Franz Randall W, Tanga Christopher F, Herrmann Joseph W
OhioHealth Vascular and Endovascular Surgery, Grant Medical Center, Columbus, Ohio.
OhioHealth Vascular and Endovascular Surgery, Grant Medical Center, Columbus, Ohio.
J Vasc Surg. 2017 Aug;66(2):461-465. doi: 10.1016/j.jvs.2017.01.050. Epub 2017 Apr 19.
This review was conducted to evaluate the types of endovascular procedures that can be performed via brachial artery access, evaluate the access success rate, and determine the incidence of technical complications.
A retrospective 10-year record review at a tertiary facility from January 1, 2005, through June 30, 2015, was completed. Patients who underwent attempted brachial artery access were eligible for review. Outcomes intended to be evaluated included ability to access the vessel, reach an identified lesion, and perform an indicated procedure, while describing the incidence and type of complications that occurred to clarify the utility and safety of brachial artery access.
The review included 265 access cases in 179 patients. The access success rate was 98.9%. Intervention was performed in 223 cases (84.2%). Angioplasty was the most common intervention (59%, [154 cases]), with stents, atherectomy, coiling, and percutaneous thrombectomy having also been performed. Complications included hematoma (2.3%) and pseudoaneurysm (1.5%). Complications requiring intervention occurred in 1.9% of procedures. Interventions were performed on all major vessels as distal as the dorsalis pedis. Sheath sizes ranged from 4F to 7F. Intervention was performed on bilateral lower extremities in 38 cases (14.5%). A femoral bypass graft was present in 141 patients (53%) as the main indication for brachial artery access.
Brachial access is a reliable and effective option for treatment of peripheral vascular disease and should be considered when femoral access is difficult or contraindicated and when a bypass graft is present in the femoral region. In addition, bilateral lesions may be approached easily through one brachial artery access site, making this approach advantageous when bilateral lesions are expected. The complication rate is similar to femoral access and can be minimized with ultrasound-guided access distally over the humerus, micropuncture access, and a dedicated postprocedure "hold team."
进行本综述以评估可通过肱动脉入路实施的血管内手术类型，评估入路成功率，并确定技术并发症的发生率。
完成了对一家三级医疗机构2005年1月1日至2015年6月30日期间10年记录的回顾性研究。尝试进行肱动脉入路的患者符合纳入标准。旨在评估的结果包括进入血管的能力、到达已确定病变部位的能力以及实施指定手术的能力，同时描述所发生并发症的发生率和类型，以阐明肱动脉入路的实用性和安全性。
该综述纳入了179例患者的265次入路病例。入路成功率为98.9%。223例（84.2%）进行了干预。血管成形术是最常见的干预方式（59%，[154例]），还进行了支架置入、斑块旋切术、弹簧圈栓塞和经皮血栓切除术。并发症包括血肿（2.3%）和假性动脉瘤（1.5%）。需要干预的并发症发生在1.9%的手术中。对包括足背动脉在内的所有主要血管均进行了干预。鞘管尺寸范围为4F至7F。38例（14.5%）对双侧下肢进行了干预。141例患者（53%）存在股动脉搭桥移植物，这是肱动脉入路的主要指征。
肱动脉入路是治疗周围血管疾病的可靠且有效的选择，当股动脉入路困难或禁忌且股部存在搭桥移植物时应予以考虑。此外，通过一个肱动脉入路部位可轻松处理双侧病变，当预期存在双侧病变时，这种方法具有优势。并发症发生率与股动脉入路相似，通过肱骨远端超声引导入路、微穿刺入路以及专门的术后“维持团队”可将其降至最低。
