应用5F与6F导管经股动脉径路行冠状动脉造影术的对比研究

目的 探讨应用5F造影导管经股动脉径路行冠状动脉造影术的可行性、安全性。方法 选择26例行冠状动脉造影及左心室造影患者，随机分为应用5F及6F造影导管组，观察两组病人的手术成功率、手术操作时间、x线曝光时间、造影剂用量、术中、术后并发症、术后压迫血管止血时间及卧床时间。结果 5F导管组在手术成功率、手术时间、x线曝光时间、造影剂用量与6F导管组比较无明显差异(P＞0．05)。术中、术后并发症、术后压迫血管止血时间、卧床时间5F导管组较6F导管组明显减少(P＜0．01)。结论 使用外径较小的5F导管较目前常用的6F导管具有并发症少，安全可靠、容易止血、卧床时间短、患者痛苦小的优点，值得推广应用。     

使用4F导管经股动脉径路行冠脉造影115例体会

目的　探讨使用 4F造影导管经股动脉径路行冠脉造影的可行性及安全性。方法　选择 1 1 5例疑诊冠心病的病人作为研究对象 ,使用常规股动脉穿刺方法 ,均全部使用Judkins冠脉造影法 ,采用Cordis公司的 4F动脉鞘及造影导管。造影结束后 2min病人可早期活动。结果　全部病例均顺利完成冠脉造影 ,一次性置入 4F动脉鞘 ,术后 2min早期活动后 ,穿剌点伤口皮下血肿形成、出血、迷走神经反射发生率均明显低于常规动脉鞘。结论　使用 4F动脉鞘及造影管经股动脉行冠脉造影 ,是一种安全可靠且成功率高的方法 ,具有并发症少、患者可早期活动、痛苦小、易于接受的特点。     

新型大腔4F造影导管与5F桡动脉鞘导管在经桡动脉途径冠状动脉造影中的应用效果比较

目的比较新型大腔4F造影导管与5F桡动脉鞘导管在经桡动脉途径冠状动脉造影中的应用效果。方法选取2016年桂林市妇女儿童医院心血管内科收治的拟行冠状动脉造影患者427例,采用随机数字表法分为4F组214例和5F组213例。4F组患者采用新型大腔4F造影导管进行经桡动脉途径冠状动脉造影,而5F组患者采用5F桡动脉鞘导管进行经桡动脉途径冠状动脉造影。比较两组患者造影成功率、导管打结率、手术时间、压迫止血时间、对比剂用量、图像质量评分及并发症发生情况。结果两组患者造影成功率、导管打结率比较,差异均无统计学意义(P0.05)。两组患者手术时间、对比剂用量、图像质量评分比较,差异无统计学意义(P0.05),而4F组患者压迫止血时间短于5F组(P0.05)。4F组患者并发症发生率低于5F组(P0.05)。结论新型大腔4F造影导管与5F桡动脉鞘导管在经桡动脉途径冠状动脉造影中的应用效果相当,但新型大腔4F造影导管可有效缩短压迫止血时间,减少并发症的发生,安全性较高。     

5F共用型造影导管在经桡动脉径路冠状动脉造影中的应用

目的　探讨 5 F共用型造影导管在经桡动脉径路冠状动脉造影中的应用价值。方法　选择经桡动脉径路行冠状动脉及左心室造影患者 89例 ,按其造影时首选 5 F Judkins型造影导管或 5 F共用型造影导管 ,分为Judkins型组 (n=4 8)和共用型组 (n=4 1)。对比两组手术成功率、X线透视时间和手术操作时间。结果　共用型组中 39例 (95 .1% )经桡动脉径路行冠状动脉及左心室造影成功 ,Judkins型组中 4 4例 (91.7% )造影成功 ,共用型组的造影成功率明显高于 Judkins型组 (P <0 .0 1)。Judkins型组的冠状动脉及左心室造影平均 X线透视时间和手术操作时间分别为 (7.5± 5 .5 )和 (30 .8± 2 0 .1)分钟 ;共用型组分别为 (5 .4± 3.4 )和 (2 4 .2± 10 .4 )分钟 ,均少于Judkins型组 (P <0 .0 1)。结论　使用较小直径造影导管经桡动脉径路施行诊断性冠状动脉造影 ,术后不需严格卧床 ,患者损伤小 ,止血方便 ,血管并发症少 ,可作为某些经选择病例的首选径路。合理选择适于桡动脉径路的造影导管 ,对提高手术操作的便捷性、安全性 ,以及保证造影质量至关重要     

