Dawson Kathryn, Jones Tara L, Kearney Kathleen E, McCabe James M
Division of Cardiology, Department of Medicine, University of Washington Heart Institute Seattle, WA, US.
Division of Cardiovascular Medicine, University of Utah Salt Lake City, UT, US.
Interv Cardiol. 2020 Jun 15;15:e07. doi: 10.15420/icr.2019.22. eCollection 2020 Apr.
Advances in transcatheter structural heart interventions and temporary mechanical circulatory support have led to increased demand for alternative sites for large-bore vascular access. Percutaneous axillary artery access is an appealing alternative to femoral access in patients with peripheral arterial disease, obesity or for prolonged haemodynamic support where patient mobilisation may be valuable. In particular, axillary access for mechanical circulatory support allows for increased mobility while using the device, facilitating physical therapy and reducing morbidity associated with prolonged bed rest. This article outlines the basic approach to percutaneous axillary vascular access, including patient selection and procedure planning, anatomic axillary artery landmarks, access techniques, sheath removal and management of complications.
经导管结构性心脏介入治疗和临时机械循环支持的进展导致对大口径血管通路替代部位的需求增加。对于患有外周动脉疾病、肥胖的患者，或者在需要延长血流动力学支持且患者活动可能有益的情况下，经皮腋动脉穿刺是一种有吸引力的替代股动脉穿刺的方法。特别是，通过腋动脉通路进行机械循环支持可在使用该设备时增加患者的活动能力，便于进行物理治疗，并降低与长期卧床休息相关的发病率。本文概述了经皮腋动脉血管穿刺的基本方法，包括患者选择和手术规划、腋动脉的解剖标志、穿刺技术、鞘管拔除及并发症处理。
