经右桡动脉行冠状动脉造影3005例——操作失败及并发症原因分析

Ananlyzing the Causes of Procedural Failure and Complications of Coronary Angiography Throngh Right Radial Approach

目的 :分析经桡动脉冠状动脉造影操作失败和产生并发症的原因。方法 :回顾 2 0 0 0年 12月至 2 0 0 3年 7月我院 3 0 98例准备进行冠状动脉造影的患者 ,其中 3 0 0 5例穿刺成功经验介绍。记录临床和造影过程失败以及并发症的原因。结果 :97% ( 3 0 0 5 /3 0 98)穿刺成功。 1 9% ( 5 6/3 0 0 5 )因为右桡动脉、肱动脉、腋动脉、锁骨下动脉以及无名动脉闭塞迂曲无法把导管送入升主动脉。 4% ( 13 4/3 0 0 5 )因为桡动脉痉挛改为股动脉 ,其中女性占 8 1% ,男性占 3 6%。1 2 % ( 3 7/3 0 0 5 )因主动脉根部扩张、严重主动脉瓣狭窄或关闭不全、冠状动脉起源异常而无法经桡动脉完成冠状动脉造影。并发症 :前臂张力性血肿占 0 5 % ( 16/3 0 0 5 ) ;鞘管或导管拔出困难占 0 2 7% ( 8/3 0 0 5 ) ;右桡动脉急性血栓 0 1%( 3 /3 0 0 5 )。升主动脉夹层、假性动脉瘤、动静脉瘘各占 0 0 3 % (均为 1/3 0 0 5 )。结论 :右桡动脉内反复导管操作易发生痉挛。老年人合并高血压患者血管迂曲常常造成操作困难。右桡动脉造影极少有严重并发症 。

Objective: To study the causes of procedural failure of diagnostic coronary angiography with 5F universal catheter through right radial approach. Methods: We retrospectively reviewed data from 3 098 patients who were planned to undergo right radial angiography at our institution from December 2000 to July 2003. 3 005 patients were successfully punctured through right radial approach. Baseline clinical and procedural data were recorded. Results: The rate of puncture failure was 3%. Four per cent (134/3 005) of procedure failure were due to radial spasm, 1.2% (37/3 005) were due to anatomical variation, artery occlusion and vascular tortuosity in older and hypertensive patients with extreme larger artery tortuosity. All complications were seen in 1.0% of procedures. Severe forearm bleeding and hematoma were in 0.5%. Thrombus occlusion in right radial artery was in 0.1%. Arteriovenous fistula, anuresym and ascending aorta dissection were in 0.03%, separately. No compartment syndrome developed. Conclusion: The right radial artery is prone to spasm. Larger artery occlusion and anatomical variation are seldom. Procedures on right radial artery is difficult in older and hypertensive patients with extreme truncus brachiocephalicus and artery subclavia tortuosity. Severe complication is rare.