Kret Marcus R, Dalman Ronald L, Kalish Jeffrey, Mell Matthew
Division of Vascular Surgery, Stanford University School of Medicine, Stanford, Calif.
Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston, Mass.
J Vasc Surg. 2016 Jul;64(1):149-54. doi: 10.1016/j.jvs.2016.02.019. Epub 2016 Mar 23.
Factors influencing risk for brachial access site complications after peripheral vascular intervention are poorly understood. We queried the Society for Vascular Surgery Vascular Quality Initiative to identify unique demographic and technical risks for such complications.
The Vascular Quality Initiative peripheral vascular intervention data files from years 2010 to 2014 were analyzed to compare puncture site complication rates and associations encountered with either brachial or femoral arterial access for peripheral vascular intervention. Procedures requiring multiple access sites were excluded. Complications were defined as wound hematoma or access vessel stenosis/occlusion. Univariate and hierarchical logistic regression was used to identify independent factors associated with site complications after brachial access.
Of 44,634 eligible peripheral vascular intervention procedures, 732 (1.6%) were performed through brachial access. Brachial access was associated with an increased complication rate compared with femoral access (9.0% vs 3.3%; P < .001), including more hematomas (7.2% vs 3.0%; P < .001) and access site stenosis/occlusion (2.1% vs 0.4%; P < .001). On univariate analysis, factors associated with brachial access complications included age, female gender, and sheath size. Complications occurred less frequently after arterial cutdown (4.1%) compared with either ultrasound-guided (11.8%) or fluoroscopically guided percutaneous access (7.3%; P = .07 across all variables). Neither surgeons' overall peripheral vascular intervention experience nor prior experience with brachial access predicted likelihood of adverse events. By multivariate analysis, male gender (odds ratio [OR], 0.48; 95% confidence interval [CI], 0.28-0.84; P < .01) and arterial cutdown (OR, 0.25; 95% CI, 0.07-0.87; P = .04) were associated with significantly decreased risk for access complications. Larger sheath sizes (>5F) were associated with increased risk of complications (OR, 2.19; 95% CI, 1.07-4.49; P = .03).
Brachial access for peripheral vascular intervention carries significantly increased risks for access site occlusion or hematoma formation. Arterial cutdown and smaller sheath diameters are associated with lower complication rates and thus should be considered when arm access is required.
对外周血管介入术后肱动脉穿刺部位并发症的影响因素了解甚少。我们查询了血管外科学会血管质量改进项目，以确定此类并发症的独特人口统计学和技术风险。
分析2010年至2014年血管质量改进项目外周血管介入数据文件，比较外周血管介入时肱动脉或股动脉穿刺部位的并发症发生率及相关因素。排除需要多个穿刺部位的手术。并发症定义为伤口血肿或穿刺血管狭窄/闭塞。采用单因素和分层逻辑回归分析确定肱动脉穿刺后与穿刺部位并发症相关的独立因素。
在44634例符合条件的外周血管介入手术中，732例（1.6%）通过肱动脉穿刺进行。与股动脉穿刺相比，肱动脉穿刺的并发症发生率更高（9.0%对3.3%；P <.001），包括更多的血肿（7.2%对3.0%；P <.001）和穿刺部位狭窄/闭塞（2.1%对0.4%；P <.001）。单因素分析显示，与肱动脉穿刺并发症相关的因素包括年龄、女性性别和鞘管尺寸。与超声引导（11.8%）或透视引导下经皮穿刺（7.3%）相比，动脉切开术后并发症发生率较低（4.1%）（所有变量的P = 0.07）。外科医生的外周血管介入总体经验和既往肱动脉穿刺经验均不能预测不良事件的发生可能性。多因素分析显示，男性性别（比值比[OR]，0.48；95%置信区间[CI]，0.28 - 0.84；P <.01）和动脉切开术（OR，0.25；95%CI，0.07 - 0.87；P = 0.04）与穿刺并发症风险显著降低相关。较大的鞘管尺寸（>5F）与并发症风险增加相关（OR，2.19；95%CI，1.07 - 4.49；P = 0.03）。
外周血管介入采用肱动脉穿刺会显著增加穿刺部位闭塞或血肿形成的风险。动脉切开术和较小的鞘管直径与较低的并发症发生率相关，因此在需要上肢穿刺时应予以考虑。
