Acibadem City Clinic Cardiovascular Center, Sofia, Bulgaria.
Acibadem City Clinic Cardiovascular Center, Sofia, Bulgaria.
Cardiovasc Revasc Med. 2020 Oct;21(10):1269-1273. doi: 10.1016/j.carrev.2020.02.023. Epub 2020 Feb 29.
Endovascular procedures nowadays are generally performed via the femoral and radial artery. Although not routinely used by many, there is still an essential role for vascular interventions via brachial access. The technological advancement of endovascular devices leads to a significant increase of the variety of percutaneously treatable vascular pathology. The brachial artery approach nowadays is becoming crucial for complex procedures either as single access or in the context of mandatory double vascular approach for many complex interventions.
To evaluate the safety and efficacy of brachial artery access for diagnostic arteriography and endovascular interventions in different vascular territories in a single-center setting on the basis of a retrospective analysis of prospectively collected data in a large patient cohort.
Between 01/2013 and 09/2016, 11,274 endovascular procedures were performed in our hospital, 847 (7.5%) of them via brachial access, presenting the database for this study. All demographic, clinical, and periprocedural data were obtained prospectively and included in the computerized hospital records, and on this basis, a retrospective analysis was performed.
While the radial access was the most used and constant for coronary and noncoronary interventions in our center (71%) in this period, the use of brachial access increased (from 4% to 12%) causing the femoral to decrease (from 27% to 16%). We used the brachial approach for diagnostic purposes in 162 patients (19%) and for head to toe endovascular interventions (including angioplasty, stenting, thrombolysis, or as adjunctive access) in 685 patients (81%). For 53 patients (6.2%), this was the only possible access for endovascular intervention. Overall access site-related complications occurred in 25 patients (2.9%), in 19 of them (2.2%) required surgical correction, for brachial artery thrombosis or pseudoaneurysm. The other six were managed conservatively. No permanent neurological deficits of the arm or severe bleeding were observed. Minor complications, mostly hematomas, occurred in 62 patients (7.3%), but they required no further treatment.
Brachial artery access expands our capability to perform complex procedures by allowing us to reach arterial targets in all territories. Complications of brachial vascular access are gradually decreasing together with the decrease of the crossing profile of the devices used in practice. However, when they occur, they often require surgical treatment. The growing experience of the team not only while obtaining the access but also while achieving adequate hemostasis ("patent hemostasis") is of great importance for minimizing the complications.
如今，血管内治疗通常通过股动脉和桡动脉进行。尽管许多医生不常规使用，但肱动脉入路在血管介入治疗中仍具有重要作用。血管内治疗设备的技术进步导致经皮治疗的血管病变种类显著增加。肱动脉入路如今在许多复杂介入治疗中作为单一入路或强制性双重血管入路的情况下对于复杂手术至关重要。
基于对我院大型患者队列前瞻性收集数据的回顾性分析，评估肱动脉入路在不同血管区域进行诊断性血管造影和血管内介入治疗的安全性和有效性。
2013 年 1 月至 2016 年 9 月，我院共进行了 11274 例血管内治疗，其中 847 例（7.5%）经肱动脉入路，为该研究提供了数据库。所有人口统计学、临床和围手术期数据均通过前瞻性方法获得，并纳入计算机化的医院记录，在此基础上进行了回顾性分析。
在此期间，在我院，桡动脉入路是冠状动脉和非冠状动脉介入治疗中最常用且最稳定的入路（71%），而肱动脉入路的使用率增加（从 4%增加到 12%），导致股动脉入路的使用率降低（从 27%降至 16%）。我们在 162 例患者（19%）中使用肱动脉入路进行诊断，在 685 例患者（81%）中进行头到足的血管内介入治疗（包括血管成形术、支架置入术、溶栓或辅助入路）。对于 53 例患者（6.2%），这是进行血管内治疗的唯一可能入路。总体上，25 例（2.9%）患者发生与入路相关的并发症，其中 19 例（2.2%）需要手术矫正，因为肱动脉血栓形成或假性动脉瘤。其他 6 例患者接受了保守治疗。未观察到手臂永久性神经功能缺损或严重出血。62 例患者（7.3%）出现轻微并发症，主要是血肿，但无需进一步治疗。
肱动脉入路扩大了我们进行复杂手术的能力，使我们能够到达所有区域的动脉靶标。肱动脉血管入路并发症随着实践中使用的器械的交叉轮廓的降低而逐渐减少。然而，当它们发生时，它们通常需要手术治疗。团队的经验不断增加，不仅在获得入路时，而且在实现充分止血（“开放止血”）时，对于最大限度地减少并发症都非常重要。
