Transradial Intervention Research Articles

Prevention of radial artery occlusion after transradial angiography and intervention: a best practice implementation project.

Among the complications associated with transradial artery access, radial artery occlusion (RAO) is the most frequent and serious, limiting the reuse of the same radial artery for subsequent procedures and as a graft for coronary artery bypass grafting. The objective of this project was to implement best practices to reduce the incidence of RAO, thereby enhancing the quality of patient care after transradial coronary angiography or intervention. The project was conducted in cardiology department of the Huadong Hospital, Shanghai, China. The seven-phase JBI Evidence Implementation Framework was used to guide the project. Eight audit criteria were developed and a baseline audit was conducted to compare current practice with best practices for RAO prevention. Following the implementation of improvement strategies, a follow-up audit was conducted to evaluate the success of the strategies. The implementation of best practices led to significant improvements in reducing the sheath/catheter size and systematically assessing radial artery patency before discharge, with both criteria reaching 100% compliance. The use of prophylactic ulnar compression increased from 0% to 90%, and the adoption of a minimal pressure strategy improved from 0% to 70%. The use of pre-puncture and post-procedural pre-hemostasis nitrates also increased from 23% to 93%. Barriers to implementation included the lack of dedicated devices for prophylactic ulnar artery compression, the possibility of bleeding after removal of the compression device, absence of an evidence-based care workflow, and absence of nursing assessment record forms for RAO prevention. This project promoted evidence-based practices among nurses for the care of RAO patients following transradial angiography and intervention. Efforts should be made to sustain the best practices in the future. http://links.lww.com/IJEBH/A261.

Impact of FOCUS-PDCA on reducing the incidence of complications after transradial intervention.

The aim of this study was to evaluate the effect of the find, organize, clarify, understand, select-plan, do, check, act (FOCUS-PDCA) procedure on reducing the incidence of complications at the puncture site. Patients who underwent the transradial interventional therapy (TRI) were divided into control (N.=160) and FOCUS-PDCA (N.=158) groups. The postoperative complications at the puncture site was observed in the two groups, and the pain, bleeding, swelling and comfort of the two groups were compared and analyzed. Two hours after surgery, the number of pain-free patients in the observation group was significantly higher than that in the control group (62.1% vs. 44.4%, P=0.014). The degree of swelling at 6 and 2 hours after TRI in observation group was significantly lower than that in control group (-0.08±0.23 vs. -0.00±0.17, P=0.001). No early radial artery occlusion was found in either group. The postoperative comfort score in observation group was significantly higher than that in control group (101.94±9.99 vs. 91.14±14.50, P<0.001). The FOCUS-PDCA approach may reduce the incidence of early pain and long-term swelling after TRI, improve patient comfort, and enhance the quality of specialist care. The results suggested that FOCUS-PDCA had the value of popularization and application.

Benchmarking System Monitoring on Quality Improvement in Percutaneous Coronary Intervention: A Nationwide Registry in Japan

BackgroundQuality indicators (QIs) have been developed to improve and standardize care quality in percutaneous coronary intervention (PCI). In Japan, consecutive PCI procedures are registered in a nationwide database (the Japanese Percutaneous Coronary Intervention registry), which introduces a benchmarking system for comparing individual institutional performance against the national average. ObjectivesThe aim of this study was to assess the impact of the benchmarking system implementation on QI improvement at the hospital level. MethodsA total of 734,264 PCIs were conducted at 1,194 institutions between January 2019 and December 2021. In January 2018, a web-based benchmarking system encompassing 7 QIs for PCI at the institutional level, including door-to-balloon time and rate of transradial intervention, was introduced. The process by which institutions tracked their QIs was centrally monitored. ResultsDuring the 3-year study period, the benchmarking system was reviewed at least once at 742 institutions (62.1%) (median 4 times; Q1-Q3: 2-7 times). The institutions that reviewed their records had higher PCI volumes. Among these institutions, although door-to-balloon time was not directly associated, the proportion of transradial intervention increased by 2.3% in the system review group during the initial year compared with 0.7% in their counterparts. However, in the subsequent year, the association between system reviews and QI improvement was attenuated. ConclusionsThe implementation of a benchmarking system, reviewed by participating institutions in Japan, was partially associated with improved QIs during the first year; however, this improvement was attenuated in the subsequent year, highlighting the need for further efforts to develop effective and sustainable interventions to enhance care quality in PCI.

