Koroner anjiografi uygulanan hastalarda radial arter tromboz komplikasyonu sıklığı ve ilişkili risk faktörleri
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Dosyalar
Tarih
2018
Yazarlar
Dergi Başlığı
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Cilt Başlığı
Yayıncı
Düzce Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Aterosklerotik koroner arter hastalığına bağlı arter daralmalarının varlığının ve ciddiyetinin gösterilmesinde koroner anjiyografi altın standart yöntemdir. 2018 ESC/EACTS Miyokardiyal revaskülarizasyon klavuzunda, koroner anjiografi (KAG) ve peruktan koroner girişim (PKG) için standart yaklaşım olarak radiyal erişim önerilmiştir. Transradial girişimin (TRG) en sık rastlanan komplikasyonu radial arter trombozudur (RAT). Biz çalışmamızda transradial girişim (TRG) sonrasında RAT sıklığını ve ilişkili risk faktörlerini incelemeyi amaçladık. Gereç ve Yöntem: Çalışmaya Ocak 2010 – Kasım 2018 tarihleri arasında radial arter yolu ile koroner anjiografi yapılan 150 hasta dahil edilmiştir. Hastalara radial girişimden 4-6 saat sonra renkli doppler ultrasonografi çekilmiş, proksimal ve distal radial akım hızları ölçülmüştür. Hastanın demografik ve laboratuvar verileri kaydedilmiştir. Radial tromboz saptanan hastalar çalışma grubu, saptanmayanlar ise kontrol grubu olarak belirlenmiştir. Bulgular: Hastaların 20'sinde (%13,3) radial tromboz saptanmıştır. Hastaların 4'ünde (%2,7) parsiyel oklüzyon, 16'sında (%10,7) total radial oklüzyon izlenmiştir. Tek değişkenli analizde kadın cinsiyet (OR=2.48, 95% CI: 0.947-6.491, P=0.064), HT (OR=0.341, 95% CI: 0.130-0.896, P=0.029), KAH öyküsü (OR=3.581, 95% CI: 0.791-16.204, P=0.098), antiagregan kullanım öyküsü (OR=0.378, 95% CI: 0.135-1.056, P=0.064), kompresyon süresi (OR=1.446, 95% CI: 0.309-6.769, P=0.069), hastanın koroner anjiografi yapılma endikasyonu (Başvuru şekli,Elektif KAG, AKS) (OR=3.581, 95% CI: 0.791-16.204, P=0.098), hematokrit değeri (OR=0.916, 95% CI: 0.829-1.012, P=0.084), nötrofil sayısı (OR= 1.134, 95% CI: 0.979-1.314, P=0.093), kreatinin değeri (OR= 0.061, 95% CI: 0.004-0.840, P=0.097), ve e-GFR (OR=1.024, 95% CI: 0.996-1.054, P=0.094), radial tromboz gelişimi için anlamlı bulundu. Tek değişkenli analizde anlamlı bulunan parametreler, çok değişkenli model ile analize edildi. Çok değişkenli analizde; HT (OR=0.224, 95% CI: 0.068-0.738,P=0.014), antiagregan kullanım öyküsü (OR=0.278, 95% CI: 0.105-0.739, P=0.010), kompresyon süresi (OR=2.280, 95% CI: 1.419-3.662, P=0.001), hematokrit değeri (OR=0.881, 95% CI: 0.782-0.992, P=0.037) ve kreatinin (OR= 0.030, 95% CI: 0.002-0.453, P=0.011) radial arter trombozu için bağımsız prediktör olarak saptandı. Sonuç: Radial arter trombozu (RAT) radial girişim sonrası sık görünmektedir. RAT tanısında konvansiyonel nabız muayenesi RAT tanısını maskeleyebilir. RAT tanısında renkli Doppler USG altın standart yöntem olup radial girişim uygulanan hastalarda bakılması hastaların erken tanı ve tedavisini kolaylaştırabilir. Uzamış kompresyon süresinin RAT gelişimini artırması nedeniyle kompresyon süresinin olabildiğince kısa tutulması önerilmektedir.
