不同入路方式经皮冠状动脉介入治疗后周围血管并发症的发生情况

Occurrence of peripheral vascular complication after percutaneous coronary intervention with different approaches

目的探讨不同入路方式经皮冠状动脉介入治疗(PCI)后周围血管并发症的发生情况。方法收集2021年6月至2022年6月于兰州大学第一医院接受PCI后发生周围血管并发症的124例患者的临床资料,根据手术入路方式的不同将其分为股动脉组(n=51)和桡动脉组(n=73)。比较两组患者的手术相关指标及术后周围血管并发症发生情况。结果2021年6月至2022年6月共2673例患者接受PCI,股动脉入路429例,桡动脉入路2244例,PCI术后发生周围血管并发症发生率为4.6%(124/2673),其中,股动脉入路为11.9%(51/429),桡动脉入路为3.3%(73/2244)。两组患者冠心病分型、就诊情况、手术时间、手术方式、慢性完全闭塞比例比较,差异均无统计学意义(P>0.05)。股动脉组患者出血、穿刺部位动脉狭窄/闭塞比例均低于桡动脉组患者,差异均有统计学意义(P<0.05)。两组患者少见并发症发生率比较,差异无统计学意义(P>0.05)。结论不同入路方式PCI治疗后周围血管并发症发生率较低,股动脉入路并发症中出血和穿刺部位动脉狭窄/闭塞所占的比例高于桡动脉入路,但股动脉入路还可能出现特有的后腹膜血肿和动静脉瘘,在临床实践中应注意区别对待。

Objective To investigate the occurrence of peripheral vascular complication after percutaneous coronary intervention(PCI).Method The clinical data of 124 patients with peripheral vascular complications after PCI in the First Hospital of Lanzhou University from June 2021 to June 2022 were collected.They were divided into femoral artery group(n=51)and radial artery group(n=73)according to different surgical approaches.The operation-related indicators and postoperative peripheral vascular complications were compared between the two groups.Result From June 2021 to June 2022,a total of 2673 patients underwent PCI,including 429 cases of femoral artery access and 2244 cases of radial artery approach.The incidence of peripheral vascular complications after PCI was 4.6%(124/2673),of which 11.9%(51/429)were for femoral artery access and 3.3%(73/2244)for radial artery access.There were no significant differenced between the two groups in coronary heart disease classification,medical consultation,operation time,operation method,and proportion of chronic total occlusion(P>0.05).The proportion of bleeding and arterial stenosis/occlusion at the puncture site in the femoral artery group were lower than those in the radial artery group,the differences were statistically significant(P<0.05).There was no significant difference in the incidence of rare complications between the two groups(P>0.05).Conclusion The incidence of peripheral vascular complication after PCI treatment with different approaches is relatively low.The proportion of bleeding and arterial stenosis/occlusion at the puncture site in the complications of the femoral artery approach is higher than that of the radial artery approach.However,the femoral artery approach may also result in unique retroperitoneal hematoma and arteriovenous fistula,which should be treated differently in clinical practice.