左侧桡动脉和右侧桡动脉入路TACE治疗的对比分析

目的分析比较左右侧桡动脉不同入路在TACE手术治疗中的影响。方法 回顾性分析了2021年6月至2022年5月在河南省中医院接受常规TACE治疗的174例肝癌患者,其中小于65岁：左侧桡动脉入路52例,右侧桡动脉入路54例;大于65岁：左侧桡动脉入路32例,右侧桡动脉入路36例。对比分析左侧桡动脉入路和右侧桡动脉入路的并发症发生情况,插管至腹腔干的透视时间、手术整体透视时间和射线剂量。结果 小于65岁患者中左侧桡动脉入路组和右侧桡动脉入路组插管至腹腔干透视时间、手术整体透视时间、射线剂量及穿刺点并发症发生率差异无统计学意义（P>0.05）;在大于65岁患者中,左侧桡动脉入路和右侧桡动脉入路的穿刺点并发症发生率未见明显差异,无统计学意义（P>0.05）。左侧桡动脉入路插管至腹腔干透视时间、手术整体透视时间及射线剂量均低于右侧桡动脉入路[（60.3±28.3） s vs (86.3±45.2) s, P=0.003];[(11.2±4.5) min vs (14.3±6.3) min,P=0.030];[(452.2±121.7) mGy vs (563.8±181.5) mGy...     

桡动脉入路在颅内动脉瘤介入治疗中的临床应用

【摘要】 目的 探讨桡动脉入路（TRA）血管内介入治疗颅内动脉瘤的可行性和安全性。方法 回顾性分析21例TRA介入治疗的颅内动脉瘤患者临床资料。其中前循环动脉瘤10例,后循环动脉瘤11例。观察记录指引导管到位情况、手术成功率、桡动脉痉挛和穿刺点并发症、术后桡动脉搏动和闭塞情况、围手术期心脑血管并发症发生情况。结果 21例患者导引导管均到位,颅内动脉瘤介入治疗均获成功。2例出现穿刺后桡动脉痉挛,其中1例严重痉挛引起撤导管鞘困难。术后4例发生轻度相关并发症,均自行缓解。无一例出现与穿刺点相关严重并发症。术后1周桡动脉彩色超声检查显示,21例患者桡动脉血流通畅。围手术期无一例发生心脑血管并发症。结论 TRA血管内介入治疗颅内动脉瘤安全可行,是股动脉入路介入治疗颅内动脉瘤的重要补充。     

经桡动脉置入冠脉支架治疗肝移植术后迂曲型肝动脉狭窄

目的 评价经左侧桡动脉置入冠状动脉(冠脉)支架治疗肝移植术后迂曲型肝动脉狭窄的可行性和疗效.方法 2006年6月至2008年4月我科收治的6例肝移植术后迂曲型肝动脉狭窄患者.狭窄发病于肝移植术后6～110 d,平均47 d.2例患者因右侧股动脉入路置入支架失败改用左侧桡动脉入路,4例患者参考术前CTA直接经左侧桡动脉入路置入支架.合并肝动脉血栓的1例患者置入支架前使用尿激酶50万u溶栓治疗.合并肝内胆道扩张的2例患者同时行胆道穿刺引流术.结果 6例患者支架置入均成功,1例合并肝动脉血栓患者溶栓成功,2例合并肝内胆道扩张患者胆道穿刺引流成功.术后随访36～148 d,中位时间76 d.随访期间彩色多普勒超声检查未见支架狭窄,6例置入支架均通畅,各项肝功能指标好转.结论 经桡动脉置入冠脉支架能够有效治疗肝移植术后迂曲型肝动脉狭窄.     

