Zhongguo cuzhong zazhi (Jun 2024)
经远端桡动脉入路与常规桡动脉入路行数字减影血管造影的可行性及安全性研究 Study on the Feasibility and Safety of Digital Subtraction Angiography through Distal Transradial Artery Access versus Transradial Approach
Abstract
目的 对比远端桡动脉入路（distal transradial artery access，dTRA）与常规桡动脉入路（transradial approach，TRA）行DSA的可行性和安全性，优化神经介入治疗的穿刺入路策略。 方法 前瞻性连续纳入2022年7月—2023年1月北京市大兴区人民医院神经内科拟行DSA的患者，按计算机产生随机数字的方法，将患者分为dTRA组和TRA组。将按照预定入路成功完成穿刺的患者纳入分析，收集两组患者的人口学信息、既往病史等基线资料，比较两组患者穿刺血管内径、穿刺时间、穿刺次数等手术过程指标，以及手臂疼痛、麻木、肿胀、桡动脉闭塞、动静脉瘘等术后并发症情况。利用多因素logistic回归模型分析影响dTRA首次穿刺成功率的影响因素。 结果 本研究共纳入320例拟行DSA的患者，其中306例患者纳入分析，dTRA组和TRA组各153例患者。两组患者的基线资料差异无统计学意义。dTRA组的穿刺血管内径较TRA组更小[（1.97±0.42）mm vs.（2.23±0.44）mm，P＜0.001]。两组患者首次穿刺成功率差异无统计学意义，但与TRA组相比，dTRA组的穿刺时间更长（P=0.008）、穿刺次数更多（P=0.022）、总手术时间更长（P=0.003）、射线剂量更大（P=0.027）。与TRA组相比，dTRA组术后手臂疼痛评分更低（P＜0.001），麻木、肿胀发生率更低（P＜0.001），桡动脉闭塞发生率更低（P=0.002）；TRA组患者术后均未发生动静脉瘘，dTRA组有2例患者发生动静脉瘘，差异无统计学意义。多因素logistic回归模型分析显示，远端桡动脉内径（OR 3.860，95%CI 1.364～10.924，P=0.011）及心房颤动病史（OR 0.121，95%CI 0.018～0.831，P=0.032）是影响dTRA首次穿刺成功率的危险因素。 结论 与TRA相比，dTRA可降低患者桡动脉闭塞、麻木、肿胀以及疼痛等并发症的发生率，提高患者舒适度。 Abstract: Objective To compare the feasibility and safety of DSA between distal transradial artery access (dTRA) and transradial approach (TRA), and to optimize the puncture approach strategy for neurointerventional therapy. Methods Patients who planned to undergo DSA in the Department of Neurology, Daxing District People’s Hospital from July 2022 to January 2023 were continuously included. According to the method of generating random numbers by computer, the patients were randomly divided into the dTRA group and the TRA group. Patients who completed puncture according to the predetermined approach were included in the analysis. Demographic information, past medical history, and other baseline data of the two groups were collected. The internal diameter of puncture vessels, puncture time, puncture times, and other surgical process indexes, as well as postoperative complications such as arm pain, numbness, swelling, radial artery occlusion, and arteriovenous fistula, were compared between the two groups. A multivariate logistic regression model was used to analyze the influencing factors on the success rate of dTRA first puncture. Results In this study, 320 patients who intend to undergo DSA were included, of which 306 patients were included in the data analysis, with 153 patients in the dTRA group and 153 patients in the TRA group. There was no statistical difference in baseline data between the two groups. The internal diameter of puncture vessels in the dTRA group was smaller than that in the TRA group [(1.97±0.42) mm vs. (2.23±0.44) mm, P<0.001]. There was no statistical difference in the success rate of the first puncture between the two groups. However, compared with the TRA group, the dTRA group had longer puncture time (P=0.008), more puncture times (P=0.022), longer total operation time (P=0.003), and larger radiation dose (P=0.027). Compared with the TRA group, the dTRA group had a lower postoperative pain score (P＜0.001), lower incidence of numbness and swelling (P＜0.001), and lower incidence of radial artery occlusion (P=0.002). None of the patients in the TRA group had arteriovenous fistula after the operation, and two patients in the dTRA group had arteriovenous fistula, the difference was not statistically significant. Multivariate logistic regression model analysis showed that the internal diameter of the distal radial artery (OR 3.860, 95%CI 1.364-10.924, P=0.011) and the history of atrial fibrillation (OR 0.121, 95%CI 0.018-0.831, P=0.032) were the risk factors affecting the success rate of dTRA first puncture. Conclusions Compared with TRA, dTRA can reduce the incidence of complications such as radial artery occlusion, numbness, swelling, and pain, and improve the comfort of patients.
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