Stavroulakis K, Bisdas T, Torsello G, Bosiers M J, Schwindt A
Department of Vascular Surgery, St Franziskus Hospital Münster,and Clinic for Vascular and Endovascular Surgery, Münster University Hospital, Münster, Germany -
J Cardiovasc Surg (Torino). 2014 Aug;55(4):483-8. Epub 2014 Jun 30.
The femoral artery remains the access of choice in the majority of peripheral vascular interventions. However, specific conditions indicate catheterization of the brachial artery. Contrary to balloon catheters, the majority of stent delivery systems are too short to facilitate transbrachial implantation of self-expandable stents (SES) in the superficial femoral artery (SFA). We report our experience with a new 150 cm working length SES-delivery system for transbrachial lower extremity interventions.
All patients treated with the Entrust(TM) delivery system (EDS) for lower extremity peripheral arterial disease (PAD) via a transbrachial access between December 2012 and February 2014 were included into this study. All data were prospectively collected and analyzed. Primary endpoints were the feasibility and safety of the EDS in the transbrachial setting. Secondary endpoints consisted of stent length accuracy after deployment, early clinical outcome and perioperative complications.
Thirty-seven EverFlex(TM) stents with Entrust(TM) delivery system were implanted transbrachially in twenty-eight (N.=28) patients. The transbrachial implantation of a SES using the EDS was feasible in all patients. Stent compression or elongation >10%, premature jumping or movements of the implanted stents were not observed in any patient. Although no stent fractures were observed, a single stent occlusion was noticed. Early clinical success was achieved in all but one patient, with one patient requiring a surgical revision of the puncture site due to pseudoaneurysm.
The early experience with the new SES-delivery system suggests that EDS enables the safe and effective treatment of the lower extremities PAD via a transbrachial approach. However, further evaluation is needed to define whether the use of the new long shaft stent delivery system influences the performance of the EverFlex(TM) stent in the long run.
在大多数外周血管介入治疗中，股动脉仍是首选的入路。然而，特定情况下需行肱动脉插管。与球囊导管不同，大多数支架输送系统太短，无法经肱动脉在股浅动脉（SFA）植入自膨式支架（SES）。我们报告了使用一种新型150厘米工作长度的SES输送系统进行经肱动脉下肢介入治疗的经验。
纳入2012年12月至2014年2月期间经肱动脉入路使用Entrust™输送系统（EDS）治疗下肢外周动脉疾病（PAD）的所有患者。所有数据均前瞻性收集和分析。主要终点是EDS在经肱动脉情况下的可行性和安全性。次要终点包括支架释放后的长度准确性、早期临床结果和围手术期并发症。
28例患者经肱动脉植入了37枚带有Entrust™输送系统的EverFlex™支架。所有患者使用EDS经肱动脉植入SES均可行。未观察到任何患者的支架压缩或伸长>10%、过早跳跃或植入支架移动。虽未观察到支架断裂，但发现1例支架闭塞。除1例患者外，所有患者均取得早期临床成功，1例患者因假性动脉瘤需要对穿刺部位进行手术修复。
新型SES输送系统的早期经验表明，EDS能够通过经肱动脉途径安全有效地治疗下肢PAD。然而，需要进一步评估以确定从长远来看，使用新型长轴支架输送系统是否会影响EverFlex™支架的性能。
