Combined Transradial and Transpedal Approach for Femoral Artery Interventions
Combined Transradial and Transpedal Approach for Femoral Artery Interventions
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DOI：
10.1016/j.jcin.2018.03.038
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发表时间：
2018-06-11
影响因子：
11.3
通讯作者：
Merkely, Bela
中科院分区：
文献类型：
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作者：
Ruzsa, Zoltan;Bellavics, Robert;Merkely, Bela
本前瞻性研究的目的是评估经桡动脉和经足动脉联合入路进行股动脉介入的即刻成功率和并发症发生率。背景改进的设备和技术导致股浅动脉介入从经股动脉入路过渡到经桡动脉入路。方法2014年至2016年，在一项初步研究中，评价了145例连续的症状性浅表股动脉狭窄患者的临床和血管造影数据，这些患者使用6-F SheathLess Eaucath PV导引导管通过主要桡动脉通路进行治疗。通过足动脉或腘动脉实现二级入路。主要终点为主要不良事件、靶病变血运重建以及严重和轻微穿刺部位并发症的发生率。次要终点包括血管造影结果、手术因素、股动脉穿刺部位的交叉率和住院时间。22例患者（15.1%）获得了桡动脉和足动脉联合入路。股动脉穿刺部位的交叉率为2%。23.4%的患者需要植入支架。63例患者进行了慢性完全闭塞再通，技术成功率为90.4%。平均造影剂消耗量、辐射剂量和手术时间分别为112.9 ml（101.8 - 123.9 ml）、21.84戈伊/cm（2）（9.95 - 33.72戈伊/cm（2））和34.9 min（31.02 - 38.77 min）。穿刺部位并发症的累积发生率为4.8%（0%严重，4.8%轻微）。3个月和12个月随访时主要不良事件的累积发生率分别为8.3%和19.2%。3个月和12个月随访时的累积死亡率分别为2.8%和5.6%。结论经桡动脉和经足动脉入路行股动脉介入治疗安全有效，并发症可接受，技术成功率高。(c)2018作者由爱思唯尔代表美国心脏病学会基金会出版。
OBJECTIVES The purpose of this prospective study was to evaluate the acute success and complication rates of combined transradial and transpedal access for femoral artery intervention.BACKGROUND Improved equipment and techniques have resulted in transition from transfemoral to transradial access for intervention of superficial femoral artery.METHODS Between 2014 and 2016, clinical and angiographic data from 145 consecutive patients with symptomatic superficial femoral stenosis, treated via primary radial access using the 6-F SheathLess Eaucath PV guiding catheter were evaluated in a pilot study. Secondary access was achieved through the pedal or popliteal artery. The primary endpoints were major adverse events, target lesion revascularization, and rates of major and minor access-site complications. Secondary endpoints included angiographic outcome, procedural factors, crossover rate to femoral access site, and duration of hospitalization.RESULTS Technical success was achieved in 138 patients (95.2%). Combined radial and pedal access was obtained in 22 patients (15.1%). The crossover rate to a femoral access site was 2%. Stent implantation was necessary in 23.4% of patients. Chronic total occlusion recanalization was performed in 63 patients, with a 90.4% technical success rate. The mean contrast consumption, radiation dose, and procedure time were 112.9 ml (101.8 to 123.9 ml), 21.84 Gy/cm(2) (9.95 to 33.72 Gy/cm(2)), and 34.9 min (31.02 to 38.77 min), respectively. The cumulative rate of access-site complications was 4.8% (0% major, 4.8% minor). The cumulative incidence rates of major adverse events at 3 and 12 months follow-up was 8.3% and 19.2%. The cumulative incidence rates of death at 3-and 12-month follow-up were 2.8% and 5.6%.CONCLUSIONS Femoral artery intervention can be safely and effectively performed using radial and pedal access with acceptable morbidity and a high technical success rate. (c) 2018 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation.