Objective. The previous meta-analysis has assessed that distal transradial access (dTRA) in anatomical snuffbox is safe and effective for coronary angiography and intervention and can reduce radial artery occlusion. However, since the publication of the previous meta-analysis, several observational studies have been added, so we performed an updated meta-analysis to include more eligible studies to compare distal transradial access in anatomical snuffbox with conventional transradial access (cTRA). Method. Pubmed, Embase, and Cochrane Library databases were searched for relevant studies from the literature published until 5 January 2021 to evaluate catheterization/puncture failure, hematoma, radial artery spasm, radial artery occlusion (RAO), access time, fluoroscopy time, radiation dose area product, total procedure time, and hemostatic device removal time. The pooled odds ratio (OR), weighted mean difference (WMD), and standardized mean difference (SMD) with 95% confidence interval (95% CI) were calculated for dichotomous and continuous variables, respectively. Results. A total of 9,054 patients from 14 studies were included in the meta-analysis, and we found no significant difference in catheterization/puncture failure (OR = 1.94, 95CI [0.97, 3.86], ), hematoma (OR = 0.97, 95CI [0.55, 1.73], ), radial artery spasm (OR = 0.76, 95CI [0.43, 1.36], ), total procedure time (SMD = 0.23, 95CI [−0.21, 0.68], ), or radiation dose area product (WMD = 216.88 Gy/cm², 95CI [−126.24, 560.00], ), but dTRA had a lower incidence of RAO (OR = 0.39, 95CI [0.23, 0.66], ), shorter hemostatic device removal time (WMD = −66.62 min, 95CI [−76.68, −56.56], ), longer access time (SMD = 0.32, 95CI [0.08, 0.56], ), and longer fluoroscopy time (SMD = 0.16, 95CI [−0.00, 0.33], ) than cTRA. Conclusion. Compared with the cTRA, the dTRA has a lower incidence of radial artery occlusion and shorter hemostatic device removal time, which is worthy of further evaluation in clinical practice.

中文翻译：

---

用于冠状动脉造影和干预的解剖鼻烟盒中的远端经桡动脉通路：更新的荟萃分析

客观。先前的荟萃分析评估了解剖鼻烟壶中的远端经桡动脉通路（dTRA）对于冠状动脉造影和干预是安全有效的，并且可以减少桡动脉闭塞。然而，自从之前的荟萃分析发表以来，已经添加了几项观察性研究，因此我们进行了更新的荟萃分析，以纳入更多符合条件的研究，以比较解剖鼻烟盒中的远端经桡动脉通路与传统经桡动脉通路 (cTRA)。方法. 从截至 2021 年 1 月 5 日发表的文献中搜索 Pubmed、Embase 和 Cochrane Library 数据库中的相关研究，以评估导管插入/穿刺失败、血肿、桡动脉痉挛、桡动脉闭塞 (RAO)、访问时间、透视时间、辐射剂量区域产品、总手术时间和止血装置移除时间。分别计算二分类变量和连续变量的合并优势比 (OR)、加权平均差 (WMD) 和标准化平均差 (SMD) 以及 95% 置信区间 (95% CI)。结果。荟萃分析共纳入来自 14 项研究的 9,054 名患者，我们发现导管插入/穿刺失败无显着差异（OR = 1.94, 95CI [0.97, 3.86]，),血肿 (OR = 0.97, 95CI [0.55, 1.73],),桡动脉痉挛 (OR = 0.76, 95CI [0.43, 1.36],),总手术时间 (SMD = 0.23, 95CI [−0.21, 0.68],)，或辐射剂量面积乘积 (WMD = 216.88 Gy/cm ² , 95CI [−126.24, 560.00],)，但 dTRA 的 RAO 发生率较低 (OR = 0.39, 95CI [0.23, 0.66],),更短的止血装置移除时间 (WMD = -66.62 min, 95CI [-76.68, -56.56],),更长的访问时间 (SMD = 0.32, 95CI [0.08, 0.56],)，以及更长的透视时间 (SMD = 0.16, 95CI [−0.00, 0.33],)而不是 cTRA。结论。与cTRA相比，dTRA的桡动脉闭塞发生率更低，止血装置取出时间更短，值得临床进一步评价。