Smith Jason C, Cho Alex L, Fujimoto Scott T
Department of Radiology, Loma Linda University, 11234 Anderson Street, Loma Linda, California, 92354, USA.
CVIR Endovasc. 2020 Mar 9;3(1):15. doi: 10.1186/s42155-020-00105-6.
Extreme obesity is a risk factor for hemorrhagic complications of femoral access (FA). Femoral lines, hematomas, pelvic binders and coagulopathy in the trauma scenario may also add difficulty and/or risk to FA. Radial access (RA) for routine peripheral endovascular procedures has been popularized owing to decreased hemorrhagic complications, increased patient satisfaction, and decreased operator radiation dose. However, though uncommon, cerebrovascular complications from RA approach are a known risk. Relatively recently, tibial access (TA) has been used for lower extremity peripheral vascular disease interventions. The advantages of TA mirror that of RA, with few and mostly minor complications, and the risk of iatrogenic cerebral embolization is nil. We report the feasibility of TA for supra-inguinal embolization in two extremely obese patients {body mass index > 40 kg/m} following motor vehicle accidents. Commercially available base and microcatheters were used to perform embolization of the affected lower abdominal or pelvic arteries in standard fashion via a novel trans-tibial artery approach.
极度肥胖是股动脉入路（FA）出血并发症的一个危险因素。创伤情况下的股动脉置管、血肿、骨盆固定器和凝血功能障碍也可能增加FA的难度和/或风险。由于出血并发症减少、患者满意度提高以及术者辐射剂量降低，桡动脉入路（RA）在常规外周血管腔内手术中已得到普及。然而，尽管罕见，但RA入路导致的脑血管并发症是已知的风险。相对较近，胫动脉入路（TA）已用于下肢外周血管疾病的干预。TA的优点与RA相似，并发症少且大多较轻微，并且不存在医源性脑栓塞的风险。我们报告了在两名机动车事故后极度肥胖患者（体重指数>40kg/m²）中行TA进行腹股沟上栓塞的可行性。使用市售的导管座和微导管，通过一种新颖的经胫动脉途径以标准方式对受影响的下腹部或盆腔动脉进行栓塞。