Transradial intervention in dialysis patients undergoing percutaneous coronary intervention: a Japanese nationwide registry study.

Transradial intervention (TRI) for percutaneous coronary intervention (PCI) is used to reduce periprocedural complications. However, its effectiveness and safety for patients on dialysis are not well established. We aimed to investigate the association of TRI with in-hospital complications in dialysis patients undergoing PCI. We included 44 462 patients on dialysis who underwent PCI using Japanese nationwide PCI registry data (2019-21) regardless of acute or chronic coronary syndrome. Patients were categorized based on access site: TRI, transfemoral intervention (TFI). Periprocedural access site bleeding complication requiring transfusion was the primary outcome and in-hospital death, and other periprocedural complications were the secondary outcomes. Matched weighted analysis was performed for TRI and TFI. Here, 8267 (18.6%) underwent TRI, and 36 195 (81.4%) underwent TFI. Patients who received TRI were older and had lower rates of comorbidities than those who received TFI. Access site bleeding rate and in-hospital death were significantly lower in the TRI group (0.1% vs. 0.7%, P < 0.001; 1.8% vs. 3.2%, P < 0.001, respectively). After adjustment, TRI was associated with a lower risk of access site bleeding (odds ratio [OR] [95% confidence interval (CI)]: 0.19 [0.099-0.38]; P < 0.001) and in-hospital death (OR [95% CI]: 0.79 [0.65-0.96]; P = 0.02). Other periprocedural complications between TRI and TFI were not significantly different. In patients undergoing dialysis and PCI, TRI had a lower risk of access site bleeding and in-hospital death than TFI. This suggests that TRI may be safer for this patient population.

Left Transradial Access Using a Radial-Specific Neurointerventional Guiding Sheath for Coil Embolization of Anterior Circulation Aneurysm Associated With the Aberrant Right Subclavian Artery: Technical Note and Literature Review

Aberrant right subclavian artery (ARSA) is a rare condition, but the most common anomaly of the aortic arch. Although neurointerventions via transradial access (TRA) are becoming increasingly popular worldwide, transradial carotid cannulation has been extremely challenging in patients with an ARSA. Herein, we present a case of ARSA-associated anterior communicating artery (ACoA) aneurysm that was successfully treated with a radial-specific 6F Simmons guiding sheath via left TRA. We also review the relevant literature. A 68-year-old-woman who was diagnosed as having an ARSA-associated ACoA aneurysm underwent simple coiling via left TRA. After the 6F Simmons guiding sheath was engaged into the right common carotid artery using the pull-back-technique, transradial quadraxial system (6F Simmons guiding sheath/6F intermediate catheter/3.2F intermediate catheter/coil-delivery microcatheter) was implemented. Simple coiling of the aneurysm was successfully achieved without catheter kinking or system instability. The postprocedural course was uneventful. A follow-up magnetic resonance angiography showed no evidence of recanalization 1 years 9 months after the procedure. Transradial anterior circulation intervention has been rarely used for patients with an ARSA due to unfavorable catheter trajectory. Left TRA using the 6F Simmons guiding sheath is a useful treatment option to address anterior circulation interventions for patients with an ARSA. Preoperative diagnosis of ARSA is necessary for the application of our method.

