Dosluoglu Hasan H, Cherr Gregory S, Harris Linda M, Dryjski Maciej L
Division of Vascular Surgery, VA Western NY Healthcare System, State University of New York at Buffalo, New York 14215, USA.
J Endovasc Ther. 2007 Apr;14(2):184-8. doi: 10.1177/152660280701400210.
To describe a technique for access site closure in percutaneous abdominal aortic aneurysm (AAA) repair using double Perclose ProGlide devices to overcome the problems associated with the bulky delivery system and braided suture of the antecedent (Prostar) device.
After obtaining guidewire access, 2 Perclose ProGlide sutures are deployed at 90 degrees to each other. The appropriate sheaths are placed over the stiff guidewires. After the stent-graft procedure is completed, an assistant holds pressure while the knots are tightened with the stiff guidewire still in the artery. Once the second knot is tightened with the knot pusher and after confirming adequate hemostasis, the wire is removed, pressure is applied, and heparin reversed. This method has been used in 17 consecutive patients (age range 65-85 years) undergoing endovascular AAA repair. One patient needed patch angioplasty and 2 required small incisions for additional suture placements (81% primary success rate for total percutaneous repair, 90% success rate for all sites).
We have found the double Perclose ProGlide technique to be easy to use, safe, and feasible for total percutaneous AAA repair. More experience with longer follow-up is needed to assess its potential to replace the Perclose Prostar closure device for total percutaneous AAA repairs.
描述一种在经皮腹主动脉瘤（AAA）修复术中使用双Perclose ProGlide装置进行穿刺点闭合的技术，以克服与先前的（Prostar）装置的庞大输送系统和编织缝线相关的问题。
在获得导丝通路后，将2根Perclose ProGlide缝线相互呈90度展开。将合适的鞘管套在硬导丝上。在完成支架移植物手术之后，一名助手施加压力，同时在硬导丝仍留在动脉内的情况下收紧缝线结。一旦用结推器收紧第二个结并确认止血充分后，拔出导丝，施加压力，并逆转肝素化。该方法已用于17例连续接受血管腔内AAA修复术的患者（年龄范围65 - 85岁）。1例患者需要补片血管成形术，2例需要小切口以进行额外的缝线放置（全经皮修复的总成功率为81%，所有穿刺点的成功率为90%）。
我们发现双Perclose ProGlide技术对于全经皮AAA修复术而言易于使用、安全且可行。需要更多的经验以及更长时间的随访来评估其取代Perclose Prostar闭合装置用于全经皮AAA修复的潜力。