Introduction: Coronary angiography is the gold standard method for the diagnosis of atherosclerotic coronary artery disease. Radial access is accepted as the gold standard for coronary angiography (CAG) and percutaneous coronary intervention in 2018 ESC / EACTS In myocardial revascularization guidelines. Radial artery thrombosis (RAT) is the most common complication of trans-radial access (TRA). In our study, we aimed to investigate the incidence of RAT and associated risk factors. Materials and Methods: A total of 150 patients who underwent coronary angiography through TRA between January 2018 and November 2018 were included to the study. Color doppler ultrasonography was performed and the proximal and distal radial flow rates were measured 4-6 hours after TRA. Demographic and laboratory data of the patient were recorded. Patients with RAT were accepted as the study group while the others compromise the controls. Results: Of these 150 patients, 20 (13.3%) of them had RAT (4 (2.7%) of them with partial occlusion, 16 (10.7%) of them with total occlusion). In the univariate analysis, female gender (OR = 2.48, 95% CI: 0.947-6.491, P = 0.064), HT (OR = 0.341, 95% CI: 0.130-0.896, P = 0.029), history of CAD (OR = 3.581, 95 % CI: 0.791-16.204, P = 0.098), antiaggregant usage history (OR = 0.378, 95% CI: 0.135-1.056, P = 0.064), compression time (OR = 1.446, 95% CI: 0.309-6.769, P = 0.069), indication for coronary angiography for the patient (elective CAG, ACS presentation) (OR = 3.581, 95% CI: 0.791-16.204, P = 0.098), hematocrit value (OR = 0.916, 95% CI: 0.829-1.012, P = 0.084), neutrophil count (OR = 1.134, 95% CI: 0.979-1.314, P = 0.093), creatinine value (OR = 0.061, 95% CI: 0.004-0.840, P = 0.097), and e-GFR ( OR = 1.024, 95% CI: 0.996-1.054, P = 0.094), were found to be statistically significant for RAT. In multivariate analysis; HT (OR = 0.224, 95% CI: 0.068-0.738, P = 0.014), antiaggregant usage history (OR = 0.278, 95% CI: 0.105-0.739, P = 0.010), compression time (OR = 2.280, 95% CI: 1.419-3.662, P = 0.001), hematocrit value (OR = 0.881, 95% CI: 0.782-0.992, P = 0.037) and creatinine (OR = 0.030, 95% CI: 0.002-0.453, P = 0.011) were found to be independent predictors for RAT. Conclusion: Radial artery thrombosis (RAT) is frequently seen after radial intervention. Conventional pulse examination in the diagnosis of RAT may mask the diagnosis of RAT. Color Doppler USG is the gold standard method for RAT diagnosis. Besides, and it can facilitate early diagnosis and treatment of RAT. It would be appropriate to keep radial band duration as short as possible since it increases the RAT rates.
Introduction: Coronary angiography is the gold standard method for the diagnosis of atherosclerotic coronary artery disease. Radial access is accepted as the gold standard for coronary angiography (CAG) and percutaneous coronary intervention in 2018 ESC / EACTS In myocardial revascularization guidelines. Radial artery thrombosis (RAT) is the most common complication of trans-radial access (TRA). In our study, we aimed to investigate the incidence of RAT and associated risk factors. Materials and Methods: A total of 150 patients who underwent coronary angiography through TRA between January 2018 and November 2018 were included to the study. Color doppler ultrasonography was performed and the proximal and distal radial flow rates were measured 4-6 hours after TRA. Demographic and laboratory data of the patient were recorded. Patients with RAT were accepted as the study group while the others compromise the controls. Results: Of these 150 patients, 20 (13.3%) of them had RAT (4 (2.7%) of them with partial occlusion, 16 (10.7%) of them with total occlusion). In the univariate analysis, female gender (OR = 2.48, 95% CI: 0.947-6.491, P = 0.064), HT (OR = 0.341, 95% CI: 0.130-0.896, P = 0.029), history of CAD (OR = 3.581, 95 % CI: 0.791-16.204, P = 0.098), antiaggregant usage history (OR = 0.378, 95% CI: 0.135-1.056, P = 0.064), compression time (OR = 1.446, 95% CI: 0.309-6.769, P = 0.069), indication for coronary angiography for the patient (elective CAG, ACS presentation) (OR = 3.581, 95% CI: 0.791-16.204, P = 0.098), hematocrit value (OR = 0.916, 95% CI: 0.829-1.012, P = 0.084), neutrophil count (OR = 1.134, 95% CI: 0.979-1.314, P = 0.093), creatinine value (OR = 0.061, 95% CI: 0.004-0.840, P = 0.097), and e-GFR ( OR = 1.024, 95% CI: 0.996-1.054, P = 0.094), were found to be statistically significant for RAT. In multivariate analysis; HT (OR = 0.224, 95% CI: 0.068-0.738, P = 0.014), antiaggregant usage history (OR = 0.278, 95% CI: 0.105-0.739, P = 0.010), compression time (OR = 2.280, 95% CI: 1.419-3.662, P = 0.001), hematocrit value (OR = 0.881, 95% CI: 0.782-0.992, P = 0.037) and creatinine (OR = 0.030, 95% CI: 0.002-0.453, P = 0.011) were found to be independent predictors for RAT. Conclusion: Radial artery thrombosis (RAT) is frequently seen after radial intervention. Conventional pulse examination in the diagnosis of RAT may mask the diagnosis of RAT. Color Doppler USG is the gold standard method for RAT diagnosis. Besides, and it can facilitate early diagnosis and treatment of RAT. It would be appropriate to keep radial band duration as short as possible since it increases the RAT rates.
Açıklama
YÖK Tez No: 538666
Anahtar Kelimeler
Kardiyoloji, Cardiology, Anjiyografi, Angiography, Arteryel oklüzif hastalıklar, Arterial occlusive diseases, Ateroskleroz, Atherosclerosis, Kardiyovasküler cerrahi girişimler, Cardiovascular surgical procedures, Koroner anjiyografi, Coronary angiography, Radyal arter, Radial artery, Risk faktörleri, Risk factors, Tromboz, Thrombosis
