高频超声评价经桡动脉的冠状动脉造影对桡动脉的影响

冠状动脉造影术的常规入径为经股动脉。近年来,随着设备的精密化和微型化以及冠状动脉介入性手术技术的日趋成熟,国内外开始采用经皮穿刺桡动脉的方法完成。这种方法对血管的创伤小、并发症发生率低、术后患者即可下床活动,越来越受到临床医生和患者的欢迎。但经桡动脉冠状动脉造影术对桡动脉、尺动脉的管径、内膜、管腔及血流动力学方面的影响报道尚不多,近一年来,我院采用了经桡动脉冠状动脉造影介入治疗,我们与之同步进行了手术前后桡动脉变化的超声观察。1对象和方法1.1对象20004年10月至2005年1月拟行桡动脉穿刺冠状动脉造影术的住院患…     

经桡动脉入路冠状动脉介入术后血管并发症的超声研究

目的应用血管超声对经桡动脉入路冠状动脉介入术后血管并发症及其发生的危险因素进行研究。方法选择152例拟行经桡动脉穿刺冠状动脉造影或介入治疗的患者,应用血管超声于术前及术后1个月测量其右侧桡动脉舒张期内径并结合血流频谱评价有无血管狭窄并发症。结果152例患者中148例(98%)成功经桡动脉行冠状动脉造影和/或介入治疗,所有患者均无动脉血肿、假性动脉瘤或动静脉漏,所有患者均无手部缺血症状。术后出现桡动脉血管并发症21例(局限性狭窄18例,占12·2%;弥漫性狭窄3例,占2·0%)。经桡动脉穿刺冠状动脉介入术前后桡动脉内径无明显差别(2·51±0·56mm对2·47±0·60mm,P>0·05)。多元回归分析显示,经桡动脉穿刺冠状动脉介入术后1个月出现桡动脉局限性或弥漫性狭窄的危险因素为桡动脉内径与动脉鞘管外径之差、操作时间和糖尿病。结论经桡动脉穿刺冠状动脉介入安全可靠。应用高频超声对桡动脉进行检查,术前有利于导管和动脉鞘的选择,特别是对合并糖尿病的患者更有意义;术后有利于血管并发症的发现。     

三种不同路径行冠状动脉介入诊治的可行性和安全性的临床观察

目的 研宛经股动脉、桡动脉和尺动脉三种不同路径对冠状动脉介入的诊治方法,探讨经尺动脉径路行冠状动脉造影或介入治疗的可行性及安全性.方法 入选行冠状动脉造影及介入治疗的患者284倒,其中经尺动脉途径32例,经桡动脉途径168例,经股动脉途径91例,观察其手术成功率、失败原因和并发症.结果 冠状动脉介入诊治成功率,股动脉组100.0％,桡动脉组6.4％,尺动脉组96.9％.血管并发症发生率,股动脉组为(8.425±6.395)％,桡动脉组为(2.282±1.971)％,尺动脉组为(3.125±1.975)％.失败原因:3倒是因经桡动脉穿刺失败改尺动脉径路成功,3例桡动脉痉挛改尺动脉径路成功,1例尺动脉痉挛穿刺失败改股动脉穿刺成功.结论 经尺动脉路径行冠脉造影及介入治疗和经桡动脉径路一样是一种安全可行的介入诊疗路径.不仅可作为部分患者的首选穿刺血管,也可作为经桡动脉或股动脉途径的补充.     

经尺动脉径路行经皮冠状动脉介入治疗12例

目的探讨经尺动脉径路行经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗的可行性与安全性。方法选择2006年12月～2008年12月在清华大学第一附属医院住院,完成冠状动脉造影检查的1360例患者中26例经尺动脉径路行冠状动脉造影患者为研究对象,其中冠状动脉性心脏病(冠心病)稳定型心绞痛患者12例,男8例,女4例,年龄(61±10.4)岁,行经尺动脉径路行PCI治疗。另外,选择26例经桡动脉造影的患者设为经桡动脉组。所有患者均行Allen′s试验检查,记录动脉穿刺时间,冠状动脉造影时间,计算穿刺成功率和并发症的发生率。结果两组穿刺成功率比较,差异无统计学意义(χ2=0.354,P>0.05)。两组冠状动脉造影时间比较,差异无统计学意义[(20.0±3.6)minvs.(20.0±4.2)min,P>0.05]。两组并发症发生率比较,差异无统计学意义(P>0.05)。12例患者尺动脉均穿刺成功,应用6F指引导管对15条血管的17处病变行PCI治疗,均获得成功,共植入支架17枚。1例有穿刺部位淤血,无严重的出血并发症的发生。结论经尺动脉径路行PCI治疗是一种安全、...     

