导丝抓捕技术在急性肱动脉损伤介入治疗中的应用

Application of guidewire capture technique for interventional treatment of acute brachial artery injury

目的探讨导丝抓捕技术在急性肱动脉损伤介入治疗中的应用价值。方法 2008年1月至2016年10月间解放军第148医院经股动脉脉插管失败的15例急性肱动脉损伤患者,在经股动脉入路行患侧肱动脉插管失败的情况下,采用患侧桡动脉穿刺成功后,将导丝插入肱动脉损伤段,从股动脉引入圈套器,运用导丝抓捕技术将导丝拉出体外建立股桡动脉通道,然后行球囊扩张及支架植入术。结果 15例患者均采用导丝抓捕技术获得成功,共植入20枚支架(10例植入1枚,5例植入2枚),术中肱动脉血流恢复。15例随访时间6~36个月(中位随访时间18个月)。14例支架内血流通畅或支架腔内狭窄小于30%未予介入干预,1例患者支架腔内狭窄超过50%再次给予球囊扩张治疗,造影显示血流恢复通畅。随访期间无支架移位、内漏、断裂,无截肢现象发生。结论导丝抓捕技术可提高急性肱动脉损伤介入治疗成功率。

Objective To assess the value of guidewire capture technique in interventional therapy of acute brachial artery injury.Methods A retrospective analysis was performed on15cases of acute brachial artery injury who failed the catheterization of the affected brachial artery via the femoral artery at No.148Hospital of Chinese People′s Liberation Army from January2008to October2016.A guide wire was inserted into the injured brachial artery after puncturing the radial artery of the affected side successfully.By using guidewire capture technique,a goose neck snare was introduced through the femoral artery,which was pulled out of the body to establish femoral-radial artery passage.Then,balloon dilatation and stent implantation were performed.Results The technique was successful in all the15patients.A total of20stents were deployed,with only one stent used in ten patients and two stents used in five patients.After stenting,the blood flow of the brachial artery was restored.The patients were followed for6-36months(median,18months).Stent patency or stent lumen stenosis<30%was achieved in14patients(without any interventional therapy);stent lumen stenosis>50%occurred in one patient,and he was treated by balloon dilation,after which the blood flow returned to normal rapidly.During the follow-up period,no stent displacement,leakage,or fracture occurred,and no amputation surgery was required.Conclusion Guidewire capture technique can significantly improve the treatment success rate in acute brachial artery injury.