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首页> 外文期刊>Vascular and endovascular surgery >Arterial injuries from femoral artery cannulation with port access cardiac surgery.
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Arterial injuries from femoral artery cannulation with port access cardiac surgery.

机译：股动脉插管并经心脏入路手术引起的动脉损伤。

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Although minimally invasive (MI) cardiac surgery reduces blood loss, hospital stay, and recovery time, some MI approaches require femoral arterial cannulation, which introduces a heretofore unknown risk of femoral arterial injury. This study was performed to examine the risk of femoral arterial injury after Port Access MI cardiac surgery (PA-MICS) with femoral cannulation. Data were prospectively obtained on 739 consecutive patients who had PA-MICS with femoral cannulation between June 1996 and April 2000, identifying any patient with new (<30 days postoperative) arterial insufficiency from the cannulation site. Patient characteristics (gender, age, height, weight, body surface area, smoking, peripheral vascular disease, diabetes) and operative variables (cannula size, cross-clamp time) were examined with univariate and multivariate analysis to identify risk factors for arterial injury. Injuries were defined and classified by radiologic and intraoperative assessment, and follow-up was obtained by patient examination and from the medical records. Femoral arterial occlusion (FAC) occurred in 0.68% (5/739) of patients (4 women, 1 man; age range 26-74 years). The risk of femoral injury was higher in women: 1.31% vs 0.23% (p = 0.07). One patient had intraoperative limb ischemia from iliofemoral dissection and was treated by axillopopliteal bypass. Four patients presented postoperatively with claudication. Three of these had iliofemoral arterial occlusion or localized iliofemoral dissection and were treated with iliofemoral bypass, and 1 patient had localized femoral artery stenosis treated by angioplasty. With a mean follow-up of 17.8 months (range 13-26 months) limb salvage was achieved in all patients. Secondary or tertiary interventions were required in 40% (2/5), both in patients with iliofemoral occlusion, and 1 patient (20% of femoral injuries, 0.135% of overall series) has chronic graft occlusion and long-term claudication. The risk of arterial injury after femoral arterial cannulation and perfusionfor Port Access surgery was low (0.68%). This risk is increased in women and is unpredictable. Initial vascular repair has a significant failure rate, and secondary interventions are often necessary. Although the femoral cannulation and perfusion technique is safe overall, the risk must be clearly recognized.
机译：尽管微创（MI）心脏手术减少了失血量，住院时间和恢复时间，但某些MI方法需要股动脉插管，这带来了迄今未知的股动脉损伤风险。这项研究的目的是检查带有股动脉插管的Port Access MI心脏手术（PA-MICS）后股动脉损伤的风险。前瞻性地获得了1996年6月至2000年4月间739例行PA-MICS股动脉插管的患者的数据，从插管部位确定了任何新的（术后<30天）动脉供血不足的患者。通过单因素和多因素分析检查患者特征（性别，年龄，身高，体重，体表面积，吸烟，周围血管疾病，糖尿病）和手术变量（插管大小，交叉钳夹时间），以确定动脉损伤的危险因素。通过放射学和术中评估确定损伤并进行分类，并通过患者检查和病历获得随访。 0.68％（5/739）的患者（4名女性，1名男性;年龄范围26-74岁）发生股动脉阻塞（FAC）。女性股骨受伤的风险较高：1.31％比0.23％（p = 0.07）。一名患者因ili股解剖而术中出现肢体缺血，并经x腓旁路治疗。术后出现lau行的4例患者。其中3例患有股动脉闭塞或局限性股解剖，并经股搭桥术治疗，其中1例患者经血管成形术治疗而局限性股动脉狭窄。平均随访17.8个月（范围13-26个月），所有患者均获得了肢体抢救。股闭塞的患者中，需要40％（2/5）进行二级或三级干预，并且1名患者（慢性股骨损伤为20％，总系列为0.135％）有慢性移植物闭塞和长期c行。进行Port Access手术的股动脉插管和灌注后发生动脉损伤的风险很低（0.68％）。妇女的这种风险增加并且是不可预测的。初始血管修复的失败率很高，通常需要进行二次干预。尽管总的来说，股骨插管和灌注技术是安全的，但必须明确认识到这种风险。

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