经皮穿刺桡动脉冠状动脉造影术304例

目的探讨经桡动脉冠状动脉造影术的可行性、安全性和方法学.方法304例患者经桡动脉途径行冠状动脉造影术.结果291例获得成功,13例失败,6例桡动脉穿刺和插管未成功,4例导丝或导管在上肢动脉中前进受阻,3例因锁骨下动脉硬化和迂曲而不能插管至冠状动脉开口处.结论经皮穿刺桡动脉冠状动脉造影术是一种安全、可行的冠状动脉介入诊断新途径,具有止血容易、术后无须卧床休息、病人痛苦小和并发症少的优点.     

经尺动脉径路行经皮冠状动脉介入治疗12例

目的 探讨经尺动脉径路行经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗的可行性与安全性.方法 选择2006年12月～2008年12月在清华大学第一附属医院住院,完成冠状动脉造影检查的1 360例患者中26例经尺动脉径路行冠状动脉造影患者为研究对象,其中冠状动脉性心脏病(冠心病)稳定型心绞痛患者12例.男8例,女4例,年龄(61±10.4)岁,行经尺动脉径路行PCI治疗.另外,选择26例经桡动脉造影的患者设为经桡动脉组.所有患者均行Allen's试验检查,记录动脉穿刺时间,冠状动脉造影时间,计算穿刺成功率和并发症的发生率.结果 两组穿刺成功率比较,差异无统计学意义(X2=0.354,P>0.05).两组冠状动脉造影时间比较,差异无统计学意义[(20.0±3.6)min vs.(20.0±4.2)min,P>0.05].两组并发症发生率比较,差异无统计学意义(P>0.05).12例患者尺动脉均穿刺成功,应用6F指引导管对15条血管的17处病变行PCI治疗,均获得成功,共植入支架17枚.1例有穿刺部位淤血,无严重的出血并发症的发生.结论 经尺动脉径路行PCI治疗是一种安全、有效的介入途径,是股动脉、桡动脉介入途径的补充,值得在临床实践中进一步推广应用.     

经桡动脉途径行冠状动脉造影术1200例临床分析

目的探讨常规经桡动脉冠状动脉造影术的可行性、安全性和方法学。方法1200例患者经桡动脉途径行冠状动脉造影术。结果1174例获得成功,成功率97.8%,26例失败,8例桡动脉穿刺和插管未成功,3例导丝或导管在上肢动脉中前进受阻,11例因锁骨下动脉硬化和迂曲而不能插管至冠状动脉开口处,4例严重桡动脉痉挛;1200例患者中无一例造影相关的死亡,1174例中3例桡动脉搏动消失,无1例手部缺血的事件发生,21例(1.7%)出现前壁肿胀、瘀斑,无1例出现骨筋膜室综合征。结论经皮穿刺桡动脉冠状动脉造影术是一种安全、可行的冠状动脉介入诊断新途径,具有止血容易、术后无须卧床休息、病人痛苦小和并发症少的优点。     

经尺动脉穿刺行冠状动脉介入治疗的护理

目的探讨经尺动脉径路行冠状动脉介入治疗的护理。方法总结2008年6月—2011年3月我科36例疑似冠心病患者经桡动脉径路穿刺失败后改经同侧尺动脉径路行冠状动脉介入术的护理方法。结果 33例患者经尺动脉穿刺行冠状动脉介入术获得成功,3例因尺动脉严重迂曲痉挛、硬化而穿刺失败,改为股动脉穿刺成功。术后无严重并发症发生。结论 充分做好术前准备和术中护理,术后加强尺动脉穿刺部位的护理,是提高经尺动脉径路行冠状动脉介入手术成功率,防止并发症发生的关键。     

疑诊冠心病患者经桡动脉冠脉造影术510例分析

目的　探讨经桡动脉径路行冠脉造影的可行性和安全性。方法　 5 10例临床疑诊为冠心病的患者接受了经桡动脉径路冠脉造影术。结果　 5 0 3例获得成功 ,7例失败 ,其中 3例为穿刺失败 ,1例为桡动脉走行畸形 ,2例是由于无名动脉过于迂曲致导管操作极度困难而失败 ,1例为左锁骨下动脉闭塞。所有病例无严重并发症发生 ,只有 1例于术后发生桡动脉闭塞。结论　桡动脉径路行冠脉造影具有止血容易、病人术后无须长时间卧床和并发症少的优点 ,操作成功率高 ,临床应用安全     

经尺动脉冠状动脉造影和经皮冠状动脉介入治疗的可行性探讨

目的 探讨经尺动脉冠状动脉(冠脉)造影和经皮冠状动脉介入治疗(PCI)的可行性.方法 共入选14例经桡动脉穿刺失败患者,男9例,女5例.全部患者均符合冠脉造影适应征.尺动脉穿刺方法、导管选择和操作手法基本同经桡动脉法.结果 14例尺动脉造影全部成功,其中3例成功行PCI,植入支架5枚,其中LAD2枚,LCX1枚,RCA2枚.术后均一次拔除动脉鞘管,无并发症.结论 经尺动脉冠脉造影和PCI是可行的,值得临床推广应用.     

