Kalapatapu Venkat R, Ali Ahsan T, Masroor Farzad, Moursi Mohammed M, Eidt John F
University of Arkansas for Medical Sciences, Little Rock, AR, USA.
Vasc Endovascular Surg. 2006 Oct-Nov;40(5):399-408. doi: 10.1177/1538574406293760.
According to data reported by the American Heart Association, more than 5 million diagnostic and therapeutic catheterizations are performed each year in the United States. The number of catheterizations has tripled since 1979. It has been estimated that complications related to the access site result in more than 75,000 surgical procedures annually. Thus, improved management of the access site itself is essential to achieve the greater goals of improved care and reduced cost. Manual compression directly over the site of arterial puncture usually results in adequate hemostasis but has several significant drawbacks. Manual compression is uncomfortable for the patient, is fatiguing and time-consuming for staff, and necessitates several hours of costly in-hospital observation. In addition, it may be ineffective in achieving hemostasis, especially in the setting of systemic anticoagulation or following the use of large-bore devices. Based on the perceived need for an improved method of managing the arterial access site following catheterization, various vascular sealing devices have been developed. There are at least 8 (and the number is increasing) hemostatic vascular closure devices that are currently approved by the FDA for access site closure after femoral arterial catheterization. The chief advantage attributed to vascular sealing devices is accelerated access site hemostasis, even in the setting of anticoagulation, leading to earlier ambulation and hospital discharge following arterial catheterization. The most important drawbacks related to vascular sealing devices include the cost of the devices and the possibility of increased access site complications. Despite the paucity of properly designed studies supporting their use, it is estimated that over one million vascular sealing devices are used annually in the United States, a number that has increased dramatically in the past 5 years.In this review, we present a brief description of the design and function of the most widely used devices, describe the most common mechanisms of failure, and recommend strategies for management of access site complications including hemorrhage, arterial obstruction, and infection.
根据美国心脏协会报告的数据，美国每年进行超过500万次诊断性和治疗性导管插入术。自1979年以来，导管插入术的数量增加了两倍。据估计，与穿刺部位相关的并发症每年导致超过75000例外科手术。因此，改善穿刺部位本身的管理对于实现改善护理和降低成本这一更大目标至关重要。直接在动脉穿刺部位进行手动压迫通常可实现充分止血，但存在几个显著缺点。手动压迫对患者来说不舒服，对工作人员来说既疲劳又耗时，并且需要数小时的昂贵住院观察。此外，它在实现止血方面可能无效，尤其是在全身抗凝的情况下或使用大口径器械之后。基于对导管插入术后管理动脉穿刺部位的改进方法的需求，已开发出各种血管封堵装置。目前至少有8种（且数量在增加）止血血管闭合装置已获美国食品药品监督管理局批准用于股动脉导管插入术后的穿刺部位闭合。血管封堵装置的主要优点是即使在抗凝情况下也能加速穿刺部位止血，从而使动脉导管插入术后能更早下地活动和出院。与血管封堵装置相关的最重要缺点包括装置成本以及穿刺部位并发症增加的可能性。尽管缺乏支持其使用的设计合理的研究，但据估计美国每年使用超过100万种血管封堵装置，这一数字在过去5年中急剧增加。在本综述中，我们简要描述了最常用装置的设计和功能，描述了最常见的故障机制，并推荐了处理穿刺部位并发症（包括出血、动脉阻塞和感染）的策略。
