The brachial artery: A critical access for endovascular procedures
The brachial artery: A critical access for endovascular procedures
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DOI：
10.1016/j.jvs.2008.09.017
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发表时间：
2009-02-01
影响因子：
4.3
通讯作者：
Kashyap, Vikram S.
中科院分区：
文献类型：
--
作者：
Alvarez-Tostado, Javier A.;Moise, Mireille A.;Kashyap, Vikram S.
目的：肱动脉是冠状动脉造影的常用部位。然而，关于主动脉和外周血管介入的肱动脉入路的数据有限。本研究评价了我们在诊断性动脉造影和血管内介入中应用肱动脉导管插入术的经验。在2004年8月至2005年8月期间，进行了2026例血管内手术。其中，289例患者中的323例（16%）需要肱动脉入路，这构成了本研究的基础。接受多次介入但采用单一通路（即溶栓）的患者被视为单一病例。人口统计学和临床数据记录在一个数据库中，并使用Logistic回归分析与广义估计方程和Fisher精确检验的名义variable.Results：所有患者的平均年龄为66.4岁，57%的男性。27%的患者使用肱动脉通路进行诊断，73%的患者使用肱动脉通路进行介入治疗，包括血管成形术、支架植入术和溶栓。40%的患者认为必须使用肱动脉入路，19%的患者认为必须使用肱动脉入路（即腹主动脉瘤和胸主动脉瘤的腔内修复术），41%的患者认为优先于股动脉入路。在91%的患者中，肱动脉是经皮进入的，9%的患者接受了手术切开进入。在肱动脉经皮穿刺的患者中，除1例（99.6%的技术成功率）外，其余均实现了穿刺。89%的患者在插管后通过手动压迫止血。手术死亡率为6.2%，与肱动脉入路无关。21例患者（6.5%）发生了肱动脉穿刺部位相关并发症。这21例患者中有13例（62%）需要手术矫正，主要是肱动脉血栓形成或假性动脉瘤。发生并发症的患者更常见于女性（比值比[OR]，4.7; 95%置信区间[CI]，1.68-13.26; P = 0.003），并且具有较长的介入鞘管（OR，6.7; 95% CI，1.53-29.07; P= 0.012）。肱动脉并发症的风险与溶栓、手术类型、治疗的血管区域或肝素的使用无关。无上肢肢体或手指缺失。肱动脉入路对于复杂的血管内手术是必要的，并且可以在大多数患者中安全地实现。术后警惕是必要的，因为大多数并发症患者需要手术矫正。（I Vasc Surg 2009;49：378-85.）
Objective: The brachial artery is often used for coronary angiography. However, data on brachial access for aortic and peripheral interventions are limited. This study evaluated our experience with brachial artery catheterization for diagnostic arteriography and endovascular interventions.Methods. Between August 2004 and August 2005, 2026 endovascular procedures were performed. Of these, 323 cases (16%) in 289 patients required brachial artery access, forming the basis for this study. Patients who underwent multiple interventions, but with a single access (ie, thrombolysis), were considered a single case. Demographic and clinical data were recorded in a database and analyzed using logistic regression analyses with generalized estimating equations and the Fisher exact test for nominal variables.Results: The mean age of all patients was 66.4 years, with 57% men. Brachial access was used for diagnostic purposes in 27% and for interventions including angioplasty, stenting, and thrombolysis in 73%. The use of brachial access was considered obligatory in 40%, adjunctive in 19% (ie, endovascular repair of abdominal aortic and thoracic aortic aneurysms) and preferential to femoral access in 41%. In 91% of patients, the brachial arteries were accessed percutaneously, and 9% underwent surgical cutdown for access. In patients whose brachial artery was approached percutaneously, access was achieved in all but one (99.6% technical success rate). Hemostasis after catheterization was achieved by manual compression in 89%. Operative mortality rate was 6.2% and not related to brachial artery access. Brachial access site-related complications occurred in 21 patients (6.5%). Thirteen of these 21 patients (62%) required a surgical correction, mostly for brachial artery thrombosis or pseudoaneurysm. Patients with complications were more commonly women (odds ratio [OR], 4.7; 95% confidence interval [CI], 1.68-13.26; P =.003) and had a long interventional sheath (OR, 6.7; 95% CI, 1.53-29.07; P=.012). The risk of a brachial artery complication was not associated with thrombolysis, procedure type, vascular territory treated, or the use of heparin. No upper extremity limb or finger loss occurred.Conclusions. Brachial artery access is necessary for complex endovascular procedures and can be achieved in most patients safety. Postprocedural vigilance is warranted because most patients with complications will require operative correction. (I Vasc Surg 2009;49:378-85.)