Division of Cardiology, Newark Beth Israel Medical Centre, Newark, New Jersey 07112, USA.
Catheter Cardiovasc Interv. 2013 Mar;81(4):674-9. doi: 10.1002/ccd.24335. Epub 2013 Jan 3.
Vascular access complications remain the leading cause of morbidity after cardiac catheterization procedures. Fluoroscopy-guided vascular access has been recommended to reduce these complications. However, the use of current recommendations still results in arterial access above the inferior epigastric artery (IEA) (high stick) or below the common femoral artery (CFA) bifurcation (low stick).
The goal of our study was to evaluate the influence of patient characteristics like age, body mass index, and pelvic anatomy on current recommendations.
We prospectively collected clinical, anatomic, and angiographic data on 631 consecutive patients who underwent coronary and noncoronary procedures via CFA access. Anatomic location of IEA loop, CFA bifurcation, public tubercle (PT), and anterior superior iliac spine were identified in relationship to the femoral head Location of IEA loop was used as a surrogate for inguinal ligament (IL).
Approximately 12% of patients had a low-lying IEA loop (group B). These patients had a significantly higher BMI compared with patients with IEA loop above the centerline of femoral head (group A) (P = 0.018). The anatomic location of PT was below the lower border of femoral head significantly more frequently in group B compared to group A (P < 0.0001). Fifteen percent of patients had a high CFA bifurcation. On clinical follow-up during index hospitalization, there was no significant difference between the two groups, in terms of complications including retroperitoneal hemorrhage, access site hematoma >5 cm, bleeding requiring transfusion or pseudoaneurysm.
Anatomic location of PT on fluoroscopy can be used as an additional surrogate to predict the location of IL. Patients with high BMI have a low lying IL, which may predispose them to "high sticks." The location of IEA cannot be used as a surrogate for IL in all patients.
血管通路并发症仍然是心脏导管术后发病率的主要原因。荧光透视引导下的血管通路已被推荐用于减少这些并发症。然而，即使使用当前的建议，仍然会导致动脉通路高于下腹部动脉（IEA）（高位穿刺）或低于股总动脉（CFA）分叉（低位穿刺）。
我们的研究旨在评估患者特征（如年龄、体重指数和骨盆解剖结构）对当前建议的影响。
我们前瞻性地收集了 631 例连续接受 CFA 入路进行冠状动脉和非冠状动脉手术的患者的临床、解剖和血管造影数据。IEA 环、CFA 分叉、公共结节（PT）和前上髂棘的解剖位置与股骨头的关系被确定。IEA 环的位置被用作腹股沟韧带（IL）的替代物。
约 12%的患者 IEA 环位置较低（B 组）。与 IEA 环位于股骨头中线以上的患者（A 组）相比，B 组患者的 BMI 显著更高（P = 0.018）。与 A 组相比，B 组 PT 的解剖位置明显更靠近股骨头下缘（P < 0.0001）。15%的患者 CFA 分叉较高。在住院期间的临床随访中，两组患者在并发症方面没有显著差异，包括腹膜后出血、穿刺部位血肿>5cm、需要输血或假性动脉瘤的出血。
透视时 PT 的解剖位置可以作为预测 IL 位置的附加替代物。BMI 较高的患者 IL 位置较低，这可能使他们更容易出现“高位穿刺”。IEA 的位置不能作为所有患者 IL 的替代物。