经桡动脉4F导管行冠状动脉造影的可行性与安全性研究

目的评价4F造影导管经桡动脉途径行冠状动脉造影的可行性与安全性。方法入选2008年5月至2009年5月于安贞医院就诊初次行冠状动脉造影的患者947例,使用随机数字表随机分为4F导管组和5F导管组。比较两组间造影成功率、造影图像质量、手术时间、对比剂用量、压迫止血时间、单导管完成率、导管打结率、桡动脉痉挛发生率以及术中和术后不良心血管事件,分别于术前24h,术后24h,术后4周行右桡动脉彩色多普勒超声。结果 4F导管组和5F导管组在造影成功率、造影图像质量、手术时间、对比剂用量、单导管完成率、导管打结率、桡动脉痉挛发生率等方面差异均无统计学意义,压迫止血时间4F组显著短于5F组(4.62±0.98)h比(6.36±0.93)h,P<0.001。除5F组一例患者于术中出现心室颤动外,两组患者均未出现院内、院外死亡、急性血栓事件、严重出血事件、前臂大血肿等;4F组桡动脉闭塞、桡动脉内膜增厚率均显著少于5F组(分别为0.60%比2.30%,P=0.038;1.10%比4.10%,P=0.003)。结论 4F造影导管经桡动脉行冠状动脉造影术安全、可行,同时对桡动脉损伤小,血管并发症少,术后压迫止血时间短,舒适度更高。     

5F和6FJudkins造影导管行选择性冠状动脉造影的临床体会

冠状动脉造影(CAG)在冠状动脉疾病的诊断和治疗中有无可替代的作用，基层医院也开始逐步开展，经股动脉Judkins法为最常用和容易掌握的CAG法，但它仍为创伤性检查，术中及术后仍有发生心律失常、心绞痛、心梗、血管并发症、造影剂反应等并发症的可能，为减少并发症发生，临床已开始使用4F，5F Judkins造影导管行CAG，本文评价5F     

经桡动脉冠脉介入诊疗后两种压迫器止血效果的比较

目的:比较经桡动脉冠脉介入术后使用螺旋式和气囊式两种桡动脉压迫器的止血效果。方法 :随机抽取近2年来经桡动脉途径行冠状动脉介入术的400例患者,螺旋压迫器组、气囊压迫器组各200例,对单纯行冠脉造影者使用5F动脉鞘,而行PCI者根据情况使用6F动脉鞘。对两组患者的初次止血的成功率、肢体肿胀程度以及并发症的发生率进行比较。结果 :两组患者初次止血成功率及手掌肿胀程度并无差异,螺旋式压迫器组前臂肿胀的发生率高于气囊式压迫器组,但其皮肤并发症的发生率低于气囊式压迫器组。结论 :两种压迫器均可获得满意的止血效果,但在并发症的发生方面各具优势和不足,尚有改进的空间。     

塑型Judkins R造影导管在经桡动脉径路冠状动脉造影中的应用

目的探索塑型JudkinsR导管用于经桡动脉径路冠状动脉造影的有效性与可行性。方法2006年3月～2007年8月．我院行经桡动脉径路冠状动脉造影及介入治疗243例，男139例，女104例，年龄38～78岁。按使用造影导管分成3组，Terumo 5F共用型（TIG）导管组78例；通用型6F Cordis Judkins（JL3．5、JR4．0）导管组67例；6F Cordis Judkins R（JR4．0）导管组98例（包括使用塑型6F Judkins R导管75例）。比较上述各组间造影操作时间、X线曝光时间、冠状动脉造影成功率和并发症；比较单纯使用普通6F JR4．0导管与使用塑型6FJR4．0导管造影成功率。结果Terumo共用型导管组和JudkinsR导管组的平均操作时间、x线曝光时间低于通用型Judkins导管组（P〈0．05）。Judkins R导管组造影成功率低于Terumo共用型导管组和通用型Judkins导管组（P〈0．05），但是塑型Judkins R导管的造影成功率（88％）高于普通Judkins R导管（61％）（P〈0．05）。在Terumo共用型导管组和Judkins R导管组中桡动脉痉挛发生率低于通用型Judkins导管组（P〈0．05）。结论塑型Judkins R导管完成经桡动脉冠状动脉造影是没有共用型造影导管时的安全有效选择．合理的塑型是使用这种方法完成经桡动脉冠状动脉造影成功的关键。     

