Division of Vascular Surgery, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada.
Medical Undergraduate Program, University of British Columbia, Vancouver, British Columbia, Canada.
J Vasc Surg. 2022 Jul;76(1):165-173. doi: 10.1016/j.jvs.2022.03.031. Epub 2022 Mar 26.
The primary objective of this study is to describe and illustrate the technique of ultrasound-guided percutaneous proximal axillary artery (PAA) access, and secondarily to evaluate the versatility and safety of this approach in peripheral, visceral, and aortic endovascular interventions.
This is a single-center retrospective review of all peripheral, visceral, and aortic endovascular cases using percutaneous PAA access from February 2019 to March 2021 compared with a sample of an equivalent number of consecutive cases completed via percutaneous common femoral artery (CFA) access during the same time period. Access entry success, minor and major access site complications within 30 days, major adverse events within 30 days, demographics, and procedural details were analyzed using standard statistical analyses.
A total of 115 accesses-59 PAA and 56 CFA-were reviewed during the study period. Group demographics were not significantly different. Access entry success was achieved in 58 (98.3%) and 56 (100%) of PAA and CFA accesses, respectively, with no statistically significant difference. There were no significant differences in minor access-site complications (13.6% vs 5.4%; P = .21) major access site complications (3.4% vs 7.1%; P = .43), or major adverse events (6.8% vs 5.4%). between the PAA and CFA groups. With respect to versatility, PAA cases had a significantly greater mean number of vessels intervened on per procedure compared with CFA access (2.59 ± 1.31 vs 1.95 ± 0.98; P < .01). A wide range of target vessels were intervened on in both groups. PAA cases had significantly more bilateral lower leg interventions (28.8% vs 12.5%; P = .04). PAA access had a significantly longer mean procedure time (103.2 minutes vs 58.63 minutes; P < .001) and fluoroscopy time (18.21 minutes vs 12.87 minutes; P = .02).
The PAA is a feasible, versatile, and safe percutaneous access option for endovascular intervention. The in-line trajectory from this site facilitates visceral, renal, aortic, and bilateral lower extremity interventions with ease. Outcomes, complications, and major adverse events are similar to those of conventional CFA access in the short term.
本研究的主要目的是描述和说明超声引导经皮锁骨下动脉（PAA）入路的技术，并评估该方法在周围、内脏和主动脉血管内介入治疗中的多功能性和安全性。
这是一项回顾性研究，对 2019 年 2 月至 2021 年 3 月期间使用经皮 PAA 入路进行的所有外周、内脏和主动脉血管内介入病例与同期通过经皮股总动脉（CFA）入路进行的连续病例进行比较。使用标准统计学分析方法分析入路成功率、30 天内小和大入路部位并发症、30 天内主要不良事件、人口统计学和手术细节。
在研究期间共检查了 115 例入路-59 例 PAA 和 56 例 CFA。组间人口统计学差异无统计学意义。PAA 和 CFA 入路的入路成功率分别为 58（98.3%）和 56（100%），无统计学差异。小入路部位并发症（13.6% vs 5.4%；P=0.21）和大入路部位并发症（3.4% vs 7.1%；P=0.43）之间无显著差异。两组之间主要不良事件（6.8% vs 5.4%）也无显著差异。就多功能性而言，与 CFA 入路相比，PAA 病例的平均每例介入血管数量明显更多（2.59±1.31 vs 1.95±0.98；P<0.01）。两组均对多种目标血管进行了介入治疗。PAA 病例的双侧小腿介入明显更多（28.8% vs 12.5%；P=0.04）。PAA 入路的平均手术时间（103.2 分钟 vs 58.63 分钟；P<0.001）和透视时间（18.21 分钟 vs 12.87 分钟；P=0.02）明显更长。
PAA 是一种可行、多功能且安全的血管内介入治疗经皮入路选择。从该部位的直线轨迹可轻松进行内脏、肾脏、主动脉和双侧下肢介入治疗。短期结果、并发症和主要不良事件与传统 CFA 入路相似。
