Alvarez-Tostado Javier A, Moise Mireille A, Bena James F, Pavkov Mircea L, Greenberg Roy K, Clair Daniel G, Kashyap Vikram S
Department of Vascular Surgery, The Cleveland Clinic, Cleveland, Ohio 44195, USA.
J Vasc Surg. 2009 Feb;49(2):378-85; discussion 385. doi: 10.1016/j.jvs.2008.09.017. Epub 2008 Nov 22.
The brachial artery is often used for coronary angiography. However, data on brachial access for aortic and peripheral interventions are limited. This study evaluated our experience with brachial artery catheterization for diagnostic arteriography and endovascular interventions.
Between August 2004 and August 2005, 2026 endovascular procedures were performed. Of these, 323 cases (16%) in 289 patients required brachial artery access, forming the basis for this study. Patients who underwent multiple interventions, but with a single access (ie, thrombolysis), were considered a single case. Demographic and clinical data were recorded in a database and analyzed using logistic regression analyses with generalized estimating equations and the Fisher exact test for nominal variables.
The mean age of all patients was 66.4 years, with 57% men. Brachial access was used for diagnostic purposes in 27% and for interventions including angioplasty, stenting, and thrombolysis in 73%. The use of brachial access was considered obligatory in 40%, adjunctive in 19% (ie, endovascular repair of abdominal aortic and thoracic aortic aneurysms) and preferential to femoral access in 41%. In 91% of patients, the brachial arteries were accessed percutaneously, and 9% underwent surgical cutdown for access. In patients whose brachial artery was approached percutaneously, access was achieved in all but one (99.6% technical success rate). Hemostasis after catheterization was achieved by manual compression in 89%. Operative mortality rate was 6.2% and not related to brachial artery access. Brachial access site-related complications occurred in 21 patients (6.5%). Thirteen of these 21 patients (62%) required a surgical correction, mostly for brachial artery thrombosis or pseudoaneurysm. Patients with complications were more commonly women (odds ratio [OR], 4.7; 95% confidence interval [CI], 1.68-13.26; P = .003) and had a long interventional sheath (OR, 6.7; 95% CI, 1.53-29.07; P = .012). The risk of a brachial artery complication was not associated with thrombolysis, procedure type, vascular territory treated, or the use of heparin. No upper extremity limb or finger loss occurred.
Brachial artery access is necessary for complex endovascular procedures and can be achieved in most patients safely. Postprocedural vigilance is warranted because most patients with complications will require operative correction.
肱动脉常被用于冠状动脉造影。然而，关于经肱动脉途径进行主动脉及外周介入治疗的数据有限。本研究评估了我们在经肱动脉插管进行诊断性血管造影和血管内介入治疗方面的经验。
在2004年8月至2005年8月期间，共进行了2026例血管内手术。其中，289例患者中的323例（16%）需要经肱动脉途径，构成了本研究的基础。接受多次介入治疗但仅单次穿刺（如溶栓）的患者被视为单例。人口统计学和临床数据记录在数据库中，并使用广义估计方程的逻辑回归分析以及名义变量的Fisher精确检验进行分析。
所有患者的平均年龄为66.4岁，男性占57%。经肱动脉途径用于诊断目的的占27%，用于包括血管成形术、支架置入术和溶栓在内的介入治疗的占73%。40%的情况下认为必须采用经肱动脉途径，19%为辅助性（如腹主动脉和胸主动脉瘤的血管内修复），41%优先于经股动脉途径。91%的患者经皮穿刺肱动脉，9%接受手术切开暴露肱动脉。在经皮穿刺肱动脉的患者中，除1例（技术成功率99.6%）外均成功穿刺。89%的患者在导管插入术后通过手动压迫实现止血。手术死亡率为6.2%，与经肱动脉途径无关。21例患者（6.5%）发生了与肱动脉穿刺部位相关的并发症。这21例患者中有13例（62%）需要手术矫正，主要是因为肱动脉血栓形成或假性动脉瘤。发生并发症的患者女性更为常见（优势比[OR]为4.7；95%置信区间[CI]为1.68 - 13.26；P = 0.003），且介入鞘管留置时间长（OR为6.7；95%CI为1.53 - 29.07；P = 0.012）。肱动脉并发症的风险与溶栓、手术类型、治疗的血管区域或肝素的使用无关。未发生上肢或手指缺失情况。
对于复杂的血管内手术，经肱动脉途径是必要的，且大多数患者可安全实现。术后需保持警惕，因为大多数发生并发症的患者需要手术矫正。
