Importance of measurement of the diameter of the distal radial artery in a distal radial approach from the anatomical snuffbox before coronary catheterization
Importance of measurement of the diameter of the distal radial artery in a distal radial approach from the anatomical snuffbox before coronary catheterization
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DOI：
10.1007/s00380-019-01404-2
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发表时间：
2019-10-01
影响因子：
1.5
通讯作者：
Miura, Shin-ichiro
中科院分区：
文献类型：
--
作者：
Norimatsu, Kenji;Kusumoto, Takaaki;Miura, Shin-ichiro
最近有报道称，在解剖鼻烟盒部位通过远端桡侧入路进行冠状动脉导管插入术既安全又有用。日本没有关于远端桡动脉 (DRA) 直径的数据，也不清楚 DRA 是否足够大，能够承受通过传统桡动脉入路插入常规鞘管。我们招募了 142 名接受冠状动脉导管插入术的患者，并使用超声评估了 DRA 的血管直径。解剖鼻烟盒中DRA的血管直径（2.6+/-0.5mm）明显小于传统穿刺部位的近端桡动脉（PRA）的血管直径（3.1+/-0.4mm）。 DRA 和 PRA 之间的血管直径差异为 0.5 +/- 0.4 mm，DRA/PRA 比率为 0.8 +/- 0.1。尽管 DRA 的血管直径与 PRA 的血管直径呈正相关（r = 0.66，p < 0.0001），但在某些情况下，DRA 与 PRA 相比非常小。当DRA的血管直径小于预定使用的鞘管外径时，应在开始时对PRA进行穿刺。我们可以通过远端桡骨入路进行冠状动脉插管，没有大出血或不良事件，并且在解剖鼻烟盒或前臂部位没有发生桡动脉闭塞。对于经远端桡动脉入路的冠状动脉插管，术前应使用超声评估是否有足够的血管直径。此外，从保留桡动脉的角度来看，这种方法可能是一种有效的选择。
Coronary catheterization by a distal radial approach at the site of the anatomical snuffbox has recently been reported to be both safe and useful. No data are available on the diameter of the distal radial artery (DRA) in Japan, and it is unclear whether the DRA is large enough to withstand the insertion of a conventional sheath by a traditional radial approach. We enrolled 142 patients who underwent coronary catheterization and evaluated the vessel diameter of the DRA using ultrasound. The vessel diameter of the DRA in the anatomical snuffbox (2.6 +/- 0.5 mm) was significantly smaller than that of the proximal radial artery (PRA) at the conventional puncture site (3.1 +/- 0.4 mm). The difference in vessel diameter between the DRA and PRA was 0.5 +/- 0.4 mm, and the DRA/PRA ratio was 0.8 +/- 0.1. Although the vessel diameter of the DRA was positively correlated with that of the PRA (r = 0.66, p < 0.0001), in some cases the DRA was extremely small compared to the PRA. When the vessel diameter of the DRA is smaller than the outer diameter of the sheath scheduled for use, we should puncture the PRA at the outset. We could perform coronary catheterization by a distal radial approach without major bleeding or adverse events, and there was no radial artery occlusion at the site of the anatomical snuffbox or the forearm. For coronary catheterization by a distal radial approach, we should evaluate whether there is sufficient vessel diameter using ultrasound before the procedure. In addition, this approach can be an effective option from the viewpoint of radial artery preservation.