不同入路行冠脉造影术的临床比较

目的 比较从不同入路行冠状动脉造影的优缺点.方法 812例行选择性冠状动脉造影的患者,按照入路不同分为左、右桡动脉和股动脉途径3组,比较手术成功率、并发症种类及发生率,患者术后的舒适度,联合其他介入诊治的种类及成功率等.结果 3组患者的手术时间、X线暴露时间、对比剂用量无明显差异(P>0.05),右侧桡动脉组手术成功率稍低于股动脉组(P<0.05).桡动脉组有一定的血管痉挛、术后的动脉闭塞发生率,而股动脉组的局部血管并发症发生率较高.2组桡动脉组的舒适度均高于股动脉途径组(P<0.05).3种入路均分别口I成功联合行其他种类的介入诊治.结论 正确地个体化选择造影入路可为患者及临床医师本身带来极大的益处.     

左桡动脉远端入路冠状动脉介入诊疗术的安全性和可靠性北大核心CSCD

目的评估经左桡动脉远端穿刺行冠状动脉介入诊疗术的安全性和可靠性。方法选取2019年1月至2020年1月于大连大学附属中山医院接受冠状动脉造影和经皮冠状动脉介入治疗(PCI)的550例患者为研究对象,其中260例行右桡动脉穿刺,290例行左桡动脉远端穿刺,穿刺成功者分别入组A组、B组。观察两组介入穿刺置管时X线曝光时间、造影使用导管数、完成靶血管重建数、PCI复杂程度以及术后前臂出血、桡动脉并发症等。结果248例(95.4%)患者顺利完成右桡动脉穿刺冠脉诊疗术(A组),277例(95.5%)顺利完成经左桡动脉远端冠脉诊疗术(B组),差异无统计学意义(P>0.05)。两组X线曝光时间、造影使用导管数、完成靶血管重建数、PCI复杂程度差异无统计学意义(均P>0.05)。但B组围术期前臂出血、桡动脉闭塞发生率远小于A组(P<0.01,P=0.036)。结论经左桡动脉远端途径行冠状动脉诊疗术安全可靠,提高了术者和患者舒适性。     

桡动脉入路猪尾导管辅助6.5 F指引导管和6 F指引导管治疗冠状动脉病变对比研究

目的对比桡动脉入路猪尾导管辅助6.5 F指引导管和6 F指引导管治疗冠状动脉病变的有效性和安全性。方法 连续纳入2021年1月至2022年6月于空军军医大学西京医院接受PCI治疗冠状动脉病变患者共390例,随机数字表法分为猪尾导管辅助组、6.5 F鞘组与6 F鞘组,各130例。比较3组指引导管到位成功率、桡动脉痉挛、前臂疼痛或不适、前臂血肿、桡动脉创口压迫时间、止血成功率、术后桡动脉直径、远端肿胀消退时间、假性动脉瘤、桡动脉闭塞等情况。结果 3组患者指引导管到位时间、桡动脉创口压迫时间、前臂血肿、止血成功率、术后桡动脉直径及桡动脉闭塞率比较差异无统计学意义（均P>0.05）。6.5 F鞘组与6 F鞘组相比,术中桡动脉痉挛、前臂疼痛或不适比较差异无统计学意义（均P>0.05）,猪尾导管辅助组桡动脉痉挛和前臂疼痛不适明显好于6.5 F鞘组、6 F鞘组（均P<0.05）。结论 桡动脉入路PCI治疗中6.5 F指引导管和6 F指引导管同样安全有效。采用猪尾导管辅助6.5 F指引导管可改善患者桡动脉痉挛,减轻前臂疼痛。     

经桡动脉及股动脉入路对肝癌患者行TACE的前瞻性研究

目的 通过对比股动脉（CFA）入路探讨经桡动脉（RA）入路行TACE的安全性、可行性及优缺点。方法 376例行TACE手术患者,采取CFA入路、右侧RA入路、左侧RA入路的例数依次为238例、88例、50例,就手术时间、手术与穿刺成功率、X线透视时间、发生并发症状况、病例选择倾向,对3组展开对比分析。结果 在手术与穿刺成功率方面,两侧RA组皆未表现出明显不同（P> 0.05）,但在这2项指标上,相较CFA组,两侧RA组皆表现为显著偏低（P<0.05）。在手术时间与X线透视时间上相较左侧RA组与CFA组,右侧RA皆表现为显著偏高（P<0.05）,同时在这2项指标中,相较CFA组,左侧RA组皆表现为显著偏高（P<0.05）。在并发症发生状况相较CFA组,两侧RA组皆表现出优势,多数患者更倾向于再次手术时选择两侧RA入路进行手术。结论 经桡动脉行TACE是安全可行的,在患者中接受度更高,虽存在操作难度较高等不足,但仍值得进一步发展及应用。     

