目的:目前关于肱动脉通路使用的文献存在争议。一些研究发现穿刺部位并发症增加。其他人没有发现比股骨或桡动脉入路患者更高的并发症发生率。这项研究的目的是确定超声(US)指导对进入部位并发症的影响。
方法:这是一项单中心回顾性研究,对所有连续的肱动脉介入治疗患者进行研究。并发症分为轻微并发症(仅保守治疗)和主要并发症(需要手术干预)。在美国的指导下,将肱动脉插入肘前窝。干预之后,手动压缩或闭合装置,然后用压迫绷带包扎3小时,要么实现止血。
结果:在研究期间,对71例患者进行了75次手术。在所有情况下访问均成功(100%)。在不同血管区域进行手术:神经血管(10/13.5%),上肢(32/43.2%),内脏(20/27.0%),和下肢(12/16.3%)。鞘大小范围为3.2F至8F(平均:5F)。闭合装置17例(22.7%)。总的来说,观察到6种并发症(8.0%),4次轻微并发症(5.3%,主要是穿刺部位血肿),和两大并发症,需要手术治疗(2.7%)。无肱动脉血栓形成及上肢缺血发生。
结论:在我们的研究中,与文献相比,仅使用美国指南可降低肱动脉通路部位并发症的风险。在多项股骨入路研究中,美国指南已被证明可以降低入路部位并发症的风险。此外,肱动脉通路的技术成功率很高,不需要额外注射解痉挛药物。鞘管大小是并发症的唯一重要预测因素。
OBJECTIVE: The current literature on the use of brachial artery access is controversial. Some studies found increased puncture site complications. Others found no higher complication rates than in patients with femoral or radial access. The purpose of this study was to determine the impact of ultrasound (US)-guidance on access site complications.
METHODS: This is a single-center retrospective study of all consecutive patients with brachial arterial access for interventional procedures. Complications were classified into minor complications (conservative treatment only) and major complications (requiring surgical intervention). The brachial artery was cannulated in the antecubital fossa under US-guidance. After the intervention, manual compression or closure devices, both followed by a compression bandage for 3 h, either achieved hemostasis.
RESULTS: Seventy-five procedures in seventy-one patients were performed in the study period using brachial access. Access was successful in all cases (100%). Procedures in different vascular territories were performed: neurovascular (10/13.5%), upper extremity (32/43.2%), visceral (20/27.0%), and lower extremity (12/16.3%). Sheath size ranged from 3.2F to 8F (mean: 5F). Closure devices were used in 17 cases (22.7%). In total, six complications were observed (8.0%), four minor complications (5.3%, mostly puncture site hematomas), and two major complications, that needed surgical treatment (2.7%). No brachial artery thrombosis or upper extremity ischemia occurred.
CONCLUSIONS: Exclusive use of US-guidance resulted in a low risk of brachial artery access site complications in our study compared to the literature. US-guidance has been proven to reduce the risk of access site complications in several studies in femoral access. In addition, brachial artery access yields a high technical success rate and requires no additional injection of spasmolytic medication. Sheath size was the single significant predictor for complications.