Endo Tomohide, Saito Kazumasa, Sakai Shuntaro, Horiuchi Daisuke, Matsui Hiromitsu
Department of Cardiology, Hachinohe City Hospital, 3-1-1 Tamukai, Hachinohe-shi, Aomori, 031-0011, Japan.
Cardiovasc Interv Ther. 2025 Aug 18. doi: 10.1007/s12928-025-01182-x.
Transradial access (TRA) is increasingly used in endovascular therapy (EVT) due to its favorable safety profile. However, its procedural efficiency compared to transfemoral access (TFA) remains under investigation. We retrospectively analyzed 132 consecutive EVT procedures for iliac artery lesions performed between April 2020 and March 2024. After excluding 11 dialysis-dependent and 3 urgent cases, 118 elective cases were included (TRA: 65; TFA: 53). Four procedural time intervals were assessed: (1) room entry to local anesthesia, (2) local anesthesia to sheath removal, (3) sheath removal to room exit, and (4) total room time. In the primary analysis, 45 matched pairs were created using propensity score matching based on five covariates: chronic total occlusion (CTO), bilateral calcification, TASC C/D lesions, stent occlusion, and covered stent use. A secondary analysis was performed in 19 matched CTO cases using three covariates. In the matched cohort, TRA demonstrated significantly shorter total room time compared to TFA (75 [60-115] vs. 105 [74-163] min, p = 0.003). Sheath removal to room exit time was also consistently shorter in the TRA group (7 [5-10] vs. 14 [12-17] min, p < 0.001). Similar findings were observed in the CTO-matched subgroup (93 [77-163] vs. 160 [110-220] min, p = 0.012). TRA significantly reduces procedural time compared to TFA in iliac artery EVT. The consistent reduction across all phases, including the post-procedural period, highlights TRA as an efficient and practical access strategy in peripheral vascular interventions.
由于经桡动脉入路（TRA）具有良好的安全性，其在血管内治疗（EVT）中的应用越来越广泛。然而，与经股动脉入路（TFA）相比，其操作效率仍在研究中。我们回顾性分析了2020年4月至2024年3月期间连续进行的132例髂动脉病变的EVT手术。排除11例依赖透析和3例急诊病例后，纳入118例择期病例（TRA：65例；TFA：53例）。评估了四个手术时间间隔：（1）进入手术室至局部麻醉，（2）局部麻醉至拔除鞘管，（3）拔除鞘管至离开手术室，（4）总手术室时间。在初步分析中，基于五个协变量（慢性完全闭塞（CTO）、双侧钙化、TASC C/D病变、支架闭塞和使用覆膜支架）使用倾向评分匹配创建了45对匹配病例。在19例匹配的CTO病例中使用三个协变量进行了二次分析。在匹配队列中，与TFA相比，TRA的总手术室时间显著缩短（75 [60 - 115] 分钟 vs. 105 [74 - 163] 分钟，p = 0.003）。TRA组从拔除鞘管到离开手术室的时间也始终较短（7 [5 - 10] 分钟 vs. 14 [12 - 17] 分钟，p < 0.001）。在CTO匹配亚组中也观察到了类似的结果（93 [77 - 163] 分钟 vs. 160 [110 - 220] 分钟，p = 0.012）。在髂动脉EVT中，与TFA相比，TRA显著缩短了手术时间。包括术后阶段在内的所有阶段的持续缩短突出了TRA作为外周血管介入中一种高效且实用的入路策略。