彩超探查经桡动脉冠状动脉造影入路的应用价值

目的：评价彩超探查经桡动脉途径冠状动脉造影（ transradial coronary angiography , TRA ）入路的应用价值。方法择期行经桡动脉冠状动脉造影患者400例,随机分为术前彩色多普勒超声检查组（实验组）和非多普勒超声检查组（对照组）,各200例。主要评价指标包括造影成功率、造影时间、不同直径造影鞘管使用率、术中及术后不良事件（如死亡、急性心肌梗死、局部血肿、假性动脉瘤、骨筋膜室综合征和桡动脉闭塞）;次要评价指标包括桡动脉内径、超声下入路解剖变异发生率。结果实验组造影成功率（100％）较对照组（90％）高,但差异无统计学意义（P＞0．05）。实验组造影时间比对照组缩短[（10．7±1．0）min vs （12．5±3．5）min,P＜0．05]。实验组血管并发症发生率显著低于对照组;两组均未发生死亡、假性动脉瘤、桡动脉闭塞及骨筋膜室综合征。结论 TRA前应用彩超探查造影入路可提高造影成功率,缩短造影时间,减少术中桡动脉痉挛及术后局部并发症。     

经桡动脉途径行冠状动脉介入治疗的护理

经皮冠状动脉介入治疗（percutaneouscoronaryintervention,PCI）是治疗冠心病的重要而有效的方法．传统途径是经股动脉途径,1992年荷兰医生Kiemeneij首先开展了经桡动脉行PCI术^[1]。由于桡动脉附近没有重要的神经和血管。经此途径的介入治疗：不易造成神经、血管的损伤,而且手掌为双重供血,即使该治疗使桡动脉闭塞。也不容易发生手部缺血;另外经桡动脉行冠脉介入治疗手术的患者术后可立即拔除动脉鞘管,加压固定3。6h即可．因此术后患者无体位限制、痛苦小、术后出血并发症少、住院时间短。由于经桡动脉入路具有不可替代的优势,不少医院已将其作为常规路径使用。我院2010年1月～2012年10月间,经桡动脉行冠状动脉介入治疗322例患者,经过精心的护理,尤其是加强术前、术后护理,及时发现并处理不良反应和并发症．取得良好的疗效,现将护理体会报道如下。     

经桡动脉穿刺行糖尿病足介入治疗的并发症观察及护理

目的 探讨经桡动脉穿刺行糖尿病足介入治疗的并发症及其护理要点。方法 回顾性分析20例经桡动脉穿刺行糖尿病足介入治疗穿刺口并发症及溶栓并发症的观察及护理。结果 桡动脉穿刺口血肿1例,渗血3例,牙龈出血1例,疼痛3例,穿刺术后未出现尿潴留、感染,渗血、血肿、疼痛等并发症少。结论 加强桡动脉穿刺口及保留鞘管的护理和及时病情观察可减少患者穿刺并发症,丰富的临床知识、细致的病情观察能预防及减少溶栓并发症,短期内可提高患者的舒适度和生活质量。     

Distal Transradial Access for Diagnostic Cerebral Angiography and Neurointervention: Systematic Review and Meta-analysis

