Hull Jeffrey, Workman Stephanie, Heath Jean Isabell
Richmond Vascular Center, North Chesterfield, VA, USA.
J Vasc Access. 2020 Mar;21(2):237-240. doi: 10.1177/1129729819871434. Epub 2019 Aug 29.
The aim of this article is to retrospectively compare snuff box radial artery access with direct fistula access for radiocephalic fistula intervention.
Review of 68 consecutive radiocephalic interventions between April 2013 and April 2017 was performed. The snuff box radial access was performed under ultrasound guidance with the hand in a neutral position (thumb up). The snuff box radial artery was entered distal to the extensor pollicis longus, over the trapezium bone. Hand held pressure was applied for hemostasis. The procedure times, success, and complications of snuff box radial artery access procedures were reviewed.
Snuff box radial artery access was used in 25% (17/68) of radiocephalic fistula interventions. All access procedures were successful. Snuff box radial artery access was only used in cases involving the proximal fistula. Lesions treated from snuff box radial artery access approach included 19% (10/54) of fistula stenosis, 50% (1/2) thrombosis, 63% (5/8) immature fistulae, 100% (1/1) steal syndrome, and none of the (0/5) symptomatic outflow occlusions. The mean procedure times for snuff box radial artery access and direct fistula access were not significant at 29.1 ± 16.3 min (range = 10-81) and 26.8 ± 14.0 min (range = 5-70), respectively (p < 0.57). Minor hematoma occurred in 12% (2/17) snuff box radial artery access and 2% (1/51) direct fistula access. There were no major complications.
Snuff box radial access was used successfully for radiocephalic fistula intervention with procedure times similar to direct fistula access without major complications.
本文旨在回顾性比较鼻烟壶区桡动脉入路与直接造瘘入路在头静脉桡动脉内瘘介入治疗中的应用。
回顾性分析2013年4月至2017年4月期间连续进行的68例头静脉桡动脉内瘘介入治疗病例。鼻烟壶区桡动脉入路在超声引导下进行，手部处于中立位（拇指向上）。在拇长伸肌腱远端、大多角骨上方进入鼻烟壶区桡动脉。采用手压法止血。回顾鼻烟壶区桡动脉入路手术的操作时间、成功率及并发症情况。
68例头静脉桡动脉内瘘介入治疗中，25%（17/68）采用了鼻烟壶区桡动脉入路。所有入路手术均成功。鼻烟壶区桡动脉入路仅用于近端内瘘病例。经鼻烟壶区桡动脉入路治疗的病变包括19%（10/54）的内瘘狭窄、50%（1/2）的血栓形成、63%（5/8）的未成熟内瘘、100%（1/1）的窃血综合征，且无（0/5）有症状的流出道闭塞病例出现。鼻烟壶区桡动脉入路和直接造瘘入路的平均手术时间分别为29.1±16.3分钟（范围=10 - 81分钟）和26.8±14.0分钟（范围=5 - 70分钟），差异无统计学意义（p<0.57）。鼻烟壶区桡动脉入路组有12%（2/17）发生轻微血肿，直接造瘘入路组有2%（1/51）发生轻微血肿。无严重并发症发生。
鼻烟壶区桡动脉入路成功应用于头静脉桡动脉内瘘介入治疗，手术时间与直接造瘘入路相似，且无严重并发症。
