Dauerman Harold L, Applegate Robert J, Cohen David J
Division of Cardiology, University of Vermont College of Medicine, Burlington, Vermont 05401, USA.
J Am Coll Cardiol. 2007 Oct 23;50(17):1617-26. doi: 10.1016/j.jacc.2007.07.028.
Vascular closure devices (VCDs) introduce a novel means for improving patient comfort and accelerating ambulation after invasive cardiovascular procedures performed via femoral arterial access. Vascular closure devices have provided simple, rapid, and reliable hemostasis in a variety of clinical settings. Despite more than a decade of development, however, VCD utilization has neither been routine in the U.S. nor around the world. Their limited adoption reflects concerns of higher costs for cardiac procedures and a lack of data confirming a significant reduction in vascular complications compared with manual compression. Recent data, however, suggest that VCD are improving, complication rates associated with their use may be decreasing, and their utilization may improve the process of care after femoral artery access. Challenges in the second decade of VCD experience will include performing definitive randomized trials, evaluating outcomes in higher-risk patients, and developing more ideal closure devices.
血管闭合装置（VCDs）为改善患者舒适度以及加快经股动脉入路进行侵入性心血管手术后的下床活动提供了一种新方法。血管闭合装置已在各种临床环境中实现了简单、快速且可靠的止血。然而，尽管经过了十多年的发展，VCD在美国和全球范围内的使用都尚未成为常规操作。它们应用有限反映出人们担心心脏手术成本更高，且缺乏数据证实与手动压迫相比，血管并发症显著减少。不过，近期数据表明VCD正在改进，与其使用相关的并发症发生率可能在降低，并且其应用可能会改善股动脉入路后的护理过程。VCD应用第二个十年面临的挑战将包括开展确定性随机试验、评估高危患者的结局以及研发更理想的闭合装置。