Predictors of Bleeding after Percutaneous Coronary Intervention

Background: Acute coronary syndrome patient outcomes have been improved using early invasive techniques. The aim of this study was to investigate the incidence, location, and severity of bleeding in PCI-treated cases to identify patient risk profiles and increased bleeding occurrences.&#x0D; Methods: This prospective observational study evaluated percutaneous coronary angiography in 80 patients with hypertension and diabetes mellitus who planned to undergo primary or elective PCI. The cases were separated into 2 groups; those who reported bleeding (n=11) and those who did not (n=69). All patients underwent physical examination, laboratory evaluation, 12-lead electrocardiography, and PCI.&#x0D; Results: In univariate regression analysis, age (OR: 1.09, 95% CI: 1.009 – 1.192), female gender (OR: 4.32, 95% CI: 1.157 – 16.131), history of peripheral arterial disease (OR: 7.31, 95% CI: 1.585 – 33.742), and femoral site of vascular access (OR: 9.6, 95% CI: 2.263 – 40.721) were independent predictors of major bleeding after PCI. In multivariate regression analysis, age (OR: 1.12, 95% CI:1.014 – 1.269), female gender (OR: 13.75, 95% CI: 1.983 – 161.2), history of peripheral arterial disease (OR: 43.38, 95% CI: 3.754 - 1042) and femoral site of vascular access (OR: 13.29, 95% CI: 2.233 – 128.5) were independent predictors of major bleeding after PCI.&#x0D; Conclusions: Patients who reported bleeding after PCI had a significantly higher age, prevalence of female sex, serum creatinine, and transfemoral intervention before and after intervention compared to patients who did not report bleeding, while haemoglobin and transradial intervention before and after intervention were significantly lower in the bleeding cases than in the non-bleeding cases.

What’s New in Transradial Access

Transradial access (TRA) is a key strategy to avoid bleeding during percutaneous coronary intervention (PCI) and coronary angiography, as it reduces the risk of bleeding associated with transfemoral access (TFA). The distal radial artery (dRA) is located at the anatomical snuffbox, or radial fossa, which is a triangular depression on the lateral aspect of the dorsum of the hand. Distal transradial access (dTRA) at the anatomical snuffbox has recently gained interest as a non-femoral alternative access route for vascular procedures. Opportunities and challenges in the TRA/dTRA space include adoption of different and more complex procedures, technical innovation in access and haemostasis, and financial savings for institutions and healthcare systems. Historically, the adoption of TRA has been concentrated among interventional cardiologists, with much less adoption in the interventional radiology, vascular surgery, and neurointerventional radiology communities. This article highlights key aspects of the Think Radial webinar, an educational training session conducted by Merit Medical. The training session was conducted by three experts: Sandeep Nathan, Department of Cardiology, University of Chicago Medicine, Illinois, USA; Darren Klass, Department of Radiology, University of British Columbia, Vancouver, and Department of Radiology, Vancouver General Hospital, British Columbia, Canada; and Ajit Puri, New England Center for Stroke Research, Department of Radiology, University of Massachusetts Medical Center, Worcester, USA, all of whom have a wealth of experience in vascular access. The experts provided valuable insights into topics such as why and how to adopt a dTRA approach, the value of ultrasound for guided vascular access, and dTRA and ultrasound tips and techniques. The experts also explored the challenges in transradial intervention and management of radial access complications. Drawing on their individual specialist knowledge, the experts concluded with presentations on PCI, radial approaches in interventional radiology, and dRA access in neurointervention. The aim of this educational article is to disseminate key information on TRA provided by the experts to guide and update healthcare practitioners, particularly interventional cardiologists and interventional radiologists, working in vascular access.

Radial Artery Occlusion Following Cardiac Catheterization by Conventional Radial Approach versus Distal Radial Approach: Incidence and Predictors

Purpose: In comparison to transfemoral approach, transradial access (TRA) has developed to be the conventional entry site and is quickly expanding. Radial artery occlusion (RAO) which can occur during transradial intervention, impairs radial artery (RA) to be the future access site, and prohibits the artery from being used as an arterial conduit. Aim of this research was comparing incidence and predictors of RAO among individuals receiving elective cardiac catheterization by conventional radial access vs distal radial access.&#x0D; Methodology: This prospective study enrolled 120 patients from June 2022 to January 2023 (84 males, 36 females; mean age 68.5 (10.4) years with 62 patients had elective cardiac catheterization via conventional radial approach (CRA) and others via distal radial approach (DRA). Clinical follow up at 24 hours and 30 days was recorded with analysis of the incidence and predictors of RAO among all included participants.&#x0D; Findings: This study reported no substantial difference among groups in terms of socio-demographic and clinical characteristics. Time to sheath insertion and Procedure time were long among patients who had Distal radial approach with statistically significant difference (P &lt;0.01). Moreover, RAO at 24 hours and 30 days follow up was higher among patients had CRA than those had DRA with no significant difference (P &gt;0.05). This research demonstrated that RAO incidence was significantly high among younger patients, smoker, DM and those with previous CAD. Also, time to sheath insertion and hemostasis were long in patients with RAO with statistically significant difference (P &lt;0.05). Smoking, DM, long Procedure time and increased time to hemostasis with diminished blood supply in wrist throughout hemostasis were strong predictors for radial artery occlusion.&#x0D; Recommendations: Maintaining radial patency must be done with all procedures using the radial approach. DRA may be useful to lower RAO incidence through shortening hemostasis time and sustaining radial artery flow during hemostasis. Encouraging the interventional cardiologists for more practicing about utilizing DRA was recommended due to its advantages like safety with less vascular complications.

