Abstract：
OBJECTIVE: This systematic review and meta-analysis aimed to evaluate the safety and feasibility of transradial access for peripheral vascular interventions.
METHODS: MEDLINE and Embase.
METHODS: MEDLINE and Embase databases were searched to June 2023 to identify studies investigating the outcomes of peripheral vascular interventions in lower extremity, carotid, and visceral arteries via transradial vs. transfemoral access. The primary outcome was procedural failure rate. Secondary outcomes were total access site complications, minor and major bleeding, stroke, access vessel occlusion, procedural time, fluoroscopy time, and contrast volume.
RESULTS: Eight randomised controlled trials and 29 observational studies yielded a total of 70 882 patients treated via transradial (n = 2 616) vs. transfemoral access (n = 68 338). The overall failure rate was 2.3 ± 0.7%, and the transradial approach was associated with a statistically significantly higher procedural failure rate than the transfemoral approach (3.9 ± 0.7% vs. 1.0 ± 0.3%; odds ratio [OR] 3.07, 95% confidence interval [CI] 1.84 - 5.12; I2 = 32%; p < .001). Subgroup analysis showed the highest failure rate in lower extremity interventions with 12.4 ± 4.9% for transradial vs. 4.0 ± 1.2% for transfemoral access. Conversely, procedural complications were statistically significantly fewer with transradial access for total access site complications (OR 0.64, 95% CI 0.45 - 0.91; I2 = 36%; p = .010). Minor bleeding was statistically significantly less with the transradial approach (OR 0.52, 95% CI 0.31 - 0.86; I2 = 30%; p = .010), whereas major bleeding and stroke rates were similar. Transradial access had more access vessel occlusion than transfemoral access (1.9% ± 0.5% vs. < 0.1% ± 0.0%; p = .004), although most remained asymptomatic. Procedural time, fluoroscopy time, and contrast volume were all comparable. GRADE certainty was low to moderate in most outcomes.
CONCLUSIONS: The transradial approach was associated with a higher procedural failure rate. Total access site complications and minor bleeding were lower with the transradial approach, albeit with more frequent access vessel occlusion. Transradial access may be a feasible and safe approach; however, appropriate patient selection is imperative.
METHODS: MEDLINE and Embase.
METHODS: MEDLINE and Embase databases were searched to June 2023 to identify studies investigating the outcomes of peripheral vascular interventions in lower extremity, carotid, and visceral arteries via transradial vs. transfemoral access. The primary outcome was procedural failure rate. Secondary outcomes were total access site complications, minor and major bleeding, stroke, access vessel occlusion, procedural time, fluoroscopy time, and contrast volume.
RESULTS: Eight randomised controlled trials and 29 observational studies yielded a total of 70 882 patients treated via transradial (n = 2 616) vs. transfemoral access (n = 68 338). The overall failure rate was 2.3 ± 0.7%, and the transradial approach was associated with a statistically significantly higher procedural failure rate than the transfemoral approach (3.9 ± 0.7% vs. 1.0 ± 0.3%; odds ratio [OR] 3.07, 95% confidence interval [CI] 1.84 - 5.12; I2 = 32%; p < .001). Subgroup analysis showed the highest failure rate in lower extremity interventions with 12.4 ± 4.9% for transradial vs. 4.0 ± 1.2% for transfemoral access. Conversely, procedural complications were statistically significantly fewer with transradial access for total access site complications (OR 0.64, 95% CI 0.45 - 0.91; I2 = 36%; p = .010). Minor bleeding was statistically significantly less with the transradial approach (OR 0.52, 95% CI 0.31 - 0.86; I2 = 30%; p = .010), whereas major bleeding and stroke rates were similar. Transradial access had more access vessel occlusion than transfemoral access (1.9% ± 0.5% vs. < 0.1% ± 0.0%; p = .004), although most remained asymptomatic. Procedural time, fluoroscopy time, and contrast volume were all comparable. GRADE certainty was low to moderate in most outcomes.
