Dobrin P B
Department of Surgery, Loyola University Medical Center, Maywood, Ill.
Surgery. 1989 Sep;106(3):457-66.
In summary, this article reviews the spectrum of clinical injuries produced by balloon embolectomy The concepts of lateral wall pressure and balloon-artery shear force are presented, and the histologic reactions to passage of embolectomy catheters are described. On the basis of the results of experimental investigations, technical recommendations are made regarding the performance of embolectomy in patients. Attention to these technical details will prevent excessive shear forces and should decrease the incidence of catheter-induced vascular injuries. The following are recommended for performance of balloon embolectomy in patients: 1. Select smallest-sized catheter that will be effective. 2. Use small-bore, long-stroke syringe, such as tuberculin syringe. 3. Whenever possible, fill embolectomy balloons with fluid; air may be preferable in 2F catheters. 4. Before insertion into vessel, fill balloon to check for leaks and for eccentricity. 5. Reject balloons that leak or are markedly eccentric. 6. Insert catheter into vessel, taking care to enter true lumen; do not create false passage. 7. Do not force catheter against resistance: this may cause arterial perforation. 8. Begin to withdraw catheter before balloon is inflated; within first centimeter of motion, inflate balloon. 9. Withdraw catheter slowly and, if possible, continuously. 10. Repeat until lumen is clear, but do not pass catheter excessive number of times. 11. Obtain intraoperative completion arteriogram.
总之，本文回顾了球囊取栓术所导致的一系列临床损伤。介绍了侧壁压力和球囊 - 动脉剪切力的概念，并描述了对取栓导管通过的组织学反应。基于实验研究结果，针对患者的取栓操作提出了技术建议。关注这些技术细节可防止过大的剪切力，并应降低导管引起的血管损伤发生率。以下是对患者进行球囊取栓术的建议：1. 选择有效的最小尺寸导管。2. 使用小口径、长冲程注射器，如结核菌素注射器。3. 尽可能用液体充盈取栓球囊；对于2F导管，空气可能更合适。4. 在插入血管前，充盈球囊以检查是否漏气及有无偏心。5. 拒收漏气或明显偏心的球囊。6. 将导管插入血管，注意进入真腔；不要造成假道。7. 不要强行将导管对抗阻力推进：这可能导致动脉穿孔。8. 在球囊膨胀前开始回撤导管；在最初移动的1厘米内，充盈球囊。9. 缓慢且尽可能连续地回撤导管。10. 重复操作直至管腔通畅，但不要过度多次推送导管。11. 术中完成动脉造影。
