Acesso radial em intervenções coronarianas percutâneas: panorama atual brasileiro

Andrade, Pedro Beraldo de; Tebet, Marden André; Andrade, Mônoca Vieira Athanazio de; Labrunie, André; Mattos, Luiz Alberto

doi:10.1590/s0066-782x2011005000026

Cited by 28 publications

(10 citation statements)

References 19 publications

(16 reference statements)

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“…s ince its introduction into interventional cardiology, 1,2 the use of the radial access has grown steadily in recent years. 3 The advantages of the radial access route include lower rates of bleeding and vascular complications, 4-8 as well as more comfort for patients, with a significant reduction in hospital costs and length of hospitalization. 9 Some studies have even shown a reduction in mortality in certain subgroups of patients.…”

Section: Resultsmentioning

confidence: 99%

Exposição radiológica em procedimentos coronários realizados pelas vias radial e femoral

Mattos¹,

Cardoso²,

Moraes³

et al. 2013

Rev. Bras. Cardiol. Invasiva

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background: Although the transradial approach had significantly reduced vascular complications, studies have demonstrated that it may be related to higher radiation exposure. The objective of this study is to compare radiation exposure in invasive cardiologic procedures using the transradial and transfemoral approaches. Methods: Prospective cohort study including patients undergoing diagnostic cardiac catheterization or percutaneous coronary intervention (PCI) between August 2010 and December 2011. Clinical, angiographic and radiation exposure characteristics were recorded in a dedicated database. Patients were analyzed according to the access route: femoral or radial. Results: Of the 1,197 patients included in the study, 782 were submitted to procedures using the femoral access and 415 using the radial access. There was a lower prevalence of females (36.2% vs. 45.6%; P < 0.01), previous coronary artery bypass graft surgery (4% vs. 12.7%; P < 0.01) and severe valvular heart disease (0.3% vs. 1.4%; P = 0.07) in the radial group. The median radiation dose received by the patients was higher with the radial approach, both for diagnostic (621.6 mGy vs 445.7 mGy; P < 0.01) and therapeutic procedures (1,241.6 mGy vs 990.9 mGy; P < 0.01). Less experienced operators in the radial approach exposed patients to higher radiation doses (1,463 mGy vs 1,196 mGy; P = 0.02), which did not occur with the more experienced operators (1,311 mGy vs 1,449 mGy; P = 0.84). Conclusions: Patients undergoing invasive cardiologic procedures are exposed to higher radiation levels when the

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Section: Resultsmentioning

confidence: 99%

Exposição radiológica em procedimentos coronários realizados pelas vias radial e femoral

Mattos¹,

Cardoso²,

Moraes³

et al. 2013

Rev. Bras. Cardiol. Invasiva

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“…Estudos prévios demonstram que no início da aprendizagem os insucessos com a técnica e a necessidade de crossover para a técnica femoral são relativamente frequentes. 7,12 No cenário nacional, a utilização da técnica radial foi recentemente demonstrada por Andrade et al 16 com dados da Central Nacional de Intervenções Cardiovasculares (CENIC). Esses autores demonstraram que, apesar da redução significativa das complicações vasculares, a via radial foi utilizada em apenas 12,6% dos procedimentos entre os anos de 2005 e 2008.…”

Section: Discussionunclassified

Influência da curva de aprendizado nos procedimentos percutâneos por via transradial

