经桡动脉穿刺全脑血管造影27例分析

目的探讨经桡动脉途径穿刺全脑血管造影的可行性、安全性及相关问题。方法选择27例无手术禁忌证的患者,在局麻下以桡动脉为穿刺点,采用Seldinger技术,在0.035英寸超滑导丝引导下,用4F SimmonsⅢ型导管,行全脑血管造影。结果27例患者中25例顺利完成手术,成功率92.6%,1例桡动脉穿刺失败者改穿同侧肱动脉成功完成手术。1例因严重的动脉硬化而血管过于纡曲,导管未能进入主动脉弓。无手部缺血、桡动脉搏动消失及其他严重并发症。结论经桡动脉进行全脑血管造影操作安全可行,成功率高、并发症少,对适宜病例可作为首选途径,值得推广应用。     

对比经远端桡动脉与肱动脉入路支架成形术治疗髂动脉慢性闭塞症的有效性及安全性

目的 对比经远端桡动脉入路与肱动脉入路支架成形术治疗髂动脉慢性闭塞症的有效性及安全性。方法 回顾性分析70例接受经左侧桡动脉远端入路（A组）与72例经左侧肱动脉入路（B组）支架成形术治疗髂动脉慢性闭塞症患者,其中B组18例因穿刺左侧桡动脉远端失败而改为穿刺左侧肱动脉;观察2种方法穿刺成功率、2组髂动脉开通成功率和穿刺并发症发生率。结果 穿刺桡动脉远端成功率为79.55%（70/88）,穿刺肱动脉成功率为100%（72/72）。髂动脉顺行开通成功率[78.57%（55/70）vs.80.56%（58/72）,<χ²=3.67,P=0.09]及总体开通成功率[94.29%（66/70）vs.95.83%（69/72）,χ²=2.34,P=0.10]组间差异均无统计学意义。A组穿刺并发症发生率低于B组[5.71%（4/70）vs.13.89%（10/72）,<χ²=3.24,P=0.02]。结论 相比经肱动脉入路,经远端桡动脉穿刺入路腔内支架成形术治疗髂动脉慢性闭塞症更为安全,而开通成功率相当。     

经桡动脉脑血管造影及术后血管封堵术对患者疗效分析

目的探究经桡动脉脑血管造影及术后血管封堵术对患者疗效。方法回顾性分析2018年12月至2020年12月在本院住院并行全脑血管造影术的患者260例的临床资料,对照组130例选择经股动脉途径,实验患者130例选择经桡动脉途径。观察手术相关指标,比较两组患者的穿刺成功率和选择性动脉造影技术成功率,比较两组患者的并发症的发生情况。结果两组患者手术相关指标的比较,穿刺时间、手术时间、曝光时间和止血时间对照组均高于实验组,差异具备统计学意义,P0.05。两组患者穿刺成功率和选择性动脉造影技术成功率的比较,两组患者均100%穿刺成功。选择性动脉造影技术成功率实验组高于对照组,差异具备统计学意义,P0.05。两组患者并发症比较,对照组并发症发生率13.1%,实验组并发症发生率2.3%,对照组高于实验组,差异具备统计学意义,P0.05。结论经桡动脉脑血管造影及术后血管封堵术效果更为操作更为简便,同时术后发病率也较低,血管造影成功率更高,值得临床推荐使用。     

