Kline R M, Hertzer N R, Beven E G, Krajewski L P, O'Hara P J
Department of Vascular Surgery, Cleveland Clinic Foundation, OH 44195-5272.
J Vasc Surg. 1990 Jul;12(1):20-4. doi: 10.1067/mva.1990.19945.
A consecutive series of 532 patients (1.5%) required local thrombectomy and arterial repair after 34,291 transbrachial cardiac catheterizations performed at the Cleveland Clinic from 1980 to 1988. A total of 514 patients (97%) were discharged from the hospital with normal radial pulses and/or normal ulnar pulses after a single surgical procedure. Fourteen others (3%) each required one additional procedure to regain a distal pulse, and four patients either underwent two reoperations, received thrombolytic therapy, and/or remained pulseless. Surgical delay of more than 1 day after catheterization was associated with a higher incidence of recurrent thrombosis (12% vs 2%, p = 0.025). In comparison to our previous experience with iatrogenic brachial injuries, the liberal use of segmental arterial resection and overnight heparin anticoagulation seem especially to reduce the risk for early failure in all patients, but improvement was particularly marked in women (25% vs 6%, p = 0.0004).
1980年至1988年在克利夫兰诊所进行的34291例经肱动脉心脏导管插入术后，连续有532例患者（1.5%）需要进行局部血栓切除术和动脉修复。共有514例患者（97%）在单次手术后出院时桡动脉搏动和/或尺动脉搏动正常。另外14例患者（3%）各自需要再进行一次手术以恢复远端脉搏，4例患者要么接受了两次再次手术，接受了溶栓治疗，和/或仍然无脉。导管插入术后手术延迟超过1天与复发性血栓形成的发生率较高相关（12%对2%，p = 0.025）。与我们之前处理医源性肱动脉损伤的经验相比，广泛使用节段性动脉切除术和夜间肝素抗凝似乎特别能降低所有患者早期失败的风险，但在女性患者中改善尤为明显（25%对6%，p = 0.0004）。