Optimal Hemostatic Band Duration After Transradial Angiography or Intervention: Insights From a Mixed Treatment Comparison Meta-Analysis of Randomized Trials.

The optimal duration of hemostatic compression post transradial access is controversial. Longer duration increases the risk of radial artery occlusion (RAO) while shorter duration increases the risk of access site bleeding or hematoma. As such, a target of 2 hours is typically used. Whether a shorter or longer duration is better is not known. A PubMed, EMBASE, and clinicaltrials.gov databases were searched for randomized clinical trials of different duration (<90 minutes, 90 minutes, 2 hours, and 2-4 hours) of hemostasis banding. The efficacy outcome was RAO, primary safety outcome was access site hematoma, and secondary safety outcome was access site rebleeding. Primary analysis compared the effect of various duration in reference to the 2 hours duration using a mixed treatment comparison meta-analysis. Of the 10 randomized clinical trials included with 4911 patients, when compared to the 2-hour reference duration, there was a significantly higher risk of access site hematoma with 90 minutes (odds ratio, 2.39 [95% CI, 1.40-4.06]) and <90 minutes (odds ratio, 3.61 [95% CI, 1.79-7.29]) but not with the 2 to 4 hours duration. When compared with the 2-hour reference, there was no significant difference in access site rebleeding or RAO with shorter or longer duration but the point estimates favored longer duration for access site rebleeding and shorter duration for RAO. Duration of <90 minutes and 90 minutes ranked 1 and duration of 2 hours ranked 2 as the most efficacious duration whereas duration of 2 hours ranked 1 and 2 to 4 hours ranked 2 as the safest duration. In patients undergoing transradial access for coronary angiography or intervention, a hemostasis duration of 2 hours offers the best balance for efficacy (prevention of RAO) and safety (prevention of access site hematoma/rebleeding).

The technical features of the diagnosis or treatment of coronary artery disease through the distal radial artery approach at the anatomical snuffbox compared with the conventional radial artery approach

BackgroundTo compare the surgical effects of coronary intervention through the transradial intervention (TRI) versus distal transradial intervention (dTRI) approach.MethodsFrom September 2020 to April 2021, 302 patients undergoing coronary artery angiography (CAG) or percutaneous coronary intervention in our hospital were retrospectively included. Patients were divided into the TRI group and dTRI group with 151 cases in each group. The technique features, lesion features, and cannulation process were compared between the two groups.ResultsThe number of patients who underwent CAG in the dTRI group (35.1%) was significantly greater compared with the TRI group (12.6%) (P < 0.01). The rates of triple vessel lesions, calcification lesions and chronic total occlusion lesions were increased in the TRI group compared with the dTRI group (P < 0.05). The average radial artery diameter (RAD) in the TRI group (2.550 ± 0.417 mm) was greater than that in the dTRI group (2.070 ± 0.360 mm) (P < 0.05). The hemostasis time of the dTRI group (173.272 ± 41.807 min) was lower than that of the TRI group (273.417 ± 42.098 min) (P < 0.05). The radial artery occlusion (RAO) rates in the dTRI group (2.6%) were lower than those in the TRI group (8.6%) (P < 0.05). The dTRI group had a higher satisfaction score than the TRI group (P > 0.05). RAD at the puncture site was a predictor of the overall cannulation success rate with an AUC of 0.747 (95% CI 0.663–0.860; P < 0.05).ConclusionsDespite a steep learning curve, the dTRI approach had a shorter hemostasis time, reduced RAO rates, and notable preliminary safety results compared with the TRI approach. The dTRI approach can be used as a supplemental method to the TRI approach.

