Clinical Study Of Peripheral Vascular Intervention Via Radial Artery

Background and ObjectiveTrans-radial access(TRA)has been used in the field of cardiac intervention for nearly30 years.Relevant studies have shown that TRA has great advantages and is an effective alternative to trans-femoral access(TFA)in this field.In recent years,the application of TRA in the field of peripheral intervention has gradually increased,but many domestic medical institutions have not yet developed this technology.Therefore,it is necessary to reassess its advantages and disadvantages,for the promotion in the country.This study will evaluate the safety and feasibility of TRA in performing the peripheral arterial intervention.MethodsTo retrospectively collect clinical data of tumor patients who underwent the peripheral vascular interventional therapy via TRA in the Department of Interventional Radiology,Cancer Hospital of Peking Union Medical College from August 2017 to February 2021.The success rate of the radial artery puncture and follow-up operations were completed after punctures.The success rate and surgery-related complications were summarized and analyzed.ResultsA total of 295 patients in our department underwent peripheral vascular interventional treatment via TRA.A total of 332 TRA operations were performed,of which 263 people had 1 operation,28 had 2 operations,3 had 3 operations,and 1 had 4 operations.Of the 332 operations,74.1% were transcatheter arterial chemoembolization(TACE)(246 cases),7.53% were interventional therapy for pelvic tumors(25 cases),and 7.23%were liver metastases TACE(24 cases),11.14% were other operations(37 cases).Among 332 operations,96.69%(321 cases)were successfully punctured by TRA,and11 cases failed.After 321 successful punctures,99.07%(318 times)completed the operations,and 3 failed(2 cases due to aortic arch variation and 1 case due to celiac trunk variation).The failed patients completed the operation by TFA.The overall technical success rate is 95.78%(318/332).The success rate of punctures during the first TRA operation(97.97%)was higher than that of the second(84.38%).The third(4 cases)and the fourth(1 case)TRA operations rate were 100%,due to the fewer TRA operations.There are 0.6%(2 cases)of patients who had aortic dissection during the operation.There are 0.6%(2 cases)of patients who found radial artery occlusion before the second TRA.There is 0.3%(1 case)of patients with radial artery intubation because radial artery spasm occurred during the operation.There are 3.84%(10 cases)of patients who had subcutaneous hematoma or hemorrhage after the operation,which can be absorbed.There are 1.05%(3 cases)of patients who had arm pain after the operation,which gradually relieved.The incidence of major complications and minor complications was 0.6%(2/332)and 5.43%,respectively.In 10 patients with secondary bleeding or hematoma,platelets were ?50×109/L,and there was no significant difference in the distribution of hemorrhage or hematoma between the platelet <50×109/L group and the platelet ?50×109/L group(P=1.000).The prothrombin time of 10 patients with secondary bleeding or hematoma were all less than1.5s.There was no significant difference in the distribution of bleeding or hematoma between the prothrombin time less than the 1.5s group and the prothrombin time ?1.5s group(P=1.000).All the emergency operations were completed without complications.ConclusionsTRA has a high surgical success rate and low complication rate in peripheral vascular interventional therapy,and it is safe and feasible.Therefore,TRA is an effective way for peripheral vascular intervention,especially for the patients with poor coagulation function and some emergency patients,which is worthy of promotion.However,the reproducibility of the radial artery needs further studies.Background and ObjectiveTrans-radial access(TRA)has greater advantages than trans-femoral access(TFA),but radiation exposure is a problem that has to be faced during the promotion of TRA.Some researchers believe that TRA will increase the risk of radiation exposure.At present,there are few researches on radiation exposure in the field of peripheral intervention.Therefore,this study adopted a prospectively randomized controlled study to evaluate the radiation doses received by patients and surgeons in the treatment of primary liver cancer by transcatheter arterial chemoembolization(TACE).TRA provides a basis for the safety of radiation exposure via TRA and theoretical support for the promotion of TRA.MethodsWe prospectively collected TACE patients with liver cancer in our department and randomly divided them into TFA group and TRA group from October 2020,in the Department of Interventional Therapy,Cancer Hospital of Peking Union Medical College.In this study,dose-area product(DAP)was used as the primary endpoint.The effective dose(ED)of the surgeon,the radiation dose of different parts of the body,the fluoroscopy time(FT),and the air kerma(AK),etc.are the secondary endpoint.We compare the difference between the radiation dose received by patients and surgeons of the two surgical approaches.ResultsFrom October 2020 to March 2021,a total of 140 liver cancer patients were enrolled,70 patients in the TRA group and the TFA group respectively.There was no difference among gender,age group,weight,height,BMI classification,diabetes,smoking history,and drinking history between the two groups(P>0.05).There were differences in hypertension between the two groups(P<0.05).There was no difference in the history