Tamanaha Yusuke, Sakakura Kenichi, Taniguchi Yousuke, Yamamoto Kei, Tsukui Takunori, Seguchi Masaru, Wada Hiroshi, Momomura Shin-Ichi, Fujita Hideo
Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University.
Int Heart J. 2019 Sep 27;60(5):1030-1036. doi: 10.1536/ihj.18-551. Epub 2019 Aug 23.
Postcatheterization pseudoaneurysm is a serious complication following diagnostic or therapeutic catheterization. Because radial access is unsuitable in some situations, there is still a need to use femoral or brachial access for arterial catheterization. The aim of this study was to compare the incidence and clinical characteristics of pseudoaneurysm between brachial and femoral access. We identified patients who underwent arterial catheterization from our cardiac catheter records. A total of 5,990 cardiac catheter records and discharge summaries were reviewed, and 23 pseudoaneurysm cases were identified. Those pseudoaneurysm cases were divided into a brachial pseudoaneurysm group (n = 9) and a femoral pseudoaneurysm group (n = 14). The incidence of pseudoaneurysm was significantly higher in brachial access than in femoral access (odds ratio: 4.16, 95% confidence interval: 1.80-9.65; P < 0.001). Successful manual compression was frequently achieved in both the brachial (77.8%) and the femoral (92.9%) pseudoaneurysm groups (P = 0.295). Surgical intervention was more frequently performed in the brachial pseudoaneurysm group (22.2%) than in the femoral pseudoaneurysm group (0%) without reaching statistical significance (P = 0.07). Moreover, neurological disorders were observed only in the brachial pseudoaneurysm group (22.2%). In conclusion, the incidence of pseudoaneurysm was significantly higher in brachial access than in femoral access, indicating the potential risk of brachial access. Successful manual compression was frequently achieved in both groups, but neurological disorders were observed only in brachial access, suggesting the greater risk of brachial pseudoaneurysms.
导管插入术后假性动脉瘤是诊断性或治疗性导管插入术后的一种严重并发症。由于在某些情况下桡动脉入路不适用，因此仍有必要使用股动脉或肱动脉入路进行动脉导管插入术。本研究的目的是比较肱动脉入路和股动脉入路假性动脉瘤的发生率及临床特征。我们从心脏导管记录中识别出接受动脉导管插入术的患者。共查阅了5990份心脏导管记录和出院小结，识别出23例假性动脉瘤病例。这些假性动脉瘤病例被分为肱动脉假性动脉瘤组（n = 9）和股动脉假性动脉瘤组（n = 14）。肱动脉入路假性动脉瘤的发生率显著高于股动脉入路（优势比：4.16，95%置信区间：1.80 - 9.65；P < 0.001）。肱动脉假性动脉瘤组（77.8%）和股动脉假性动脉瘤组（92.9%）均经常成功进行手动压迫（P = 0.295）。肱动脉假性动脉瘤组（22.2%）比股动脉假性动脉瘤组（0%）更频繁地进行手术干预，但未达到统计学意义（P = 0.07）。此外，仅在肱动脉假性动脉瘤组观察到神经功能障碍（22.2%）。总之，肱动脉入路假性动脉瘤的发生率显著高于股动脉入路，表明肱动脉入路存在潜在风险。两组均经常成功进行手动压迫，但仅在肱动脉入路观察到神经功能障碍，提示肱动脉假性动脉瘤风险更大。
