the distal radial artery (DRart) in the anatomical snuffbox, offering an alternative to traditional radial and femoral access, with demonstrated benefits over conventional transradial access (TRA), such as a lower rate of radial artery occlusion, shorter hemostasis time, and improved patient comfort. DRA is technically more demanding compared to TRA. The smaller size of the DRart and the anatomical landmarks that surround it make it more difficult to cannulate, especially for operators who are less experienced with the approach. This increased difficulty can result in higher initial failure rates and longer procedural times, all of which contribute to a steeper learning curve. This review aims to provide a comprehensive guide to the use of DRA for the interventional cardiologist to take full advantage of the approach by summarizing current evidence and experienced operator recommendations, focusing on practical recommendations on techniques to improve procedural success, minimize complications, and optimize results.

摘要

桡动脉远端入路（DRA）是介入心脏病学中一种相对新颖的方法，代表了桡动脉技术的一种演进。这种方法涉及在解剖学鼻烟壶处穿刺桡动脉远端（DRart），为传统的桡动脉和股动脉入路提供了一种替代方案，已证明其优于传统的经桡动脉入路（TRA），如桡动脉闭塞率更低、止血时间更短以及患者舒适度提高。与TRA相比，DRA在技术上要求更高。DRart管径较小及其周围的解剖标志使其插管更困难，尤其是对于经验较少的术者。这种难度增加可能导致更高的初始失败率和更长的手术时间，所有这些都导致学习曲线更陡。本综述旨在通过总结当前证据和经验丰富的术者建议，为介入心脏病学家提供一份关于使用DRA的全面指南，以充分利用该方法，重点是关于提高手术成功率、减少并发症和优化结果的技术实用建议。

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