| Objective: To explore the risk factors of forearm radial or ulnar occlusion after the transradial or transulnar approach coronary intervention procedure.Methods: We enrolled 187 patients who underwent transradial or transulnar angiography or angioplasty from April to June in 2015 admitted in the Fifth Department of cardiology of the Second Hospital of Hebei Medical University,including transulnar approach by 40 cases.All patients were examined by doppler ultrasound 24-72 hours after the operation to detect the antegrade blood flow of the access artery.According to the results of the doppler the patients were divided into forearm arterial occlusion group and the non forearm arterial occlusion group.Artery ultrasound would be performed again to learn the late patency of the access artery 6 months later.The clinical baseline data were collected: age,gender,BMI,smoking history,past artery intervention by the forearm artery,hypertension,diabetes,dyslipidemia.Record the operative parameters: surgical approach(TRA or TUA),heparin dosage,the use of Tirofiban,quantity of the coronary lesions,type of operation(CAG or PCI),repeated puncture,time of compression,forearm artery inner diameter to sheath outer diameter ratio(AID/SOD).Statistical Methods: Multivariate Logistic regression analysis was applied to explore the independent risk factors of forearm arterial occlusion after the suegery.With P<0.05 was considered statistically significant difference.SPSS13.0 statistical software was used for data analysis.Results: 187 cases was enrolled in the study,including transulnar approach by 40 cases(21.39%).Forearm arterial occlusion after the intervention were 13 cases,the rate was 6.95%,where the ulnar artery approach in 1 case(2.50%),the radial artery approach in 12 cases(8.16%).Clinical baseline data: There are no difference between the acute arterial occlusion group and non occlusion group in age,gender,smoking,dyslipidemia,hypertension,BMI,history of forearm artery CAG or PCI.The incidence of diabetes in the occlusion group was higher than that in the non occlusion group(69.23% vs.33.33%,P=0.014).Surgical procedure data: There are no difference in the use of Tirofiban,coronary angiography proportion,repeated puncture,time of compression between the two groups.While the heparin dosage and AID/SOD were significantly lower in the occlusion group than that in the non occlusion group,[3000(3000,3000)vs.3000(3000,6000),P=0.042 ]、[0.95(0.86,1.11)vs.1.07(0.95,1.19),P=0.036].The multivessel disease proportion was higher in the occlusion group than that in the non occlusion group,P<0.05.Among the 187 cases who underwent CAG or PCI,147 cases were transradial approach and 40 cases were transulnar approach.The ratio was higher in occlusion group via radial artery access than that in the non occlusion group,but the difference was not statistically significant(92.31% vs.77.59%,P= 0.305).Multivariate Logistic regression analysis showed that dosage of heparin(< 5000IU)(OR=6.976,95%CI=1.291~37.686,P=0.024),AID/SOD(OR=0.013,95%CI=0.000~0.573,P=0.024),diabetes(OR=5.760,95%CI=1.574~21.088,P=0.008)are the independent risk factors for the forearm artery occlusion after the operation.After 6 months,there were 155 patients participated in the follow-up(82.89%).Occlusion group,11 patients(84.62%).Non occlusion group,144 patients(82.76%).In the occlusion group,1 case via transradial approach the antegrade blood flow was resumed,recanalization rate was 9.09%.None of the 11 patients with access artery occlusion in our study show clinical symptoms of ischemia.All the 144 cases followed up in the non occlusion group,the access artery were still patent.Conclusion:The fully use of heparin for anticoagulation can be effectively in preventing the happens of access artery occlusion after the operation.And by using ultrasound preoperative,choosing suitable diameter arterial sheath can also reduce the incidence of forearm artery occlusion. |
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