Significance Of Forearm Ultrasound In Approach Selection For Coronary Angiography And Coronary Interventional Treatment

Object: Nowadays transradial approach(TRA) for coronary angiography(CAG) and percutaneous coronary intervention(PCI) has become the first choice worldwide. However, the TRA does not seem to be suitable for 5%–15% of patients undergoing coronary angiography and angioplasty for reasons including the state of palm arch, significant anatomical and distribution variations of the radial artery [1-4]. Transulnar approach(TUA) was originally proposed as a viable, alternative forearm approach in patients unable to undergo TRA. And safety and feasibility of TUA for CAG and PCI have been proved [5,6]. Pre-procedure line forearm ultrasound examination can show information of the forearm arteries, which may facilitate operator to choose puncture blood vessels. The purpose of this paper is to study the significance of forearm ultrasound in approach selection for coronary angiography and coronary interventional treatment.Methods: 240 patients in the Second Hospital of Hebei Medical University diagnosed with acute coronary syndrome(ACS) were enrolled into this study from January 2014 to October 2014. All of them needed to undertake CAG and/or PCI procedure. All of the selected patients were randomized into experiment group and control group, Before operation, patients of the experiment group underwent forearm artery ultrasound to observe the diameter, depth, blood flow and the presence of deformity of both the radial artery and ulnar artery, Contrast the diameter and depth of the radial artery and ulnar artery. We used gray model to measure the diameter and depth. The transducer was initially held perpendicular to the vessel wall to obtain a transverse image. Maximum and minimum diameters and depth of the radial artery were measured within 1-3 cm proximal to the radial styloid process, and the average diameter was taken as the period of radial artery diameter, the average depth was taken as the period of radial artery depth. Maximum and minimum diameters and depth of the ulnar artery were measured within 1-3 cm proximal to the ulnar styloid process, and the average diameter was taken as the period of ulnar artery diameter, the average depth was taken as the period of ulnar artery depth. Next, color Doppler imaging was performed to scan the arteries from the site 1cm proximal to the radial\ulnar styloid process until to the brachial artery. In order to understand the blood flow, and view the presence of vascular malformation. The transducer was oriented at an angle of intonation of 45° to 60° on both sides of the artery to measure blood flow spectrum, in order to known whether vascular stenosis existed. Normal flow was represented by a bi- or tri-phasic signal, meaning there is no stenosis or occlusion. While monophasic signal suggested there are patches or narrow in the proximal artery. According to the results, we would advise the operator to puncture the artery, which was bigger, straighter, without vascular malformation and had a better blood flow. The control group’s patients would not undertake this examination and they were conventional punctured the radial artery. If failed, according to the order in which they could choose ipsilateral ulnar artery, heterolateral radial artery, heterolateral ulnar artery. In the procedure we observed the puncture success rate of the two groups of patients(the first puncture and cannulation succeed), Time needed for puncture success(time needed from the puncture started to the catheter placed), vasospasm rate and the post-procedure access site related hemorrhage and occlusion within three days.Results:1 Comparison of baseline information between the two groups: there was no significant difference in ages, sex, risk factors, distribution of diseases, medications(P>0.05).2 In the experiment group(excluding 2 cases with radial artery occlusion and 1 case with severe radial artery and ulnar artery circuity, n = 117), the average diameter of ulnar artery was larger than radial artery(2.81±0.28 mm vs. 2.70±0.26 mm, P=0.03), the average depth of ulnar artery was deeper than radial artery(7.42±2.74 mm vs. 3.71±1.28 mm, P<0.01).3 The puncture success rate in experiment group was higher than control group(60.00% vs. 40.83%, P<0.01), Time needed for puncture success was shorter than control group(180±58s vs. 256±72s, P<0.01).4 The forearm artery vasospasm rate in patients of experiment group was lower than control group(3.3% vs. 10.8%, P<0.05). The radial artery vasospasm rate in patients experiment group was lower than control group(2.5% vs. 10.0%, P<0.05), and there was no significant difference in ulnar artery vasospasm rate between experiment group and control group(0.8% vs. 0.8%, P=1.0).5 There was no significant difference in bleeding(2.5% vs. 4.2%, P=0.722) and vascular occlusion(0.8% vs. 2.5%, P=0.622) within 3 days after operation between experiment group and control group.Conclusion:The forearm ultrasound examination before trans forearm artery coronary interventional diagnosis and treatment can discover malformation and severe stenosis/occlusion of the forearm artery, which may facilitate operator to choose puncture blood vessels, improve the puncture success rate, shorten the time needed for puncture success, reduce the the incidence of vasospasm. And it has certain preventive effect for vascular bleeding and occlusion postoperatively, So the forearm ultrasound examination is significant in approach selection for CAG/PCI.