Lee Michael S, Applegate Bob, Rao Sunil V, Kirtane Ajay J, Seto Arnold, Stone Gregg W
Division of Cardiology, UCLA Medical Center, Los Angeles, California.
Catheter Cardiovasc Interv. 2014 Jul 1;84(1):62-9. doi: 10.1002/ccd.25435. Epub 2014 Mar 10.
Major bleeding complications after percutaneous coronary intervention (PCI) increase patient morbidity, prolong the hospital stay and costs, and are associated with reduced survival. Transfemoral access is still preferred at many centers given its familiarity and ease of use and is necessary in cases where large bore access is needed. Multimodality imaging with fluoroscopy, ultrasonography, and angiography can facilitate proper puncture of the common femoral artery. A proper technique (which includes femoral artery puncture and vascular access site closure) associated with adequate pharmacotherapy (both during PCI and peri-procedural, for the treatment of the underlying coronary artery disease) has been shown to reduce the risk of bleeding and vascular complications associated with femoral artery access. Avoiding the use of arterial sheaths >6 French may further reduce the risk of bleeding. Data with vascular closure devices as a bleeding avoidance strategy are evolving but when used appropriately may further reduce the risk of bleeding and vascular access complications, and in this regard are synergistic with bivalirudin. Randomized trials to confirm these recommendations are needed.
经皮冠状动脉介入治疗（PCI）后的严重出血并发症会增加患者的发病率，延长住院时间并增加费用，还与生存率降低相关。鉴于经股动脉入路的熟悉性和易用性，许多中心仍更倾向于采用该入路，并且在需要大口径入路的情况下是必要的。使用荧光透视、超声检查和血管造影的多模态成像可以促进股总动脉的正确穿刺。已证明，与适当的药物治疗（在PCI期间和围手术期，用于治疗潜在的冠状动脉疾病）相结合的适当技术（包括股动脉穿刺和血管入路部位闭合）可降低与股动脉入路相关的出血和血管并发症风险。避免使用大于6法式的动脉鞘管可能会进一步降低出血风险。作为避免出血策略的血管闭合装置的数据正在不断发展，但如果使用得当，可能会进一步降低出血和血管入路并发症的风险，在这方面与比伐芦定具有协同作用。需要进行随机试验来证实这些建议。