经右桡动脉冠状动脉造影时右锁骨下动脉和(或)头臂干迂曲致选择左冠状动脉口困难的处理

目的探讨经右桡动脉冠状动脉造影时右锁骨下动脉和(或)头臂干迂曲致选择左冠状动脉口困难的处理方法。方法经右桡动脉行冠状动脉造影时,由于右锁骨下动脉和(或)头臂干迂曲,致共用导管选择左冠状动脉口困难,此时将共用导管前端即第一、二弯之间及第二弯近段徒手塑形,使其弯曲度增大,观察用此方法行选择性左冠状动脉造影的结果及安全性。结果 35例选择左冠状动脉口困难的患者均造影成功,成功率100%,无相关并发症发生。28例患者经造影确诊冠心病。结论经右桡动脉冠状动脉造影时右锁骨下动脉和(或)头臂干迂曲致选择左冠状动脉口困难时,行导管前端塑形是一种有效、简便、安全且经济的方法。     

Bilateral selective internal mammary artery angiography via right radial approach: clinical experience with newly designed Yumiko catheter.

The radial artery has been increasingly used as a primary access site for coronary angiography and intervention. But the technique for internal mammary artery (IMA) visualization via the right radial artery has not been well described. Therefore, the study was conducted to investigate the feasibility, safety, and adequacy of selective bilateral IMA angiography via the right radial artery using the recently developed Yumiko catheter. From November 1999 to October 2000, both IMA angiographies were undertaken immediately following the diagnostic coronary angiogram taken from right transradial approach in 114 patients. IMA angiography was successfully obtained in 99% (113/114) patients. For left IMA angiography, 73 (64%), 28 (25%), and 12 (11%) imagings were obtained in a selective, a semiselective, and a nonselective way, respectively. After initial periods of 33 left-IMA-only imaging, right IMA angiography was obtained in 81 patients (phase 2). Selective right IMA imaging was done in 73 (90%), semiselective in 6, and nonselective in 2 patients. The reasons for failure of selective or semiselective visualization were severe vascular tortuosity, far distal anatomical origin of left IMA and ulcerative plaque, or acutely angled left subclavian artery. The feasibility and safety of selective and semiselective bilateral IMA angiography were demonstrated using a 5 Fr Yumiko catheter from the right radial approach. Cathet Cardiovasc Intervent 2001;54:19-24.     

Impact of radial artery cannulation for coronary angiography and angioplasty on radial artery function

The radial artery is commonly used as a conduit in coronary artery bypass grafting. No data exist on the effects of radial sheath insertion on radial artery function. Because many patients considered for coronary artery bypass grafting have had previous radial procedures, it is important to understand any effects radial sheath insertion may have on radial artery function. Twenty-two patients who underwent elective coronary angiography or angioplasty with a 6Fr sheath through the right radial artery were studied. Radial artery function was assessed using ultrasound to measure flow-mediated dilation (FMD). Reactive hyperemia was produced by 5-minute cuff inflation on the arm to suprasystolic pressures. Radial artery diameter was measured at rest and 1 minute after cuff deflation. FMD was expressed as percent change in radial diameter compared with at rest. In all cases, the left radial artery was studied as a control. Patients were studied before sheath insertion, immediately after sheath insertion, and 6 weeks after sheath insertion. The FMD of the cannulated arm was 13.2% before sheath insertion versus 3.6% immediately after sheath insertion (p <0.01) and 0.2% (p <0.01) 9 weeks after sheath insertion. In contrast, there were no significant changes in the noncannulated arm at either time point. In conclusion, radial artery sheath insertion for coronary angiography or angioplasty results in immediate and persistent blunting of FMD, suggesting severe vasomotor dysfunction. Radial artery sheath insertion has important effects on radial artery function that must be considered when selecting radial conduits for coronary artery bypass grafting.     