CONCLUSIONS: The transradial approach was associated with a higher procedural failure rate. Total access site complications and minor bleeding were lower with the transradial approach, albeit with more frequent access vessel occlusion. Transradial access may be a feasible and safe approach; however, appropriate patient selection is imperative.
摘要：
目的：本系统综述和荟萃分析旨在评估经桡动脉途径用于外周血管介入治疗的安全性和可行性。
方法：MEDLINE和Embase。
方法：MEDLINE和Embase数据库被搜索到2023年6月，以确定调查下肢外周血管干预结果的研究，颈动脉,经桡动脉和内脏动脉经股动脉入路。主要结果是手术失败率。次要结果是总通路部位并发症，轻微和大出血，中风,进入血管闭塞,程序时间,透视时间,和对比体积。
结果：8项随机对照试验和29项观察性研究共得到70882例经桡动脉治疗的患者（n=2616）与经股动脉入路（n=68338）。总体故障率为2.3±0.7%，经桡动脉入路的手术失败率明显高于经股动脉入路(3.9±0.7%vs.1.0±0.3%；比值比[OR]3.07，95%置信区间[CI]1.84-5.12；I2=32%；p<.001）。亚组分析显示，下肢干预的失败率最高，经桡骨与下肢干预的失败率为12.4±4.9%。经股动脉入路4.0±1.2%。相反，经桡动脉入路的手术并发症在统计学上显著较少(OR0.64,95%CI0.45-0.91;I2=36%;p=.010).经桡动脉途径的轻微出血在统计学上显著减少(OR0.52,95%CI0.31-0.86;I2=30%;p=.010),而大出血和卒中发生率相似.经桡动脉入路的入路血管闭塞多于经股动脉入路(1.9%±0.5%vs.<0.1%±0.0%；p=.004)，尽管大多数仍然无症状。程序时间,透视时间,和对比体积都相当。在大多数结果中，等级确定性为低至中等。
结论：经桡动脉入路与较高的手术失败率相关。经桡动脉入路的总入路并发症和少量出血较低，尽管更频繁的进入血管闭塞。经radial入路可能是一种可行且安全的方法；但是，适当的患者选择势在必行。
方法：MEDLINE和Embase。
方法：MEDLINE和Embase数据库被搜索到2023年6月，以确定调查下肢外周血管干预结果的研究，颈动脉,经桡动脉和内脏动脉经股动脉入路。主要结果是手术失败率。次要结果是总通路部位并发症，轻微和大出血，中风,进入血管闭塞,程序时间,透视时间,和对比体积。
结果：8项随机对照试验和29项观察性研究共得到70882例经桡动脉治疗的患者（n=2616）与经股动脉入路（n=68338）。总体故障率为2.3±0.7%，经桡动脉入路的手术失败率明显高于经股动脉入路(3.9±0.7%vs.1.0±0.3%；比值比[OR]3.07，95%置信区间[CI]1.84-5.12；I2=32%；p<.001）。亚组分析显示，下肢干预的失败率最高，经桡骨与下肢干预的失败率为12.4±4.9%。经股动脉入路4.0±1.2%。相反，经桡动脉入路的手术并发症在统计学上显著较少(OR0.64,95%CI0.45-0.91;I2=36%;p=.010).经桡动脉途径的轻微出血在统计学上显著减少(OR0.52,95%CI0.31-0.86;I2=30%;p=.010),而大出血和卒中发生率相似.经桡动脉入路的入路血管闭塞多于经股动脉入路(1.9%±0.5%vs.<0.1%±0.0%；p=.004)，尽管大多数仍然无症状。程序时间,透视时间,和对比体积都相当。在大多数结果中，等级确定性为低至中等。
结论：经桡动脉入路与较高的手术失败率相关。经桡动脉入路的总入路并发症和少量出血较低，尽管更频繁的进入血管闭塞。经radial入路可能是一种可行且安全的方法；但是，适当的患者选择势在必行。
