背景:最近已经描述了一种通过解剖鼻烟盒在桡动脉远端的新型动脉通路,用于冠状动脉介入手术。然而,没有足够的数据来比较远端经桡动脉入路(dTRA)的优势和局限性,传统的经桡动脉通路(TRA),和经股动脉入路(TFA)。这项研究的目的是比较冠状动脉介入手术期间或之后的三个进入部位的局部疼痛和并发症。
方法:这项前瞻性单中心观察性研究包括211例接受心导管插入术或经皮冠状动脉介入治疗的患者,分为三组:dTRA(n=69),TRA(n=71),和TFA(n=71)。访问站点是由三个操作员自行决定的。我们对所有患者进行了问卷调查,解决手术期间或之后的局部疼痛或不适,以及可能出现的并发症,如远端苍白,局部出血,访问网站上的紫色。
结果:在TRA组中,手术期间进入部位疼痛的发生率更高(dTRA15.9%vs.TRA32.4%与TFA15.5%)。三组术后局部疼痛的发生率均无差异(dTRA组为29.6%,TRA组28.2%,TFA组为26.8%)。疼痛强度,当它发生时,在dTRA组中较高(dTRA5.8vs.TRA4.8vs.TFA4.6在1-10量表上),持续时间也是如此(dTRA13.7vs.TRA7.6vs.TFA8.2天)。仅报告了两次局部出血事件,都在TFA组中。无重大并发症记录。
结论:三组冠状动脉介入术后穿刺部位局部疼痛的发生率无差异。与TRA相比,dTRA组在手术过程中的疼痛发生率较低,而与TFA相比,紫色的发生率较低。然而,报告疼痛时,dTRA组的疼痛强度和持续时间较高.在某些情况下,使用dTRA进行冠状动脉手术是可行且安全的策略。
BACKGROUND: A novel arterial access distally on the radial artery through the anatomical snuffbox has been recently described for coronary interventional procedures. However, there is insufficient data comparing the advantages and limitations of distal transradial access (dTRA), conventional transradial access (TRA), and transfemoral access (TFA). The aim of this study was to compare the three access sites regarding local pain and complications during or after coronary interventional procedures.
METHODS: This prospective observational single-center study included 211 patients undergoing cardiac catheterization or percutaneous coronary intervention, divided into three groups: dTRA (n=69), TRA (n=71), and TFA (n=71). The access site was chosen at the discretion of three operators. We administered a questionnaire to all patients, addressing local pain or discomfort during or after the procedure and the occurrence of possible complications such as distal pallor, local bleeding, and purple color on the access site.
RESULTS: Pain on the access site during the procedure was reported more frequently in the TRA group (dTRA 15.9% vs. TRA 32.4% vs. TFA 15.5%). There were no differences in the occurrence of local pain after the procedure in all three groups (29.6% in the dTRA group, 28.2% in the TRA group, and 26.8% in the TFA group). Pain intensity, when it occurred, was higher in the dTRA group (dTRA 5.8 vs. TRA 4.8 vs. TFA 4.6 on a 1-10 scale), as was its duration (dTRA 13.7 vs. TRA 7.6 vs. TFA 8.2 days). Only two local bleeding events were reported, both in the TFA group. No major complications were recorded.
CONCLUSIONS: The occurrence of local pain on the puncture site after coronary interventional procedures did not differ among the three groups. The dTRA group presented a lower incidence of pain during the procedure when compared to TRA and a lower incidence of purple color when compared to TFA. However, pain intensity and duration were higher in the dTRA group when pain was reported. Using dTRA for coronary procedures is a feasible and safe strategy in selected cases.