Antegrader Zugang für periphere Interventionen: Schritt für Schritt

Vorteile des antegraden Zugangs sind die komplette Darstellung der Zielläsion, inklusive des peripheren Ausstroms, der im Falle einer distalen Embolie bis in die kleinsten Endgefäße sondiert werden kann. Komplexe Katheterverfahren wie Atherektomie und Thrombektomie können häufig nur antegrad angewendet werden. In diesem Artikel sollen die Zugangsoptionen Schritt für Schritt erläutert werden, der Fokus liegt auf dem antegraden ipsilateralen transfemoralen Zugang.

Schlüsselwörter

endovaskuläre Therapie - arterieller Zugang - Arteria femoralis - Arteria brachialis - Arteria radialis - Schleuse - Angioplastie

• Literatur

• 1 Aboyans V, Ricco JB, Bartelink MEL. et al. 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS): Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteriesEndorsed by: the European Stroke Organization (ESO)The Task Force for the Diagnosis and Treatment of Peripheral Arterial Diseases of the European Society of Cardiology (ESC) and of the European Society for Vascular Surgery (ESVS). Eur Heart J 2018; 39: 763-816
• 2 Putz R, Zeller T, Schilling T. et al. Konservative, endovaskuläre und chirurgische Therapie femoropoplitealer Läsionen. In: Zeller T, Cissarek T, Gray WA, Kröger K. Gefäßmedizin – Therapie und Praxis. 2. Berlin: ABW-Wissenschaftsverlag; 2013
• 3 DeCarlo C, Latz CA, Boitano LT. et al. Percutaneous brachial access associated with increased incidence of complications compared with open exposure for peripheral vascular interventions in a contemporary series. J Vasc Surg 2021; 73: 1723-1730
• 4 Mantripragada K, Abadi K, Echeverry N. et al. Transbrachial Access Site Complications in Endovascular Interventions: A Systematic Review of the Literature. Cureus 2022; 14: e25894
• 5 Siracuse JJ, Farber A, Cheng TW. et al. Common femoral artery antegrade and retrograde approaches have similar access site complications. J Vasc Surg 2019; 69: 1160-1166.e2
• 6 Marquis-Gravel G, Tremblay-Gravel M, Lévesque J. et al. Ultrasound guidance versus anatomical landmark approach for femoral artery access in coronary angiography: a randomized controlled trial and a meta-analysis. J Interv Cardiol 2018; 31: 496-503
• 7 Sartorius B, Behnes M, Ünsal M. et al. Arterial access-site complications after use of a vascular closure device related to puncture height. BMC Cardiovasc Disord 2017; 17: 64
• 8 Ramirez JL, Zarkowsky DS, Sorrentino TA. et al. Antegrade common femoral artery closure device use is associated with decreased complications. J Vasc Surg 2020; 72: 1610-1617.e1
• 9 Ramirez JL, Smith EJT, Zarkowsky DS. et al. Closure device use for common femoral artery antegrade access is higher risk than retrograde access. Ann Vasc Surg 2021; 76: 49-58