Alonso Andrea G, Kobzeva-Herzog Anna, Siracuse Jeffrey J
Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA.
J Vasc Surg Cases Innov Tech. 2023 May 24;9(3):101232. doi: 10.1016/j.jvscit.2023.101232. eCollection 2023 Sep.
Percutaneous endovascular interventions for advanced lower extremity peripheral arterial disease are becoming increasingly used, often as first-line treatment of chronic limb threatening ischemia. Advancements in endovascular techniques have provided safe and effective alternative revascularization options, especially for high-risk surgical patients. Although the classic transfemoral approach results in high technical success and patency rates, an estimated 20% of lesions remain challenging to access via an antegrade approach. As such, alternative access sites are important in the endovascular armamentarium for the management of chronic limb threatening ischemia. The goal of this review is to discuss alternative access sites, specifically the transradial, transpopliteal, and transpedal approaches, in addition to transbrachial and transaxillary access, and their outcomes in peripheral arterial disease and limb salvage.
经皮血管腔内介入治疗晚期下肢外周动脉疾病的应用越来越广泛，常作为慢性肢体威胁性缺血的一线治疗方法。血管腔内技术的进步提供了安全有效的替代血管重建选择，特别是对于高风险手术患者。尽管经典的经股动脉入路技术成功率和通畅率较高，但估计仍有20%的病变经顺行入路难以到达。因此，在血管腔内治疗慢性肢体威胁性缺血的器械库中，替代入路部位很重要。本综述的目的是讨论替代入路部位，特别是桡动脉、腘动脉和足背动脉入路，以及肱动脉和腋动脉入路，及其在外周动脉疾病和肢体挽救中的结果。