冠状动脉造影和血管成形术诊治老年冠心病:经桡动脉与经股动脉途径对比

目的比较经桡动脉和经股动脉途径在冠状动脉造影和血管成形术中的优缺点,评价经桡动脉途径介入治疗老年冠心病的有效性与安全性。方法 60岁及以上冠心病或可疑冠心病患者1637例,按穿刺途径随机分为桡动脉组（n=909）和股动脉组（n=728）,比较两组间动脉穿刺成功时间、穿刺成功率、造影时间、X线曝光时间、经皮冠状动脉介入治疗（PCI）成功率、穿刺相关血管并发症、迷走反射发生率、平均住院时间及随访术后3个月主要心脏不良事件（MACE）发生情况。结果桡动脉组桡动脉穿刺成功897例（897/909,98.68%）,股动脉组股动脉穿刺成功722例（722/728,99.18%）。桡动脉组穿刺时间较股动脉组长（P〈0.05）。两组的穿刺成功率、PCI成功率,术后MACE等差异均无统计学意义（P〉0.05）。在造影时间、X线曝光时间、穿刺相关血管并发症、迷走反射发生率、平均住院时间等方面,桡动脉组明显低于股动脉组（P〈0.01）。结论经桡动脉途径行冠状动脉造影及PCI治疗老年冠心病安全可行,且易止血,术后无须卧床,并发症少,创伤小,可作为老年冠心病介入治疗的首选途径。     

经腹股沟结内淋巴管造影用于腹盆腔创伤性淋巴漏

目的 观察经腹股沟结内淋巴管造影用于腹盆腔创伤性淋巴漏患者的疗效及其安全性。方法 回顾性分析12例经保守治疗无效的腹盆腔创伤性淋巴漏患者,均接受经腹股沟结内淋巴管造影;记录临床表现、疗效及并发症。结果 12例共接受21次经腹股沟结内淋巴管造影,其中5例接受单次、6例接受2次、1例接受4次造影;造影技术成功率100%。造影后,12例中,7例（7/12,58.33%）治愈、5例（5/12,41.67%）无效。经腹股沟结内淋巴管造影并发症发生率为14.29%（3/21）,包括慢性腹泻2例次、穿刺点疼痛1例次;未见严重并发症。结论 经腹股沟结内淋巴管造影对腹盆腔创伤性淋巴漏具有一定治疗效果,且安全性较高。     

橡皮擦用于经桡动脉行冠状动脉介入术后穿刺点止血

经桡动脉行冠状动脉造影／介入治疗因并发症少、痛苦小而广泛应用于临床。因穿刺易损伤桡动脉,且术后使用抗凝药物,若穿刺点处理不当,穿刺部位易出现渗血、前臂血肿。给患者带来心理压力,影响治疗效果。2008年1～12月我科将橡皮擦用于566例经桡动脉行冠状动脉介入治疗患者,以预防穿刺部位出血,效果较好,介绍如下。     

经桡动脉和股动脉行冠状动脉造影 和支架植入术的对比分析

目的探讨经桡动脉和股动脉行冠状动脉介入的优缺点。方法回顾分析2004年6月到2005年6月在我院接受冠状动脉造影术和支架植入术的患者235例。按股动脉途径(125例)或桡动脉途径(110例)分为两组。比较两组造影使用的导管数、动脉穿刺成功率、X线照射时间,支架植入的手术操作时间、成功率、并发症发生率。结果①冠状动脉造影:经桡动脉、股动脉行冠状动脉造影血管穿刺成功率分别为94.5%、100%(P<0.05);X线照射时间分别为(3.35±1.25)min和(2.72±0.58)min(P<0.05);造影成功率分别为93.6%、100%(P<0.05)。②PTCA或支架植入:经桡动脉、股动脉植入单个支架的手术操作时间分别为(21.43±6.21)min、(15.24±4.15)min(P<0.05);成功率分别为92.7%、97.6%(P>0.05);血管并发症发生率分别为2.7%、11.2%(P<0.01)。结论①经桡动脉行冠状动脉造影及支架植入术不需卧床、损伤小、止血方便、血管并发症少,为其优点。②经桡动脉行冠状动脉介入要求术者有较高的技术水平,血管穿刺失败和桡动脉痉挛是影响造影和支架植入成功的重要原因,且推送导管过程中需持续透视,增加了术者和患者X线照射时间。③无论从桡动脉入路还是从股动脉入路都以手术成功为最终目的,选择何种路径当根据患者的具体情况确定。     

橡皮擦用于经桡动脉行冠状动脉介入术后穿刺点止血

经桡动脉行冠状动脉造影/介入治疗因并发症少、痛苦小而广泛应用于临床.因穿刺易损伤桡动脉,且术后使用抗凝药物,若穿刺点处理不当,穿刺部位易出现渗血、前臂血肿,给患者带来心理压力,影响治疗效果.     