Cardoso¹,

Moraes²,

Voltolini³

et al. 2011

Rev. Bras. Cardiol. Invasiva

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RESUMOIntrodução: A curva de aprendizado é uma das limitações da técnica radial. O estudo teve como objetivo avaliar a influência desse aprendizado nos resultados de procedimentos realizados pelo acesso radial. Métodos: Estudo de coorte prospectivo, com pacientes submetidos a cateterismo cardía-co e alocados no grupo A (intervenções realizadas por operadores com > 500 procedimentos por via radial) e no grupo B (intervenções realizadas por operadores com < 500 procedimentos por via radial). O pulso radial foi avaliado com Doppler antes, imediatamente após e aos sete dias da intervenção. Resultados: O estudo incluiu 58 pacientes no grupo A e 62 no grupo B. A maioria era do sexo feminino (57,5%), com média de idade de 59 + 10,3 anos, e 25% eram diabéticos. A doença arterial coronária foi diagnosticada em igual proporção entre os grupos (43,9% vs. 42,4%; P > 0,99), mas a doença valvar apresentou maior prevalência no grupo A (24,1% vs. 3,2%; P = 0,001). A taxa de crossover para a técnica femoral foi semelhante (1,7% vs. 1,6%; P > 0,99). Os operadores com maior experiência realizaram os procedimentos com menor tempo de punção e de fluoroscopia e com menor tempo total de exame (13,2 + 5,2 minutos vs. 16,3 + 4,8 minutos; P = 0,001). Não ocorreram complicações maiores. Não foram observadas diferenças em relação à presença de hematomas tipo I (12% vs. 3,2%), tipo II (1,7% vs. 1,7%) e tipo III (0 vs. 1,7%). Na avaliação pelo Doppler, o fluxo do pulso e a oclusão da artéria radial foram semelhantes entre os grupos. Conclusões: A curva de aprendizado exerce papel importante em alguns dos desfechos relacionados aos procedimentos pela via de acesso radial. Operadores experientes realizam exames com menor tempo total, de fluoroscopia e de punção. DESCRITORES: Cateterismo cardíaco. Artéria radial. Curva de aprendizado. ABSTRACT Influence of the Learning Curve in Percutaneous Procedures by Transradial ApproachBackground: The learning curve is one of the limitations of the transradial technique. The aim of this study was to evaluate the influence of the learning curve in the outcomes of procedures using the radial approach. Methods: Prospective cohort study in patients undergoing cardiac catheterization allocated to Group A (interventions performed by operators with > 500 procedures by radial approach) and Group B (interventions performed by operators with < 500 procedures by radial approach). Radial pulse was evaluated by Doppler before, immediately after and seven days after the intervention. Results: Fifty-eight patients were included in Group A and 62 in Group B. Most of them were female (57.5%), with mean age of 59 + 10.3 years and 25% were diabetic. Coronary artery disease was diagnosed in equal proportion between groups (43.9% vs. 42.4%; P > 0.99), but valve disease was more prevalent in Group A (24.1% vs. 3.2%; P = 0.001). The crossover rate for the femoral technique was similar (1.7% vs. 1.6%; P > 0.99). The more experienced operators performed the procedures with shorter puncture, fluoroscopy and total procedure time (13...

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“…The advantages of this approach include lower bleeding and vascular complication rates, and greater patient comfort, with a significant reduction in hospital costs and length of stay. 6,7 The higher radiological exposure via radial access compared with femoral access is related to the operator's experience. 8,9 Combining ad hoc PCI with the radial technique, compared with the femoral technique, provides more comfort for the patient, and reduces hemorrhagic complications and costs.…”

Section: Introductionmentioning

confidence: 99%

Comparison of radiological exposure of patients undergoing coronary angiography and staged or ad hoc percutaneous coronary intervention by radial access

Rodrigues¹,

Meireles²,

Rodrigues³

et al. 2019

J Transcat Intervent

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Acesso radial em intervenções coronarianas percutâneas: panorama atual brasileiro

Abstract: Background: Although the radial approach offers an unquestionable result in terms of reduction of vascular complications and occurrence of severe bleeding in comparison to the femoral approach, so far it has only been used in few centers which elected it as the preferential access.

Cited by 28 publications

References 19 publications

Exposição radiológica em procedimentos coronários realizados pelas vias radial e femoral

Exposição radiológica em procedimentos coronários realizados pelas vias radial e femoral

Influência da curva de aprendizado nos procedimentos percutâneos por via transradial

Comparison of radiological exposure of patients undergoing coronary angiography and staged or ad hoc percutaneous coronary intervention by radial access

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