Elbow joint fixation device lessens complications after percutaneous coronary procedure

The novel elbow joint fixation device demonstrates superiority over simple manual compression in reducing puncture site-related discomfort, swelling, and subcutaneous bleeding area in patients undergoing percutaneous coronary procedures.

“[T]he 3D-printed elbow external fixation device combined with manual compression was associated with a lower incidence of puncture site-related discomfort, a lower degree of swelling in the arm, and a reduced area of subcutaneous haemorrhage in patients who underwent percutaneous coronary diagnostic or therapeutic procedures via brachial access,” the researchers said.

This randomized controlled trial determined whether 3D printing of an elbow joint fixation device could reduce postoperative complications after percutaneous coronary procedures. The researchers randomly allocated participants to receive either a 3D-printed elbow joint fixation device (brace group) or traditional compression (control group) from March 2023 to December 2023.

Patients in the brace group experienced a significantly reduced severity of puncture site-related discomfort at 24 h following surgery (p=0.014) compared with the control group. Likewise, the brace group had a significantly lower upper arm calibration rate (0.024 vs 0.077; p<0.001) and forearm calibration rate (0.026 vs 0.050; p=0.007) at 24 h postsurgery. [Sci Rep 2024;14:20535]

Furthermore, the area of subcutaneous haemorrhage at 24 h after surgery was significantly lower in the brace group than the control group (0.255 vs 1 cm²).

Immobilization

Postoperative patients who underwent diagnostic or interventional coronary procedures must adhere to strict immobilization requirements because the brachial artery area has many muscles and soft tissues, according to the researchers.

“When the elbow joint moves and the forearm rotates forward, the braking effect can be compromised, leading to insufficient immobilization and potential complications such as haemorrhage or pseudoaneurysm,” they said.

Excessive compression can also result in ischaemia, numbness, swelling, and pain in the limb. These issues can bring discomfort at the puncture site, the researchers said.

Performance

There are several ways to elucidate the better performance of the 3D-printed elbow external fixation device in the prevention of puncture site-related discomfort shown in this study.

“First, the greater comfort of 3D-printed elbow external fixation devices than traditional devices is probably related to the greater suitability of 3D-printed elbow external fixation devices because they are custom-made based on the patient's specific skeletal structure and needs,” the researchers said.

“Second, the fixed brace can not only restrict the movement of the elbow joint but also limit the pronation of the forearm caused by the contraction of the pronator teres muscle originating from the lower segment of the humerus,” they added.

Finally, patients feel more secure knowing that the surgical site is protected, giving a more relaxed physical and mental state. “This helps to avoid discomfort caused by excessive tension and anxiety,” the researchers said.

In a previous systematic review of five studies, the authors found the brachial artery puncture to be a good alternative strategy following radial artery puncture failure. [J Vasc 2022;27:11297298221145752]

“This is because there is no difference in vascular complications, and the risk of bleeding at the brachial artery puncture site is lower than that at the femoral artery puncture site,” the researchers said.