课件：正确认识股动脉途径以及闭合股动脉穿刺口.ppt

正确认识股动脉途径,中国医学科学院阜外心血管病医院冠心病诊治中心 戴 军,讨论,桡动脉与股动脉途径比较 股动脉并发症原因的分析 赞成血管闭合设备的观点 AngioSeal装置的正确使用,急性桡动脉与股动脉局部并发症,桡动脉4-6% 股动脉5-6%,桡动脉特点,桡动脉是三级动脉，属肌性动脉。桡动脉壁厚，其中膜层500m。桡动脉无穿支血管供应，靠从腔内渗透，容易出现由缺血引起的中膜增生。拇指和食指桡侧完全由桡动脉供，,动脉搭桥材料特有的解剖学基础,桡动脉的管径与冠状动脉相似，其长度8.931.86 cm足以达到任何靶血管。 桡动脉远端口内径2.450.32mm 乳内动脉 1.40.01mm 胃网膜动脉 1.60.1mm,桡动脉移植应用,冠脉桥血管材料 前臂桡动脉皮瓣提供美容皮肤材料以及舌缺如修复材料 前臂皮瓣进行全鼻再造,介入后桡动脉状态,6%12%桡动脉闭塞 15% 桡动脉波动消失,股动脉并发症原因分析,血液溢出血管：出血、血肿、假性动脉瘤、腹膜后血肿 动静脉瘘 股神经以及侧支损伤 感染 远端栓塞,正确的股动脉穿刺技术,股动脉穿刺位置正确是减少并发症决定因素 对于强化抗血小板治疗以及肝素化的病人不易反复穿刺 术后应该股动脉造影，评价股动脉解剖、鞘管位置、血管直径，以及出现并发症的风险,Figure 2: Optimal Femoral Puncture Zone,Figure 2: Optimal Femoral Puncture Zone,髂前上棘,腹股沟韧带,耻骨联合,股深动脉,股浅动脉,股总动脉,股静脉,隐静脉,腹股沟韧带下动脉穿刺区域,2019/8/22,15,可编辑,Figure 1: Puncture site anatomy,Figure 1: Puncture site anatomy,腹股沟韧带,髂外动脉,耻骨,股总动脉,股深动脉,股浅动脉,正确,不正确,不正确,To optimize Hemostasis Device results in terms of:,Patient comfort Time to ambulation Vascular complications,工欲善其事必先利其器 古代名言,A meta-analysis of percutaneous vascular closure devices after diagnostic catheterization and percutaneous coronary intervention,16 prospective, randomized clinical trials 5,048 5,048 patients included. The pooled OR was 0.89 (95% confidence interval), indicating a significant decrease in risk by devices Angio-Seal was associated with a significant reduction in risk (OR, 0.51) Perclose had a neutral result (OR, 1.0), Vasoseal had an increased risk of complications (OR, 1.18). J Invasive Cardiol. 2004 May;16(5):243-6.,Angio-SealTM Device Provides Hemostasis by,“Active closure” which mechanically seals the arteriotomy utilizing three bio-absorbable components:,Anchor Intravascularpulled up against the vessel wall Collagen plug Extravascular Suture Sandwiches the vessel wall between the anchor and collagen,总结,股动脉始终为最可靠、便捷、安全介入途径，尤其在紧急情况下。正确的穿刺部位是减少并发症的关键。 可能冠脉搭