Dataset Information

Distal transradial access for post-CABG coronary and surgical grafts angiography and interventions.

ABSTRACT:

Background

Post-CABG coronary and grafts angiography (CGAG) and interventions (PCI) have historically been performed via classic transfemoral approach. Particularly for those with left internal mammary artery (LIMA) grafts, left standard transradial access (lsTRA) represents a feasible alternative, with significant fewer vascular complications, but it has ergonomic disadvantage for the operator because of the need to bend over the patients, especially in obese ones. Distal transradial access (dTRA) may provide important advantages, including shorter hemostasis and greater patient and operator comfort, mainly for left dTRA (ldTRA). We aim to describe the feasibility and safety of right and left dTRA for post-CABG CGAG and PCI.

Material and methods

From February 2019 to April 2021, 111 consecutive post-CABG patients submitted to CGAG and/or PCI via dTRA have been enrolled.

Results

Mean patient age was 67.6 years old. Most were male (88.3%) and had chronic coronary syndromes (61.3%). Overall, 35.1% had acute coronary syndromes. Distal RA was successfully punctured in all 111 patients, always without ultrasound guidance. All procedures involving LIMA grafts were done via ipsilateral ldTRA. We had only 5 (4.5%) access site crossovers. Successful dTRA sheath insertion was then achieved in 95.5% of all patients, mostly (74.8%) via ldTRA and with standard 6Fr sheath (99.1%). Distal and proximal RA pulses were palpable in all patients at hospital discharge. No major adverse cardiac and cerebrovascular events and no major complications related to dTRA were recorded.

Conclusions

dTRA for routine post-CABG CGAG and PCI by experienced transradial operators appears to be feasible. Further randomized and larger trials are needed to assure clinical benefits and safety of this new technique.

SUBMITTER: Oliveira MDP

PROVIDER: S-EPMC8424285 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:ObjectiveThe previous meta-analysis has assessed that distal transradial access (dTRA) in anatomical snuffbox is safe and effective for coronary angiography and intervention and can reduce radial artery occlusion. However, since the publication of the previous meta-analysis, several observational studies have been added, so we performed an updated meta-analysis to include more eligible studies to compare distal transradial access in anatomical snuffbox with conventional transradial access (cTRA).MethodPubmed, Embase, and Cochrane Library databases were searched for relevant studies from the literature published until 5 January 2021 to evaluate catheterization/puncture failure, hematoma, radial artery spasm, radial artery occlusion (RAO), access time, fluoroscopy time, radiation dose area product, total procedure time, and hemostatic device removal time. The pooled odds ratio (OR), weighted mean difference (WMD), and standardized mean difference (SMD) with 95% confidence interval (95% CI) were calculated for dichotomous and continuous variables, respectively.ResultsA total of 9,054 patients from 14 studies were included in the meta-analysis, and we found no significant difference in catheterization/puncture failure (OR = 1.94, 95CI [0.97, 3.86], P=0.06), hematoma (OR = 0.97, 95CI [0.55, 1.73], P=0.926), radial artery spasm (OR = 0.76, 95CI [0.43, 1.36], P=0.354), total procedure time (SMD = 0.23, 95CI [-0.21, 0.68], P=0.308), or radiation dose area product (WMD = 216.88 Gy/cm2, 95CI [-126.24, 560.00], P=0.215), but dTRA had a lower incidence of RAO (OR = 0.39, 95CI [0.23, 0.66], P < 0.001), shorter hemostatic device removal time (WMD = -66.62 min, 95CI [-76.68, -56.56], P < 0.001), longer access time (SMD = 0.32, 95CI [0.08, 0.56], P=0.008), and longer fluoroscopy time (SMD = 0.16, 95CI [-0.00, 0.33], P=0.05) than cTRA.ConclusionCompared with the cTRA, the dTRA has a lower incidence of radial artery occlusion and shorter hemostatic device removal time, which is worthy of further evaluation in clinical practice.