Sarhan Daour Yousef Al, Kölbel Tilo, Grandi Alessandro, Nana Petroula, Torrealba José I, Behrendt Christian-Alexander, Panuccio Giuseppe
German Aortic Centre, Department of Vascular Medicine, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany.
J Clin Med. 2024 Sep 11;13(18):5375. doi: 10.3390/jcm13185375.
: Transfemoral access (TFA) is a valuable alternative to upper extremity access (UEA) for branched endovascular aortic repair (bEVAR). However, TFA requires large introducer sheaths, which can reduce blood flow to lower limbs and the pelvis. This study aimed to evaluate the efficacy of sheath downsizing to maintain lower limb perfusion during TFA-bEVAR. : A single-center retrospective review was conducted including patients managed with TFA-performed bEVAR between December 2020 and May 2021. Intra-operative lower limb perfusion was assessed using non-invasive ankle blood pressure measurements and great toe pulse oximetry, with measurements being taken prior to puncture (baseline), one minute after 10F-sheath insertion, three minutes after the main body delivery system insertion, and three minutes after downsizing to a 14F sheath. Outcomes included the incidence of limb perfusion reduction (LPR), defined as a drop in the ankle-brachial index (ABI) < 0.5 or peripheral oxygen saturation (SpO) < 90%. : Out of 47 patients, 24 met the inclusion criteria. LPR occurred in 4.2% of cases after 10F-sheath placement, and 87.5% after main body delivery system placement, and decreased to 12.6% after downsizing to a 14F sheath. No periprocedural major bleeding occurred. Two patients required revision for inadequate hemostasis post-operatively. SCI occurred in 16% of patients, all recovered by discharge. Pre-operative hypogastric artery occlusion was related to persistent LPR after downsizing (100% vs. 16%, = 0.009). : Downsizing the introducer sheath during bEVAR is feasible and safe to restore lower limb and pelvic perfusion. Further research is needed to clarify the access downsizing value during bEVAR.
对于分支型血管腔内主动脉修复术（bEVAR），经股动脉入路（TFA）是上肢入路（UEA）的一种有价值的替代方法。然而，TFA需要大型导入鞘管，这可能会减少下肢和骨盆的血流。本研究旨在评估在TFA-bEVAR期间鞘管尺寸缩小以维持下肢灌注的疗效。：进行了一项单中心回顾性研究，纳入2020年12月至2021年5月期间接受TFA辅助bEVAR治疗的患者。术中使用无创踝部血压测量和大脚趾脉搏血氧饱和度测定评估下肢灌注，在穿刺前（基线）、插入10F鞘管后1分钟、插入主体输送系统后3分钟以及缩小至14F鞘管后3分钟进行测量。观察指标包括肢体灌注减少（LPR）的发生率，定义为踝肱指数（ABI）下降<0.5或外周血氧饱和度（SpO）<90%。：47例患者中，24例符合纳入标准。放置10F鞘管后，4.2%的病例发生LPR，放置主体输送系统后为87.5%，缩小至14F鞘管后降至12.6%。围手术期无重大出血发生。两名患者术后因止血不充分需要再次手术。16%的患者发生脊髓损伤，出院时均已恢复。术前腹下动脉闭塞与缩小鞘管尺寸后持续的LPR相关（100%对16%，P = 0.）。：在bEVAR期间缩小导入鞘管尺寸以恢复下肢和骨盆灌注是可行且安全的。需要进一步研究以阐明bEVAR期间入路尺寸缩小的价值。