BACKGROUND:Radial artery access for cerebral angiography is traditionally performed in the wrist. Distal transradial access in the anatomic snuffbox is an alternative with several advantages.PURPOSE:Our aim was to review the safety and efficacy of distal transradial access for diagnostic cerebral angiography and neurointerventions.DATA SOURCES:We performed a comprehensive search of the literature using PubMed, Scopus, and EMBASE.STUDY SELECTION:The study included all case series of at least 10 patients describing outcomes associated with distal transradial access for diagnostic cerebral angiography or a neurointervention.DATA ANALYSIS:Random-effects models were used to obtain pooled rates of procedural success and complications.DATA SYNTHESIS:A total of 7 studies comprising 348 (75.8%) diagnostic cerebral angiograms and 111 (24.2%) interventions met the inclusion criteria. The pooled success rate was 95% (95% CI, 91%–98%; I² = 74.33). The pooled minor complication rate was 2% (95% CI, 1%–4%; I² = 0. No major complications were reported. For diagnostic procedures, the combined mean fluoroscopy time was 13.53 [SD, 8.82] minutes and the mean contrast dose was 74.9 [SD, 35.6] mL.LIMITATIONS:A small number of studies met the inclusion criteria, all of them were retrospective, and none compared outcomes with proximal transradial or femoral access.CONCLUSIONS:Early experience with distal transradial access suggests that it is a safe and effective alternative to proximal radial and femoral access for performing diagnostic cerebral angiography and interventions. Additional studies are needed to establish its efficacy and compare it with other access sites.

Neuroendovascular procedures have traditionally been performed using transfemoral access (TFA). Transradial access (TRA) recently gained popularity due to its lower rate of access site complications, quicker recovery time, and greater patient satisfaction.¹ However, TRA is not without complications, including radial artery occlusion (RAO), hematoma, vasospasm, pseudoaneurysm, and arteriovenous fistula.² Distal transradial access (dTRA) with puncture of the radial artery in the anatomic snuffbox may be safer than proximal transradial access (pTRA) in the forearm.³ The former is distal to the origin of the superficial palmar arch, lowering the risk of hand ischemia with RAO, and preserves the proximal radial artery for future interventions. It also affords shorter time to achieve hemostasis and improved ergonomics for both the patient and the operator.⁴ The latter may be especially beneficial in left-sided approaches and in patients who have limited supination.Although numerous reports on the safety and efficacy of dTRA for coronary angiography and percutaneous coronary interventions are available, data regarding this approach for neuroendovascular procedures are sparse and have not been reviewed. The goal of this study was to perform a systematic review and meta-analysis of dTRA for cerebral angiography and neurointerventions to determine the success and complication rates of this approach.     

使用5F共用型造影导管经桡动脉途径冠状动脉造影

 目的探讨使用较小口径共用型造影导管经桡动脉途径冠状动脉造影的安全性、可行性和方法学.方法使用5F共用型造影导管经桡动脉途径冠状动脉造影.结果152例接受经桡动脉途径冠状动脉造影的患者,桡动脉穿刺成功145例.失败的7例中,6例肱动脉穿刺成功,1例经股动脉途径.选用5F共用型造影导管进行冠状动脉造影149例,左右冠状动脉造影均成功140例.结论使用较小口径共用型造影导管经桡动脉途径冠状动脉造影安全、可行,术后无须卧床、患者痛苦小、并发症少.     

Prospective Study of Radial Artery Occlusion Following Transradial Arterial Access during IR Procedures

PurposeTo prospectively determine the rate of radial artery occlusion (RAO) in patients undergoing transradial access for intra-arterial interventions.Materials and MethodsSeventy-seven patients undergoing transradial access from August 2019 to March 2021 for 120 intra-arterial procedures (yttrium-90 mapping [n = 39] and radioembolization [n = 38], uterine artery embolization [n = 19], transarterial chemoembolization [n = 10], active bleed embolization [n = 8], angiomyolipoma embolization [n = 4], and other [n = 2]) were enrolled. The average patient age was 59 years ± 13.1 (range, 30–90 years), and 43 (55.8%) of the 77 patients were men. The patients underwent radial artery (RA) palpation, ultrasound evaluation, the Barbeau test, and the reverse Barbeau test prior to and following the intervention. Verapamil, nitroglycerin, and heparin were administered in a total of 114 (95%) of the 120 procedures prior to starting the procedure. The incidence of RAO and radial artery spasm (RAS) was calculated, and univariate logistic regression was performed to analyze the predictors of RAS.ResultsThe preprocedural RA diameter (3.0 mm ± 0.67) was not significantly different from the postprocedural RA diameter (3.0 mm ± 0.65, P = .904). The RAO rate was determined to be 0.8% (1/120), and this artery recanalized within 1 week. Due to the small number of occlusions, statistical analysis of predictors of RAO was not performed. The rate of RAS was 22.7% (27/119). None of the variables tested—including age, sex, RA diameter, initial versus repeat access, operator experience, and artery puncture technique—showed significant prediction for RAS. Patients were seen for follow-up after 111 (92.5%) of the 120 procedures.ConclusionsTransradial access resulted in a <1% rate of RAO.     

