血管缝合器在经皮穿刺主动脉腔内修复术的临床应用-现代医学

血管缝合器在经皮穿刺主动脉腔内修复术的临床应用

单位：中国医科大学附属盛京医院放射科, 辽宁沈阳 110004

分类号：R816.2

出版年·卷·期（页码）：2017·36·第三期（394-397）

摘要：

目的：探讨Perclose ProGlide血管缝合器在经皮穿刺主动脉腔内修复术中应用的安全性和有效性。方法：回顾性分析42例行经皮穿刺主动脉腔内修复术患者的临床资料，采用预先埋置Perclose ProGlide血管缝合器方法缝合股动脉，观察评价术后止血及并发症情况。结果：所有患者均顺利完成经皮穿刺主动脉腔内修复术，共缝合股动脉62条，预置2把缝合器42条（穿刺入口18F-22F），其中1例出现缝线脱落，置入第3把缝合器；缝合完毕后立即停止出血33条，压迫5 min止血8条，压迫10 min止血1条，1例术后即刻造影显示股总动脉闭塞并行腔内治疗；使用1把缝合器20条（穿刺入口14F-16F），缝合完毕后立即停止出血15条，压迫5 min止血4条，压迫10 min止血1条。术后随访1例股总动脉中度狭窄，未行进一步治疗，无其它并发症。结论：应用Perclose ProGlide血管缝合器完成经皮穿刺主动脉腔内修复术是一种安全和有效的方法。

Objective: To evaluate the safety and efficacy of percutaneous endovascular aortic repair(PEVAR) using the Perclose ProGlide vascular closure devices. Methods:We retrospectively analyzed clinical data of 42 patients who were treated by PEVAR with Perclose ProGlide vascular closure devices.The hemostatic effect and complication were observed. Results: PEVAR was performed successfully for all the patients with 62 femoral arteries suture.42 arteries used the pre-close technique with 2 vascular closure devices(18F-22F access sites). Due to suture tearing out,a third ProGlide device was used for 1 of them.33 of them stopped bleeding immediately,8 stopped bleeding after compression for 5 mins and 1 compression for 10 mins. Occlusion of common femoral artery was found for 1 patient by postoperative angiography and endovascular treatment was performed. 20 arteries used the pre-close technique with 1 vascular closure devices(14F-16F access sites).15 of them stopped bleeding immediately,4 of them stopped bleeding after compression for 5 mins and 1 compression for 10 mins. During following-up,moderate stenosis of femoral artery was found for 1 patient and no further treatment was needed.No other complication was found. Conclusion: PEVAR with the Perclose ProGlide vascular closure devices is a safe and reliable method.

参考文献：

[1] STEUER J,ERIKSSON M O,NYMAN R,et al.Early and long-term outcome after thoracic endovascular aortic repair(TEVAR) for acute complicated type B aortic dissection[J].Eur J Vasc Endovasc Surg,2011,41(3):318-323.
[2] JONKER F H,TRIMARCHI S,VERHAGEN H J,et al.Meta-analysis of open versus endovascular repair for ruptured descending thoracic aortic aneurysm[J].J Vasc Surg,2010,51(4):1026-1032.
[3] HARKIN D W,DILLON M,BLAIR P H,et al.Endovascular ruptured abdominal aortic aneurysm repair(EVRAR):a systematic review[J].Eur J Vasc Endovasc Surg,2007,34(6):673-681.
[4] SCHERMERHORN M L,BENSLEY R P,GILES K A,et al.Changes in abdominal aortic aneurysm rupture and short-term mortality,1995-2008:a retrospective observational study[J].Ann Surg,2012,256(4):651-658.
[5] HAAS P C,KRAJCER Z,DIETHRICH E B.Closure of large percutaneous access sites using the Prostar XL Percutaneous Vascular Surgery device[J].J Endovasc Surg,1999,6(2):168-170.
[6] ARSLAN B,TURBA U C,SABRI S,et al.Current status of percutaneous endografting[J].Semin Intervent Radiol,2009,26(1):67-73.
[7] PATEL P J,KELLY Q,HIEB R A,et al.Current status of percutaneous endografting[J].Semin Intervent Radiol,2015,32(3):278-288.
[8] DOSLUOGLU H H,CHERR G S,HARRIS L M,et al.Total percutaneous endovascular repair of abdominal aortic aneurysms using Perclose ProGlide closure devices[J].J Endovasc Ther,2007,14(2):184-188.
[9] 唐骁,郭大乔,陈斌,等.经皮穿刺腹主动脉瘤腔内修复术单中心经验总结[J].中国血管外科杂志:电子版,2013,5(3):166-169.
[10] JAFFAN A A,PRINCE E A,HAMPSON C O,et al.The preclose technique in percutaneous endovascular aortic repair:a systematic literature review and meta-analysis[J].Cardiovasc Intervent Radiol,2013,36(3):567-577.
[11] NELSON P R,KRACJER Z,KANSAL N,et al.A multicenter,randomized,controlled trial of totally percutaneous access versus open femoral exposure for endovascular aortic aneurysm repair(the PEVAR trial)[J].J Vasc Surg,2014,59(5):1181-1193.
[12] MOUSA A Y,CAMPBELL J E,BROCE M,et al.Predictors of percutaneous access failure requiring open femoral surgical conversion during endovascular aortic aneurysm repair[J].J Vasc Surg,2013,58(5):1213-1219.
[13] BENSLEY R P,HURKS R,HUANG Z,et al.Ultrasound-guided percutaneous endovascular aneurysm repair success is predicted by access vessel diameter[J].J Vasc Surg,2012,55(6):1554-1561.
[14] HU G,CHEN B,FU W,et al.Predictors and treatments of proglide-related complications in percutaneous endovascular aortic repair[J].PLoS One,2015,22:10(4):e0123739.
[15] ICHIHASHI T,ITO T,KINOSHITA Y,et al.Safety and utility of total percutaneous endovascular aortic repair with a single Perclose ProGlide closure device[J].J Vasc Surg,2016,63(3):585-588.
[16] LEE W A,BROWN M P,NELSON P R,et al.Midterm outcomes of femoral arteries after percutaneous endovascular aortic repair using the Preclose technique[J].J Vasc Surg,2008,47(5):919-923.
[17] JOHANNING J M,FRANKLIN D P,ELMORE J R,et al.Femoral artery infections associated with percutaneous arterial closure devices[J].J Vasc Surg,2001,34(6):983-985.

服务与反馈：

【文章下载】【发表评论】【查看评论】【加入收藏】

提示：您还未登录，请登录！点此登录