Meyerson Shari L, Feldman Ted, Desai Tina R, Leef Jeffrey, Schwartz Lewis B, McKinsey James F
Department of Surgery, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL 60637, USA.
Vasc Endovascular Surg. 2002 Mar-Apr;36(2):137-44. doi: 10.1177/153857440203600208.
Coronary and peripheral angiography is associated with a low but significant risk of access site complications. While percutaneous devices have been shown to permit more rapid puncture site closure, previous reports have suggested the incidence and severity of complications associated with these devices are greater than with manual compression. This study compares access site complications with and without closure devices in the current era. The authors conducted a retrospective review of patients with access site complications after coronary or peripheral angiography between 1998 and 2000. Forty-five complications requiring vascular surgical consultation were identified in the 4,800 procedures performed during this time period. Fourteen complications occurred in 1,536 procedures (0.9%) using suture-mediated or collagen devices and 31 occurred in 3,264 procedures without devices (0.9%). The types of procedures and catheter sizes (mean 7 Fr) used were not different in the 2 groups. Other than complications involving a retained device, there was no difference between device and manual compression with respect to incidence or types of complication,requirement for operation, type of operation, or outcome. Access site complications identified included pseudoaneurysm (n = 22; 49%), bleeding or hematoma (n = 8;18%), arteriovenous fistula (n=5;11%), arterial thrombosis (n = 4;9%), infection (n = 4;9%), and retained device (n = 2;4%). Twenty-four patients (71% vs 45%; p = NS) required operative intervention including pseudoaneurysm repair, hematoma drainage, and thrombectomy. Eleven patients (26%) underwent successful ultra-sound-guided pseudoaneurysm compression and 9 patients (21%) required no intervention. These data demonstrate that closure devices facilitate arterial puncture site repair without an increase in access site complications. These devices can be safely utilized when rapid hemostasis is desired after coronary or peripheral angiography.
冠状动脉和外周血管造影与穿刺部位并发症的发生风险较低但具有统计学意义。虽然经皮装置已被证明能使穿刺部位更快闭合，但既往报告提示，与这些装置相关的并发症的发生率和严重程度高于手动压迫。本研究比较了当前时代使用和未使用闭合装置时穿刺部位的并发症情况。作者对1998年至2000年间冠状动脉或外周血管造影术后发生穿刺部位并发症的患者进行了回顾性研究。在此期间进行的4800例手术中，确定了45例需要血管外科会诊的并发症。1536例使用缝线介导或胶原蛋白装置的手术中有14例发生并发症（0.9%），3264例未使用装置的手术中有31例发生并发症（0.9%）。两组所采用的手术类型和导管尺寸（平均7F）无差异。除了与装置残留相关的并发症外，在并发症的发生率或类型、手术需求、手术类型或结局方面，装置组与手动压迫组之间没有差异。所确定的穿刺部位并发症包括假性动脉瘤（n = 22；49%）、出血或血肿（n = 8；18%）、动静脉瘘（n = 5；11%）、动脉血栓形成（n = 4；9%）、感染（n = 4；9%）和装置残留（n = 2；4%）。24例患者（71%对45%；p = 无统计学意义）需要手术干预，包括假性动脉瘤修复、血肿引流和血栓切除术。11例患者（26%）成功接受了超声引导下的假性动脉瘤压迫，9例患者（21%）无需干预。这些数据表明，闭合装置有助于动脉穿刺部位的修复，而不会增加穿刺部位并发症。在冠状动脉或外周血管造影术后需要快速止血时，这些装置可以安全使用。
