Lee W Anthony, Brown Michael P, Nelson Peter R, Huber Thomas S, Seeger James M
University of Florida, Division of Vascular Surgery and Endovascular Therapy, Gainesville, FL 32610-0286, USA.
J Vasc Surg. 2008 May;47(5):919-23. doi: 10.1016/j.jvs.2007.12.029. Epub 2008 Mar 6.
Percutaneous access during endovascular aortic repair has been shown to be feasible and safe using a suture-mediated closure device ("Preclose" technique) for closure of up to 24F introducer sheaths. The purpose of this study is to examine the late outcomes of those femoral arteries repaired in this manner.
The Preclose technique has been previously described. Briefly, the technique involves two Perclose Proglide devices deployed in the femoral artery prior to insertion of the large diameter introducer sheath and then closure of the arteriotomy by tying down knots of the Proglide following removal of the sheath. The medical records of all patients who underwent endovascular aortic repairs using the Preclose technique between December 2004 and August 2007 were reviewed. Follow-up protocol consisted of computed tomography (CT) angiograms performed at 1, 6, and 12 months, and annually thereafter. All Preclose patients who had at least a 6-month postoperative scan were included in the study. For each patient, the most recent postoperative scan was compared with the preoperative scan for evidence of any new anatomic abnormalities of the femoral artery such as dissection, stenosis, or pseudoaneurysm. Three-dimensional post processing with multiplanar reconstructions was also performed as necessary to confirm axial scan findings.
A total of 292 patients underwent percutaneous endovascular aortic repairs (TEVAR-125, EVAR-167). Four hundred thirty-two femoral arteries were closed with 870 devices. Four hundred eighteen vessels were approximated with two devices, while 30 arteries required three devices for hemostasis and an additional four vessels only required a single device. Two hundred seventy-eight (64.3%) vessels were accessed with sheaths 18 to 24F. Four hundred eight femoral arteries (94.4%) were closed successfully with the Preclose technique. There were 100 patients (TEVAR-35, EVAR-65) who had adequate postoperative CT scan at 6-months or later. The mean follow up was 11.6 +/- 5.0 months. Of the 156 femoral arteries in these 100 patients repaired using the Preclose technique, there were 3 late complications in 3 patients, 1 asymptomatic femoral artery dissection, and 2 femoral artery pseudoaneurysms requiring surgical repair, resulting in a late complication rate of 1.92% (3/156).
Percutaneous closure of femoral arteries after large diameter introducer sheaths using the Preclose technique has a low incidence of early and late complications related to the closure site.
血管腔内主动脉修复术中，使用缝线介导的闭合装置（“预闭合”技术）闭合直径达24F的导入鞘管已被证明是可行且安全的。本研究的目的是检查以这种方式修复的股动脉的远期结果。
预闭合技术先前已有描述。简要来说，该技术包括在插入大直径导入鞘管之前，在股动脉中部署两个Perclose Proglide装置，然后在移除鞘管后通过系紧Proglide的结来闭合动脉切开处。回顾了2004年12月至2007年8月间所有使用预闭合技术进行血管腔内主动脉修复的患者的病历。随访方案包括在术后1个月、6个月和12个月以及此后每年进行计算机断层扫描（CT）血管造影。所有术后至少有一次6个月扫描的预闭合患者均纳入研究。对于每位患者，将最近的术后扫描与术前扫描进行比较，以寻找股动脉任何新的解剖异常证据，如夹层、狭窄或假性动脉瘤。必要时还进行三维后处理及多平面重建以确认轴向扫描结果。
共有292例患者接受了经皮血管腔内主动脉修复术（胸主动脉腔内修复术125例，腹主动脉腔内修复术167例）。用870个装置闭合了432条股动脉。418条血管用两个装置进行了近似闭合，而30条动脉需要三个装置来止血，另外4条血管仅需一个装置。278条（64.3%）血管使用的鞘管直径为18至24F。408条股动脉（94.4%）通过预闭合技术成功闭合。有100例患者（胸主动脉腔内修复术35例，腹主动脉腔内修复术65例）在术后6个月或更晚进行了充分的CT扫描。平均随访时间为11.6±5.0个月。在这100例使用预闭合技术修复的患者中的156条股动脉中，有3例患者出现3例晚期并发症，1例无症状股动脉夹层，2例股动脉假性动脉瘤需要手术修复，晚期并发症发生率为1.92%（3/156）。
使用预闭合技术经皮闭合大直径导入鞘管后的股动脉，与闭合部位相关的早期和晚期并发症发生率较低。