经左桡动脉路径对矮小患者行冠脉造影的可行性

探讨经左桡动脉路径对矮小患者行冠脉造影的可行性及安全性。方法：选择2009年2月至2013年2月在我院住院,经左桡动脉路径行冠脉造影的患者898例,分成矮小患者组（449例）和正常身高患者组（对照组,449例）,矮小定义为：男性身高≤160cm、女性身高≤150cm。矮小患者均为Allen试验阳性,使用5F或6F桡动脉专用穿刺鞘组穿刺左桡动脉,使用5FTIG造影导管或Judkins型造影导管行冠脉造影检查,对比两组冠脉造影完成率、导丝导管交换率、X线曝光时间、血管并发症。结果：矮小患者组和对照患者组经左桡动脉路径行冠脉造影完成率均为96.2%,超滑导丝更换率（9.6%比8.6%）、X线曝光时间[（3.6±2.7）min比（3.4±2.7）min]、并发症[桡动脉闭塞（0.4%比0.4%）,易控性前臂出血或血肿（2.7%比1.8%）]等差异均无显著性（P〉0.05）。结论：经左桡动脉路径对矮小患者行冠脉造影检查是安全可行的,值得临床推广。     

冠状动脉瘘的CT血管成像表现

目的 分析冠状动脉瘘的CT血管成像表现.方法 回顾性分析12717例行冠状动脉多排螺旋CT血管成像检查病例,其中诊断冠状动脉瘘66例.综合多种后处理图像,记录冠状动脉瘘的起源、瘘口、冠状动脉有无斑块及狭窄.其中14例患者行冠状动脉造影,比较两种检查方法结果的异同.结果 66例冠状动脉瘘中,起源于双侧冠状动脉21例,左冠状动脉26例,右冠状动脉19例;而瘘口在肺动脉41例,左心房10例,右心房8例,左心室4例,冠状静脉2例,右心室1例.14例患者冠状动脉造影显示的瘘管起源和瘘口部位均与多排螺旋CT血管成像一致.31例冠状动脉瘘同时伴冠状动脉斑块形成,其中狭窄程度≥50%者7例.结论 双侧冠状动脉起源的冠状动脉瘘并不少见,且瘘口在肺动脉者最多.CT血管成像可作为冠状动脉瘘的首选检查手段,可为该病的治疗提供重要的术前信息.

Abstract：

Objective To analyzed the computed tomography angiography (CTA) features of the coronary artery fistulas. Methods Sixty-six coronary artery fistulas were diagnosed out of 12 717 patients underwent the coronary artery multiple detector CTA examination. The origin and drainage site of the coronary artery fistulas and the plaque and stenosis of the coronary artery were observed by post-processing analysis on various images. Coronary artery angiography was performed in 14 out of 66 coronary artery fistulas patients. Results Coronary artery fistulas arose from bilateral coronary artery system in 21 cases, from left coronary artery in 26 cases and from right coronary artery in 19 cases. The majority of coronary artery fistulas entered into pulmonary artery (41 cases). The rest drainage sites included left atrium (10 cases), right atrium (8 cases),left ventricle (4 cases), coronary sinus (2 cases) and right ventricle (1 case). The findings of CTA and coronary artery angiography were consistent in 14 patients with DSA examination. Coronary artery plagues were evidenced in 31 cases and stenosis was greater than 50% in 7 coronary artery fistulas patients. Conclusions Multiple coronary artery fistulas are not rare, and pulmonary artery is the most frequent drainage site. When suspecting the coronary artery fistulas, coronary artery CTA can be the first choice of diagnose. CTA can supply adequate information for therapy.     

Anatomical consideration of the radial artery for transradial coronary procedures: arterial diameter, branching anomaly and vessel tortuosity

BACKGROUND: The radial artery is currently regarded as a useful vascular access site for coronary procedures. Adequate anatomical information of the radial artery should be helpful in performing the transradial coronary procedure. Therefore, we tried to evaluate the size of radial artery, the incidence and clinical significance of anomalous branching patterns and tortuosity of the radial artery related with transradial coronary procedure. MATERIALS AND METHOD: In 1191 cases, mean radial arterial diameter (RAD) was measured before and after the procedure using a two-dimensional ultrasound and retrograde radial artery angiography was performed before the transradial coronary procedure in all patients. Branching anomaly, tortuosity of the radial artery and procedural characteristics including procedure times and local vascular complications were analyzed. RESULTS: The mean RAD was 2.60 +/- 0.41 mm by two-dimensional ultrasound: 2.69 +/- 0.40 mm in men and 2.43 +/- 0.38 mm in women (p < 0.001). Radial artery occlusion occurred in 0.6% in coronary angiography and 1.4% in coronary intervention. In multivariate analysis, coronary intervention was significantly related to the radial artery occlusion (p = 0.048). Anomalous branching of upper extremity artery was found in 38 cases (3.2%); high origin of the radial artery was most frequent in 28 cases (2.4%). Tortuosity of radial and brachial artery was found in 67 of 50 cases (4.2%). Most common forms of tortuosity were S-shape in 21 cases (31.3%) and Omega-shape in 21 cases (31.3%). And most common site of radial artery tortuosity was proximal third of antecubital fossa (35 cases, 52.2%). Prolonged procedure times and cross-overs to other arteries were related with tortuosity of the radial artery, but not with anomalous branching. CONCLUSION: In our study, radial artery diameter was larger than the outer diameter of 5Fr sheath in 82.7% for transradial coronary procedure. Radial artery occlusion was associated with coronary intervention using larger size sheath than diagnostic angiography using 5Fr sheath. The incidence in branching anomaly and tortuosity of radial artery was not rare in our study. Radial artery tortuosity was associated with old age and prolonged procedure time.     

