Lentz Charlotte M, Zogaj Donika, Wessel Hanna K, Zeebregts Clark J, Bokkers Reinoud P H, van der Laan Maarten J
Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Department of Radiology, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Ann Vasc Surg. 2022 Apr;81:292-299. doi: 10.1016/j.avsg.2021.09.052. Epub 2021 Nov 11.
Endovascular access is usually achieved through the common femoral artery due to its large size and accessibility. Access through the upper extremity can however be necessary due to anatomic reasons, obesity, or peripheral arterial disease. The 2 main methods of access are surgical cutdown and percutaneous puncture. In this single-centre retrospective cohort study we compared complication risks for both surgical cutdown and percutaneous puncture of an upper arm approach.
Data was obtained from patients receiving endovascular access through the brachial or axillary artery between 2005 and 2018. A total of 109 patients were included. Patient demographics including age, sex, medical history, smoking status, and actual medication were registered, as well as postoperative complications including hematoma, thrombosis, dissection, infection, pseudoaneurysm, nerve injury, reoperation, and readmission.
Access was achieved through surgical cutdown in 53% (n = 58) and through percutaneous puncture in 47% (n = 51) of patients. Fifty-eight percent (n = 63) received access via the brachial artery (BA) and 42% (n = 46) via the axillary artery. Complication rate was 25.0% (3 of 12) for surgical cutdown via the BA, 29.4% (15 of 51) for percutaneous puncture via the BA, and 10.9% (5 of 46) for surgical cutdown via the axillary artery. Major complication rate was 8.3% (1 of 12) for surgical cutdown via the BA, 13.7% (7 of 51) for percutaneous puncture via the BA, and 4.3% (2 of 46) for surgical cutdown via the axillary artery. There was no association between baseline patient characteristics and complication rate.
In this nonrandomized retrospective study, surgical cutdown via the axillary artery was the safest option with fewest complications, but selection of patients may have blurred the results. Surgical cutdown and percutaneous puncture seem equally safe in terms of complication rate in the BA.
由于股总动脉管径大且易于触及，血管内介入通路通常经此建立。然而，由于解剖学原因、肥胖或外周动脉疾病，上肢入路可能是必要的。两种主要的入路方法是外科切开和经皮穿刺。在这项单中心回顾性队列研究中，我们比较了上臂入路的外科切开和经皮穿刺的并发症风险。
数据来自2005年至2018年间通过肱动脉或腋动脉接受血管内介入通路的患者。共纳入109例患者。记录患者的人口统计学信息，包括年龄、性别、病史、吸烟状况和实际用药情况，以及术后并发症，包括血肿、血栓形成、夹层、感染、假性动脉瘤、神经损伤、再次手术和再次入院。
53%（n = 58）的患者通过外科切开建立通路，47%（n = 51）的患者通过经皮穿刺建立通路。63%（n = 63）的患者通过肱动脉（BA）入路，42%（n = 46）的患者通过腋动脉入路。经肱动脉外科切开的并发症发生率为25.0%（12例中的3例），经肱动脉经皮穿刺的并发症发生率为29.4%（51例中的15例），经腋动脉外科切开的并发症发生率为10.9%（46例中的5例）。经肱动脉外科切开的主要并发症发生率为8.3%（12例中的1例），经肱动脉经皮穿刺的主要并发症发生率为13.7%（51例中的7例），经腋动脉外科切开的主要并发症发生率为4.3%（46例中的2例）。患者基线特征与并发症发生率之间无关联。
在这项非随机回顾性研究中，经腋动脉外科切开是并发症最少的最安全选择，但患者的选择可能使结果模糊。就肱动脉入路的并发症发生率而言，外科切开和经皮穿刺似乎同样安全。
