经皮绕动脉入路并发症：出血

经皮桡动脉入路出血并发症包括穿刺部位出血和导管路径出血

在讨论经桡动脉路径穿刺的几个焦点问题中，出血是一个重点问题

优点

缺点

improved patient comfort -Early ambulation

reduced bleeding risk

Non inferiority results

Re-use？

stroke risk ×

long-term consequence to radial artery（re-access or for use as bypass graft）unknown？×

greater radiation exposure to operator ×

RIFLE (Radial Versus Femoral Randomized)

RCT with 1001 pts. with acute coronary syndrome undergoing

primary/rescue percutaneous coronary intervention

出血并发症发生率低 Lower rate of bleeding complication:

7.8% (桡动脉) vs. 12.2% (股动脉) p=0.026

RIFLE-STEACS的结果清楚地显示了STEACS患者在桡动脉入路比股动脉入路方面的优势。这种显著性差异和高成功率应该是使用桡动脉入路治疗急性患者的主要原因。

Minimizing Adverse Haemorrhagic Events by TRansradial Access Site and Systemic Implementation of angioX (MATRIX)

RCT with 8404 pts. with acute coronary syndrome undergoing percutaneous coronary intervention
Lower rate of major bleeding (unrelated to coronary artery bypass graft):

1.6% vs 2.3%, RR 0.67, 95% CI 0.49–0.92; p=0.013

Valgimigli et al. Lancet 2015; 385: 2465–76

Since 2007 radial access has grown 25% per year in the UK, accounting for > 65% of all PCI’s in 2012

经桡动脉介入放射学应用首次报告

Technical success 98.2%: cross-over to femoral 1.8%

pseudoaneurysm (n=1)

hematoma/bleeding (n=13)

radial artery occlusion (n=11): all asymptomatic

Posham et al. JVIR 2016;27:159–166

Conclusions: TRA was safe and well tolerated in a heterogeneous patient population across a range of peripheral vascular interventions.

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