经股动脉桡动脉介入性诊疗并发症及术后舒适度的比较

目的:评价经股动脉桡动脉行介入性诊疗的并发症及术后舒适度.方法:将本院2009年9月-2010年7月完成的680例冠状动脉介入诊疗患者分为经经桡/尺动脉(380例)和股动脉途径组(300例),比较两组患者的并发症技术后患者的舒适度情况.结果:所有患者均成功完成冠状动脉诊疗,股动脉径路组在穿刺处血肿发生率7.0%,明显高于挠/尺动脉组0.79%,P<0.01;因尿潴留需要导尿股动脉组发生率16.3%,明显高于桡/尺动脉组0.026,P<0.01;桡/尺动脉途径术后病人护理简单,并发症较少,病人的舒适度明显高于股动脉途径组,使用镇痛剂股动脉组发生率17.3%,明显高于桡/尺动脉组0.78%,P<0.01.结论:经挠/尺动脉动脉途径进行诊疗并发症少,术后护理简单,病人舒适度增加,是冠状动脉介入性诊疗的良好途径.     

经桡动脉冠状动脉造影术围术期的综合护理

目的探讨综合护理在经桡动脉冠状动脉造影术围术期中的应用效果。方法回顾性分析96例于西平县人民医院行经桡动脉冠状动脉造影术患者的临床资料。术前加强心理护理及做好术前准备,术中密切配合、预防桡动脉痉挛,术后加强穿刺口及并发症的观察等围术期综合护理措施。结果本组96例患者均一次置管及造影成功,顺利完成手术。术后4例出现穿刺部位皮下血肿,经对症处理后均消失。术中及术后未发生心室颤动、冠脉穿孔、穿刺口感染、静脉回流障碍、动脉闭塞等其他并发症。结论术前做好心理护理及各项准备工作,术中密切配合、预防桡动脉痉挛,术后加强穿刺口及术侧肢体的观察和护理。能提高经桡动脉冠脉造影术的成功率,减少术后并发症风险。     

经桡动脉介入诊疗后局部压迫方法的选择

目的探讨经桡动脉介入诊疗后适宜的局部压迫方法,以预防或减轻穿刺局部出血。方法将156例经桡动脉行冠状动脉介入诊疗的术后患者按随机数字表法分为观察组（80例）和对照组（76例）。对照组介入术后用3块无菌纱布条按压穿刺点,再以普通弹力绷带加压固定;观察组介入术后用1块无菌纱布覆盖穿刺点,在穿刺点上方沿血管方向放置小纸筒。再以优格弹力绷带加压固定．松紧以穿刺点不出血为宜。结果观察组桡动脉穿刺局部淤血及肢体肿胀发生率显著低于对照组（均P〈0．05）。结论经桡动脉途径进行冠状动脉介入诊疗后在1块小纱布上加小纸筒压迫局部,再予优格弹力绷带加压固定,效果确实、止血简便。护理人员加强术前护患沟通、术后手部血液循环及穿刺点的观察和护理．对于保障止血措施的成功起着重要作用。     

老年冠心病患者经桡动脉与股动脉行冠状动脉造影效果比较

目的 比较经桡动脉与股动脉穿刺行冠状动脉造影患者术后护理的优缺点,为针对性护理提供依据.方法 119例老年冠心病患者中57例经桡动脉途径置管(桡动脉组)、62例经股动脉途径置管(股动脉组),比较两组一次置管成功率、肢体制动时间、术后患者主诉、并发症发生率及住院时间.结果 肢体制动时间、患者主诉、局部血肿发生率及住院时间,桡动脉组显著优于股动脉组(均P＜0.01);两组一次置管成功率比较,差异无显著性意义(P＞0.05).结论 经桡动脉与股动脉穿刺均安全、有效、可行;桡动脉组术后治疗性损害相对较轻,更适合老年患者.     

老年冠心病患者经桡动脉与股动脉行冠状动脉造影效果比较

目的 比较经桡动脉与股动脉穿刺行冠状动脉造影患者术后护理的优缺点，为针对性护理提供依据。方法 119例老年冠心病患者中57例经桡动脉途径置管（桡动脉组）、62例经股动脉途径置管（股动脉组），比较两组一次置管成功率、肢体制动时间、术后患者主诉、并发症发生率及住院时间。结果 肢体制动时间、患者主诉、局部血肿发生率及住院时间，桡动脉组显著优于股动脉组（均P〈0．01）；两组一次置管成功率比较。差异无显著性意义（P〉0．05）。结论 经桡动脉与股动脉穿刺均安全、有效、可行；桡动脉组术后治疗性损害相对较轻，更适合老年患者。     

经桡动脉介入诊疗后局部压迫方法的选择

目的 探讨经桡动脉介入诊疗后适宜的局部压迫方法 ,以预防或减轻穿刺局部出血.方法 将156例经桡动脉行冠状动脉介入诊疗的术后患者按随机数字表法分为观察组(80例)和对照组(76例),对照组介入术后用3块无菌纱布条按压穿刺点,再以普通弹力绷带加压固定;观察组介入术后用1块无菌纱布覆盖穿刺点,在穿刺点上方沿血管方向放置小纸筒,再以优格弹力绷带加压固定,松紧以穿刺点不出血为宜,结果 观察组桡动脉穿刺局部淤血及肢体肿胀发生率显著低于对照组(均P<0.05).结论 经挠动脉途径进行冠状动脉介入诊疗后在1块小纱布上加小纸筒压迫局部,再予优格弹力绷带加压固定,效果确实、止血简便.护理人员加强术前护患沟通、术后手部血液循环及穿刺点的观察和护理,对于保障止血措施的成功起着重要作用.     

