| Objectives:In this study,135 patients underwent coronary angiography or interventional therapy through the radial artery were compared by preoperative and postoperative ultrasound examination,aiming to find the changes of the radial artery in the acute period after surgery,and to explore the related factors of vascular complications of the radial artery.Methods:A total of 135 patients admitted to the Department of Cardiology,Affiliated Hospital of Chengde Medical College from September 2019 to November 2019,who underwent coronary intervention via radial artery were selected.Philips CX50 ultrasound diagnostic instrument and L12-3 probe were used to perform two-dimensional and color Doppler ultrasound examination of right radial artery in each patient before and 24h after surgery.The radial artery inner diameter(RAID)Intima-media thickness(IMT)was measured at 1cm from the radial styloid process(lower segment)and 1cm from the brachial artery bifurcation(upper segment).The peak systolic velocity(PSV),end diastolic velocity(EDV)and resistance index(RI)were repeated for three times and averaged.All data were statistically analyzed using SPSS 26.0 and tested for normality.Measurement data conforming to normal distribution were expressed as(?)±s,measurement data conforming to skewed distribution were expressed as median(P25,P75),and qualitative data were expressed as ratio or constituent ratio(%).t test was used for comparison of measurement data conforming to normal distribution.u test was used for measurement data not conforming to normal distribution.χ~2test was used for counting data to evaluate the influence of risk factors on vascular complications by Logistic regression analysis.P<0.05 indicates that the difference is statistically significant.Results:1 Among the 135 patients,there were 74 males(54.8%)and 61 f emales(45.2%),with an average age of(60.7±10.0)years.The RAID and IMT in the upper and lower radial arteries of females was smaller than that of males.AID[upper:2.49(2.08,2.88)mm vs 3.24(2.69,3.51)mm,P<0.001,lower:1.89(1.72,2.26)mm vs 2.41(2.11,2.83)mm,P<0.001].IMT[up per:0.33(0.31,0.37)mm vs 0.35(0.34,0.38)mm,P<0.05,lower:0.29(0.26,0.34)mm vs 0.31(0.28,0.35)mm,P<0.05)].There were no significant difference s in PSV EDV and RI between male and female radial arteries(P>0.05).2 The RAID of the lower radial artery was reduced after surgery:[2.05(1.70,2.27)mm vs 2.24(1.86,2.65)mm,P<0.01];The IMT was thicker than before operation:[0.36(0.33,0.41)mm vs 0.30(0.27,0.34)mm,P<0.01];PSV increased faster and EDV decreased slightly,respectively:PSV(62.48±12.79cm/s vs 58.30±13.06cm/s,P<0.01),EDV(14.98±3.46cm/s vs 14.55±3.00cm/s,P<0.05).RI was increased:(0.77±0.03 vs 0.74±0.03,P<0.01).Th ere was no significant difference in the RAID,IMT,PSV,EDV and RI of the upper radial artery after operation(P>0.05).3 Among the 135 patients,37 cases(27.4%)had negative coronary angiography and 98 cases(72.6%)had positive angiography.Among them,54 cases(39.3%)underwent coronary interventional therapy(PCI),17 cases of radial artery malformation were found by preoperative ultrasound examination,including 11 cases of high radial artery and 6 cases of radial artery tortuosity.34 cases(25.2%)of intraoperative and/or postoperative radial artery complications,including:radial artery spasm(RAS)26 cases(19.3%)upper arm hematoma 1 case(0.7%)radial artery thrombosis 3 cases(2.2%)radial artery occlusion(RAO)10 cases(7.4%).The 135 patients were divided into vascular complication group and normal group according to the occurrence of vascular complications,The clinical features of the two groups were compared:The proportion of elderly,female and radial artery tortuosity patients in vascular complications group was higher than that in normal group,and the RAID,RAID/SOD of the vascular complications group was smaller than that of the normal group,the difference was statistically significant P<0.05.The ROC curve was made to find the defined values,and the continuous variables were transformed into classified variables based on the boundary of the defined values.The above 5 risk factors were taken as independent variables and vascular complications as dependent variables for binary logistic regression analysis.The results showed that:age>60.5,RAID/SOD<0.86 and Radial artery tortuosity were independent risk factor for vascular complications.Conclusions:1 Compared with men,women’s RAID and IMT of both upper and lower segments were thinner.2 After TRI,the radial artery in the acute phase showed RAID tapered and IMT thickened near the puncture point,and hemodynamic changes showed PSV increased and EDV decreased and RI increased.However the upper radial artery had no sonographic findings of the above acute injury.3 Female,elderly,thinner RAID,smaller RAID/SOD and artery tortuosity patients had higher risk of vascular complications during TRI.4 Preoperative ultrasonography is helpful to master the radial artery inner diameter blood flow and shape,and can provide reference for the selection of sheath type and puncture route.Because of the double blood supply in the upper limbs,all 10 patients with RAO in this study had no conscious symptoms,so ultrasound was helpful to improve the diagnostic rate of postoperative complications. |
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