Waksman R, King S B, Douglas J S, Shen Y, Ewing H, Mueller L, Ghazzal Z M, Weintraub W S
Andreas Gruentzig Cardiovascular Center, Emory University Hospital, Atlanta, Georgia 30322, USA.
Am J Cardiol. 1995 May 1;75(14):886-9. doi: 10.1016/s0002-9149(99)80681-x.
We reviewed the clinical course of 5,042 patients who underwent percutaneous transluminal coronary angioplasty (PTCA) using balloons or new devices: (stent, laser, directional and rotational atherectomy). A vascular complication was defined as the formation of a groin hematoma, bleeding, pseudoaneurysm, fistula, or the need for surgical repair. Vascular complications occurred in 309 (6.1%) patients, and 117 (2.3%) required vascular repair; among these patients, surgery was performed for correction of an an arteriovenous fistula in 12%, repair of pseudoaneurysm in 72%, repair for expanding hematoma and femoral artery lacerations in 10%, and retroperitoneal bleeding in 6%. The correlates of vascular complications were older age (66.8 vs 62.1 years; p < 0.0001), female gender (43% vs 26%; p < 0.0001), increased weight (82.1 +/- 16.46 vs 78.0 +/- 16.6 kg; p < 0.001), higher systolic blood pressure (140 +/- 25 vs 134 +/- 20 mm Hg; p < 0.001), increased heparin dose during the procedure (14,352 +/- 3,879 vs 13,599 +/- 3,508 IU; p = 0.001), administration of heparin after the procedure (232 vs 2,985 patients; p < 0.0001) and intracoronary stenting (14.9% vs 3.5%; p < 0.0001). Fifteen patients of 214 (7.0%) who underwent stent implantation had surgical repair. Vascular complications were not related to the size of the arterial sheath (8.11 +/- 0.8 vs 8.8 +/- 0.7Fr; p = 0.11) and the use of devices other than stents (laser, atherectomy) did not increase the rate of vascular complications.
我们回顾了5042例接受经皮腔内冠状动脉成形术（PTCA）的患者的临床病程，这些患者使用了球囊或新装置（支架、激光、定向旋切术和旋磨术）。血管并发症定义为腹股沟血肿形成、出血、假性动脉瘤、瘘管形成或需要进行手术修复。309例（6.1%）患者发生了血管并发症，117例（2.3%）需要进行血管修复；在这些患者中，因动静脉瘘矫正而进行手术的占12%，因假性动脉瘤修复而进行手术的占72%，因扩大血肿和股动脉撕裂修复而进行手术的占10%，因腹膜后出血而进行手术的占6%。血管并发症的相关因素包括年龄较大（66.8岁对62.1岁；p<0.0001）、女性（43%对26%；p<0.0001）、体重增加（82.1±16.46对78.0±16.6kg；p<0.001）、收缩压较高（140±25对134±20mmHg；p<0.001）、术中肝素剂量增加（14352±3879对13599±3508IU；p=0.001）、术后肝素给药（232例对2985例患者；p<0.0001）以及冠状动脉内支架置入（14.9%对3.5%；p<0.0001）。214例接受支架植入的患者中有15例（7.0%）进行了手术修复。血管并发症与动脉鞘的大小无关（8.11±0.8对8.8±0.7Fr；p=0.11），并且使用除支架以外的其他装置（激光、旋切术）并未增加血管并发症的发生率。