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。     

实施护理专案降低经桡动脉路径心脏介入术后穿刺部位并发症发生率

目的探讨降低心内科经桡动脉路径心脏介入术后穿刺部位并发症发生率的护理方法。方法调查分析2015年5~6月126例心内科经桡动脉路径心脏介入术患者穿刺部位并发症发生情况,建立护理专案小组,开展"降低经桡动脉路径心脏介入术后穿刺部位并发症发生率"的护理专案改善活动,对2015年11~12月145例心内科经桡动脉路径心脏介入术患者进行穿刺部位质控管理,比较专案活动实施前后患者介入术后穿刺部位并发症发生率。结果经桡动脉路径心脏介入术后穿刺部位并发症发生率由专案改善活动前的26.2%降至8.3%,活动前后比较,差异有统计学意义(P0.01)。结论通过实施护理专案,可降低经桡动脉路径心脏介入术后穿刺部位并发症发生率。     

经桡动脉冠心病介入治疗的护理

目的:评价34例经桡动脉冠心痛介入诊疗的优势,将更广泛的运用于临床.方法:通过做好术前患者的评估与准备、心理干预;术中默契配合医生,保障桡动脉穿刺、置管、手术及拔管等各项操作顺利进行;术后24小时严密观察生命体征、病情、伤口、手部及术肢,有效促进了患者的术后康复.结论:只要规范化操作,经挠动脉介入治疗是一种安全、有效的介入治疗方法.     

Lateral approach to the popliteal artery

A lateral approach to the popliteal artery is described. The anatomic limits of the exposure, appropriate technical maneuvers to maximize this exposure, and alternative procedures are discussed. Groin or thigh infections in patients requiring urgent revascularization are the most common indications. However, some traumatic injuries and certain elective reconstructions are appropriately treated with this technique. The lateral exposure to the popliteal artery is not technically demanding and offers a useful alternative for treatment of selected vascular problems.     

Medial approach for popliteal artery injuries

Objective： To evaluate the clinical application of the medial approach for repairing popliteal artery injuries. Methods： From 2002 to 2008, 11 cases ofpopliteal artery injuries had been repaired via the medial approach. Of these cases, 8 had limb fractures, 1 had knee dislocation, and 2 had visceral injuries. Ten popliteal arteries were anastomosed directly while one was repaired with a great saphenous vein graft. Results： The operation time ranged from 3 to 4 hours （averaging 3.6 hours）. All the injured limbs survived. At the follow up, 8 legs recovered the full function, 2 had minor contracture, and 1 serious Volkmann＇s contracture without amputation. Conclusion： The medial approach for repair of the popliteal artery is effective, applicable, and more advantageous to the management of multi-injures.     

Lateral approach to the popliteal artery

Techniques for exposure of the popliteal artery via lateral approaches above and below the knee are described. These techniques were used successfully in 21 patients who required secondary arterial reconstructions in the presence of extensive scarring, infection, or both in the standard medial access routes.     

Endoscopic approach for carotid artery surgery

Background: Although recent advances in the treatment of carotid artery stenosis have included endovascular angioplasty and stent placement, carotid endarterectomy is still the approach of choice for carotid disease and is one of the most commonly performed operations today. Minimally invasive surgeries involving the neck have recently been performed for thyroid and parathyroid diseases. The purpose of this study was to evaluate the feasibility of an endoscopic approach for carotid artery surgery in a large animal model. Methods: Eight 25- to 30-kg pigs were used. Animals underwent endoscopic carotid dissection with carbon dioxide insufflation at 10 mmHg. A 1.5- to 2-cm arteriotomy was made in the common carotid artery. Four animals underwent direct arteriotomy closure, and four animals underwent synthetic patch graft placement using intracorporeal suturing techniques. Open examination of the operative site and carotid angiograms were performed at the end of the procedure. Operative time was recorded in the last four cases. Results: All animals tolerated the procedure well and carotid artery repair was successfully performed in all cases using a four-trocar technique. The entire extent of the cervical common and internal carotid arteries was exposed up to the cranial base. Cranial nerves and cervical structures were clearly visualized and preserved. No bleeding occurred at the end of the procedure. Carotid angiograms confirmed patent, nonstenotic vessels in all cases. Conclusion: Endoscopic approach for carotid surgery is technically feasible in the porcine model. This approach may represent a valuable option for surgery of the carotid artery since it offers the advantages of minimally invasive techniques while maintaining the benefits of surgical arterial repair.     

Posterior approach to the deep femoral artery

Unusual surgical approaches to the deep femoral artery are valuable when the standard anterior approach is difficult because of scarring or infection. A posterior approach to the deep femoral artery in patients, in whom all other approaches were unsuitable, is described.     

Peroneal-plantar artery bypass: a prone approach

The potential space behind the distal tibia and ventral to the Achilles' tendon provides a route for bypass grafts to the plantar artery. Grafts may follow the communicating branch of the distal peroneal artery to reach the medial aspect of the foot. A prone approach for distal bypasses from the peroneal artery may facilitate exposure, conserve scarce venous conduit, and avoid scarred or infected sites. This peroneal-plantar bypass route has not been described previously. This technique was successfully used in a patient with diabetes mellitus, recurrent foot ischemia, infection, and limited venous conduit after a failed femorotibial bypass.