桡动脉5F共用导管与股动脉左右冠导管冠脉造影对比分析

目的比较5F共用造影导管经桡动脉和左右冠导管经股动脉行冠脉造影的优缺点。方法426例临床疑诊冠心病拟行冠状动脉造影的患者,随机分成桡动脉组218例和股动脉组208例,观察比较两组患者的冠脉造影效果。结果两组穿刺成功率比较差异无统计学意义(P>0.05);桡动脉组平均X线透视时间、手术操作时间和术后住院时间分别为(4.68±3.53)min、(18.84±12.35)min和(1.73±1.07)d,股动脉组分别为(5.98±4.12)min、(25.96±10.66)min和(3.92±2.14)d,两组比较差异有统计学意义(P<0.05);且桡动脉组局部血肿和尿潴留的发生率均较股动脉组低(P<0.01)。结论经桡动脉行冠脉造影止血容易、并发症少,且X线透视、手术操作和术后住院时间短,值得推荐使用。     

经皮股动脉冠状动脉造影术后6小时下地活动的可行性探讨

目的观察经皮股动脉行冠状动脉造影、人工压迫止血后6h下地活动的可行性和安全性。方法377例非肝素化经皮股动脉行冠状动脉造影的患者在拔除动脉鞘管、人工压迫止血后无加压包扎，沙袋压迫10～30min，6h下地活动，观察患者舒适度及其穿刺部位并发症。结果人工压迫止血时间5～30（11．89±3．22）min，即刻止血成功率100％，沙袋压迫时间10～40（24．42±5．68）min。压迫止血后患肢床上活动时间2～6（4．12±0．66）h，下地活动时间4～8（6．10±0．78）h，58（15．4％）例患者出现腰痛不适，10（2．7％）例患者导尿，33（8．75％）例患者穿刺部位有出血并发症：轻微渗血11（2．92％）例、大血肿5（1．33％）例、小血肿15（3．98％）例、皮下淤斑25（6．63％）例、假性动脉瘤2（0．53％）例。随访1～3d，无严重出血并发症。结论使用6F动脉鞘、经皮股动脉穿刺、无肝素化冠状动脉造影、人工压迫止血后无加压包扎，6h下地活动是可行和安全的。     

Coronary angiography using 4 French catheters with power injection: a randomized comparison with 6 French catheters

BACKGROUND: Coronary angiography using 4 F catheters may reduce access-site complications and enable early ambulation, although earlier studies suggested that the quality of images may be an issue of concern. METHODS AND RESULTS: To ascertain the quality of angiographic images and safety of early ambulation, 500 patients were randomized to coronary angiography with either 4 F or 6 F catheters. Procedural characteristics, angiographic quality scores and results of ambulation were analyzed in the two groups. Patients in the 4 F group were mobilized at 2 hours post-procedure while those in the 6 F group were ambulated at 6 hours. There was no procedure-related complication in either group. The procedure was successfully completed in 250 of 252 patients randomized to the 4 F group. In two patients in the 4 F group, sheaths were upgraded to 6 F to complete the procedure, as difficulty was encountered in hooking the coronary ostium with a 4 F Judkin's catheter. Coronary angiographic quality scores in these two groups were comparable. Angiographic scores for the 4 F and 6 F groups for the left coronary artery averaged 4.45+/-0.5 and 4.58+/-0.3 (p>0.1), respectively. The right coronary artery scores averaged 4.30+/-0.4 and 4.35+/-0.2 (p>0.1) in the 4 F and 6 F groups. Angiographic scores for the left ventricular angiogram averaged 4.22+/-0.1 and 4.44+/-0.3 (p>0.1) in the 4 F and 6 F groups, respectively. None of the angiograms were assigned a score of <3.0 (not diagnostic). The total contrast volume consumed in the two groups was also equivalent. There were no groin-related complications in the 4 F group although these patients were ambulated 2 hours after the procedure. CONCLUSIONS: Coronary angiography performed with a 4 F catheter is a safe and reliable procedure. The quality of image obtained with a 4 F catheter is equivalent to that obtained with a 6 F catheter. Early ambulation at 2 hours is feasible without compromising safety.     

