一种穿刺置管新方法在ECMO联合IABP介入治疗复杂高危冠心病中的应用

A clinical study of a novel approach of puncture catheterization in extracorporeal membrane oxygenation combined with intra-aortic balloon counter pulsation assisted percutaneous coronary intervention in treatment of complex and high-risk coronary heart disease

目的评估应用同侧股动脉置入主动脉内球囊反搏(IABP)和大直径经皮冠状动脉介入(PCI)治疗指引导管,联合对侧股动脉与股静脉用于置入体外膜肺氧合(ECMO)的穿刺策略,观察该置管方式对于复杂高危冠心病患者(CHIP)完成PCI手术的安全性和可行性。方法共纳入7例患者,左侧股动脉与股静脉置入ECMO鞘管(动脉置管直径15F,静脉置管直径17F),右侧股浅动脉置入IABP(均为7F动脉鞘管),右侧股总动脉置入PCI股动脉鞘管(均为7F动脉鞘管),ECMO动脉及静脉穿刺处采用预置ProGlide血管缝合器止血,PCI和IABP股动脉穿刺处应用Angioseal血管封堵器止血。术后针对股动脉、股静脉穿刺部位进行临床症状与体征评估,并全部进行血管超声检查,观察该穿刺置管的成功率以及完成PCI手术的可行性,观察住院期间穿刺部位相关的并发症发生率。结果7例患者中,男性6例,女性1例,年龄(57±12)岁,合并高血压5例(71%)、糖尿病3例(43%)、慢性肾病1例(14%)、高脂血症4例(57%)、卒中1例(14%)、外周血管疾病4例(57%)。双侧股动脉,左侧股静脉穿刺成功率100%,PCI手术完成率100%。仅一例患者术后超声检查发现股浅动脉穿刺部位发生皮下小血肿,所有患者住院期间均未观察到严重血管并发症。结论在CHIP患者中,当需要ECMO联合IABP维持血流动力学稳定,并需要穿刺股动脉置入大直径指引导管完成复杂PCI手术的情况下,可采用同侧股浅动脉置入IABP,股总动脉置入大直径(7F)PCI动脉鞘管,对侧股动脉、股静脉置入ECMO的手术穿刺策略,该方法安全可行。

AIM To evaluate the safety and feasibility of a novel puncture strategy for complex high-risk coronary intervention using an intra-aortic balloon counter pulsation(IABP)and large-diameter percutaneous coronary intervention(PCI)guiding catheter placed in the ipsilateral femoral artery and the extracorporeal membrane pulmonary oxygenation(ECMO)placed contralateral femoral artery and vein.METHODS This was a retrospective study.A total of 7 patients were enrolled,in whom the left femoral artery and femoral vein were used to cannulate by ECMO(arterial cannulation 15F diameter and venous cannulation 17F diameter),the right superficial femoral artery was used to cannulate by IABP(7F arterial sheath)and the right common femoral artery was used to cannulate by PCI femoral sheath(7F arterial sheath).The hemostasis at arterial and venous puncture sites of ECMO was performed by preplaced ProGlide vascular suture.Angioseal vascular blocker was used to stop the bleeding at the PCI and IABP femoral artery punctures.All puncture sites were evaluated by ultrasound to observe the success rate of puncture sites,complication rates and the feasibility of completing PCI.RESULTS Among the 7 patients,6 were male and 1 was female,with a mean age of 57±12 years,combined with hypertension in 5 cases(71%),diabetes mellitus in 3 cases(43%),chronic kidney disease in 1 case(14%),hyperlipidemia in 4 cases(57%),stroke in 1 case(14%)and peripheral vascular disease in 4 cases(57%).The results showed 100%success rate of left femoral vein and bilateral femoral arteries puncture,and 100%completion rate of PCI procedures.Only one patient had a small subcutaneous hematoma,less than 2cm in diameter.No serious vascular complications were observed during hospitalization in all patients.CONCLUSION In patients with complex and high-risk coronary heart disease,when ECMO combined with IABP is required to maintain hemodynamic stability and a largediameter guiding catheter is needed to puncture the femoral artery to complete a complex PCI procedure,a surgical puncture strategy of ipsilateral superficial femoral artery placement of IABP,common femoral artery placement of a large-diameter(7F)PCI arterial sheath,and contralateral femoral artery and femoral vein placement of ECMO can be used,and this protocol is safe and feasible.