Mayer Dieter, Rancic Zoran, Wilhelm Markus, Genoni Michele, Veith Frank J, Lachat Mario
University Hospital, Zurich, Switzerland.
J Endovasc Ther. 2008 Jun;15(3):322-5. doi: 10.1583/08-2365.1.
To present a technique for vascular access that features minimal surgical visualization of the target vessel, fast and safe access using an open Seldinger technique under tactile and visual control, and suture closure.
After minimal surgical access to the target vessel, exposing only the anterior wall, 4 preliminary 5-0 polypropylene transmural single sutures are placed in the horizontal plane, 2 on either side of the proposed entry point. If the anterior wall is calcified, the sutures are placed more laterally or medially in a suitable plaque-free area. The vessel is then accessed via an open Seldinger technique in the midline between the 4 sutures, and the corresponding sheaths are inserted over the wire. At the end of the procedure, the sheath and wire are removed, and with digital pressure on the vessel distally, the access site is washed out in antegrade fashion. All 4 sutures are then pulled tight by an assistant, and the surgeon ties all the sutures sequentially. Over a 4-year period, this technique has been used in 536 accesses involving the common femoral (n = 500) and iliac (n = 32) arteries and the abdominal aorta (n = 4). Up to 24-F sheaths were introduced. Mean time for vascular access was 9.0+/-3.3 minutes. There were no access-related early complications detected in routine postprocedural imaging and clinical evaluation.
The "Surgiclose" technique, which is easy to learn and applicable to all vessels, provides a fast, easy, and reliable remote vascular access. It combines the best of both surgical and interventional access techniques, affording minimal surgical access and maximal safety.
介绍一种血管通路技术，其特点是对目标血管的手术可视化程度降至最低，在触觉和视觉控制下使用开放塞丁格技术实现快速、安全的通路，并采用缝合闭合。
在对目标血管进行最小限度的手术暴露，仅暴露前壁后，在水平面上放置4根初步的5-0聚丙烯全层单缝线，在所提议的穿刺点两侧各2根。如果前壁钙化，则将缝线放置在更外侧或内侧合适的无斑块区域。然后通过开放塞丁格技术在4根缝线之间的中线进入血管，并将相应的鞘管沿导丝插入。手术结束时，拔出鞘管和导丝，用手指在血管远端施加压力，以顺行方式冲洗穿刺部位。然后由助手拉紧所有4根缝线，外科医生依次结扎所有缝线。在4年的时间里，该技术已用于536次血管通路操作，涉及股总动脉（n = 500）、髂动脉（n = 32）和腹主动脉（n = 4）。引入的鞘管最大达24F。血管通路的平均时间为9.0±3.3分钟。在常规术后影像学检查和临床评估中未发现与通路相关的早期并发症。
“外科闭合”技术易于学习且适用于所有血管，提供了一种快速、简便且可靠的远程血管通路。它结合了手术和介入通路技术的优点，手术暴露最小且安全性最高。
