Mustapha J A, Diaz-Sandoval Larry J, Jaff Michael R, Adams George, Beasley Robert, Finton Sara, McGoff Theresa, Miller Larry E, Ansari Mohammad, Saab Fadi
Metro Health Hospital, 5900 Byron Center SW, PO Box 9490, Wyoming, MI 49519 USA.
J Invasive Cardiol. 2016 Jun;28(6):259-64.
Arterial cannulation is a vital component of endovascular interventions and often unconventional access approaches are required due to disease complexity. Historically, varying maneuvers have been utilized to obtain arterial access. Lack of consensus exists regarding the safest and most effective method. This study examined the feasibility and immediate outcomes of ultrasound-guided access in traditional and advanced access approaches.
Data were analyzed from a cohort of 407 patients enrolled in the Peripheral RegIstry of Endovascular Clinical OutcoMEs (PRIME). The 407 patients underwent 649 procedures with 896 access sites utilized. Access success, immediate outcomes, complications, and length of hospital stay were analyzed.
Mean age was 70 years, and 67% were male. The majority of patients had critical limb ischemia (58%), 39% were Rutherford classification III. Most commonly utilized access sites were common femoral retrograde, common femoral antegrade, posterior tibial, and anterior tibial arteries (34.6%, 33.0%, 12.1%, and 12.1%, respectively). Mean number of attempts was 1.2, 1.2, 1.5, and 1.4, respectively; median time to access was 39, 45, 41, and 59 seconds, respectively; and access success rate was 99.4%, 97.3%, 90.7%, and 92.6%; respectively. Access-site combinations utilized were femoral antegrade (n = 188), femoral retrograde (n = 185), dual femoral/ tibio-pedal (n = 130), dual femoral retrograde (n = 44), retrograde tibio-pedal (n = 73), and other (n = 29). Access-related complications were low overall: hematoma (1.2%), bleeding requiring transfusion/intervention (1.7%), pseudoaneurysm (1.7%), arteriovenous fistula (0.3%), aneurysm (0%), compartment syndrome (0%), and death (0%).
Utilization of ultrasound-guided arterial access in this complex cohort was shown to be safe and effective regardless of arterial bed and approach.
动脉插管是血管内介入治疗的重要组成部分，由于疾病的复杂性，通常需要采用非常规的入路方法。历史上，人们采用了各种操作来实现动脉入路。关于最安全、最有效的方法，目前尚无共识。本研究探讨了超声引导下在传统和高级入路方法中进行动脉入路的可行性及即时结果。
对纳入血管内临床结局外周登记研究（PRIME）的407例患者的数据进行分析。这407例患者接受了649例手术，共使用了896个入路部位。分析入路成功率、即时结果、并发症及住院时间。
平均年龄为70岁，67%为男性。大多数患者患有严重肢体缺血（58%），39%为卢瑟福分级III级。最常用的入路部位是股总动脉逆行、股总动脉顺行、胫后动脉和胫前动脉（分别为34.6%、33.0%、12.1%和12.1%）。平均尝试次数分别为1.2次、1.2次、1.5次和1.4次；入路中位时间分别为39秒、45秒、41秒和59秒；入路成功率分别为99.4%、97.3%、90.7%和92.6%。使用的入路部位组合包括股动脉顺行（n = 188）、股动脉逆行（n = 185）、双股/胫-足（n = 130）、双股动脉逆行（n = 44）、逆行胫-足（n = 73）和其他（n = 29）。总体而言与入路相关的并发症较低：血肿（1.2%）、需要输血/干预的出血（1.7%）、假性动脉瘤（1.7%）、动静脉瘘（0.3%）、动脉瘤（0%）、骨筋膜室综合征（0%）和死亡（0%）。
在这个复杂的队列中，无论动脉床和入路方法如何，超声引导下的动脉入路均显示出安全有效。
