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A Transradial Approach of Cardiac Catheterization for Patients on Dialysis
Toshiki Kuno1, Keita Hirano, Syohei Imaeda
1Department of Cardiology, Japanese Red Cross Ashikaga Hospital, 284-1 Yobe-cho, Ashikaga, Japan. kuno-toshiki@hotmail.co.jp.
Insights
Transradial approach (TRA) is safe for patients on dialysis undergoing percutaneous coronary intervention (PCI). This method showed zero mortality and reduced bleeding complications, improving patient outcomes.
Area of Science:
- Cardiology
- Vascular Access
- Interventional Cardiology
Background:
- Periprocedural bleeding during percutaneous coronary intervention (PCI) increases mortality risk in dialysis patients.
- Transradial approach (TRA) is recommended but often avoided due to radial artery occlusion (RAO) concerns.
- This study aimed to establish a TRA system and assess its safety in dialysis patients.
Purpose of the Study:
- To construct a transradial approach (TRA) system for patients on dialysis.
- To evaluate the safety and efficacy of TRA in this high-risk population.
- To determine if TRA can reduce complications compared to transfemoral approach (TFA).
Main Methods:
- Prospective study of 88 dialysis patients undergoing cardiac catheterization.
- Patients were divided into TRA (n=62) and transfemoral approach (TFA) (n=26) groups.
- Endpoints included mortality, bleeding, procedural success, and radial artery occlusion (RAO) rates.
Main Results:
- In-hospital and 30-day mortality rates were 0% in both TRA and TFA groups.
- TRA group had 0% puncture-site bleeding compared to 3.8% in TFA group (P=.12).
- TRA procedural success was 98.4% with a 6.5% RAO rate.
Conclusions:
- The constructed transradial approach (TRA) system is safe for dialysis patients.
- Increased TRA utilization in this population may improve prognosis and patient comfort.
- TRA offers a viable alternative to TFA, with comparable safety and reduced bleeding risk.
Background:
Periprocedural bleeding is associated with increased risk of early mortality during percutaneous coronary intervention (PCI), especially in patients on dialysis. A transradial approach (TRA) should be considered for these patients; however, PCI operators avoid this approach because of the risk of radial artery occlusion (RAO). The aim of this study is to construct a TRA system and clarify its safety in patients on dialysis.
Methods:
Eighty-eight consecutive patients on dialysis who underwent cardiac catheterization were prospectively included in this study and divided according to the access site into either the TRA group or the transfemoral approach (TFA) group. Radial access was limited in the opposite side of arteriovenous fistula. The study endpoints were in-hospital and 30-day mortality rates, puncture-site related bleeding complications, and other complications. The study safety endpoints were procedure success rate and RAO rate in the TRA group.
Results:
Mean patient age was 70.4 ± 8.5 years. PCI was performed in 43 patients (48.9%). The TRA and TFA groups included 62 patients (70.5%) and 26 patients (29.5%), respectively. In-hospital and 30-day mortality rates were 0.0% in both groups. Puncture-site bleeding rates were 3.8% in the TFA group and 0.0% in the TRA group (P=.12). Procedural success rate in the TRA group was 98.4%. Crossover to TFA was necessary in 1 patient due to radial artery spasm. RAO occurred in 4 patients (6.5%).
Conclusions:
Constructed TRA can be safely used in patients on dialysis. Our study could lead to an increase in TRA in these patients, which would lead to better prognosis and patient comfort.
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