#1
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ëó÷åâîé äîñòóï äëÿ ïåðèôåðè÷åñêèõ âìåøàòåëüñòâ
Íà àïðåëüñêîé êîíôåðåíöèè «ÝÍÄÎÂÀÑÊÓËßÐÍÎÅ ËÅ×ÅÍÈÅ ÏÎÐÀÆÅÍÈÉ ÀÐÒÅÐÈÉ ÍÈÆÍÈÕ ÊÎÍÅ×ÍÎÑÒÅÉ È ÀÍÅÂÐÈÇÌ ÃÐÓÄÍÎÉ È
ÁÐÞØÍÎÉ ÀÎÐÒÛ» â Êðàñíîäàðå áûëà íåáîëüøàÿ äèñêóññèÿ ïî ëó÷åâîìó äîñòóïó. Áîëüøèíñòâî âûñòóïàþùèõ êðèòèêîâàëî òàêîé ïîäõîä. Ìíå êàæåòñÿ, ÷òî ýòîò äîñòóï â îïûòíûõ ðóêàõ î÷åíü ïîëåçíûé. Âîò îïóáëèêîâàííûå ñòàòüè çà ïîñëåäíèå ãîäû î ïîëîæèòåëüíîì îïûòå òðàíñðàäèàëüíûõ èíòåðâåíöèé íà àðòåðèÿõ í/ê: 1. Cortese B, Peretti E, Troisi N, et al. Transradial percutaneous iliac intervention, a feasible alternative to the transfemoral route. Cardiovasc Revasc Med. 2012;13:331-334. 2. Staniloae CS, Korabathina R, Yu J, Kurian D, Coppola J. Safety and efficacy of transradial aortoiliac interventions. Catheter Cardiovasc Interv. 2010;75:659–662. 3. Korabathina R, Yadav S, Coppola J, Staniloae C. Transradial approach to lower extremity interventions. Vasc Health Risk Manag. 2010;6:503–509. 4. Sanghvi K, Kurian D, Coppola J. Transradial intervention of iliac and superficial femoral artery disease is feasible. J Interven Cardiol 2008;21:385–7. 5. Trani C, Burzotta F, Tommasino A, Giammarinaro M. Transradial approach to treat superficial femoral artery in-stent restenosis. Catheter Cardiovasc Interv. 2009;74:494–498. 6. Staniloae C, Kurian D, Coppola J. Transradial Bilateral Iliac Stenting. Journal of Invasive Cardiology [Internet]. 2006 Oct. Available from: [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]. 7. Flachskampf FA, Wolf T, Daniel WG, Ludwig J. Transradial stenting of the iliac artery: A case report. Catheter Cardiovasc Interv 2005;65:193–195. 8. Sang Hyuk Lee, Hun Sik Park, Se Yong Jang, Jae Hee Kim, Seon Hee Park, Hyeon Min Ryu, Gui Lyen Jang. A Case of Peripheral Revascularization Via the Radial Artery Using Devices Designed for Percutaneous Coronary Intervention. Korean Circ J 2008;38:671–673. 9. Lorenzoni R, Lisi C, Lazzari M, Bovenzi F. Tools & Techniques: Above the knee angioplasty by transradial access. EuroIntervention. 2012 Jan;7(9):1118–9. 10. Trani C, Tommasino A, Burzotta F. Pushing the limits forward: Transradial superficial femoral artery stenting. Catheter Cardiovascular Interv. 2010;76(7):1065–1071. Åñëè êòî-òî çàèíòåðåñóåòñÿ ó ìåíÿ åñòü ïîëíûå òåêñòû âñåõ ýòèõ ñòàòåé. Êðîìå òîãî, íà ôîðóìå äàâàëè ññûëêè íà 2 êîíñåíñóñà ïî òðàíñðàäèàëüíîìó äîñòóïó (àìåð 2011, åâð 2013), â êîòîðûõ òàêæå äîïóñêàåòñÿ èñïîëüçîâàíèå òàêîé ìåòîäèêè. Åñëè ó êîãî-òî åñòü íåóïîìÿíóòûå èñòî÷íèêè ïî òåìå, äîáàâüòå ïîæàëóéñòà. |
#3
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×òî Âû, Ñåðãåé Àëåêñàíäðîâè÷, êàêîé èç ìåíÿ ãåðîé. |
#4
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Ïîääåðæèâàþ ä-ðà Ìèçèíà, îäíàêî èñïîëüçîâàíèå ëó÷åâîãî äîñòóïà äëÿ ïîäâçäîøíûõ è íèæåëåæàùèõ àðòåðèé òðåáóåò ñïåöèôè÷åñêîãî èíñòðóìåíòà ïîâûøåííîé äëèíà, èìåþòñÿ òðóäíîñòè ñ ïðîèçâîäèòåëÿìè (êàæåòñÿ âïåðåäè Îïòèìåä). Ìíå êàæåòñÿ, äàííûé äîñòóï äîëæåí ïðèìåíÿòüñÿ èíäèâèäóàëüíî, â çàâèñèìîñòè îò õàðàêòåðà è ëîêàëèçàöèè ïîðàæåíèÿ.