伴脑动脉狭窄的症状性腔隙性脑梗死患者脑血管造影分析

目的分析伴脑供血动脉狭窄的症状性腔隙性脑梗死患者的全脑血管造影结果。方法选择经CT或MRI确诊的51例症状性腔隙性脑梗死患者,全部接受全脑血管造影检查,均存在脑供血动脉狭窄,观察统计病变血管的狭窄程度及闭塞血管的侧支代偿情况。结果全部患者均成功接受全脑血管造影,无严重并发症发生,狭窄程度：9例（17.65%）≤50%,12例（23.53%）50%～70%,14例（27.45%）71%～99%,16例（31.37%）闭塞。51例中,40例（78.43%）存在梗死相关病变血管。16例闭塞病例中,12例有侧支循环形成。结论对伴脑供血动脉狭窄的症状性腔隙性脑梗死患者行全脑血管造影具有较高的阳性率,梗死主要由前循环系统血管病变引起,观察血管病变程度及侧支代偿建立情况对疾病下一步治疗具有重要指导作用。     

经股动脉顺行入路与经桡动脉逆行入路介入治疗左锁骨下动脉闭塞

目的比较经股动脉顺行入路和经桡动脉逆行入路介入治疗左锁骨下动脉闭塞的有效性和安全性。方法回顾性分析2014年1月～2017年12月我院收治的72例左锁骨下动脉闭塞患者血管腔内治疗的效果,其中36例经股动脉顺行入路行介入治疗(股动脉组),36例经桡动脉逆行入路行介入治疗(桡动脉组)。结果股动脉组手术成功率、并发症发生率分别为83. 33%和16. 67%,桡动脉组分别为97. 22%和2. 78%。两组比较,桡动脉组手术成功率高于股动脉组,而手术并发症发生率显著低于股动脉组,差异均有统计学意义(P 0. 05)。结论经桡动脉逆行入路介入治疗左锁骨下动脉闭塞动脉开通效果好,并发症少,安全性高。     

经桡动脉行自体动静脉内瘘功能不良的介入治疗

目的探讨经桡动脉行自体动静脉瘘(AVF)腔内成形和(或)溶栓治疗的可行性。方法于因AVF狭窄或血栓闭塞而需行介入治疗的患者中,选取经桡动脉入路介入治疗的8例患者进行回顾性分析。结果首次造影证实6例患者为AVF重度狭窄,即刻行腔内球囊成形术,术后狭窄程度改善;对2例急性血栓形成患者行动脉内溶栓治疗,次日复查造影示血栓溶解,其中1例溶栓后造影显示吻合口附近静脉狭窄严重,行PTA治疗,另1例狭窄程度较轻者未进一步PTA治疗。对8例患者随访2~13个月,其中7例可正常行AVF透析,1例单纯PTA治疗患者2个月后再次行PTA治疗,4个月后因AVF功能不良而改行颈内静脉插管透析。结论经桡动脉行AVF功能不良的介入治疗有一定的可行性。     

Late massive radial artery pseudoaneurysm following cardiac catheterization: A case report

IntroductionTransradial artery approach for cardiac catheterization was first introduced in the late 1980s and has now become the approach of choice due to its anatomical advantage, reduction in complications, and overall improved patient experience.Case presentationWe present a case of a 77 year-old female who presented with an extremely rare and late complication of radial artery pseudoaneurysm after transradial coronary intervention. The patient presented at a post-procedural follow-up with severe pain at the radial access site and was found to have a partially thrombosed pseudoaneurysm. Given the anatomical variance of the pseudoaneurysm, the patient underwent successful open surgical repair.Clinical discussionAlthough radial artery access is a relatively safe approach in comparison to the transfemoral approach, the risk of adverse events still exists. Among the complications of the transradial approach, pseudoaneurysms are relatively rare, occurring in less than 0.1% of cases. Regardless, early identification of this complication is essential to timely intervention.ConclusionOur case highlights the importance of post procedural monitoring and early identification and diagnosis of the complication to facilitate appropriate therapy.     

