Bosiers Marc, Deloose Koen, Callaert Joren
Department of Vascular Surgery, St Blasius Hospital, Kroonveldlaan 50, 9200 Dendermonde, Belgium.
Department of Vascular Surgery, St Blasius Hospital, Kroonveldlaan 50, 9200 Dendermonde, Belgium.
Semin Vasc Surg. 2018 Jun-Dec;31(2-4):76-80. doi: 10.1053/j.semvascsurg.2018.12.005. Epub 2019 Jan 4.
The selection of an optimal vascular access strategy for lower limb endovascular intervention is key for procedural safety and success, and is particularly relevant in diabetic patients, in whom extensive occlusive disease commonly involves the infrapopliteal arteries. Individualizing vascular access requires careful planning, including determining normal and abnormal arterial anatomy; the patient's co-medical conditions, especially renal insufficiency; and review of noninvasive vascular laboratory testing. It is essential to be cognizant of the technical nuances, relative safety, advantages, and disadvantages of each potential access site. Retrograde and antegrade femoral approaches; upper extremity access via the radial, brachial, or axillary arteries; or retrograde access via the below-the-knee popliteal or pedal arteries should all be considered in endovascular intervention planning.
为下肢血管腔内介入选择最佳的血管入路策略是手术安全和成功的关键，这在糖尿病患者中尤为重要，因为这类患者广泛的闭塞性疾病通常累及腘动脉以下的动脉。个体化的血管入路需要仔细规划，包括确定正常和异常的动脉解剖结构；患者的合并症，尤其是肾功能不全；以及回顾无创血管实验室检查结果。必须了解每个潜在入路部位的技术细微差别、相对安全性、优点和缺点。在血管腔内介入治疗规划中，应考虑逆行和顺行股动脉入路；经桡动脉、肱动脉或腋动脉的上肢入路；或经膝下腘动脉或足背动脉的逆行入路。
