Franx, V.J.F.H. (Victoire) (2018) Slender transradial procedures reduce short-term Upper Extremity Dysfunction when compared to Conventional procedures. thesis, Medicine.
Full text available on request.Abstract
Introduction The transradial approach (TRA) for coronary interventions and catheterizations dramatically reduces access-site complications compared to the transfemoral. Radial artery occlusion (RAO) is clinically benign, but it prevents operators to repeat interventions. Puncture and cannulation of introducers/catheters causes Upper Extremity Dysfunction (UED) which is an underappreciated phenomenon. Miniaturizing material (Slender) should thereby prevent post-procedural damage. In this study we examined if Slender transradial angiographies (trCAGs) and interventions (trPCIs) reduce procedure-related UED and RAO, compared to the Conventional technique. Methods In this prospective cohort study, we included patients scheduled for either an elective trPCI or trCAG at OLVG Amsterdam. The Conventional group consisted of ≥6 French (Fr) procedures and the Slender group of ´virtual´ 3 Fr (Sheathless 5 Fr), 4 and 5 Fr procedures. UED was assessed by the QuickDASH and CISS questionnaires, pre-procedural and after 2 weeks and 2 months. RAO-patency was checked by the Reversed Barbeau Test (RBT) and abnormal results were referred for Duplex. Primary endpoint was UED at 2 months and secondary endpoints UED at 2 weeks and RAO. Results We included 212 (100 Slender and 112 Conventional) patients with a mean age of 67 (± 11), of which 173 were analysed for RAO. The total incidence of procedure-related UED after 2 months measured by QuickDASH (QD) was 7% and by CISS 2%. There was no difference between Slender and Conventional (7% versus 7%, p=0.97). After 2 weeks, UED (QD) was lower, although not significant, in the Slender versus Conventional group (9 (9%) versus 17 (15%), p=0.17). UED (CISS) was negligible. Multivariate analysis showed an OR of 0.49 (CI 0.11-2.19) for UED (QD) at 2 months (p=0.36) and an OR of 0.26 (CI 0.08-0.84) at 2 weeks (p=0.03). Lowest values of UED were seen for ‘virtual’ 3 Fr and 4 Fr (3.4% and 5.0%) and highest for 5 Fr and Conventional 6 Fr (9.8% and 7.0%, respectively) (p=0.73). A significant association between RAO and UED was found after 2 months (40% versus 6.5% in patients without RAO, p=0.046). Conclusion The incidence of post-procedural UED is about 1 out of 10 patients. UED seems to be a temporary phenomenon, except for the patients with RAO, which recovers in a period of 2 months. Slender shows significant lower incidence of UED in short-term, but not in long-term follow-up.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Faculty supervisor: and Heuvel, dr. A. F.M. van den and interventional cardiologist at University Medical Center Gro |
| Supervisor name: | Second supervisor: and Amoroso, dr. G. interventional cardiologist at Onze Lieve V |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 11:07 |
| Last Modified: | 25 Jun 2020 11:07 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2641 |
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