不同类型5F共用型造影导管在经桡动脉径路冠状动脉造影中的应用

目的　探讨使用较小直径 (5F)共用型造影导管经桡动脉径路行诊断性冠状动脉造影的可行性。方法　选择 2 0 0 1年 5月至 2 0 0 4年 4月间在阜外医院行择期经桡动脉径路冠状动脉及左心室造影患者 30 94例 ,其中男性 2 396例 ,女性 6 98例 ,平均年龄 5 6 1± 9 8(30～ 81)岁。入选患者按其造影时首先选用可供左、右冠状动脉插管的 5F共用型造影导管分为共用型导管Ⅰ组 (Mitsudo型 ,日本Hanako公司产品 ,n =985 )、共用型导管Ⅱ组 (Terumo型 ,日本Terumo公司产品 ,n =10 2 4 )和共用型导管Ⅲ组 (Medtronic型 ,美国Medtronic公司产品 ,n =10 85 )。比较上述三组间手术成功率、冠状动脉及左心室造影平均手术操作时间和X光透视时间。结果　 (1)共用型导管Ⅰ组、Ⅱ组和Ⅲ组经桡动脉径路行冠状动脉及左心室造影成功率分别为 98 4 %、98 0 %和 96 0 % ,Ⅰ组和Ⅱ组间差异无统计学意义 ,但高于Ⅲ组 (P <0 0 5 )。 (2 )共用型导管Ⅰ组的冠状动脉及左室造影平均手术操作时间和X光透视时间分别为 (17 9± 5 8)min和 (4 8± 1 8)min ,共用型导管Ⅱ组为 (18 2± 5 5 )min和(5 0± 1 7)min ,而Ⅲ组为 (2 1 1± 7 2 )min和 (5 2± 1 9)min ,均明显长于前两组 (P <0 0 5 )。结论(1)使用较小直径的共用型造影导管经桡     

门诊患者使用4F导管经桡动脉行冠状动脉造影的安全性与可行性

目的 :评价门诊患者使用4F造影导管,经桡动脉途径行冠状动脉造影的安全性与可行性。方法:入选2008年5月至2009年10月,于北京安贞医院门诊就诊拟行冠状动脉造影的患者966例,使用随机数字表随机分为门诊组和住院组。所有患者均应用4F Judkins造影导管完成冠状动脉造影。比较两组间造影成功率、手术时间、单导管完成率、离院时间、医疗费用以及术中和术后桡动脉并发症和不良心血管事件。结果:门诊组与住院组相比,造影成功率、手术时间、单导管完成率等方面差异均无统计学意义(P>0.05),离院时间门诊组明显短于住院组[(7.62±0.98)vs.(41.67±7.00)h,P<0.001],医疗费用门诊组显著低于住院组[(4 183.11±189.44)vs.(5 492.12±294.12)元,P<0.001],主要为检查费、药费、护理费、床位费及住院诊疗费。两组患者桡动脉痉挛、桡动脉闭塞、穿刺处血肿等,差异均无统计学意义,无其他心血管不良事件。结论:经选择的病情稳定的门诊患者使用4F导管经桡动脉行冠状动脉造影术安全、可行,同时避免繁琐的住院手续,缩短离院时间,加强病房周转,节约医疗成本。     

Feasibility and application of single 5F multipurpose catheter in coronary and peripheral angiography via a transradial approach

Objective

Atherosclerosis is a systemic disease, in which coronary and peripheral angiographies are required to be done at the same time in a large number of patients. To shorten the procedure time, and reduce complications, we tested the feasibility and the safety of using a single 5F multipurpose catheter, via transradial approach, for coronary, cerebral and renal angiographies.

