Whitton Hollis H, Rehring Thomas F
Colorado Permanente Medical Group, Division of Vascular Surgery, Exempla Saint Joseph Hospital Department of Surgery, and The University of Colorado Health Sciences Center, Denver, Colorado 80205, USA.
J Vasc Surg. 2003 Jul;38(1):83-7. doi: 10.1016/s0741-5214(03)00126-5.
Use of percutaneous suture closure devices after catheter-based interventions is increasing. We recently have seen several severe femoral arterial wall infections after use of such devices. The purpose of this study was to examine the incidence, comorbid associations, and management of femoral arterial infections associated with percutaneous suture closure devices.
We retrospectively reviewed all infectious complications that occurred after 2223 consecutive cardiac catheterization procedures performed over 12 months in a university-affiliated community teaching hospital. Outcome variables included demographics, procedural details, infection, type of arterial reconstruction required, mortality, and limb loss.
During this study, 822 patients received percutaneous suture devices. Infection developed in 6 patients (0.7%). The incidence of diabetes in the population undergoing percutaneous suture closure was 219 of 822 patients (26.6%). Three comorbid conditions, noted in multiple patients with infectious complications, included diabetes mellitus, obesity, and placement of a percutaneous suture closure device within the past 6 months. Invasive femoral endarteritis developed in 4 patients. Gram-positive cocci predominated in 4 patients. In 1 patient with polymicrobial infection catastrophic complications developed, including multiple anastomotic ruptures and hemorrhage. A new method of repair that incorporated double-thickness everted saphenous vein was used in 2 patients, and safe arterial closure was achieved. There was 1 late fatality on postoperative day 36. Limb salvage was achieved in all patients.
Femoral endarteritis complicating percutaneous suture closure is a challenging new problem for vascular surgeons and can result in catastrophic complications. Customary techniques that use saphenous vein patch or interposition grafting are not adequate in all circumstances. Successful outcome requires operative exploration in patients with suspected infection. Removal of the percutaneous suture closure device and debridement to normal arterial wall is recommended in all patients with suspected femoral endarteritis, based on positive intraoperative Gram stains or abnormal appearance of the adjacent femoral artery. Early success with an autologous bolstered repair is reported. Caution is advised when considering the use of a percutaneous suture closure device in patients with comorbid conditions including diabetes, obesity, and previously implanted devices.
基于导管的介入治疗后经皮缝合闭合装置的使用正在增加。我们最近见到了使用此类装置后几例严重的股动脉壁感染。本研究的目的是检查与经皮缝合闭合装置相关的股动脉感染的发生率、合并症关联及处理方法。
我们回顾性分析了在一所大学附属医院社区教学医院连续12个月进行的2223例心脏导管插入术之后发生的所有感染性并发症。结果变量包括人口统计学资料、手术细节、感染情况、所需动脉重建类型、死亡率及肢体丧失情况。
在本研究期间，822例患者接受了经皮缝合装置。6例患者（0.7%）发生了感染。接受经皮缝合闭合的人群中糖尿病发病率为822例患者中的219例（26.6%）。在多例有感染性并发症的患者中发现的三种合并症包括糖尿病、肥胖以及在过去6个月内使用过经皮缝合闭合装置。4例患者发生了侵袭性股动脉内膜炎。4例患者中革兰氏阳性球菌占主导。1例有多种微生物感染的患者发生了灾难性并发症，包括多处吻合口破裂和出血。2例患者采用了一种包含双层翻转大隐静脉的新修复方法，实现了安全的动脉闭合。术后第36天有1例晚期死亡。所有患者均成功保肢。
经皮缝合闭合并发股动脉内膜炎对血管外科医生来说是一个具有挑战性的新问题，可能导致灾难性并发症。使用大隐静脉补片或间置移植的传统技术在所有情况下都不够用。对于疑似感染的患者，成功的治疗结果需要进行手术探查。基于术中革兰氏染色阳性或相邻股动脉外观异常，建议对所有疑似股动脉内膜炎患者取出经皮缝合闭合装置并清创至正常动脉壁。报告了自体支撑修复的早期成功案例。对于患有糖尿病、肥胖及先前植入过装置等合并症的患者，在考虑使用经皮缝合闭合装置时应谨慎。
