Lee Michael S, Kong Jeremy
Division of Cardiology, UCLA Medical Center, 100 Medical Plaza, Suite 630, Los Angeles, CA, 90095, USA,
Curr Cardiol Rep. 2015 Jun;17(6):44. doi: 10.1007/s11886-015-0596-6.
Percutaneous coronary intervention can lead to vascular access complications that prolong patient hospital stay and costs as well as increase patient morbidity and mortality. Given its ease of use and familiarity, transfemoral access is still the preferred method of approach by many operators. The transfemoral approach is used when large bore access is required or if transradial access is not feasible due to variations in the anatomy of the upper extremity artery. The use of fluoroscopy, ultrasonography, and femoral angiography can help the operator obtain proper arteriotomy of the common femoral artery. Measures to decrease vascular access complications include proper technique, optimal pharmacotherapy, and avoiding the use of arterial sheaths >6 Fr. Optimal pharmacotherapy includes the use of bivalirudin and weight-based unfractionated heparin to avoid supratherapeutic activated clotting times, and to avoid glycoprotein IIb/IIIa inhibitors. When used appropriately, vascular closure devices can decrease the risk of bleeding complications. Randomized trials are needed to confirm these recommendations.
经皮冠状动脉介入治疗可导致血管入路并发症，这会延长患者住院时间、增加费用，并提高患者的发病率和死亡率。鉴于其使用方便且为人熟知，经股动脉入路仍是许多操作者首选的方法。当需要大口径入路或由于上肢动脉解剖结构变异而无法采用经桡动脉入路时，可采用经股动脉入路。使用荧光透视、超声检查和股动脉血管造影有助于操作者对股总动脉进行适当的动脉切开。减少血管入路并发症的措施包括采用适当技术、优化药物治疗以及避免使用大于6F的动脉鞘。优化药物治疗包括使用比伐卢定和基于体重的普通肝素，以避免活化凝血时间超过治疗范围，并避免使用糖蛋白IIb/IIIa抑制剂。适当使用血管闭合装置可降低出血并发症的风险。需要进行随机试验来证实这些建议。