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#5
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Ãðóïïà àìåðèêàíñêèõ èññëåäîâàòåëåé (èçâåñòíûå ïðîïàãàíäèñòû ëó÷åâîãî äîñòóïà äëÿ ïåðèôåðè÷åñêèõ âìåøàòåëüñòâ) â îáçîðå "Transradial Access for Peripheral Vascular Interventions" (æóðíàë Catheterization and Cardiovascular Interventions çà ýòîò ãîä) ïðåäëîæèëè èíòåðåñíûé ïîäõîä ê îïðåäåëåíèþ íåîáõîäèìîé äëèíû ïðîâîäíèêîâûõ êàòåòåðîâ:
"Starting a program of TRPI requires good knowledge of the distance from the access site (RA) to the target artery. Figure 1 shows the average distance from the left wrist to the various arterial beds. Because of the long distance to various targets, the choice of sheath length should be individualized for each vascular territory. As a general rule, one should choose a sheath 5–10 cm longer than the estimated distance from the access site to the target vessel." Ïðàâäà, íèêàêèõ ññûëîê íà ïîäòâåðæäàþùèå èññëåäîâàíèÿ íå íàøåë. |
#7
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"Infrainguinal interventions, particularly below knee, do represent the new frontier for TR interventions, and their future depends on the ability of the industry to develop low-profile, long-shaft equipment."
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#8
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Íà äíÿõ ïîëó÷èëîñü íàãëÿäíî ïðîäåìîíñòðèðîâàòü íàøó ãèïîòåçó î ïî÷òè îäèíàêîâîé äëèíå êàòåòåðîâ, ñîåäèíÿþùèõ äîñòóïû íà ïðàâîé è ëåâîé â/ê ñ áèôóðêàöèåé àîðòû.
Ïàöèåíòó ðîñòîì 170 ñì ñ ñóáòîòàëüíûìè óñòüåâûìè ñòåíîçàìè îáåèõ ÎÏÀ ïðåäëîæèëè âûïîëíèòü ñòåíòèðîâàíèå ÷åðåç äâà ëó÷åâûõ äîñòóïà ñðàçó ïîñëå äèàãíîñòè÷åñêîé àðòåðèîãðàôèè. [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] Äâà îäèíàêîâûõ ñòåíòà ñïîçèöèîíèðîâàëè íà îäíîì óðîâíå â áèôóðêàöèþ àîðòû. È ïîìåðÿëè ñòåðèëüíîé ëèíåéêîé íàðóæíûå ÷àñòè äîñòàâëÿþùèõ êàòåòåðîâ. Ðàçíèöà ñîñòàâèëà âñåãî ëèøü 1,5 ñì (ñëåâà êîðî÷å). |
#9
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Öèòàòà:
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#10
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Ñïàñèáî çà ïîääåðæêó.
Íåò, ïóòü ñ ëåâîãî äîñòóïà êîðî÷å íà 1.5 ñì, êàê è äîëæíî áûòü. Êàêîé òèï äóãè ÿ íå çíàþ, íî õîä êàòåòåðîâ â äóãå àîðòû ÿ ñôîòîãðàôèðîâàë. Ëó÷åâûå àðòåðèè êîëîë â îáû÷íîì ìåñòå ñèììåòðè÷íî. [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] |
#11
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Àáñîëþòíîé ñèììåòðèè íå áûâàåò, ïî-ìîåìó îäíà íîãà êîðî÷å äðóãîé, ÷òîáû ìîæíî áûëî õîäèòü. Äëÿ íàóêè áûëî-áû ïîëåçíî ñäåëàòü ðåíòãåíîãðàììû îáåèõ çàïÿñòèé â êîíöå ïðîöåäóðû, âåäü íå÷àñòî äåëàþò îäíîìîìåíòíî äâà ëó÷à. ÀÃ, íåëüçÿ ëè ïîêàçàòü ÷òî áûëî ó ïàöèåíòà äî è ÷òî ñòàëî ïîñëå â ïîäâçäîøíûõ àðòåðèÿõ, ÷òîáû ìû ïîíÿëè çà÷åì ýòî ñäåëàíî.
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#12
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[Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
[Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] Ñàìî ñòåíòèðîâàíèå íè÷åãî èíòåðåñíîãî íå ïðåäñòàâëÿåò. Êðîìå òîãî, ÷òî èìïëàíòàöèÿ áûëà êàê îáû÷íî áåç ãàéäîâ, äà ýòîãî íà êàðòèíêå íå óâèäåòü. |
#13
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ÀÃ! Ñòåíòû áûëè áàëëîí-ðàñøèðÿåìûå, êèññèíã äåëàëè?, åñëè íåò, òî çà÷åì äâóõñòîðîííèé äîñòóï. Êðàñèâûé ñëó÷àé, åñëè ìîæíî êîíòðîëü ïîêàçàòü áåç êîíòðàñòà - ïîñìîòðåòü íà ñòåíòû.
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#14
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Íó äà, êèññèíã. Èíà÷å çà÷åì âåñü ñûð-áîð? Äâà ñòåíòà íà áàëëîíàõ. Ìèíèìàëüíûé âûõîä â àîðòó. Êàðòèíêó ïîêàæó.
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