冠状动脉旁路移植术后经左桡动脉及股动脉途径行介入治疗的有效性及安全性研究

Safety and feasibility of transradial approach for intervention therapy after coronary artery bypass graft

目的比较冠状动脉旁路移植术后患者经左桡动脉及股动脉途径行介入治疗的有效性及安全性。方法回顾性分析116例冠状动脉旁路移植术后进行介入治疗的患者,其中桡动脉组46例,股动脉组70例,比较两组的基线资料、手术资料、并发症及近期疗效。结果两组患者的基线资料比较,差异均无统计学意义(均P>0.05)。两组的手术时间、射线曝光时间、穿刺时间及住院时间比较,差异均无统计学意义(均P>0.05)。桥血管经皮冠状动脉介入治疗(PCI)全部成功,两组的PCI成功率比较,差异无统计学意义(P=0.669)。桡动脉组未出现并发症;股动脉组在拔管压迫后共出现7例(10.0%)血管并发症,其中1例(1.4%)大出血,3例(4.3%)小出血,2例(2.9%)血肿,1例(1.4%)动静脉瘘。结论与经股动脉途径相比,冠状动脉旁路移植术后患者经左桡动脉行介入治疗可减少血管并发症发生率。

Objective To compare safety and feasibility using radial versus femoral access during cardiac catheterization of patients who had previously undergone coronary artery bypass graft （CABG） surgery. Methods We retrospectively evaluated 116 consecutive patients who underwent graft intervention via the transradial （TRA group, n = 46） or transfemoral approach （TFA group, n = 70） , and observed the baseline clinical characteristics, angiography characteristics and complications between the 2 groups. Results The baseline clinical characteristics between the 2 groups were similar （ all P 〉 0. 05 ）. No significant difference was observed in angiography characteristics and procedural parameters including operation time, radiation exposure and puncture time between the 2 groups （ all P 〉 0. 05 ）. There was no significant difference in major adverse cardiac events during hospitalization. PCI to graft vessels were all successful and procedural success rates were similar between the 2 groups （ P = 0. 669 ）. Vascular access site complications were significantly lower （P = 0. 03 ） in the TRA group. No access site complication was recorded in the TRA group. 7 eases （ 10. 0% ） with complications were recorded in the TFA group including 1 case of major bleeding （ 1.4% ） , 3 cases of minor bleeding （4. 3% ） , 2 cases of local hematorna （2. 9% ） and 1 case of A-V fistula formation. Conclusions In contrast to the transfemoral route, the rate of major vascular complications was negligible using the transradial approach.