Department of Cardiology, Newark Beth Israel Medical Center, Newark, New Jersey.
Catheter Cardiovasc Interv. 2019 Aug 1;94(2):243-248. doi: 10.1002/ccd.28333. Epub 2019 May 27.
To assess the safety and feasibility of percutaneous transaxillary (TAx) access for peripheral endovascular interventions.
The common femoral artery (CFA) is the most commonly used access site for peripheral endovascular interventions. However, its use might be precluded in multiple circumstances. The axillary artery is comparable in size to the CFA and is less affected by atherosclerosis. Data regarding its percutaneous use in peripheral endovascular interventions are scarce.
Consecutive patients who underwent percutaneous TAx peripheral endovascular interventions were identified. Demographic and periprocedural data were extracted. Axillary artery access was obtained percutaneously with the arm abducted. A destination sheath was advanced to the relevant vessel. Endovascular interventions were performed using standard devices and techniques. Vascular closure devices were utilized to achieve hemostasis. Primary endpoints included procedural technical success, access-related complications, and major adverse events (MAEs). Secondary endpoints included cannulation time, total procedure time, fluoroscopy time, and length of stay (LOS).
Percutaneous TAx access was successfully utilized to perform 41 procedures in 29 patients, lacking a suitable conventional access. Three quarters of target vessels were infrainguinal. The lesions of 61% were classified as TransAtlantic Inter-Society Consensus (TASC) C or D. Access-related complications occurred in two procedures (5%). No MAEs occurred. Median cannulation time was 12 min, procedure time 135 min, fluoroscopy time 20 min, and LOS 1 day.
When no suitable access exists for lower extremity catheter-based interventions, percutaneous TAx approach is a feasible and safe alternative. As such facility with this approach is a valuable asset for interventionalists.
评估经皮经腋（TAx）入路进行外周血管腔内介入治疗的安全性和可行性。
股总动脉（CFA）是外周血管腔内介入治疗最常用的入路部位。然而，在多种情况下可能会排除其使用。腋动脉的大小与 CFA 相当，且较少受动脉粥样硬化的影响。关于其在经皮外周血管腔内介入治疗中的应用的数据很少。
确定了接受经皮 TAx 外周血管腔内介入治疗的连续患者。提取人口统计学和围手术期数据。腋动脉经皮穿刺时手臂外展。将目的地护套推进相关血管。使用标准设备和技术进行血管腔内介入治疗。使用血管闭合装置实现止血。主要终点包括程序技术成功率、与入路相关的并发症和主要不良事件（MAE）。次要终点包括穿刺时间、总手术时间、透视时间和住院时间（LOS）。
在缺乏合适的常规入路的情况下，成功地利用经皮 TAx 入路进行了 29 例 41 例手术。四分之三的靶血管位于下肢。61%的病变为 TransAtlantic Inter-Society Consensus (TASC) C 或 D 级。2 例（5%）发生与入路相关的并发症。无 MAE 发生。中位穿刺时间为 12 分钟，手术时间为 135 分钟，透视时间为 20 分钟，住院时间为 1 天。
当下肢基于导管的介入治疗没有合适的入路时，经皮 TAx 入路是一种可行且安全的替代方法。因此，熟练掌握这种方法对于介入治疗医生来说是一项有价值的资产。
