股动静脉解剖位置关系与超声指导下股静脉穿刺技术的临床应用

Anatomical relationship of femoral artery and femoral vein and clinical application of ultrasound-guided femoral vein puncture technique

目的探讨双侧股动脉与股静脉解剖位置变异特征和采用超声指导进行股静脉穿刺技术的临床应用。方法回顾性分析2023年1~2月连续接受心内电生理检查与导管消融治疗患者的临床资料、血管超声资料、介入手术资料和术后随访资料。根据股静脉与股动脉解剖学位置关系分为4种类型(Ⅰ型、Ⅱ型、Ⅲ型和Ⅳ型),将穿刺针进针方向分为3种类型(A型正方位、B型侧方位、C型反方位)。结果149例患者纳入研究。在腹股沟高位,大多数(87.6%)股静脉与股静脉呈Ⅱ型,其次是Ⅰ型(11.1%),极少部分是Ⅲ型(1.0%)和Ⅳ型(0.3%),左侧与右侧没有明显差异(P=0.17)。但在腹股沟区低位,虽然Ⅱ型仍占大部分(57.1%),但是Ⅲ型(34.9%)和Ⅳ型(8.1%)比例明显升高,而且左侧与右侧存在明显差异(P=0.027)。根据超声定位结果,部分(21.7%,64例)患者采用A型(即经典的方法)进针穿刺,但大多数(50.5%,149例)患者需要采用B型进针穿刺,少数(7.5%,22例)患者需要采用C型进针方向完成股静脉穿刺。左侧与右侧无明显差异。血管穿刺并发症发生率仅为0.7%。结论股动静脉解剖位置毗邻关系的变异性较大,采用超声指导下股静脉穿刺技术的并发症率极低。

Objective:To investigate the characteristics of the anatomical variation of the bilateral femoral artery and femoral vein and the clinical application of the femoral vein puncture technique guided by ultrasound.Methods The clinical data,vascular ultrasound data,interventional procedure data,and postoperative follow-up data of consecutive patients who underwent intracardiac electrophysiological examination and catheter ablation treatment at Fu Wai Hospital from January to February 2023 were retrospectively analyzed.The femoral vein was classified into 4 types(type Ⅰ,type Ⅱ,type Ⅲ,and type Ⅳ)according to the anatomical relationship between the femoral vein and the femoral artery,and the direction of puncture needle insertion was classified into 3 types(type A positive orientation insertion,type B lateral orientation insertion,and type C reverse orientation insertion).Results One hundred and forty-nine patients were included in the study.At the high inguinal level,type Ⅱ was the majority(87.6%),followed by type Ⅰ(11.1%),and very few were type Ⅲ(1.0%)and type Ⅳ(0.3%),with no significant difference between the left and right sides(P=0.17).However,in the low groin area,although type Ⅱ still accounted for the majority(57.1%),the proportion of type Ⅲ(34.9%)and type Ⅳ(8.1%)was significantly higher,and with a significant difference between the left and the right side(P=0.027).According to the ultrasound findings,some(21.7%/64 patients)patients were punctured with the type A(i.e.E.classical method)approach,but most(50.5%/149 patients)required type B approach puncture,and a few(7.5%/22 patients)required type C approach direction to complete the femoral vein puncture.No significant difference was found between the left and right approaches.The incidence of vascular puncture complicationswas 0.7%.Conclusion Femoral artery and vein anatomical location are highly variable,and the complication rate of femoral venipuncture technique guided by ultrasound is extremely low.