Methods

One thousand and ninety-two patients were enrolled in the study. The procedure time, local vessel complications, duration of hospitalization, and costs were evaluated.

Results

Among 1092 patients, the radial artery puncture was successful in 1081 patients, a successful coronary angiography via the radial artery was done in 1074 patients, and the remaining 18 patients had to be accessed via the femoral artery. Thus, successful angiography rate was 97.7% for the right coronary artery, 95.8% for the left coronary artery, 100% for the right cerebral artery, 95.2% for the left subclavian artery, 96.1% for the left carotid artery and 83.1% for the renal artery. The failures were caused by abnormal curvature of the aortic arch and abnormal origins of the above-mentioned arteries. There were 1460 artery stenosis lesions found in 661 patients and 624 lesions (93.3%) needed stents via the transradial approach. The mean procedure time was 20.9 ± 9.3 min including puncture, angiography and hemostasis time. There were 4.35% complications. No local hematoma, hand ischemia, or cerebral infraction was found in this study.

Conclusion

Angiography using a single 5F multipurpose catheter, via transradial approach, is associated with a short procedure time and a low rate of complications without affecting the angiography success rate.     

Percutaneous suture of femoral artery after diagnostic coronary angiography

Complete local haemostasis after femoral artery catheterization can be performed using percutaneous suture devices. To evaluate efficacy and safety of these systems after diagnostic coronary angiography, we performed a randomized study where patients were treated either with a manual compression (group C) or a percutaneous suture (group T). Fifty patients were included in each group. Patients in group C had to rest at bed during 24 hours while patients in group T had to stand up and walk immediately after complete haemostasis was obtained. All angiographies were performed using a 6 F sheath. All patients had a clinical evaluation and an echography 24 hours after the procedure and all were reached by phone call at 15 days. Both groups were similar in term of age, sex ratio, diabetes, height and weight. Complete haemostasis was obtained in 20 +/- 6 mn in group C and in 6 +/- 10 mn in group T (p < 0.001). Device technical success rate in group T was 90%; 70% of patients walked immediately down the X ray table and 90% before the 4 hours. Ambulation delay was 24 +/- 5 hours in group C and 5 +/- 9 hours in group T (p < 0.0001). Clinical and echographic complications rate were similar in both groups (8%). There was no post procedure complication in group T (especially after ambulation) nor at the phone call. CONCLUSION: Femoral artery percutaneous suture after diagnostic coronary angiography is as safe and working than manual compression. It allows an immediate mobilization and ambulation, far earlier than compression.     

Randomized comparison of 4F and 6F catheters for diagnostic coronary angiographies via the femoral approach

The use of 6F catheters has been validated for coronary angiography. The use of small-caliber catheters is a more recent development. The aim of this study was to assess the feasibility, the cost and complications of coronary angiography using the femoral approach with 4F catheters. The authors undertook a randomized prospective study of 4F Care Infiniti catheters (N = 100) and 6F Spertorque Plus catheters (N = 100) in hospitalised patients. Criteria of non-inclusion were valvular pathology, acute myocardial infarction, aorto-coronary bypass or aorto-femoral bypass procedures. No statistical difference was observed between the two groups with respect to feasibility, to duration of the procedure, or of irradiation or to cost. The quality of the angiograms was good except in one patient in the 4F group; 4 patients in the 6F group required a 4F catheter to complete their examination. Left ventricular catheterisation was more difficult with 4F catheters (p = 0.016). Use of 4F catheters was associated with injection of significantly less contrast (p = 0.00007), reduced the duration of compression (p < 10(-6)) and its complications (p = 0.004). The authors conclude that 4F catheters are safe and well tolerated. They are associated with less patient morbidity, without any loss in quality of the angiogrammes. Other studies in valvular heart disease and after coronary bypass surgery should lead to the generalisation of their use in all coronary patients.