经导管弹簧圈栓堵法治疗先天性冠状动脉瘘

目的　探讨经导管弹簧圈栓堵冠状动脉瘘的安全性和有效性。方法　总结我院 1999年 5月至 2 0 0 2年 12月 6例 38～ 70岁 (平均年龄 5 0 7岁 )的先天性冠状动脉瘘进行栓堵治疗的患者 ,其中冠状动脉瘘由左冠状动脉至肺动脉 2例、右冠状动脉至肺动脉 2例、右冠状动脉至右下肺静脉及双侧冠状动脉至肺动脉各 1例。结果　 5例 (83 3% )栓堵后完全闭合 ;1例因瘘管迂曲 ,导管到位困难而放弃介入治疗。无手术死亡及并发症。 5例患者经体检和超声心动图随访 3～ 4 6个月 ,无残余瘘 ,无复发。结论　经导管弹簧圈栓堵先天性冠状动脉瘘不用开胸 ,病人易接受 ,安全、有效、方便 ,可作为治疗冠状动脉瘘的一种方法。     

冠脉造影桡动脉穿刺部位与血管并发症的关系

目的:探讨提高冠脉造影桡动脉穿刺成功率及减少并发症的部位。方法:共640例进行经桡动脉冠脉造影的患者,被随机分为两组:(1)穿刺点距腕横纹近端2~3cm组(A组,320例);(2)穿刺点距腕横纹近端4~5 cm组(B组,320例)。比较两组的成功率、平均穿刺操作时间、桡动脉痉挛及穿刺并发症发生率。结果:B组一次性穿刺成功率较A组显著提高(92.5%∶77.8%,P0.01)。B组平均穿刺时间较A组明显缩短[(2.5±0.6)min∶4.6±1.2)min,P0.01]。两组前臂血肿的发生率无明显差异,但B组桡动脉痉挛(3.75%∶8.13%)、桡动脉闭塞(0.93%∶5.0%)的比例均明显小于A组(P均0.05)。结论:距腕横纹4~5 cm进行首次桡动脉穿刺可以提高一次性穿刺成功率,节约手术时间,减少桡动脉痉挛和桡动脉闭塞的发生率。     

经桡动脉行冠状动脉造影术的安全性观察

目的探讨经桡动脉行冠状动脉(冠脉)造影术的特点及安全性。方法200例患者接受经桡动脉径路行冠脉造影术。结果196例成功,4例失败,其中3例桡动脉迂曲畸形导丝不能通过,1例为锁骨下动脉闭塞。所有患者无严重的并发症出现。结论桡动脉径路行冠状动脉造影具有止血容易,患者卧床时间短和并发症少的优点,是一种安全、有效的介入途径。     

左冠状动脉异常起源于肺动脉的超声心动图诊断价值

目的:探讨左冠状动脉异常起源于肺动脉(ALCAPA)的超声心动图诊断价值。方法:以CTA和手术证实的16例ALCAPA患儿为研究对象,回顾分析其超声心动图表现特征。结果:16例中,超声首诊11例,误诊5例,5例均误诊为心内膜弹力纤维增生症(EFE),复诊检出3例,余2例最后经CTA检出,超声首诊正确率69%。其主要超声表现为:左冠状动脉主干异常开口于肺动脉;右冠状动脉扩张;左心室扩大;心内膜、二尖瓣腱索及乳头肌及回声增强。彩色多普勒显示左冠状动脉内血流为逆向灌注,肺动脉内舒张期见异常血流进入;室间隔可见异常交通循环血流信号。结论:ALCAPA具有特征性超声心动图表现,超声是早期诊断的重要手段。