Antecubital vein access for balloon pulmonary angioplasty in patients with chronic thromboembolic pulmonary hypertension: safe new approach

Abstract

Background-Balloon pulmonary angioplasty (BPA) is an effective and safe method of treating patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH). Currently, femoral and jugular vein accesses are the most frequently used for BPA. Authors all over the world report different numbers of access side complications, mostly exceeding 0.4%. We suggest new alternative access for BPA procedures-antecubital vein access (AVA) that is safe and easy. Methods-In 2015-2017 period we performed 64 BPA in 19 patients with inoperable CTEPH. We performed BPA via AVA using standard radial access kit and in case of unsuccessful AVA we switched to femoral vein access (FVA). All procedures were successful with no serious complications and patients demonstrated clinical and hemodynamic improvement. Results-Fifty-six from 64 procedures (87.5%) were performed via AVA, 8-via femoral access (12.5%). There were no severe complications via AVA, local extravasates were managed with bandage compression. Conclusion-Performing BPA via AVA in patients with CTEPH is a new alternative approach that is safe and easy.

Eurasian guidelines for the diagnosis and treatment of pulmonary hypertension (2023)

“…Подготовка пациента к ТЛА заключается в снижении уровня МНО <3,0 при приеме антагонистов витамина К [363], при приеме новых пероральных антикоагулянтов - их отмене за 24 часа. Техника доступа соответствует КПОС: наиболее безопасным является кубитальный доступ [364]. Процедура проводится на фоне введения гепарина под контролем активированного времени свертывания крови и ингаляции увлажненного кислорода для поддержания SaO 2 >92%.…”