Quinn Stephen F, Kim Jinho
Radiology Associates, P.C., Eugene, Oregon, USA.
Cardiovasc Intervent Radiol. 2004 May-Jun;27(3):231-6. doi: 10.1007/s00270-003-2713-y. Epub 2004 Mar 25.
To describe our early clinical experience using the Prostar Perclose device for arterial closure after placement of a stent-graft.
Sixty-three patients had stent-graft devices placed for iliac (n = 7), abdominal aortic (n = 43) or thoracic applications (n = 13). The devices were introduced through 18 Fr (22 Fr O.D.) (n = 3), 16 Fr (20 Fr O.D.) (n = 15), 14 Fr (18 Fr O.D.) (n = 44) or 12 Fr (14 Fr O.D.) (n = 38) sheaths. After Perclose deployment, the arteriotomies were dilated to the appropriate sizes for the deployment sheaths. All patients were anticoagulated during the procedure. After stent-graft deployment, hemostasis was achieved by the Perclose sutures that were in place. All the femoral sites were followed with physical examination and CT angiography (CTA).
The follow-up periods have ranged from 2 to 18 months (mean 7.5 months). All 100 femoral sites were closed without the need for surgical closure. In 4% (4/100) of the femoral sites, the Perclose sutures were pulled out while securing the knots and these patients required manual compression. In 2% (2/100) of the sites, additional manual compression was required after successful deployment of the Perclose devices. In 1% (1/100) of the femoral sites, there was acute femoral popliteal thrombosis perhaps related to common femoral artery narrowing at the site of Perclose deployment. In 5% (5/100) of the femoral sites, pseudoaneurysms were seen on follow-up CTA examinations. In 1% (1/100) of patients, there was infection at the puncture site requiring surgical bypass. In 1% (1/100) of patients, there was a stable, asymptomatic intimal dissection at the puncture site. By CTA criteria, none of the patients have developed stenotic lesions at the sites of Perclose deployment with follow-up periods limited to 6 months. Fifty-one of 63 patients (81%) patients ambulated within 4-6 hr.
The Perclose device, when placed prior to arterial dilatation, can be used to achieve hemostasis for stent-graft procedures. The device used in this manner is associated with complications, the most common being pseudoaneurysm formation. The long-term effect on the femoral arteries is uncertain.
描述我们使用Prostar Perclose装置在植入支架型人工血管后进行动脉闭合的早期临床经验。
63例患者植入了用于髂动脉（n = 7）、腹主动脉（n = 43）或胸主动脉（n = 13）的支架型人工血管装置。这些装置通过18 Fr（外径22 Fr）（n = 3）、16 Fr（外径20 Fr）（n = 15）、14 Fr（外径18 Fr）（n = 44）或12 Fr（外径14 Fr）（n = 38）的鞘管置入。在Perclose装置展开后，将动脉切开处扩张至适合展开鞘管的尺寸。所有患者在手术过程中均接受抗凝治疗。在支架型人工血管置入后，通过已就位的Perclose缝线实现止血。所有股动脉部位均通过体格检查和CT血管造影（CTA）进行随访。
随访期为2至18个月（平均7.5个月）。所有100个股动脉部位均成功闭合，无需手术缝合。在4%（4/100）的股动脉部位，Perclose缝线在系结时被拔出，这些患者需要手动压迫止血。在2%（2/100）的部位，Perclose装置成功展开后还需要额外的手动压迫。在1%（1/100）的股动脉部位，出现急性股腘动脉血栓形成，可能与Perclose装置置入部位的股总动脉狭窄有关。在5%（5/100）的股动脉部位，随访CTA检查发现假性动脉瘤。在1%（1/100）的患者中，穿刺部位发生感染，需要进行外科搭桥手术。在1%（1/100）的患者中，穿刺部位出现稳定、无症状的内膜剥离。根据CTA标准，在随访期限于6个月的情况下，没有患者在Perclose装置置入部位出现狭窄病变。63例患者中有51例（81%）在4至6小时内可下地行走。
在动脉扩张前放置Perclose装置，可用于支架型人工血管手术的止血。以这种方式使用该装置会出现一些并发症，最常见的是假性动脉瘤形成。对股动脉的长期影响尚不确定。