The operative cooperation and nursing in transradial intervention for cerebrovascular diseases

The operative cooperation and nursing in transradial intervention for cerebrovascular diseases

Prevention of Radial Artery Occlusion of 3Hemostatic Methods in Transradial Intervention for Coronary Angiography.

The main objective of this study was to compare the efficacy of 3 hemostatic methods for the prevention of early radial artery occlusion (RAO): standard patent hemostasis, patent hemostasis with ulnar compression or the ulnar artery transient compression facilitating radial artery patent hemostasis (ULTRA) method, and facilitated hemostasis with a hemostatic disc. There are no prospective randomized studies that compare early RAO rates with the 3 most used nonocclusive hemostatic methods. This was a prospective, longitudinal, comparative, and randomized study. The final population analyzed was 1,469, and they were randomized into 3 groups: 491 patients in group 1 with standard patent hemostasis, 490 patients in group 2 with the ULTRA method, and 488 patients in group 3 with facilitated hemostasis with a hemostatic disc. The RAO rate at 24 hours of the total population analyzed was 4.6%. By hemostasis groups, it was 3.6% for patent hemostasis, 5.5% for the ULTRA method, and 4.7% for facilitated hemostasis with a hemostatic disc, with no statistical difference among the 3 groups (P=0.387). At 30days, the overall rate of RAO was 1.8%, and by groups, it was 1.4% for the patent hemostasis group, 1.8% for the ULTRA method group, and 2.2% for the facilitated hemostasis with a hemostatic disc group, respectively (P=0.185). The rates of RAO at 24 hours evaluated by plethysmography oximetry and confirmed by ultrasound among 3 current radial hemostasis methods (ie, patent hemostasis, the ULTRA method, and facilitated hemostasis with a hemostatic disc) are not different.

TCTAP C-145 Successful Revascularization Case Using Trans-Radial Iliac Intervention With Direct Needle Crossing to the Calcified Plaque of CFA for Very Long Total Occlusion From CIA to CFA

TCTAP C-145 Successful Revascularization Case Using Trans-Radial Iliac Intervention With Direct Needle Crossing to the Calcified Plaque of CFA for Very Long Total Occlusion From CIA to CFA

The Effect of Conventional and Distal Radial Access Techniques on Radial Artery Structure and Vascular Functions

Introduction: To compare radial artery (RA) diameters, intima-media thickness (IMT), and vascular functions before and after conventional and distal RA cannulation. It has been proposed that distal transradial (DTRA) cannulation can reduce RA complications. However, there has been no comparative study examining the effects of DTR and conventional transradial (CTRA) intervention on RA structure and function. Patients and Methods: Radial artery diameter, IMT, flow-mediated vasodilation (FMD) response were measured using conventional and Doppler RA ultrasonography before, and one day and one month after the procedure in patients who underwent CTRA or DTRA. Results: While baseline and first-day IMT values were similar between the groups, first-month IMT values in the CTRA group were found to be significantly increased compared to those in the DTRA group (CTRA= 0.39 ± 0.10 mm, DTRA= 0.32 ± 0.07 mm, p= 0.016). While proximal RA occlusion developed in three patients who underwent CTRA, it did not develop in any of the patients undergoing DTRA (p= 0.072). Conclusion: In patients who underwent CTRA, RA IMT increased significantly in the first month after the procedure, compared to patients who underwent DTRA. Proximal RAO was not observed in any of the patients who underwent DTRA.

