桡动脉穿刺相关并发症识别和处理

摘要/Abstract

摘要： 经桡动脉入路（TRA）比经股入路更适合进行冠状动脉造影检查（CAG）和经皮冠状动脉介入治疗（PCI）, 经桡动脉入路实施过程中，血管与出血相关并发症风险性得以降低。可分为术中或术后两类的TRA并发症，进一步划分为出血与非出血问题性。至关重要者在于TRA并发症预防策略化，本文技术总结涉及预防、识别及处理方面。实例表明，该入路方式安全性较优。由此可见，操作者需掌握相关技术要点。

关键词: 桡动脉, 并发症, 出血, 痉挛

Abstract: Compared with the transfemoral access, transradial access (TRA) is more suitable for coronary angiography and percutaneous coronary intervention, and the risk of vascular and bleeding-related complications is reduced during the TRA procedure. TRA complications, which can be categorized into intraoperative and postoperative complications, are further classified into hemorrhagic and non-hemorrhagic events. It is of great importance to develop preventive strategies for TRA complications, and this article summarizes the technical issues of prevention, identification, and management. Clinical practice shows that this access has a good safety profile. Therefore, it is essential for operators to master key technical points.

Key words: Radial artery, Complication, Hemorrhage, Spasm

周辉, 李志成, 龚敏, 赵翰文. 桡动脉穿刺相关并发症识别和处理[J]. 心血管病防治知识, 2025, 15(20): 139-144.

ZHOU Hui, LI Zhicheng, GONG Min, ZHAO Hanwen. Identification and treatment of complications associated with radial artery puncture[J]. Prevention and Treatment of Cardiovascular Disease, 2025, 15(20): 139-144.

