Sonnenschein Kristina
Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
Herzschrittmacherther Elektrophysiol. 2025 Feb 3. doi: 10.1007/s00399-025-01067-9.
Both the performance of electrophysiological examinations and the implantation of cardiac devices (pacemakers, implantable cardioverter-defibrillator [ICDs], and cardiac resynchronization therapy defibrillator [CRT-D] systems) are associated with vascular punctures. This article provides an overview of possible vascular complications and their management from the perspective of angiology. The most common access site for invasive electrophysiological procedures is usually via the femoral veins and/or arteries. Puncture of the brachial vessels is a possible but rarely used alternative. For implantation of transvenous cardiac devices, access via the cephalic vein or axillary vein is used. The electrodes located in the venous vascular system represent a foreign material and increase the risk of thrombus formation in the affected vein. Punctures of the femoral vessels can lead to bleeding, thrombosis and the formation of arteriovenous fistulas or pseudoaneurysms (aneurysma spurium). Venous thromboses can occur postprocedurally. The correct puncture technique is essential to avoid complications. Ultrasound-guided puncture also significantly reduces the rate of vascular complications.
电生理检查以及心脏设备（起搏器、植入式心脏复律除颤器[ICD]和心脏再同步治疗除颤器[CRT-D]系统）植入均与血管穿刺有关。本文从血管学角度概述了可能出现的血管并发症及其处理方法。侵入性电生理检查最常用的穿刺部位通常是股静脉和/或股动脉。肱血管穿刺是一种可行但很少使用的替代方法。对于经静脉心脏设备植入，采用头静脉或腋静脉入路。位于静脉血管系统的电极属于异物，会增加患静脉血栓形成的风险。股血管穿刺可能导致出血、血栓形成以及动静脉瘘或假性动脉瘤（假动脉瘤）。术后可能发生静脉血栓。正确的穿刺技术对于避免并发症至关重要。超声引导下穿刺也能显著降低血管并发症的发生率。
