Heintzen M P, Strauer B E
Medizinische Klinik und Poliklinik B, Heinrich-Heine-Universität Düsseldorf.
Herz. 1998 Feb;23(1):4-20. doi: 10.1007/BF03043007.
After diagnostic and interventional cardiac catheterization, local vascular complications at the arterial entry site must be expected. With respect to the method applied for catheterization and the puncture site, the type of complications may vary. With transfemoral approach a large variety of vascular complications have to be feared, mostly in the form of bleeding complications and hematomas, arterial dissections or occlusions, pseudoaneurysms and AV-fistulas. Each of these complications may have the potential for serious morbidity. When cardiac catheterization is performed via the arteries of the arm (either in the classical Sones technique by arterial cutdown to the brachial artery or by direct puncture of the brachial or radial artery) vascular occlusions will mostly occur as local vascular complications. These occlusions can often be managed conservatively or by a surgical procedure. The incidence of a vascular complication is mainly dependent on patient-related (sex, age, height, weight, arterial hypertension, diabetes, presence of peripheral vascular disease and compliance of the patient after withdrawal of the sheath) and procedure-related (arterial access site, diagnostic or interventional study, sheath size, periprocedural anticoagulation, duration of intra-arterial sheath placement, faulty puncture technique, operator skill) factors. In addition, the definition of a complication, the publication year of a certain study and the technique used for identification of complications seem to play a role for the reported incidence of peripheral vascular complications after cardiac catheterization. Currently, incidences of 0.1 to 2% for significant local vascular complications after diagnostic transfemoral catheterization are reported, after interventional transfemoral treatment 0.5 to 5% and after complex procedures using large sheath sizes with periprocedural anticoagulation (directional atherectomy, IABP, left-heart assist, valvuloplasty) up to 14%. Following transbrachial and transradial catheterization, local vascular complications at the entry site amount to 1 to 3% after diagnostic and 1 to 5% after interventional procedures. Local vascular complications may be diminished by a cautious and sensitive puncture technique with additional care in patients at higher risk for vascular complications (females, prediagnosed peripheral vascular disease, mandatory anticoagulation, necessity for large sheaths). By using smaller sized catheters and an adequate, defensive anticoagulation regimen, the rate of arterial access site complications may be reduced. Proper methods for achievement of hemostasis as well as a close and careful observation after sheath withdrawal are required.
在进行诊断性和介入性心导管检查后，必须预料到动脉穿刺部位会出现局部血管并发症。根据所应用的导管插入术方法和穿刺部位的不同，并发症的类型可能会有所差异。采用经股动脉途径时，必须担心会出现各种各样的血管并发症，主要表现为出血并发症和血肿、动脉夹层或闭塞、假性动脉瘤和动静脉瘘。这些并发症中的每一种都可能导致严重的发病风险。当通过手臂动脉进行心导管检查时（无论是采用经典的索尼斯技术通过切开动脉至肱动脉，还是直接穿刺肱动脉或桡动脉），血管闭塞大多会作为局部血管并发症出现。这些闭塞情况通常可以通过保守治疗或外科手术来处理。血管并发症的发生率主要取决于与患者相关的因素（性别、年龄、身高、体重、动脉高血压、糖尿病、外周血管疾病的存在以及拔除鞘管后患者的依从性）和与手术相关的因素（动脉穿刺部位、诊断性或介入性检查、鞘管尺寸、围手术期抗凝、动脉内鞘管放置的持续时间、穿刺技术不当、操作者技能）。此外，并发症的定义、某项研究的发表年份以及用于识别并发症的技术似乎也会对报道的心导管检查后外周血管并发症的发生率产生影响。目前，据报道，诊断性经股动脉导管插入术后严重局部血管并发症的发生率为0.1%至2%，经股动脉介入治疗后为0.5%至5%，在使用大尺寸鞘管并进行围手术期抗凝的复杂手术（定向斑块旋切术、主动脉内球囊反搏、左心辅助、瓣膜成形术）后高达14%。经肱动脉和经桡动脉导管插入术后，诊断性操作后穿刺部位局部血管并发症的发生率为1%至3%，介入性操作后为1%至5%。对于血管并发症风险较高的患者（女性、预先诊断为外周血管疾病、强制抗凝、需要使用大鞘管），谨慎且敏感的穿刺技术以及额外的护理措施可以减少局部血管并发症的发生。通过使用较小尺寸的导管和适当的、预防性的抗凝方案，可以降低动脉穿刺部位并发症的发生率。需要采用适当的止血方法以及在拔除鞘管后进行密切仔细的观察。
