Dixon Oliver G B, Smith George E, Carradice Daniel, Chetter Ian C
Academic Vascular Surgical Unit, Hull Royal Infirmary, Hull - UK.
J Vasc Access. 2017 Mar 21;18(2):97-102. doi: 10.5301/jva.5000611. Epub 2016 Oct 22.
Central venous catheterisation (CVC) is a technique commonly used to obtain vascular access and over five million CVCs are inserted annually. This systematic review of CVC-related arterial injury aims to compare outcomes reported with different management strategies.
PRISMA guidelines were followed. A search of Medline, Embase, Central and CINAHL was performed. Results were limited to papers in humans and in English with duplicates removed. Details of cases including site and nature of arterial injury, use of ultrasound, methods for identifying arterial placement, management methods used, and any reported outcomes were collated from all papers. Successful management was defined as control of haemorrhage without evidence of further complications.
We screened 2187 abstracts and 78 full manuscripts were obtained and reviewed. Twenty-four papers were of relevance and were included in this review. Amongst the papers, 80 cases of arterial injury were reported. Successful treatment by removal and compression, endovascular methods, and open surgical repair were 5.6%, 94.6% and 100%, respectively.
Removal and compression of the arterial site is a poor management method and is associated with a high rate of complications. Endovascular approaches had a high rate of success with advantages of endovascular techniques including access to arteries which are difficult to expose surgically and avoidance of general anaesthesia. Endovascular repair might be considered depending on site of injury or local expertise though surgical repair reported the best results in this review with no complications seen.
中心静脉置管（CVC）是一种常用于建立血管通路的技术，每年有超过五百万次的CVC置管操作。本项关于CVC相关动脉损伤的系统评价旨在比较不同管理策略所报告的结果。
遵循PRISMA指南。对Medline、Embase、Central和CINAHL进行了检索。结果仅限于关于人类的英文论文，并去除了重复项。从所有论文中整理出病例的详细信息，包括动脉损伤的部位和性质、超声的使用、动脉置管的识别方法、所采用的管理方法以及任何报告的结果。成功的管理定义为出血得到控制且无进一步并发症的证据。
我们筛选了2187篇摘要，获得并审阅了78篇全文。24篇论文具有相关性并被纳入本评价。在这些论文中，共报告了80例动脉损伤。通过拔除并压迫、血管内方法和开放手术修复的成功治疗率分别为5.6%、94.6%和100%。
动脉部位的拔除并压迫是一种不佳的管理方法，且并发症发生率较高。血管内方法成功率较高，具有血管内技术的优势，包括能够处理手术难以暴露的动脉以及避免全身麻醉。可根据损伤部位或当地专业水平考虑血管内修复，尽管在本评价中手术修复报告的结果最佳，未观察到并发症。