经桡动脉途径前列腺动脉栓塞术可行性及安全性研究

目的 探讨经桡动脉途径前列腺动脉栓塞术(PAE)治疗前列腺增生的可行性及安全性.方法 回顾性分析18例经左侧或右侧桡动脉行C形臂CT引导下PAE术患者临床资料,观察记录上肢动脉痉挛、损伤和穿刺点出血发生率,术后桡动脉搏动及堵塞情况,手指血供及神经损伤情况,手术成功率,围手术期脑血管并发症发生率,手术时间,射线辐射剂量及临床疗效.结果18例患者中接受经左侧桡动脉、右侧桡动脉途径PAE术分别为14例、4例.16例接受双侧栓塞,2例因前列腺动脉开口扭曲伴狭窄仅完成单侧栓塞.术后1例出现桡动脉搏动减弱,超声提示血流减慢.手术时间96～245 min,患者所受辐射剂量2 435～4 958 mGy,平均(3 342±156) mGy,与同期经股动脉途径PAE术差异无统计学意义(P=0.1167).结论采用经桡动脉途径行PAE术安全、可行.     

The transradial approach for selective carotid and vertebral angiography

Purpose:
The transradial approach is not so popular in cerebral angiography. The purpose of this study was therefore to present our experience of success rate and safety of this method. Material and Methods:
From December 1998 to June 2001, 526 carotid and vertebral angiographies with DSA were performed via the radial artery. A 1.4-mm catheter was used through a 1.4-mm introducer sheath. We evaluated the procedure as successful if sufficient images for diagnosis were obtained of the bilateral carotid arteries and unilateral vertebral artery. Each patient was reassessed for any complications, occurring until the next morning. The length of time needed for an examination was measured in the last 10 cases. Results:
In all but 5 cases, the procedures were evaluated as successful (99.0%). Unsuccessful cases manifested severe pain at the radial puncture, angiospasm at the radial artery, loop formation at the radial artery, occlusion at the subclavian artery, and an aberrant right subclavian artery. No severe complications including neurological ones were encountered. Minor complications were noted in 17 cases (3.2%): 4 cases of thrombus at the ulnar artery, 1 angiospasm at the radial artery, and 12 cases of small hematoma at the puncture site. The radial approach took 14 min less in the common carotid study and 3 min 30 s less in the internal carotid study than by the femoral approach. Conclusion:
The transradial approach enabled selective studies for carotid and vertebral angiography with a high success rate and safety with few complications.     

Uterine Artery Embolization Using a Transradial Approach: Initial Experience and Technique

This study investigates the feasibility of performing uterine artery embolization (UAE) via transradial access (TRA). Growing evidence demonstrates significant benefits of TRA versus standard transfemoral access during percutaneous coronary intervention, now making it the preferred approach at many centers worldwide. At a single institution from March 2013 to October 2013, 29 consecutive patients were treated by transradial UAE. Technical success rate was 100%, with no immediate major or minor complications. The radial artery was patent at 1-month follow-up evaluation in all cases. These preliminary data suggest that transradial UAE is feasible and safe.     

