Kaufman J, Moglia R, Lacy C, Dinerstein C, Moreyra A
Department of Surgery, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, New Brunswick.
Am J Med Sci. 1989 Jan;297(1):22-5. doi: 10.1097/00000441-198901000-00006.
The peripheral vascular complications associated with percutaneous transfemoral coronary angioplasty were compared with those that occurred during conventional transfemoral cardiac catheterization. Among 644 patients undergoing percutaneous transluminal coronary angioplasty (PTCA), 6 patients (0.9%) suffered peripheral vascular complications, whereas 35 of 2904 patients having cardiac catheterizations (1.2%) had a peripheral vascular complication. The types of complications associated with both procedures were similar and included groin hematomas, false aneurysms, arterial dissection, arterial perforation, and neurological deficits. The frequency of surgical repair of these complications also was similar in the two groups (50% required repair for a PTCA complication, 34% were repaired after a catheterization complication). The PTCA-associated complications included one myocardial infarction and one death, whereas neither of these occurred in association with a catheterization-induced vascular complication. The surgical management of five of the six PTCA complications was difficult, largely because of the size of the sheath-related puncture site and the presence of active bleeding from the associated systemic anticoagulation. PTCA carries the same risk of development of a peripheral vascular complication as found in transfemoral cardiac catheterization. Care must be taken to prevent sheath-related injury to the aorta-iliac-femoral system and hemorrhagic complications at the puncture site are of particular concern and require urgent surgical attention.
将经皮股动脉冠状动脉成形术相关的外周血管并发症与传统股动脉心脏导管插入术期间发生的并发症进行了比较。在644例行经皮腔内冠状动脉成形术（PTCA）的患者中，6例（0.9%）出现外周血管并发症，而在2904例行心脏导管插入术的患者中，35例（1.2%）出现外周血管并发症。两种手术相关的并发症类型相似，包括腹股沟血肿、假性动脉瘤、动脉夹层、动脉穿孔和神经功能缺损。两组中这些并发症的手术修复频率也相似（50%的PTCA并发症需要修复，34%的导管插入术并发症后进行了修复）。与PTCA相关的并发症包括1例心肌梗死和1例死亡，而这些均未发生在导管插入术引起的血管并发症中。6例PTCA并发症中有5例的手术处理困难，主要是因为鞘管相关穿刺部位的大小以及相关全身抗凝导致的活动性出血。PTCA发生外周血管并发症的风险与股动脉心脏导管插入术相同。必须注意预防鞘管对主动脉 - 髂股系统的损伤，穿刺部位的出血并发症尤其值得关注，需要紧急手术处理。
