Hesslein P S, Mullins C E, Kugler J D, Gillette P C
Cathet Cardiovasc Diagn. 1980;6(2):197-205. doi: 10.1002/ccd.1810060211.
During the past ten years we have performed certain phases of cardiac catheterization on 48 children using a modified percutaneous sheath technique to enter a superficial arm vein. Our patients ranged in age from 15 months to 21 years, with a mean age of 10.0 years. The indications for a superior approach most commonly have included electrophysiologic investigations, femoral vein occlusions, and proximal obstructions of the inferior vena cava. The advantages of a percutaneous sheath technique in the superficial brachial veins include the ease of changing catheters frequently during a case and the preservation of the vessel for possible repeat studies. It is not always possible to enter the heart with this technique, owing to sharp angulation of deep venous confluences in the axilla and occasional venous spasm. When successful, this mode of approach is attended by a very low prevalence of complications. There were no deaths, heart or vein perforations, or systemic infections. One patient developed a superficial phlebitis; this was mild and temporally limited. We have not encountered any case of clinically apparent venous thrombosis. When a superior approach for prograde heart catheterization in children is indicated, we have found that our modified percutaneous sheath technique is a simple, safe, and frequently successful alternative to a cutdown approach.
在过去十年中，我们使用改良的经皮鞘技术进入浅表臂静脉，对48名儿童进行了某些阶段的心脏导管插入术。我们的患者年龄从15个月至21岁不等，平均年龄为10.0岁。采用上腔途径的最常见适应证包括电生理检查、股静脉闭塞以及下腔静脉近端梗阻。经皮鞘技术在浅表肱静脉中的优点包括在手术过程中易于频繁更换导管，以及保留血管以便可能进行重复研究。由于腋窝深部静脉汇合处的锐角以及偶尔的静脉痉挛，使用这种技术并不总是能够进入心脏。当成功时，这种途径的并发症发生率非常低。没有死亡、心脏或静脉穿孔或全身感染的情况。1名患者发生了轻度的浅表静脉炎，且为时短暂。我们尚未遇到任何临床明显的静脉血栓形成病例。当有指征采用上腔途径进行儿童顺行性心脏导管插入术时，我们发现我们的改良经皮鞘技术是一种简单、安全且经常成功的切开法替代方法。
