Left distal transradial access in the anatomical snuffbox for coronary angiography (ldTRA) and interventions (ldTRI)
Left distal transradial access in the anatomical snuffbox for coronary angiography (ldTRA) and interventions (ldTRI)
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DOI：
10.4244/eij-d-17-00079
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发表时间：
2017-09-01
期刊：
影响因子：
6.2
通讯作者：
Kiemeneij, Ferdinand
中科院分区：
文献类型：
--
作者：
Kiemeneij, Ferdinand
目的：本技术报告的目的是证明左远端经桡动脉入路对于在冠状动脉造影和介入治疗中左桡动脉入路优于右桡动脉入路的患者的可行性。此过程对于操作者来说更加方便。对于惯用右手的患者，由于术后可以自由使用右手，因此左桡侧入路更为方便。此外，该技术还减少了前臂远端部位桡动脉闭塞的机会。 方法和结果：通过解剖鼻烟盒处的左远端桡动脉进入冠状动脉，可以将患者左手背侧舒适地定位在右侧腹股沟附近。操作者可以在距放射源安全距离处刺穿动脉并进行冠状动脉插管，而无需弯腰于患者。将详细描述该技术。描述了前 70 名患者的手术和临床结果。在分配给作者手术方案的 118 名连续患者中，70 名患者被认为适合左远端桡骨入路。有八次手术失败，需要转换为传统的右桡骨或左桡骨入路。所有其他手术均成功，患者和操作者没有出现重大不适。前臂部位没有遇到桡动脉闭塞。结论：通过解剖鼻烟盒的左远端经桡动脉进入冠状动脉，作为需要或更喜欢左桡动脉通路而不是右桡动脉通路的患者的默认技术，值得进一步探索。
Aims: The aim of this technical report is to demonstrate the feasibility of the left distal transradial approach for patients in whom left radial access is preferred over right radial access for coronary angiography and interventions. This procedure is more convenient for the operator. For the right-handed patient, the left radial access is more convenient because of the free use of the right hand after the procedure. In addition, this technique reduces the chance of radial artery occlusion at the site of the distal forearm.Methods and results: Coronary access via the left distal radial artery at the anatomical snuffbox allows comfortable positioning of the dorsal side of the patient's left hand near the right groin. The operator can puncture the artery and perform the coronary cannulation at a safe distance from the radiation source and without the need to bend over the patient. This technique will be described in detail. Procedural and clinical results in the first 70 patients are described. Out of 118 consecutive patients assigned to the author's operation programme, 70 patients were considered suitable for left distal radial access. There were eight procedural failures, requiring crossover to traditional right radial or left radial approach. All other procedures were successful, without major discomfort for the patient and operator. No radial artery occlusions at the site of the forearm were encountered.Conclusions: Left distal transradial coronary access via the anatomical snuffbox, as default technique for patients who need or prefer left radial access over right radial access, deserves further exploration.