肱动脉入路在腔内治疗中的应用及穿刺并发症分析

Brachial Artery Approach in Endovascular Treatment and Puncture-related Complications

目的探讨经肱动脉入路行动脉造影和动脉成形的适应证、并发症及其预防措施,以提高腔内治疗的成功率,降低肱动脉穿刺并发症发生率。方法回顾分析2007年1月～2011年12月采用Seldinger技术通过肱动脉穿刺行动脉造影及动脉成形86例106例次的临床资料。分析肱动脉入路的适应证、穿刺并发症及其形成原因、预防措施。结果通过肱动脉入路行动脉造影的成功率为100%(56/56),动脉成形的成功率为84.0%(42/50)。并发症发生率2.8%(3/106),为局部血肿(2例)和假性动脉瘤(1例)。结论肱动脉入路的适应证包括:股动脉无法穿刺,股动脉入路影响力量的传导,股动脉入路无法提供靶血管的受力点,锁骨下动脉开口的定位。本组肱动脉穿刺的并发症为血肿和假性动脉瘤。规范的穿刺及压迫止血技术、充分认识肱动脉解剖学特点可以减少肱动脉穿刺的并发症。

Objective To explore the indications of brachial artery approach in endovascular treatment and to analyze its complications and prevention, so that to increase the success rate of endovascular treatment and decrease the rate of brachial artery puncture related complications. Methods From January 2007 to December 2011, with the Seldinger technique, we performed 106 cases of angiography and angioplasty via the brachial artery approach, on 86 patients. The indications of the brachial arterial approach, and the causes and prevention of puncture-related complications were analyzed. Results Via the brachial artery approach, the success rate of angiography was 100% （56/56） , and that of angioplasty was 84.0% （42/50）. The rate of complications was 2.8% （3/106）, including hematomas in 2 cases and pseudoaneurysm in 1 case. Conclusions The indications for the brachial artery approach include： first, contraindication for groin femoral artery puncture; second, femoral artery approach is not good for transmitting strength; third, lack of ＂ working point＂ on the target artery by femoral artery approach; fourth, location of the subclavian artery opening. Hematoma and pseudoaneurysm are the main complications of brachial artery puncture. Standard skills of puncture and press, and fully understanding the anatomical characteristics of the brachial artery are important for avoiding the complications of brachial artery puncture.