McIvor J, Rhymer J C
X-Ray Department, Charing Cross Hospital, London.
Clin Radiol. 1992 Jun;45(6):390-4. doi: 10.1016/s0009-9260(05)80997-3.
Two hundred and forty-five transaxillary arteriograms were attempted at Charing Cross Hospital between 1982 and 1991 on 195 arteriopathic patients (mean age 64 years) in whom the femoral route was contra-indicated due to absent pulses (94), previous surgery (108), femoral artery aneurysm (5), severe aorto-iliac disease (8) or previous failure by the femoral route (30). Most arteriograms (211) were carried out to investigate peripheral vascular disease, the others were carried out to perform transluminal angioplasty (16) to assess cerebrovascular disease (10) and to investigate arterial insufficiency of the kidneys, alimentary tract and upper limb (8). There were two (0.8%) technical failures where the axillary artery could not be punctured. Selective catheterization of the carotid, vertebral, axillary, lumbar, renal, superior mesenteric, inferior mesenteric, iliac, femoral or popliteal arteries was performed in the course of 38 procedures. There were three (1.2%) serious complications related to the puncture site, a large haematoma followed by a prolonged neurological deficit of the brachial plexus in a hypertensive patient receiving haemodialysis, and thrombosis of the axillary artery in two other patients both of whom responded to surgical thrombectomy. There were three (1.2%) serious systemic complications, two patients had a cardiac arrest and although both were successfully resuscitated one became anuric and died from renal failure and septicaemia 4 weeks later. One patient with a history of transient ischaemic attacks developed a similar transient episode at the end of the procedure. Compared with six series of 290 attempted brachial artery catheterizations in patients where the femoral route was contra-indicated which have been reported since 1986, our series of 245 attempted axillary artery catheterizations had a significantly higher incidence of technical success at the first attempt (P = 0.021) and a lower incidence of vascular complications requiring surgery or angioplasty which was not statistically significant. Our conclusion is that transaxillary arterial catheterization has a high rate of technical success (99%) and should be considered in patients where the femoral route is contra-indicated due to arterial disease.
1982年至1991年间，在查令十字医院对195例动脉病变患者（平均年龄64岁）进行了245次经腋动脉造影尝试。这些患者因脉搏缺失（94例）、既往手术史（108例）、股动脉瘤（5例）、严重主-髂动脉疾病（8例）或既往股动脉途径造影失败（30例）而禁忌采用股动脉途径。大多数动脉造影（211次）是为了研究外周血管疾病，其他的是为了进行腔内血管成形术（16次）、评估脑血管疾病（10次）以及研究肾脏、消化道和上肢的动脉供血不足（8次）。有2例（0.8%）技术失败，腋动脉无法穿刺。在38例操作过程中对颈、椎、腋、腰、肾、肠系膜上、肠系膜下、髂、股或腘动脉进行了选择性插管。有3例（1.2%）与穿刺部位相关的严重并发症，1例接受血液透析的高血压患者出现巨大血肿，随后出现臂丛神经长期神经功能缺损，另外2例患者腋动脉血栓形成，均接受了手术取栓治疗。有3例（1.2%）严重的全身并发症，2例患者心脏骤停，尽管均成功复苏，但1例患者无尿，4周后死于肾衰竭和败血症。1例有短暂性脑缺血发作病史的患者在操作结束时出现了类似的短暂发作。与自1986年以来报道的6组在禁忌采用股动脉途径的患者中进行290次肱动脉插管尝试相比，我们这组245次腋动脉插管尝试的首次技术成功率显著更高（P = 0.021），需要手术或血管成形术的血管并发症发生率更低，但差异无统计学意义。我们的结论是，经腋动脉插管技术成功率高（99%），对于因动脉疾病禁忌采用股动脉途径的患者应考虑采用。