of hepatitis B,hepatitis C,Child-Pugh grade,number of tumors,portal vein tumor thrombus,liver cirrhosis,platelet level,AFP,prothrombin time between the two groups of patients(P>0.05).There were differences between the two groups of patients,who received TACE for the first time and the diameter of the target lesion(P<0.05).The DAP M(P25~P75)in the TFA group was 121.74(76.08~183.58)Gy · cm2,and the TRA group was 125.76(74.14~194.72)Gy·cm2(Z=-0.213,P=0.832)).The M(P25~P75)of FT in the TFA group was 17.28(13.73 ~29.87)min,and in the TRA group was 17.65(12.91 ~27.58)min(Z=-0.469,P=0.639).There was no significant difference in AK between the two groups(Z=-0.725,P=0.468).The M(P25~P75)of the ED of the TFA group was 0.79(0.51 ~1.22)? Sv,and the TRA group was 0.84(0.56~1.21)? Sv(Z=-0.277,P=0.781).There was no significant difference in the radiation doses of the left eye,left neck,and left front chest between the two groups(P>0.05).The radiation dose of the left wrist of the TFA group was 65.00(48.25~153.00)? Sv,which was lower than the 90.50(75.75 ~130.00)? Sv in TRA group(Z=-2.834,P=0.005).The results of linear regression analysis showed that the difference in DAP between the two approaches was not statistically significant(t=-0.336,P=0.737);the difference between the target lesion diameter ?5 cm and> 5 cm group were statistically significant(t=2.016,P=0.046).ConclusionsThis study showed that compared with TFA,TRA did not increase the patient's radiation dose and the surgeon's effective dose,but the surgeon's radiation dose of left hand increased.In general,due to the current improvement of radiation protection and the continuous improvement of surgeons' technology,this difference is acceptable at present and does not hinder the promotion of TRA in the TACE treatment of liver cancer.TRA will become an effective way in the field of peripheral intervention.Background and ObjectiveStudies in the field of cardiac intervention have shown that trans-radial access(TRA)can shorten hospital stays,reduce hospital costs,and improve cost-effectiveness.In the field of peripheral intervention,transcatheter arterial chemoembolization(TACE)treatment for liver cancer accounts for about 80% of the total tumor interventional therapies in China,but TRA is less used in this field.If it can also shorten the hospital stay and increase the turnover efficiency of beds.It will be helpful to solve the dilemma of insufficient medical resources in my country.Therefore,this study analyzed the relevant indicators of hospitalization for patients with liver cancer treated by TACE,compared the differences between TRA and trans-femoral access(TFA),and analyzed the influencing factors of the turnover rate of beds.MethodsWe retrospectively collected the hospitalization information of TACE treatment of liver cancer patients in the Department of Interventional Therapy,Cancer Hospital of Peking Union Medical College,from August 1,2017,to January 31,2021,and analyzed the influencing factors of the patient's length of stay and hospitalization costs.ResultsA total of 5249 patients with liver cancer who underwent TACE treatment were included in this study,of which 207 patients were treated via TRA and 5042 patients were treated via TFA.After PSM matching,207 patients were treated via TRA and 828 patients were treated via TFA.There was no significant difference among gender,age,number of consultations in this hospital,hypertension,diabetes,and the years between the TRA group and the TFA group(P>0.05).The median length of hospital stay in patients treated via TRA was 5.00(3.00~6.00)days,which was shorter than the 6.00(4.00~7.00)days via TFA(Z=-6.471,P<0.001).The median length of hospital stay after surgery in patients treated via TRA was 2.00(1.00~3.00)days,which was shorter than the 3.00(2.00~4.00)days via TFA(Z=-4.930,P<0.001).The median total hospitalization cost of TRA patients was 25370.63(23077.20~28975.83)vuan.which was higher than TFA's 23,434.28(20199.54 ~26928.21) yuan(Z=-5.925,P<0.001).The median cost of materials for patients treated via TRA was8002.51(7156.85~9163.54)yuan,which was higher than that of patients treated via TFA,5559.58(2837.07~7173.40)yuan(Z=-14.423,P<0.001).The median bed fee for patients treated via TRA was 250.00(150.00~300.00)yuan,which was lower than 300.00(200.00~350.00)yuan for patients treated via TFA(Z=-5.987,P<0.001).The median care cost for patients treated via TRA was 175.00(139.00~216.50)yuan,which was lower than 205.75(168.00~249.50)yuan(Z=-6.634,P<0.001)for patients treated via TFA.The median drug cost of TRA patients was 5896.88(3889.04~7562.84)yuan,which was lower than 6550.14(4860.65~9186.61)yuan for patients treated via TFA(Z=-4.067,P<0.001).The medianinterventional treatment fee for patients treated via TRA was 9393.70(5870.00~9393.70)yuan,which was consistent with 9393.70(5800.00~9393.70)yuan for patients treated via TFA(Z=-0.685,P=0.493).The median of other costs for TRA patients was 2684.00(2034.00~3682.00)yuan,there was no statistically difference between TRA and TFA(Z=-1.621,P=0.105).ConclusionsTRA in the TACE treatment of liver cancer shortens the length of hospital stay,increases the turnover rate of the department beds,provides the possibility for the development of day clinics,and makes full use of the limited medical and health resources.With the development of TRA medical devices,it will be possible to reduce the material costs and total hospitalization costs of TRA.It will be helpful for the promotion of TRA in the field of peripheral intervention.