Effect of Intravenous Fentanyl to Prevent Radial Artery Spasm During Trans Radial Intervention

Background: Radial artery spasm (RAS), one of the commonest complications in trans radial cardiac intervention, leads a variety range of adverse events. Different prevention strategies had been introduced and the use of sedation is one of them. Use of Fentanyl is common in cardiac interventions to achieve sedation and analgesia and also offers a potent vasodilatory effect. Objective: This study aimed to explore the role of fentanyl in the prevention of RAS in trans radial intervention.&#x0D; Methods: This observational analytic study was conducted in National Institute of Cardiovascular Diseases (NICVD) for a period of 1 year following approval of the protocol in the total of 260 patients who underwent coronary intervention through trans radial approach (Coronary Angiogram and or Percutaneous Coronary Intervention). They were categorized in 2 group- group I patients received intravenous fentanyl and group II patients didn’t receive fentanyl. Besides this, each patient received all treatments according to standard protocol of NICVD. RAS was identified by subjective and objective evidence. Patient is discomfort was quantified with a visual analogue scale.&#x0D; Results: The frequency of RAS was 17.70% in group I versus 30.80% in group II (p =0.014). Intravenous use of fentanyl significantly reduced radial artery spasm (p&lt; 0.05). Bivariate logistic regression analysis showed use of fentanyl had lower odds to prevent radial artery spasm (odds ratio [OR]: 0.430, 95% confidence interval [CI]: 0.239 to 0.779). The number needed to treat to avoid 1 case of spasm was 8. Multivariate logistic regression analysis also revealed use of fentanyl was the strong predictor of RAS ([OR]: 0.370; 95% [CI]: .195-.703) as well as use of reprocessed sheath, smoking, catheter diameter 6Fr and visual analogue scale (VAS) Score during cannulation became independent predictaor of RAS. Patient discomfort in VAS score was 4.75±2.70 in Group I versus 5.33±2.64 in group II (p&lt; 0 .05).&#x0D; Conclusion: In this study, use of fentanyl reduced the frequency of radial artery spasm and the procedure related level of patient discomfort.&#x0D; University Heart Journal 2022; 18(1): 54-60

Transradial peripheral vascular intervention using Fowler\u2019s position and Terumo R2P system for patients with heart failure: two case reports

BackgroundPositioning a patient on the catheterization table is important for proper cardiac or respiratory function during peripheral vascular interventions. Fowler’s position, where the patient’s head is a 45° angle, is more effective in reducing venous blood volume returning to the heart from the periphery compared with the supine position. The Terumo R2P system has been developed for transradial peripheral vascular interventions.Case presentationTwo patients with heart failure (a 75-year-old Japanese female and a 74-year-old Japanese male) underwent lower-extremity peripheral vascular interventions in Fowler’s position to prevent worsening heart failure. Because their head position was opposite the C-arm of the X-ray machine, the left radial artery was selected as the access site. The Terumo R2P system was used for transradial peripheral vascular intervention. We successfully treated superficial artery diseases with long shaft balloons and rapid-exchange Terumo R2P Misago stents.ConclusionsAlthough lower-extremity peripheral vascular intervention using Fowler’s position and the Terumo R2P system has several limitations, including device availability and technical complexity, it may be effective for particular patients who have higher risk of worsening heart failure in the supine position.

Anatomical Factors That Impede Using the Radial Artery Approach for Carotid Artery Revascularization

We investigated the anatomical characteristics that complicate utilizing the radial artery approach (RAA) for craniocervical intravascular intervention. The data of 73 lesions in 65 consecutive patients who underwent transradial cervical carotid artery intervention was evaluated. We assessed the success rate of RAA in right-sided and left-sided lesions. The diameters and angles of the left and right common carotid arteries and the aortic, brachiocephalic, and right subclavian arteries, which constitute the paths of the guiding sheath, were assessed for each of the left- and right-sided lesions. It was difficult to apply RAA in 10 cases (13.7%), of which 2 (5.0%) involved right-sided and 8 (24.2%) left-sided lesions. The approach was significantly more difficult to perform in left-sided than in right-sided lesions (P= 0.02). Although the treatments were successfully completed, crossover to the femoral artery approach was required in 4 cases (5.5%, 2 cases for left-sided lesions). Placement of the guiding sheath in the common carotid artery was successful for all right-sided lesions; however, the guiding sheath slipped off to the aorta during stent advancement in 2 cases. When the angle between the brachiocephalic artery and aortic arch was small, the introduction of the guiding sheath to left-sided lesions was difficult in eight cases (P= 0.0001). RAA was difficult to perform in cases involving left-sided lesions and a small angle between the brachiocephalic artery and aortic arch. This study could help delineate the factors associated with difficulty of catheter introduction and instability of RAA.

