de Belder A J, Smith R E, Wainwright R J, Thomas M R
Department of Cardiology, King's College Hospital, London, UK.
Clin Radiol. 1997 Feb;52(2):115-8. doi: 10.1016/s0009-9260(97)80103-1.
Traditionally, cardiac catheterization in patients with severe aorto-iliac disease has been performed using a brachial arteriotomy. This approach is associated with significant vascular and neuronal complications and requires considerable training to achieve an adequate level of expertise. Improvement and miniaturization of catheter equipment now allows the radial artery to be used for coronary investigation and intervention. The lack of important structures close to the radial artery, a good collateral ulnar artery circulation and its superficial position suggests that these procedures should have a low complication rate. The purpose of this study was to assess the efficacy and safety of percutaneous transradial diagnostic and interventional coronary catheterization in patients with severe peripheral vascular disease.
We undertook a non-randomized prospective analysis of 75 patients who had transradial artery diagnostic and interventional coronary catheterization in whom femoral angiography was impossible or relatively contraindicated (22 patients with severe claudication and absent femoral pulses, 24 patients with previous aorto-iliac surgery or intervention, 20 patients with a failed femoral approach, 9 patients with an aortic aneurysm). Three patients had an absent ulnar artery and were excluded.
Radial artery cannulation was successful in 73/75 (97%) cases. Seventy-one (95%) patients had a successful diagnostic study. There was a high incidence of 3 vessel disease (73%), and the majority of patients (64%) were referred for coronary bypass surgery. Twelve patients underwent successful follow-on intervention including the insertion of 9 intracoronary stents. Adequate haemostasis was achieved within 20 min after diagnostic angiography and 60 min after interventional procedures. One patient had a forearm haematoma with paraesthesia of the hand which settled with conservative treatment. At 4-6 weeks, all patients had normal hand sensation and function (100%) with a palpable pulse present in 59/62 (96%). All patients undergoing diagnostic angiography were discharged on the same day, and patients undergoing intervention were discharged the following day.
Transradial coronary investigation and intervention can be performed with a high degree of success and a low complication rate with early mobilization and discharge in patients with severe peripheral vascular disease. We suggest that the percutaneous transradial technique should be considered as an alternative to the Sones' technique in these patients.
传统上，患有严重主-髂动脉疾病的患者进行心导管插入术时采用肱动脉切开术。这种方法会引发显著的血管和神经并发症，并且需要大量培训才能达到足够的专业水平。导管设备的改进和小型化现在使得桡动脉可用于冠状动脉检查和干预。桡动脉附近缺乏重要结构、尺动脉侧支循环良好以及其表浅位置表明这些操作的并发症发生率应该较低。本研究的目的是评估经皮桡动脉诊断性和介入性冠状动脉导管插入术在患有严重外周血管疾病患者中的疗效和安全性。
我们对75例经桡动脉进行诊断性和介入性冠状动脉导管插入术的患者进行了非随机前瞻性分析，这些患者无法进行股动脉血管造影或存在相对禁忌证（22例严重跛行且股动脉搏动消失的患者、24例既往有主-髂动脉手术或介入治疗的患者、20例股动脉入路失败的患者、9例患有主动脉瘤的患者）。3例患者尺动脉缺如，被排除在外。
73/75（97%）例桡动脉插管成功。71（95%）例患者诊断性检查成功。三支血管病变的发生率很高（73%），大多数患者（64%）被转诊进行冠状动脉搭桥手术。12例患者接受了成功的心导管跟进干预，包括植入9枚冠状动脉支架。诊断性血管造影后20分钟内以及介入操作后60分钟内实现了充分止血。1例患者出现前臂血肿伴手部感觉异常，经保守治疗后症状缓解。在4 - 6周时，所有患者手部感觉和功能均正常（100%），59/62（96%）例可触及脉搏。所有接受诊断性血管造影的患者均在当天出院，接受介入治疗的患者在次日出院。
对于患有严重外周血管疾病的患者，经桡动脉冠状动脉检查和干预成功率高、并发症发生率低，且患者可早期活动并出院。我们建议在这些患者中，经皮桡动脉技术应被视为Sones技术的替代方法。