参考文献

[1] Shroff A R, Gulati R, Drachman D E, et al.expert consensus statement update on best practices for transradial angiography and intervention[J]. Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions, 2020, 95(2): 245-52.
[2] Byrne R A, Rossello X, Coughlan J J, et al.2023 ESC Guidelines for the management of acute coronary syndromes[J]. European heart journal, 2023, 44(38): 3720-826.
[3] Yang M, Jiang S, Wang Y, et al.Chinese expert consensus on transradial access in percutaneous peripheral interventions[J]. Journal of interventional medicine, 2023, 6(4): 145-52.
[4] Wahood W, Ghozy S, Al-Abdulghani A, et al.Radial artery diameter: a comprehensive systematic review of anatomy[J]. Journal of neurointerventional surgery, 2022, 14(12): 1274-8.
[5] Agarwal T, Agarwal V, Agarwal P, et al.Assessment of collateral hand circulation by modified Allen's test in normal Indian subjects[J]. Journal of clinical orthopaedics and trauma, 2020, 11(4): 626-9.
[6] Jayanti S, Juergens C, Makris A, et al.The Learning Curves for Transradial and Ultrasound-Guided Arterial Access: An Analysis of the Trial[J]. Heart, lung & circulation, 2021, 30(9): 1329-36.
[7] Flumignan R L, Trevisani V F, Lopes R D, et al. Ultrasound guidance for arterial (other than femoral) catheterisation in adults[J]. The Cochrane database of systematic reviews, 2021, 10(10): CD013585.
[8] Roy S, Kabach M, Patel D B, et al.Radial Artery Access Complications: Prevention, Diagnosis and Management[J]. Cardiovasc Revasc Med, 2022, 40: 163-71.
[9] Pancholy S B, Patel G A, Shah S C, et al.Vascular Complications of the Wrist: Prevention and Management[J]. Interv Cardiol Clin, 2020, 9(1): 87-97.
[10] Sandoval Y, Bell M R, Gulati R.Transradial Artery Access Complications[J]. Circ Cardiovasc Interv, 2019, 12(11): e007386.
[11] Aoun J, Hattar L, Dgayli K, et al.Update on complications and their management during transradial cardiac catheterization[J]. Expert Rev Cardiovasc Ther, 2019, 17(10): 741-51.
[12] Horie K, Tada N, Isawa T, et al.A randomised comparison of incidence of radial artery occlusion and symptomatic radial artery spasm associated with elective transradial coronary intervention using 6.5 Fr SheathLess Eaucath Guiding Catheter vs. 6.0 Fr Glidesheath Slender[J]. EuroIntervention, 2018, 13(17): 2018-25.
[13] Roczniak J, Tarnawski A, Dziewierz A, et al.Radial artery spasms-angiographic morphology, risk factors and management[J]. Postepy Kardiol Interwencyjnej, 2024, 20(1): 53-61.
[14] Astarcioglu M A, Sen T, Kilit C, et al.Procedural sedation during transradial coronary angiography to prevent spasm[J]. Herz, 2016, 41(5): 435-8.
[15] Elattar M M, R N B, Haseeb W A, et al. Topical Lidocaine And Or/Intravenous Midazolam Before Radial Coronary Angiography To Prevent Radial Artery Spasm[J]. J Pak Med Assoc, 2023, 73(Suppl 4)(4): S103-S8.
[16] Lee O H, Roh J W, Kim Y, et al.Comparison of spasmolytic regimen for prevention of radial artery spasm during the distal radial approach: A single-center, randomized study[J]. Front Cardiovasc Med, 2023, 10: 1007147.
[17] Abdelazeem B, Abuelazm M T, Swed S, et al.The efficacy of nitroglycerin to prevent radial artery spasm and occlusion during and after transradial catheterization: A systematic review and meta-analysis of randomized controlled trials[J]. Clin Cardiol, 2022, 45(12): 1171-83.
[18] Ungureanu C, Gasparini G L, Aminian A, et al.RailTracking: A Novel Technique to Overcome Difficult Anatomy During Transradial Approach[J]. J Invasive Cardiol, 2022, 34(11): E757-E62.
[19] Felekos I, Hussain R, Patel S J, et al.Balloon-assisted tracking: A practical solution to avoid radial access failure due to difficult anatomical challenges[J]. Cardiovasc Revasc Med, 2018, 19(5 Pt B): 564-9.
[20] Kala P, Kanovsky J, Novakova T, et al.Radial artery neointimal hyperplasia after transradial PCI-Serial optical coherence tomography volumetric study[J]. PLoS One, 2017, 12(10): e0185404.
[21] Costa F, Van Leeuwen M A, Daemen J, et al. The Rotterdam Radial Access Research: Ultrasound-Based Radial Artery Evaluation for Diagnostic and Therapeutic Coronary Procedures[J]. Circ Cardiovasc Interv, 2016, 9(2): e003129.
[22] Kim Y, Lee S Y, Lee D I, et al.Assessment of the conventional radial artery with optical coherent tomography after the snuffbox approach[J]. Cardiol J, 2021, 28(6): 849-54.
[23] Rashid M, Kwok C S, Pancholy S, et al.Radial Artery Occlusion After Transradial Interventions: A Systematic Review and Meta-Analysis[J]. J Am Heart Assoc, 2016, 5(1).
[24] Hahalis G N, Leopoulou M, Tsigkas G, et al.Multicenter Randomized Evaluation of High Versus Standard Heparin Dose on Incident Radial Arterial Occlusion After Transradial Coronary Angiography: The OF Study[J]. Cardiovasc Interv, 2018, 11(22): 2241-50.
[25] Jolly S S, Yusuf S, Cairns J, et al.Radial versus femoral access for coronary angiography and intervention in patients with acute coronary syndromes (): a randomised, parallel group, multicentre trial[J]. Lancet, 2011, 377(9775): 1409-20.
[26] Rymer J A, Rao S V.Preventing Acute Radial Artery Occlusion: A Battle on Multiple Fronts[J]. Cardiovasc Interv, 2018, 11(22): 2251-3.
[27] Pancholy S B, Saqib N, Shah S C, et al.Preserving Radial Patency: Multiple Prior Radial Procedures and Now Large-Bore Access[J]. Cardiovasc Revasc Med, 2023, 53S: S220-S3.
[28] Rahman A, Uddin M J, Hussain K S, et al.Effect of Duration of Hemostatic Compression on Radial Artery Occlusion after Transradial Percutaneous Coronary Intervention[J]. Mymensingh Med J, 2023, 32(2): 386-92.
[29] Islam M K, Uddin M J, Momen A, et al.Role of Intra-arterial Nitroglycerin (Post Procedural, Prehemostasis) to Reduce Radial Artery Occlusion after Transradial Catheterisation: A Doppler-guided Study[J]. Mymensingh Med J, 2023, 32(2): 412-20.
[30] Aminian A, Saito S, Takahashi A, et al.Comparison of a new slender 6 Fr sheath with a standard 5 Fr sheath for transradial coronary angiography and intervention: RAP and (Radial Artery Patency and Bleeding, Efficacy, Adverse evenT), a randomised multicentre trial[J]. EuroIntervention, 2017, 13(5): e549-e56.
[31] Pancholy S B, Bernat I, Bertrand O F, et al.Prevention of Radial Artery Occlusion After Transradial Catheterization: The-II Randomized Trial[J]. Cardiovasc Interv, 2016, 9(19): 1992-9.