RESUMO
BACKGROUND: Trans-radial and trans-ulnar accesses have been practiced and recommended as default and alternative techniques for coronary angiography and angioplasty in recent years. In this study, we present new innovative approaches using more distal access points, i.e. trans-snuff box and trans-palmar approaches. METHODS: We conducted dorsal hand access (trans-snuff box) for angiography and/or angioplasty on 235 patients, and trans-palmar access (superficial palmar branch of ulnar artery) on 175 patients in 3 hospitals in Isfahan City, Iran. RESULTS: In 221 patients out of 235 ones (94.1%) [men: 76.5%, age: 57.4 ± 10.4 (years); women: 23.5%, age: 62.4 ± 9.5 (years)], our procedure through snuff box (dorsal hand) was successfully performed. In 159 patients out of 175 ones (90.8%) [men: 76.0%, age: 58.1 ± 10.5 (years); women: 24.0%, age: 61.2 ± 9.6 (years)], our procedure through palmar artery was successfully performed. In total, the evaluated patients had mild pain (3.4% for snuff box, and 4.5% for palmar), ecchymosis in distal forearm (5.1% for snuff box, and 2.8% for palmar), with no major complications even one (amputation, infection, thrombosis, need for surgery, hand dysfunction, nerve palsy, and so forth). In addition, percutaneous coronary intervention (PCI) was done in 28.9% and 18.2% of cases via snuff box and palmar approaches, respectively. Meanwhile, hemostasis was very fast and easy with discharge time equivalent to other upper limb accesses. CONCLUSION: Although our procedures are at their early stages with about a follow-up period of 3-15 months, more researches are recommended to be conducted in forthcoming months and years, and this new innovative approaches could be suggested safe, feasible, and reliable with low complications.
RESUMO
BACKGROUND: The potential risk of vascular complications associated with heparin, the dose of heparin therapy has not been exactly examined in patients undergoing transradial angiography. Thus, this study was aimed to compare referral arterial thrombosis, hematoma and hemorrhagic complications with 2500 and 5000 IU arterial heparin and the association of these complications with predictors in patients undergoing diagnostic angiography. METHODS: This prospective, randomized, double-blind controlled trial was carried out on 441 patients aged ≥ 18-year-old in Isfahan, Iran. They were referred for diagnostic coronary angiography with radial access. First participants were randomized into to inject either 2500 IU (group A) or 5000 IU (group B) of heparin. Study's primary endpoints were thrombosis, hematoma, and hemorrhage. RESULTS: The frequency of thrombosis was 25.5% in group A vs. 2.3% in group B (P < 0.001), while the frequency of hematoma had no significant differences in group A and B. None of patients in both groups had hemorrhage. Using 5000 IU of heparin protected the occurrence of thrombosis by 95% [odds ratio (OR): 0.05, 95% confidence interval (CI): 0.02-012] after adjustment for confounders. CONCLUSION: The low dose (2500 IU) versus standard dose (5000 IU) of heparin use increased the risk of thrombosis following trans-radial diagnostic coronary angiography, with no effect on hematoma and bleeding.
