The Prevalence of Difficult Vascular Anatomy in Transulnar Versus Transradial Access for Cardiac Catheterization in Propensity Score-Matched Cohorts

IF 2.1 Q2 MEDICINE, GENERAL & INTERNAL
Mona Maria Grewe, Franziska Fochler, Peter Hubert Grewe, Lars Maier, Christian Schmidt, Kirstin Meier, Tobias Roeschl
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Abstract

Background and Aims

Transradial access (TRA) is used with a Class IA recommendation for coronary angiography (CA) or percutaneous coronary intervention (PCI). Difficult vascular anatomy (DVA) of the forearm arteries is a challenge to its success. Transulnar artery access (TUA) may constitute a viable alternative.

Methods

In this single-center study, we retrospectively compared the prevalence of DVA at the forearm arteries in 2565 consecutive cases of CA/PCI (2403 TRA and 162 TUA) between 2019 and 2022. DVA was classified as zeroth-degree if the forearm could be passed with a standard 0.035″ guidewire. First-degree was defined if a standard 0.035″ guidewire had to be switched to a hydrophilic 0.035″ or a 0.018″ guidewire to successfully reach the brachial artery and second-degree DVA if the forearm arteries could not be passed with any guidewire leading to procedural failure.

Results

In the overall cohort, DVA was significantly more prevalent in TRA versus TUA (zeroth-degree, first-degree, second-degree: 90.3%, 7.2%, and 2.5% vs. 96.9%, 3.1%, and 0%, respectively, p = 0.008). After 4:1 propensity score matching, second-degree DVA remained more prevalent in TRA versus TUA (2.9% (n = 648) vs. 0% (n = 162, p < 0.001)).

Discussion

In our retrospective analysis, primary TUA was found to be superior to TRA regarding DVA at the forearm arteries. TUA may present a superior alternative to TRA for CA/PCI in the era of ultrasound-guided arterial access.

Abstract Image

在倾向评分匹配的队列中,经鼻导管与经桡动脉导管置入时血管解剖困难的发生率
背景和目的经桡动脉通路(TRA)被推荐用于冠状动脉造影(CA)或经皮冠状动脉介入治疗(PCI)。前臂动脉的血管解剖(DVA)困难是其成功的一个挑战。经尺骨动脉通路(TUA)可能是可行的替代方法。方法在这项单中心研究中,我们回顾性比较了2019年至2022年间2565例连续CA/PCI患者(2403例TRA和162例TUA)前臂动脉DVA的发生率。如果前臂可以用标准的0.035″导丝通过,则DVA被归类为零度。如果标准的0.035″导丝必须转换为亲水的0.035″或0.018″导丝才能成功到达肱动脉,则定义为一级;如果任何导丝无法通过前臂动脉导致手术失败,则定义为二级DVA。结果在整个队列中,DVA在TRA中比在TUA中更为普遍(0度、1度、2度分别为90.3%、7.2%和2.5%比96.9%、3.1%和0%,p = 0.008)。经过4:1倾向评分匹配后,二度DVA在TRA中比在TUA中更普遍(2.9% (n = 648)比0% (n = 162, p < 0.001))。在我们的回顾性分析中,发现前臂动脉DVA的原发性TUA优于TRA。在超声引导动脉通路时代,TUA可能是CA/PCI的一种更好的选择。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Health Science Reports
Health Science Reports Medicine-Medicine (all)
CiteScore
1.80
自引率
0.00%
发文量
458
审稿时长
20 weeks
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