Compartment syndrome after transradial intervention

<h3></h3> Одним из наиболее часто используемых доступов для проведения как диагностических, так и лечебных процедур на коронарных артериях является трансрадиальный доступ. Хотя частота возникновения жизнеугрожающих осложнений после выполненной пункции лучевой артерии мала, нельзя недооценивать влияние таких осложнений на дальнейший прогноз пациента. Компартмент-синдром — крайне редкое осложнение трансрадиального доступа, характеризующееся повышением субфасциального давления за счет скопления крови в субфасциальном пространстве, что приводит к нарушению микроциркуляции и, как следствие, некрозу тканей. Его возникновение зависит от многих факторов, а главным звеном патогенеза считается наличие активного кровотечения из трансрадиального доступа в субфасциальное пространство. Для пациентов с такой патологией единственным методом лечения является своевременное оперативное вмешательство, что позволит сохранить функцию конечности. В данной статье мы делимся опытом ведения пациента с компартмент-синдромом, возникшим после проведенного стентирования.

Development and Validation of a Predictive Model for Chronic Kidney Disease After Percutaneous Coronary Intervention in Chinese.

AimThere is no model for predicting the outcomes for coronary heart disease (CHD) patients with chronic kidney disease (CKD) after percutaneous coronary intervention (PCI). To develop and validate a model to predict major adverse cardiovascular events (MACEs) in patients with comorbid CKD and CHD undergoing PCI.MethodsWe enrolled 1714 consecutive CKD patients who underwent PCI from January 1, 2008 to December 31, 2017. In the development cohort, we used least absolute shrinkage and selection operator regression for data dimension reduction and feature selection. We used multivariable logistic regression analysis to develop the prediction model. Finally, we used an independent cohort to validate the model. The performance of the prediction model was evaluated with respect to discrimination, calibration, and clinical usefulness.ResultsThe predictors included a positive family history of CHD, history of revascularization, ST segment changes, anemia, hyponatremia, transradial intervention, the number of diseased vessels, dose of contrast media >200 ml, and coronary collateral circulation. In the validation cohort, the model showed good discrimination (area under the receiver operating characteristic curve, 0.612; 95% confidence interval: 0.560, 0.664) and good calibration (Hosmer-Lemeshow test, P = 0.444). Decision curve analysis demonstrated that the model was clinically useful.ConclusionsWe created a nomogram that predicts MACEs after PCI in CHD patients with CKD and may help improve the screening and treatment outcomes.

Trans-radial percutaneous intervention for thrombosed hemodialysis access: A single-center experience.

Traditionally, percutaneous transluminal angioplasty (PTA) is a first-line approach for stenosed dialysis accesses and has been performed through the non-thrombosed vein segment. For thrombosed accesses, thrombectomy (whether open or percutaneous) is a standard approach. The primary objective of our study is to determine the clinical and technical outcomes of the trans-radial approach of PTA among thrombosed dialysis accesses, in terms of safety and feasibility, technical and clinical aspects and factors influencing them, as well as assisted primary patency, secondary patency at 6 and 12 months. This is a single-center retrospective study that included 150 patients over 3 years. About 123 patients underwent successful percutaneous balloon angioplasty through the radial access. We report an overall technical and clinical success rate of 82%, assisted primary patency rate of about 90.25% at 3 months, 82.93% at 6 months, 73.18% at 1 year, and secondary patency rate of 94% at 1 year. Twenty-seven patients were referred for surgical revisions/creation of a new fistula for reasons like inability to pass wire (6 patients), unfavorable anatomical variations like aneurysms at the proximal segments (5 patients), inability to cross the fistula (5 patients), and persistent fistula dysfunction with no flow after initial balloon dilatation (11 patients). Three patients had hematoma at the radial access site (2.5%) while two patients had the AV fistula segment rupture and were successfully treated conservatively. We conclude that PTA through the trans-radial approach to completely thrombosed hemodialysis accesses is a good alternative to transvenous access and has a very good assisted primary patency and secondary patency at 1 year without major complications.