Engelbert Travis L, Scholten Anjali, Thompson Kari, Spivack Adam, Kansal Nikhil
Veterans Administration San Diego Healthcare System, Section of Vascular and Endovascular Surgery, Department of Surgery, University of California, San Diego, San Diego, CA 92103, USA.
Ann Vasc Surg. 2010 May;24(4):518-23. doi: 10.1016/j.avsg.2010.02.002.
Patient satisfaction after percutaneous endovascular procedures is significantly influenced by the amount of time to ambulation postprocedure. The purpose of this study was to assess the complication rates of early ambulation after use of closure devices or topical hemostatic agents for femoral access sites for endovascular procedures.
A retrospective review was performed of all patients who underwent an endovascular procedure from a femoral access site between January 2004 and March 2008. The access site was closed with an Angio-Seal, StarClose, or D-Stat Dry with pressure. Patients ambulated 2 hr postprocedure when a closure device was used and 4 hr postprocedure when a D-Stat pad was applied. Access-site bleeding complications were assessed. Sheath size, closure method, patient characteristics, and antiplatelet status were analyzed.
A total of 245 patients with a mean age of 70 years were identified. Of these, 154 (63%) patients were treated with a D-Stat pad with pressure, Angio-Seal was used on 83 (34%), and StarClose was used on eight (3%). The overall complication rate was 5.7%. Complications increased with increasing age (p = 0.003) and use of StarClose (p = 0.0001). The D-Stat pad was associated with a decreased complication rate (p = 0.03). Sheath size did not influence the incidence of bleeding. There was no significant increase in complications in patients taking an antiplatelet agent.
With a protocol using closure devices and hemostatic agents, early ambulation after percutaneous femoral access can be achieved safely with an acceptable complication rate in patients with peripheral vascular disease.
经皮血管腔内手术后患者的满意度受术后下床活动时间的显著影响。本研究的目的是评估血管腔内手术中使用封堵装置或局部止血剂处理股动脉穿刺部位后早期下床活动的并发症发生率。
对2004年1月至2008年3月期间所有经股动脉穿刺部位进行血管腔内手术的患者进行回顾性研究。穿刺部位使用Angio-Seal、StarClose或带压力的D-Stat Dry进行封堵。使用封堵装置的患者术后2小时下床活动，应用D-Stat垫的患者术后4小时下床活动。评估穿刺部位出血并发症。分析鞘管大小、封堵方法、患者特征和抗血小板状态。
共纳入245例平均年龄70岁的患者。其中，154例（63%）患者使用带压力的D-Stat垫治疗，83例（34%）使用Angio-Seal，8例（3%）使用StarClose。总体并发症发生率为5.7%。并发症发生率随年龄增加（p = 0.003）和使用StarClose（p = 0.0001）而增加。D-Stat垫与较低的并发症发生率相关（p = 0.03）。鞘管大小不影响出血发生率。服用抗血小板药物的患者并发症无显著增加。
采用封堵装置和止血剂的方案，外周血管疾病患者经皮股动脉穿刺后早期下床活动可安全实现，并发症发生率可接受。