Routine transradial access for conventional cerebral angiography: a single operator's experience of its feasibility and safety

The purpose of this study is to describe a single operator's experience with the feasibility and safety of transradial access in conventional cerebral angiography. 153 patients were enrolled consecutively. Among them, 20 patients were not suitable for transradial access. A Simmons catheter was used. Haemostasis was achieved using a compressive dressing of the wrist. We analysed the success rates of the arterial puncture and the successful catheterization rate for each supra-aortic vessel as well as all complications. The arterial access was successful in 96.3%. The supra-aortic vessels were catheterized with success rates of 99.2% (127/128) for the left subclavian artery and 100% for the other arteries. The mean procedure time was 19.3 min (range 10-55 min). Haemostasis was successfully achieved in every case. The most frequent complication was arm pain which occurred in 37 patients (28.9%). In conclusion, transradial selective cerebral angiography with a reversed-angle catheter is technically feasible and safe. It might be helpful in imaging follow-up of patients with arterial stenting or coil embolisation of the cerebral aneurysms. Modification of the catheter design is required to improve the selectivity of the supra-aortic branches.     

Renal stenting from the radial artery: a novel approach

PURPOSE: To describe the technique and feasibility of renal artery angioplasty and stenting from the radial artery. METHODS: A series of 19 patients were evaluated for transradial renal artery intervention. Procedures were performed using carbon dioxide gas (CO2) as the preferred angiographic contrast agent. Intervention was performed through a 5 Fr radial artery sheath using low-profile balloons and balloon-expandable stents. RESULTS: Nineteen patients with 26 stenosed renal arteries were considered for treatment via the radial route. A negative Allen's test precluded radial puncture in two (11%). In one patient the descending aorta could not be catheterized. Stenting from the radial route was successful in 22 renal arteries in 16 patients. On an intention-to-treat basis 16 of the 19 (84%) were treatable from the radial route. In the 17 patients with radial access technical success was 94% (16 of 17) patients and 91% (21 of 23) of renal arteries. One patient experienced a cerebrovascular event during intervention. CONCLUSION: Transradial renal artery intervention is technically feasible using low-profile angioplasty balloons and stents. This route offers advantages in renal arteries with a caudal angulation and in patients with diseases or tortuous iliac arteries.     

Renal Stenting from the Radial Artery: A Novel Approach

Purpose: To describe the technique and feasibility of renal artery angioplasty and stenting from the radial artery. Methods: A series of 19 patients were evaluated for transradial renal artery intervention. Procedures were performed using carbon dioxide gas (CO₂) as the preferred angiographic contrast agent. Intervention was performed through a 5 Fr radial artery sheath using low-profile balloons and balloon-expandable stents. Results: Nineteen patients with 26 stenosed renal arteries were considered for treatment via the radial route. A negative Allens test precluded radial puncture in two (11%). In one patient the descending aorta could not be catheterized. Stenting from the radial route was successful in 22 renal arteries in 16 patients. On an intention-to-treat basis 16 of the 19 (84%) were treatable from the radial route. In the 17 patients with radial access technical success was 94% (16 of 17) patients and 91% (21 of 23) of renal arteries. One patient experienced a cerebrovascular event during intervention. Conclusion: Transradial renal artery intervention is technically feasible using low-profile angioplasty balloons and stents. This route offers advantages in renal arteries with a caudal angulation and in patients with diseases or tortuous iliac arteries.     

经桡动脉途径行下肢动脉造影的可行性研究

目的 评价经桡动脉途径行下肢动脉造影的可行性与安全性，并探讨其技术要点、适应证、禁忌证及主要优点。资料与方法 对90例下肢动脉急慢性缺血的患者采用经桡动脉穿刺插管行下肢动脉造影，统计手术成功率及并发症。结果 90例患者，87例经桡动脉行下肢动脉造影获得成功，成功率为96、7％，余3例改行经肱动脉途径。局部发生轻微血肿2例，术后8例(9、2％)桡动脉搏动微弱，无搏动消失及手部缺血事件发生。结论 经桡动脉途径行下肢动脉造影安全可行，具有成功率高、并发症少、患者舒适、不影响治疗计划等优点，应作为下肢动脉缺血患者造影的首选方法。