Naritaka Yoshihiko, Shiozawa Shunichi, Shimakawa Takeshi, Wagatsuma Yoshihisa, Tsuchiya Akira, Kim Dal Ho, Isohata Noriyuki, Asaka Shinichi, Yoshimatsu Kazuhiko, Katsube Takao, Ogawa Kenji
Department of Surgery, Tokyo Women's Medical University Medical Center East, 2-1-10 Nishiogu, Arakawa-ku, Tokyo 116-8567, Japan.
Hepatogastroenterology. 2007 Sep;54(78):1850-3.
BACKGROUND/AIMS: Transradial vascular intervention for heart disease has been expanding recently because it is less invasive, but this approach has only been used to treat abdominal disease at a few institutions. Since 2000, we have performed partial splenic embolization (PSE) via the transradial approach with the aim of achieving the least invasive procedure possible.
During the past five years, transradial abdominal angiography was performed in 426 patients and eight of them (two men and six women undergoing PSE for LC) were included in this study. They ranged from 48 years to 72 years in age, consisting of three patients in Child class A and five in Child class B. To perform transradial partial splenic embolization, a 4-Fr sheath was inserted in the left radial artery. Under fluoroscopy, intrasplenic branches of the splenic artery supplying about 60-70% of the parenchyma of the spleen were selected and embolized with a newly developed transradial catheter inserted along a guide wire running through the descending aorta. After treatment, the puncture site was compressed by applying a tourniquet. No restriction on movement of the lower or upper extremities is required and the patient is allowed to walk freely.
Transradial embolization was successful in all 8 patients. The procedure required 70 minutes on average. The mean platelet count was 3.3x10(4)/microL before treatment, and it increased to 16.3x10(4) and 11.3x10(4)/microL after two weeks and three months, respectively. All patients suffered from fever and pain after treatment, which were treated conservatively. Occlusion of the radial artery, digital paralysis, or splenic abscess did not occur in any patient.
This transcatheter technique facilitates hemostasis and requires neither shaving of hair nor insertion of a urinary catheter. In addition, no restriction on movement is needed after the procedure. Consequently, this minimally invasive transradial approach is highly satisfactory for patients and should become a first-line approach for PSE.
背景/目的：近年来，经桡动脉血管介入治疗心脏病的应用不断扩大，因为其侵入性较小，但这种方法仅在少数机构用于治疗腹部疾病。自2000年以来，我们采用经桡动脉途径进行部分脾栓塞术（PSE），旨在实现尽可能微创的手术。
在过去五年中，对426例患者进行了经桡动脉腹部血管造影，其中8例（2例男性和6例因肝硬化接受PSE的女性）纳入本研究。他们的年龄在48岁至72岁之间，其中Child A级3例，Child B级5例。为进行经桡动脉部分脾栓塞术，在左桡动脉插入一根4F鞘管。在透视下，选择供应约60%-70%脾实质的脾动脉脾内分支，并用沿穿过降主动脉的导丝插入的新开发的经桡动脉导管进行栓塞。治疗后，通过应用止血带来压迫穿刺部位。不需要限制下肢或上肢的活动，患者可以自由行走。
8例患者经桡动脉栓塞均成功。该手术平均需要70分钟。治疗前平均血小板计数为3.3×10⁴/微升，两周和三个月后分别升至16.3×10⁴和11.3×10⁴/微升。所有患者治疗后均出现发热和疼痛，经保守治疗。所有患者均未发生桡动脉闭塞、手指麻痹或脾脓肿。
这种经导管技术便于止血，既不需要剃毛也不需要插入尿管。此外，术后不需要限制活动。因此，这种微创的经桡动脉途径对患者非常满意，应成为PSE的一线治疗方法。
