[Choice of an alternative access in failed endovascular intervention through the right radial artery].

Szczegóły
Abstrakt

Tytuł:: [Choice of an alternative access in failed endovascular intervention through the right radial artery].
Autorzy:: Semitko SP; Department of Interventional Cardioagiology, Institute of Professional Education, I.M. Sechenov First Moscow State Medical University of the Ministry of Healthcare of the Russian Federation, Moscow, Russia.
Mel'nichenko IS; Department of Roentgenosurgical Methods of Diagnosis and Treatment, Mytishchi Municipal Clinical Hospital, Mytishchi, Moscow Region, Russia.
Karpeeva MI; LLC 'NORBIT', Kazan, Russia.
Bolotov PA; Department of Roentgenosurgical Methods of Diagnosis and Treatment, Municipal Clinical Hospital named after V.V. Veresaev, Moscow, Russia.
Analeev AI; Department of Roentgenosurgical Methods of Diagnosis and Treatment, Mytishchi Municipal Clinical Hospital, Mytishchi, Moscow Region, Russia.
Azarov AV; Department of Interventional Cardioagiology, Institute of Professional Education, I.M. Sechenov First Moscow State Medical University of the Ministry of Healthcare of the Russian Federation, Moscow, Russia.
Kruk SV; Department of Roentgenosurgical Methods of Diagnosis and Treatment, Municipal Clinical Hospital named after V.V. Veresaev, Moscow, Russia.
Klimov VP; Department of Roentgenosurgical Methods of Diagnosis and Treatment, Municipal Clinical Hospital named after V.V. Veresaev, Moscow, Russia.
Sorokin VV; Department of Roentgenosurgical Methods of Diagnosis and Treatment, Municipal Clinical Hospital named after V.V. Veresaev, Moscow, Russia.
Ioseliani DG; Department of Interventional Cardioagiology, Institute of Professional Education, I.M. Sechenov First Moscow State Medical University of the Ministry of Healthcare of the Russian Federation, Moscow, Russia.
Transliterated Title:: Vybor al'ternativnogo dostupa pri neudache éndovaskuliarnogo vmeshatel'stva cherez pravuiu radial'nuiu arteriiu.
Corporate Authors:: Participants of the open registry COMPAAS
Źródło:: Angiologiia i sosudistaia khirurgiia = Angiology and vascular surgery [Angiol Sosud Khir] 2020; Vol. 26 (2), pp. 76-83.
Typ publikacji:: Journal Article
Język:: Russian
Imprint Name(s):: Original Publication: [Moskva] : Izd-vo Info-Media, c1995-
MeSH Terms:: Angiography*
Radial Artery/*surgery
Humans ; Radiography ; Russia ; Upper Extremity
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Contributed Indexing:: Keywords: complex anatomy; percutaneous coronary interventions; transradial access; vascular access conversion
Local Abstract: [Publisher, Russian] Трансрадиальный доступ заслуженно стал золотым стандартом при выполнении различных рентгенэндоваскулярных вмешательств как диагностических, так и лечебных. Однако, наряду со всеми его достоинствами, он не лишен недостатков. Эти трудности в основной своей массе связаны с особенностями анатомии артерий верхних конечностей. Именно сложная анатомия является наиболее частой причиной осложнений и вынужденной смены доступа при использовании правой лучевой артерии. Целью нашего исследования стало изучение симметричности сложной анатомии артерий верхних конечностей для выбора оптимального и безопасного пути конверсии доступа в случае вынужденного отказа от правого радиального доступа. По этой причине был разработан открытый мультицентровой регистр COMPAAS (COMPlex Anatomy of Arteries and Symmetry). В период работы регистра с февраля по декабрь 2018 г. корреспондентами исследования стали 35 коллег из 23 клиник 11 городов России. Рабочей группой проанализированы 127 пациентов со 157 вариантами сложной анатомии артерий верхних конечностей: высокая бифуркация лучевой артерии (84), полная петля или извитость (66) и футлярный кальциноз артерий предплечья (7). Анатомия артерий на контрлатеральной верхней конечности изучена на основании ангиографических данных. Самым частым вариантом (84 случая) сложной анатомии была высокая бифуркация лучевой артерии на уровне a. brachialis (20,9% случаев), отхождение лучевой артерии на уровне a. axillaris выявлено в 2 раза реже (9,9%). Максимальный процент симметричности отмечен в группе пациентов с футлярным кальцинозом артерий верхних конечностей (85,7%). Полная петля или резкая (более 100°) извитость артерий на обеих руках выявлена в 54% случаев. Кроме того, в 25% случаев извитость сочеталась с высоким отхождением лучевой артерии. Примечательно, что ни у одного пациента из 127 не было отмечено проявлений сложной анатомии на a. ulnaris. При выявлении выраженного кальциноза артерий предплечья или сочетания высокой бифуркации с извитостью целесообразно рассмотреть вопрос конверсии доступа на бедренный (a. femoralis) или локтевой (a. ulnaris). При изолированной высокой бифуркации справа эффективная конверсия на контрлатеральный (левый) лучевой доступ возможна не менее чем в 75% случаев.
Entry Date(s):: Date Created: 20200630 Date Completed: 20200924 Latest Revision: 20200924
Update Code:: 20240105
DOI:: 10.33529/ANGIO2020203
PMID:: 32597887
: Czasopismo naukowe

The transradial access has deservedly become the 'gold standard' while performing various X-ray endovascular interventions both diagnostic and therapeutic ones. However, along with all its advantages, it is not without disadvantages. These difficulties for the most part are related to peculiarities of the anatomy of upper-limb arteries. It is exactly complex anatomy that is the most common cause of complications and compelled change of the access while using the right radial artery. The purpose of our study was to examine the symmetry of complex anatomy of upper-limb arteries in order to choose an optimal and safe way of conversion of the access in case of forced refusal from the right radial access. For this reason there was developed an open multicentre registry acronymized as COMPAAS (COMPlex Anatomy of Arteries and Symmetry). During the work of this Registry from February to December 2018, correspondents of the study became 35 colleagues from 23 clinics of 11 cities of Russia. The working group analysed a total of 127 patients presenting with 157 variants of complex anatomy of lower limb arteries: high bifurcation of the radial artery (84), complete loop or tortuosity (66), and compartmental calcification of brachial arteries (7). The anatomy of arteries on the opposite upper extremity was studied based on angiographic findings. The most frequent variant (84 cases) of complex anatomy was high bifurcation of the radial artery at the level of the a. brachialis (20.9% of cases), with the origin of the brachial artery at the level of the a. axillaris being revealed half as often (9.9%). The maximum percentage of symmetry was observed in the group of patients presenting with compartmental calcification of upper-limb arteries (85.7%). Complete loop or marked (more than 100°) tortuosity of arteries on both arms was revealed in 54% of cases. Besides, in 25% of cases, tortuosity was combined with the high origin of the radial artery. It is noteworthy that none of the 127 patients appeared to have complex anatomy on the a. ulnaris. When revealing pronounced calcification of arteries of the forearm or a combination of high bifurcation with tortuosity, it seems feasible to decide upon conversion of the access to the femoral one (a. femoralis) or ulnar (a. ulnaris). In isolated high bifurcation on the right, effective conversion to the contralateral (left) radial approach is possible in not less than 75% of cases.

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