Distal Transradial Access for Coronary Angiography and Interventions in Everyday Practice: Data From the TRIANGLE Registry (TwitteR Initiated registry for coronary ANgiography in Germany via distaL radial accEss).

INTRODUCTION: Transradial access (TRA) has become the primary route for coronary angiography (CAG) and percutaneous coronary interventions (PCI). Recently a new puncture site more distally in the area of the anatomical snuffbox has been described. With this multicenter registry, we wish to demonstrate the feasibility and safety of the distal radial access (dRA). METHODS: Between December 2018 and May 2019 all patients with a planned CAG or PCI via dRA in three cardiology centers in Germany were entered into this registry. Procedural data, puncture success, crossover rate and complications were registered. Proximal and distal radial artery patency were examined by ultrasound within 48 h. RESULTS: A total of 327 patients were enrolled (mean age: 69 ± 12 years, 69% male gender, 49% PCI), in 5 cases bilateral distal puncture was performed. Puncture success, defined as completed sheath placement was high (N = 316/332, 95%) and the crossover rate was low (27/332, 8%). The rate of proximal radial artery occlusion after 1-48 h was low (2/332 1%), the rate of occlusion at the distal puncture site was also very low (3/332, 1%). Major complications were not encountered. CONCLUSION: Coronary angiography and interventions via the distal transradial access in the area of the anatomical snuffbox can be performed with a high rate of success and safety. This data suggests a reduced rate of radial artery occlusion compared to previously reported data after cannulation via the standard forearm radial artery puncture site. Randomized studies are needed to further investigate these results. TRIAL REGISTRATION: This study was registered in the German registry for clinical trials: DRKS00017110, retrospectively on 07.May 2019.

Impact of isolated acetabular and lower extremity fractures on long-term outcome.

BACKGROUND: The long-term clinical status of surviving patients with multiple injuries has not been well described. The aim of this study was to evaluate the long-term outcome of acetabular and lower limb injuries. METHODS: Patients treated at a Level I trauma center at least 10 years before participation in this study were invited for a follow-up physical examination. Six hundred thirty-seven patients were examined. Inclusion criteria are as follows: Injury Severity Score ≥16 Points;treatment in a Level I trauma center; and injuries of the lower limb: fractures of the acetabulum, proximal femur, femoral shaft,knee joint, and tibial shaft. Exclusion criteria are as follows: incomplete follow-up examination, amputations, ankle and foot fractures, and patients older than 60 years and younger than 3 years. The follow-up examination included the following parameters:range of motion, pain, limping, successful rehabilitation, and outcome scores. RESULTS: Of 525 patients with fractures of the acetabulum and lower limb, 229 patients fulfilled the inclusion criteria. Mean age: 24.9 (range,3­60) years; Injury Severity Score: 19.66 (range, 16­43). The most frequent rates of ongoing local pain were stated by patients with fractures of the acetabulum (50%) and the proximal femur (45%). Moreover, the incidence of abnormal gait was significantly lower in patients with femoral shaft fractures when compared with the patients with fractures of the acetabulum (3.7% vs. 35%;p 0.0001), proximal femur (3.7% vs. 20%; p≤ 0.006), and tibial shaft (3.7% vs. 14.7%; p = 0.023). CONCLUSIONS: Our results demonstrate a better long-term outcome in patients with femur shaft fractures, whereas patients with articular fractures and proximal femur fractures were associated with poorer outcomes. Fracture location is determining factor for long-term outcome