Andros G, Harris R W, Dulawa L B, Oblath R W, Schneider P A
Vascular Laboratory, Saint Joseph Medical Center, Burbank, CA 91505-4866.
J Vasc Surg. 1994 Oct;20(4):566-74; discussion 574-6. doi: 10.1016/0741-5214(94)90281-x.
Percutaneous access to the arterial system for endovascular procedures is usually achieved through the femoral arteries. When femoral access is precluded, the axillary or brachial arteries serve as alternatives. Complications associated with the use of the latter arteries have led us to develop subclavian arterial catheterization.
From 1978 to 1993, 569 patients underwent angiography via the subclavian artery (> 99% left subclavian artery); 134 were studies of the aortic arch and brachiocephalic vessels; 435 studies involved the descending and abdominal aorta and its branches and runoff. Coronary arteriography was also feasible. Since 1986, 44 patients have undergone endovascular procedures: 33 percutaneous transluminal angioplasties of the visceral, iliac, femoral, and popliteal arteries and 11 thrombolytic procedures of aortofemoral graft limbs (n = 3) and femoral distal bypasses (n = 8) were performed. Complications (1.2%) included partial pneumothorax (n = 2), hemorrhage requiring operative control (n = 2), causalgia (n = 1) and embolization (n = 2).
Whenever percutaneous femoral catheterization cannot be achieved or an alternate access point is indicated, we select the subclavian approach as an alternative to axillary, brachial or translumbar access. It is safe, expeditious, and versatile for virtually all types of systemic and cardiac catheterization; it is also applicable to thrombolysis and balloon angioplasty.
血管内介入操作的经皮动脉入路通常通过股动脉实现。当无法进行股动脉入路时，腋动脉或肱动脉可作为替代。使用后两者动脉相关的并发症促使我们开展锁骨下动脉插管术。
1978年至1993年，569例患者经锁骨下动脉进行血管造影（>99%为左锁骨下动脉）；134例是对主动脉弓和头臂血管的研究；435例研究涉及降主动脉和腹主动脉及其分支与血流情况。冠状动脉造影也是可行的。自1986年以来，44例患者接受了血管内介入操作：对内脏、髂、股及腘动脉进行了33例经皮腔内血管成形术，对主-股动脉移植肢体（n = 3）和股动脉远端旁路（n = 8）进行了11例溶栓操作。并发症（1.2%）包括部分气胸（n = 2）、需手术控制的出血（n = 2）、灼性神经痛（n = 1）和栓塞（n = 2）。
每当无法实现经皮股动脉插管或需要选择替代入路点时，我们选择锁骨下动脉入路作为腋动脉、肱动脉或经腰入路的替代方法。它对于几乎所有类型的全身和心脏导管插入术都是安全、快速且通用的；它也适用于溶栓和球囊血管成形术。
