Trigaux J P, Van Beers B, De Wispelaere J F
Department of Radiology, Université Catholique de Louvain, Cliniques Universitaires de Mont-Godinne, Yvoir, Belgium.
AJR Am J Roentgenol. 1991 Dec;157(6):1259-62. doi: 10.2214/ajr.157.6.1950877.
The anatomic relationship between the popliteal artery and vein means that an arteriovenous fistula can be created when a popliteal artery approach is used for endovascular interventions. To determine the best site for retrograde puncture of the popliteal artery, we studied six cadaveric specimens, CT scans of 31 patients at 280 levels, and 30 plain radiographs of the knee. In the cadaveric specimens, the vessels were enclosed in a common sheath. In 92% of all levels studied on CT, the artery was anterior to the vein (anterolateral in 9%, anteromedial in 43%, strictly anterior in 40%), and more than 25% of the diameter of the artery overlapped the vein in 87% of these levels. However, at the most cranial level analyzed (64 mm above the femorotibial joint space level), such an overlap occurred in only 60%, and the artery was medial in 25%, resulting in a relationship between the artery and the vein that involved less risk of fistula. On radiographic study, the popliteal crease was located above the level of the joint space (considered the most reliable landmark of the popliteal fossa anatomy) in 97% of cases, although the values were scattered (mean, 2.9 +/- 1.5 cm). In order to minimize the risk of creating an arteriovenous fistula, we recommend a skin incision be located 3-4 cm above the joint level as determined by fluoroscopy, and a puncture directed obliquely from caudal to cranial and from medial to lateral.
腘动脉与静脉的解剖关系意味着，当采用腘动脉入路进行血管内介入治疗时，可能会形成动静脉瘘。为了确定腘动脉逆行穿刺的最佳部位，我们研究了6个尸体标本、31例患者280个层面的CT扫描以及30张膝关节平片。在尸体标本中，血管被包裹在一个共同的鞘内。在CT研究的所有层面中，92%的动脉位于静脉前方（9%为前外侧，43%为前内侧，40%为严格前方），在这些层面的87%中，动脉直径的25%以上与静脉重叠。然而，在分析的最头侧层面（股骨胫关节间隙水平上方64 mm），这种重叠仅发生在60%的情况中，25%的动脉位于内侧，从而使动脉与静脉之间的关系形成动静脉瘘的风险较低。在X线研究中，97%的病例腘横纹位于关节间隙水平上方（被认为是腘窝解剖最可靠的标志），尽管数值分散（平均值为2.9±1.5 cm）。为了将形成动静脉瘘的风险降至最低，我们建议皮肤切口位于透视确定的关节水平上方3 - 4 cm处，穿刺方向从尾侧向头侧、从内侧向外侧倾斜。
