Smith D C, Hamlin J A, Jensen D A, Pappas J M, Westengard J C, Saukel G W
Department of Radiology, Loma Linda University Medical Center, CA 92354.
Invest Radiol. 1992 Oct;27(10):763-7. doi: 10.1097/00004424-199210000-00001.
It is widely believed that down-sizing catheters, and possibly needles, will decrease damage to the entry vessel in the performance of angiography. The purposes of this in vitro experiment are to determine if smaller needles produce less arterial wall damage than larger needles and to assess the influence of subsequent catheter insertion.
Each iliac artery pair from 35 fresh human cadavers was punctured three times with an 18-g needle and three times with a 21-g needle, for a total of 210 punctures. In two of each set of three, a 5- or 7-F dilator was passed. One hundred ninety-eight puncture tracts were usable and examined microscopically. They were graded on a scale of 1 to 3 in each of four categories: size of tract, margin irregularity, approximation of edges, and shape of tract.
Chi-square analysis of the grading scores showed a significant shift of cases into lower damage grades when the smaller gauge needle was used for initial punctures (P < .0005). The subsequent insertion of a dilator, however, imposed further damage, such that the initial differences due to needle gauge were obliterated (P > .2).
These data indicate that a 21-g needle produces less arterial wall damage than an 18-g needle, but that any safety conferred by the smaller needle is eliminated by the subsequent insertion of a 5- or 7-F catheter.
人们普遍认为，减小导管尺寸，可能还有针头尺寸，会减少血管造影操作中对进入血管的损伤。本体外实验的目的是确定较细针头是否比较粗针头造成的动脉壁损伤更小，并评估随后插入导管的影响。
从35具新鲜人体尸体上获取的每对髂动脉，分别用18号针头穿刺3次，用21号针头穿刺3次，共穿刺210次。在每组3次穿刺中的2次穿刺后，插入5F或7F扩张器。198条穿刺通道可用并进行显微镜检查。它们在四个类别中的每一个类别中按1至3级进行评分：通道大小、边缘不规则度、边缘贴合度和通道形状。
对分级评分的卡方分析显示，当使用较细规格针头进行初次穿刺时，病例明显向较低损伤等级转移（P <.0005）。然而，随后插入扩张器会造成进一步损伤，以至于由于针头规格导致的初始差异被消除（P >.2）。
这些数据表明，21号针头比18号针头造成的动脉壁损伤更小，但随后插入5F或7F导管会消除较细针头带来的任何安全性。
