Schwartz Bryan G, Burstein Steven, Economides Christina, Kloner Robert A, Shavelle David M, Mayeda Guy S
Heart Institute, Good Samaritan Hospital, Los Angeles, CA, USA.
J Invasive Cardiol. 2010 Dec;22(12):599-607.
Vascular access-site complications are an important cause of morbidity following catheterization procedures. Manual compression is the "gold standard" in achieving hemostasis of an arteriotomy site; however, manual compression is limited by the need to interrupt anticoagulation, prolonged bed rest, patient discomfort and time demands for healthcare providers. Vascular closure devices (VCDs) improve patient comfort, free medical staff resources and shorten the time needed for hemostasis, ambulation and discharge. However, the safety of VCDs remains in question and they may increase the risks of infection and leg ischemia. Compared with manual compression, the rate of major complications appears to be increased with VasoSeal, decreased with Angio-Seal and decreased in diagnostic cases with Perclose. The safety of VCDs cannot be assumed due to "class effect," and nearly all individual trials are underpowered to detect differences in complication rates, so the safety of other individual VCDs is unclear. In the absence of puncture site-related risk factors, VCDs as a whole appear to have little influence on complication rates, and patients at high baseline risk for bleeding due to clinical factors may benefit from these devices. Screening with femoral angiography prior to VCD placement and avoidance of VCDs in the presence of puncture site-related risk factors might reduce the risk of vascular complications. This review describes the mechanism, efficacy and safety of VCDs including hemostasis pads, the FemoStop, Clamp Ease, Mynx, Duett, FISH, Boomerang, ExoSeal, Starclose, VasoSeal, Angio-Seal and Perclose devices.
血管穿刺部位并发症是导管插入术后发病的重要原因。手法压迫是实现动脉切开部位止血的“金标准”；然而，手法压迫存在局限性，需要中断抗凝治疗、延长卧床休息时间、患者不适以及对医护人员时间要求较高。血管闭合装置（VCD）可提高患者舒适度、释放医务人员资源并缩短止血、下床活动和出院所需时间。然而，VCD的安全性仍存在疑问，它们可能会增加感染和腿部缺血的风险。与手法压迫相比，使用VasoSeal时主要并发症发生率似乎增加，使用Angio-Seal时降低，在诊断性病例中使用Perclose时降低。由于“类效应”，不能认为VCD是安全的，而且几乎所有个体试验检测并发症发生率差异的能力都不足，因此其他个体VCD的安全性尚不清楚。在没有穿刺部位相关危险因素的情况下，总体而言VCD对并发症发生率影响不大，因临床因素导致基线出血风险高的患者可能会从这些装置中获益。在放置VCD之前进行股动脉血管造影筛查，以及在存在穿刺部位相关危险因素时避免使用VCD，可能会降低血管并发症的风险。本综述描述了VCD的机制、疗效和安全性，包括止血垫、FemoStop、Clamp Ease、Mynx、Duett、FISH、Boomerang、ExoSeal、Starclose、VasoSeal、Angio-Seal和Perclose装置。
