Influência da curva de aprendizado nos procedimentos percutâneos por via transradial

Abstract

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...

Incidence of hemorrhagic complications with use of a radial compression device: a cohort study

“…Another important factor of this approach is the preferential choice by patients, because it provides greater comfort in recovery after the intervention by enabling early ambulation and shorter hospitalization time (5)(6) . However, the small caliber of the artery makes puncture difficult and requires a longer learning curve compared to femoral access, but these challenges are often overcome with operators' experience (7)(8) . Vascular complications and radial artery occlusion (RAO) are some of the reported complications that may predispose the patient to extremity ischemia.…”

Intervenção coronária percutânea pela via radial: incorporação da técnica e resultados de um centro de formação em cardiologia intervencionista

“…In one of the few publications that addressed this topic in Brazil, Andrade et al, 7 The present study also revealed reduced incidences of bleeding and vascular complications, paralleling a series of recently published studies. 24 Review of major bleeding after PCI has become increasingly important, as the occurrence of such events related to the punc ture site is directly associated with increased morbidity and mortality, 811 in addition to reduced adherence to antiplatelet therapy, an important predictor of stent thrombosis. 12 A reduction of bleeding along the access route brings even greater benefits to highrisk subgroups, such as elderly patients, 3,13 females, 3 or those with acute coronary syndrome.…”

“…1 The radial approach, in use for over two decades, has developed into a versatile method for cardiac catheterization as well as for PCI, with equivalent or even superior clinical results to those of the femoral approach. 26 The advantages of the radial approach include lower rates of bleeding and vascular complications, 24 in addition to lower mortality rates in certain patient subgroups. 2,5 The success rate is similar to that of the femoral approach, 4,6 particularly in experienced hands.…”

Insucesso da Técnica Radial em Centro com Alto Volume de Procedimentos

“…1,2 However, due to the smaller diameter of the radial artery, as well as the greater anatomical variability of its vascular bed, there is a learning curve, which results in increased radiological exposure, use of contrast, failure rates, and need for crossing to femoral access. [3][4][5][6] Although described among surgeons with a low/ moderate use of the radial access, 7 the mechanisms and technique failure predictors in centers that prioritize this route are not adequately characterized; this was the main objective of this analysis. technique).…”