Transradial cerebral angiography: an alternative route

INTRODUCTION: The transradial approach has been well described for arteriography of the coronary vessels. To assess the safety and success rate of the transradial approach for three-vessel or four-vessel diagnostic cerebral arteriography, we reviewed the experience at our institution and compared our complication rates with those found in the literature for transfemoral cerebral angiography and transradial coronary angiography. METHODS: We reviewed the electronic medical records of 129 consecutive patients in whom 132 cerebral angiographic studies were performed by use of a transradial approach between December 1999 and June 2001. A total of 54 selective catheterizations were performed, of which 39 were of the vertebral artery, 11 of the internal carotid artery, and 4 of the external carotid artery. Records were reviewed for periprocedural and delayed complications, indications for diagnostic angiography, and requirement of conversion to a femoral approach. Records were reviewed prospectively for the first 55 procedures and retrospectively for the next 77 procedures. RESULTS: The mean time to initial clinical follow-up was 1.5 months (median, 0.5 mo). The combined rate of periprocedural and delayed complications was 9%, and there were no major complications. Minor periprocedural complications included transient radial artery spasm (four patients), failure to access the brachial artery (two patients), severe pain (one patient), skin desquamation (one patient), and hematoma (one patient). There were no major complications. At the time of follow-up evaluation, these patients were without deficits related to cannulation of the radial artery. CONCLUSION: The transradial approach for cerebral angiography is a safe alternative to the transfemoral route. After transradial cerebral angiography, patients require a shorter observation period and are not restricted to bed rest. As technological developments generate smaller, more pliable endovascular surgical devices, future endovascular surgery may be performed transradially.     

Initial experience with transradial access for carotid artery stenting

We report our experience using transradial access (TRA) for carotid artery stenting (CAS). Eighty-eight patients underwent CAS using a nonfemoral approach, 79 of them by TRA. Carotid artery stenting was performed using standard techniques with a long hydrophilic sheath. Mean age was 69.5 years. A total of 46 patients were symptomatic and 34 were asymptomatic. Transradial access and procedural success were achieved in 98.8% and 96.6% of the cases, respectively. There were no deaths, myocardial infarction, or radial access site complications. In all, 2 patients sustained a stroke, 1 hemorrhage, and 1 ischemia. Carotid artery stenting using TRA was safe and technically feasible.     

Safety and efficacy of radial access in trauma in 65 trauma endovascular cases

ObjectiveEndovascular techniques in trauma surgery are becoming increasingly important in patient management, with procedures such as pelvic and splenic angioembolization becoming the standard of care for certain injuries. Traditionally, such interventions are performed via femoral access, although the morbidity of this approach is not insignificant (3%-10%). Transradial access (TRA) is an attractive alternative, pioneered by cardiologists, with low rates of access site complications in patients undergoing coronary intervention. Recently, this technology has extended to other interventions. The aim of this study was to present the initial experience of a radial program in a busy trauma center, with specific regard to safety and complications.MethodsThe medical records of trauma patients undergoing endovascular procedures via TRA between March 2018 and December 2018 were queried for procedural and postoperative data. Demography and injury characteristics were presented for the overall cohort, followed by a comparison of procedural data and complications between laterality. Continuous variables were compared using a two-tailed t-test and categorical variables were compared using a χ² test.ResultsOver a 9-month period, 65 patients underwent 81 interventions via TRA, most commonly solid organ or pelvic angiography/embolization. Radial artery access was achieved in all patients, with procedural success achieved in all but two patients (n = 63 [96.9%]) who had hypoplastic radial artery anatomy, who underwent ulnar access. The overall technique-related complication rate was 1.5% with no difference observed between laterality (n = 1; P = .523). One patient with an admission Glasgow Coma Score of 3 and coagulopathy developed radial artery thrombosis after pelvic angiography via right TRA. Mortality was seen in seven patients (10.8%) owing to hemorrhagic shock (n = 3 [42.8%]) or multiorgan failure (n = 4 [57.1%]). There were no cases of postprocedural access site bleeding, hematoma, pseudoaneurysm, vascular injury, intraoperative arrhythmia or cerebrovascular accident, arteriovenous fistula formation, or infection.ConclusionsTRA is a feasible and low-risk alternative for endovascular intervention in the trauma patient. It yields good technical success with low morbidity. Although larger studies are needed to establish the full efficacy of TRA at the multi-institutional level, this single-institution study demonstrates the legitimacy of an alternative means for endovascular intervention in the trauma patient.     

