Izaaryene Jean, Ferre Marjorie, Dassa Michael, Daidj Nassima, Khati Idir, Gach Pierre, Ewald Jacques, Turrini Olivier, Piana Gilles
Department of Radiology, Institut Paoli Calmettes, 232 Boulevard Sainte Marguerite, 13009, Marseille, France.
Aix Marseille University, Jardin du Pharo, 58 Boulevard Charles Livon, 13007, Marseille, France.
Cardiovasc Intervent Radiol. 2021 Aug;44(8):1273-1278. doi: 10.1007/s00270-021-02850-0. Epub 2021 May 4.
To describe and study the utility of vascular suture-mediated closure systems for large bore arterial access during challenging implantation of liver intra-arterial catheters taking as a reference the conventional procedure involving patients without challenging anatomy.
Between January 2017 and January 2019, 61 consecutive patients underwent 65 intra-arterial catheter IAC implantations for colorectal cancer. Twenty-three procedures (35%) considered by the operators with challenging coeliac trunk angulations were treated using a vascular suture technique where a 6-F introducer was used, the other patients were treated with a conventional 4F access technique. Clinical and radiological characteristics of patients, technical success (implantation of catheters allowing safe infusion of chemotherapy) and complications (Common Terminology Criteria for Adverse Events, CTCAE 5.0) were recorded.
Mean coeliac trunk angulations were 36.3° (± 14.3) for the vascular closure group and 49.6° (± 17.1) for the conventional group. Technical success of the procedures was 100% for the vascular closure group and 80% in the conventional group (p < .05). Four patients with technical failure in the conventional group had a successful IAC implantation on the second attempt using the vascular closure technique. The use of a suture-mediated closure system for large bore arterial access allowed more frequent positioning of the distal tip into the gastro duodenal artery (GDA) (p = .01). No major complication occurred.
The use of a large bore arterial access combined with a suture-mediated closure system may be useful for challenging IAC implantation without major complications.
以常规手术（涉及解剖结构无挑战性的患者）为参考，描述和研究血管缝合介导的闭合系统在具有挑战性的肝动脉内导管植入术中用于大口径动脉穿刺的效用。
2017年1月至2019年1月期间，61例连续患者接受了65次用于结直肠癌的动脉内导管（IAC）植入术。术者认为有挑战性的腹腔干成角的23例手术（35%）采用血管缝合技术治疗，使用6F引导器，其他患者采用传统的4F穿刺技术治疗。记录患者的临床和放射学特征、技术成功率（导管植入允许安全输注化疗药物）和并发症（不良事件通用术语标准，CTCAE 5.0）。
血管闭合组腹腔干平均成角为36.3°（±14.3），传统组为49.6°（±17.1）。血管闭合组手术技术成功率为100%，传统组为80%（p<0.05）。传统组4例技术失败的患者在第二次尝试时采用血管闭合技术成功植入IAC。使用缝合介导的闭合系统进行大口径动脉穿刺可使远端尖端更频繁地定位到胃十二指肠动脉（GDA）（p=0.01）。未发生重大并发症。
使用大口径动脉穿刺并结合缝合介导的闭合系统可能有助于在无重大并发症的情况下进行具有挑战性的IAC植入。
