Garasic Joseph M, Marin Linda, Anderson R David
Division of Cardiology, Massachusetts General Hospital, 55 Fruit Street, GRB-8, Boston, MA 02114, USA.
J Invasive Cardiol. 2009 Jun;21(6):283-5.
The Mynx vascular closure device (VCD) (AccessClosure, Inc., Mountain View, California) is used for extravascular closure of the common femoral artery (CFA) after diagnostic or interventional endovascular procedures. Although it is common clinical practice to re-puncture a CFA, for some VCDs, acute repuncture is discouraged, while for other VCDs the safety of direct re-puncture through a previously placed VCD is still in question. The objective of this preclinical study was to evaluate the acute performance of the Mynx device where direct re-puncture has occurred through the hydrogel sealant, followed by delivery of a second Mynx device to close the reaccess puncture site.
Two ovine models with a total of 24 punctures (12 sets of puncture and re-puncture) were used for this study. Success was measured utilizing angiographic and observational endpoints.
There was no evidence of hydrogel sealant prolapse into the artery, distal embolization of sealant following repuncture, groin site bleeding or hematoma. Successful hemostasis was achieved in all punctures (mean activated clotting time = 357 secs) with the exception of a minor (non-clinically significant) contrast extravasation in the tissue tract, which resolved with 2 minutes of adjunctive compression.
Arterial re-puncture in an ovine model directly through a recently placed Mynx closure device and subsequent re-closure with a second Mynx device can be successfully accomplished.
Mynx血管闭合装置(VCD)(AccessClosure公司,加利福尼亚州山景城)用于诊断性或介入性血管内手术后股总动脉(CFA)的血管外闭合。尽管再次穿刺CFA是常见的临床操作,但对于某些VCD,不鼓励急性再次穿刺,而对于其他VCD,直接通过先前放置的VCD再次穿刺的安全性仍存在疑问。这项临床前研究的目的是评估Mynx装置在通过水凝胶密封剂进行直接再次穿刺,随后输送第二个Mynx装置以闭合再次穿刺部位时的急性性能。
本研究使用了两个绵羊模型,共进行24次穿刺(12组穿刺和再次穿刺)。利用血管造影和观察终点来衡量成功率。
没有证据表明水凝胶密封剂脱垂到动脉中、再次穿刺后密封剂远端栓塞、腹股沟部位出血或血肿。除了组织通道中有轻微(无临床意义)的造影剂外渗,在2分钟的辅助压迫后消退外,所有穿刺均成功实现止血(平均活化凝血时间 = 357秒)。
在绵羊模型中,直接通过最近放置的Mynx闭合装置进行动脉再次穿刺,随后用第二个Mynx装置再次闭合可以成功完成。