Management of Vascular Access in Transcatheter Aortic Valve Replacement Part 2: Vascular Complications
Management of Vascular Access in Transcatheter Aortic Valve Replacement Part 2: Vascular Complications
复制标题
DOI：
10.1016/j.jcin.2013.05.004
复制
发表时间：
2013-08-01
影响因子：
11.3
通讯作者：
Webb, John G.
中科院分区：
文献类型：
--
作者：
Toggweiler, Stefan;Leipsic, Jonathon;Webb, John G.
介入心脏病专家必须能够识别和处理潜在的血管并发症。髂股并发症是经股经导管主动脉瓣植入术中最常见的血管并发症。小血管尺寸，中度或重度钙化和中心经验是主要的预测因素。动脉损伤的传统治疗方法是手术重建，但血管内技术可以使动脉损伤的治疗侵入性更小，但效果更好。夹层可以通过延长球囊膨胀或部署自膨胀或球囊可膨胀支架或手术移植物来治疗。髂股破裂是一种严重的并发症，可能导致腹膜后出血，而这种出血是无法识别的。快速插入扩张器或鞘或闭塞球囊以达到止血的目的。然后应考虑延长球囊膨胀或植入覆盖支架或手术修复。经皮闭合失败的治疗选择包括长时间的人工压迫、球囊血管成形术、支架植入和手术。主动脉并发症是罕见的，但严重的并发症与高死亡率相关，即使进行紧急手术。有一些特殊的血管并发症与其他通路相关，如经根尖、经腋窝和直接主动脉通道。(C) 2013年由美国心脏病学会基金会发布
The interventional cardiologist must be able to recognize and manage potential vascular complications. Iliofemoral complications are the most frequent vascular complications in transfemoral transcatheter aortic valve implantation. Small vessel dimensions, moderate or severe calcification, and center experience are the major predictors. The traditional treatment for injured arteries has been surgical reconstruction, but endovascular techniques may allow for less invasive but effective management of arterial injuries. Dissection may be treated with prolonged balloon inflation or deployment of a self-expanding or balloon-expandable stent or a surgical graft. Iliofemoral rupture is a serious complication that may lead to retroperitoneal bleeding that can be unrecognized. Rapid insertion of a dilator or sheath or an occlusive balloon is used to achieve hemostasis. Prolonged balloon inflation or implantation of a covered stent or surgical repair should then be considered. Treatment options for failed percutaneous closure include prolonged manual compression, balloon angioplasty, stent implantation, and surgery. Aortic complications are rare, but serious complications are associated with a high mortality rate, even if emergent surgery is performed. There are specific vascular complications associated with alternative access routes such as transapical and transaxillary and direct aortic access. (C) 2013 by the American College of Cardiology Foundation