Intraoperative angiographic assessment of graft patency during extracranial-intracranial bypass procedures

The use of intraoperative angiography to monitor graft patency was retrospectively reviewed in extracranial-intracranial bypass procedures. Forty-two patients underwent 43 extracranial-intracranial bypass procedures with the use of intraoperative angiography. Superficial temporal artery (STA)-middle cerebral artery (MCA) bypass was performed in 41 patients (42 procedures) with ischemic cerebrovascular diseases, and vertebral artery-MCA bypass using radial artery graft for intentional ligation of the common carotid artery in one patient with nasopharyngeal carcinoma. Intraoperative angiography provided high-quality subtraction images in every case. There were no complications due to angiography. Graft occlusion was observed intraoperatively in three cases, but an additional procedure reopened the occluded graft in all three cases. Graft patency rate was 100% after surgery. Outcome was excellent in 40 patients and good in one patient who underwent STA-MCA bypass. Intraoperative angiography provides useful information regarding graft patency during bypass surgery. Intraoperative assessment prior to wound closure allows for the recognition and correction of technical failure and decreases the risk of postoperative complications.     

CT灌注成像早期诊断犬急性脑梗死的实验研究

目的探讨CT灌注成像技术(CTP)对脑梗死超急性期诊断的应用价值。方法成年比格犬10只,介入技术建立犬急性脑栓塞动物模型,分别在栓塞前及栓塞后2 h行脑血管造影,观察所栓塞血管的血流情况,同时在栓塞后2 h行CT平扫及CTP检查。24 h处死动物后取脑组织进行病理检查。结果10只犬全部成功栓塞左侧大脑中动脉,其中4只合并其他脑血管栓塞,至栓塞后2 h造影所有被栓血管没有发生再通。CT平扫没有发现明确异常,CTP检查显示9只局部脑血流量减少为对侧的33.7%~69.2%(平均0.483±0.132),1只无明显的变化,与数字减影血管造影诊断比较没有明显的统计学差异(P>0.05)。24 h后动物均存活,没有出现严重并发症,病理检查证实在深部脑组织皆出现脑梗死病灶。结论CTP检查可快速、准确、无创地评价犬急性局部脑梗死动物模型的脑血流动力学变化。     

经皮冠状动脉介入治疗术中桡动脉穿孔的危险因素与处置策略

目的探讨经皮冠状动脉介入治疗(PCI)术中桡动脉穿孔的危险因素及处置策略。方法回顾分析经桡动脉PCI术中桡动脉穿孔的16例患者,记录术中桡动脉造影情况、桡动脉穿孔原因、导致穿孔的器械、处理方法和术后恢复情况等,通过定义桡动脉穿孔分型指导处置策略。结果 16例患者中桡动脉穿孔的原因包括,桡动脉解剖学变异为12例,桡动脉痉挛2例,超滑导丝穿出2例。其中7例Ⅰ型桡动脉穿孔均未行特殊处理,其余9例患者均接受加压包扎,前臂血肿张力较大的患者进行穿刺减压。术后随访4例患者出现桡动脉闭塞。结论桡动脉穿孔是经桡动脉PCI的少见并发症,可能会导致严重后果,及时行桡动脉造影,早期识别桡动脉穿孔并及时给予治疗,是有效预防前臂严重血肿、骨筋膜室综合征甚至于急性手缺血的关键。