Siani Andrea, Accrocca Federico, Gabrielli Roberto, Antonelli Roberto, Giordano Alessandro G, Ambrogi Cesare, Marcucci Giustino
Vascular and Endovascular Surgery Unit, ASL RMF 'San Paolo' Hospital, Largo Donatori di Sangue, Civitavecchia, 00053 Rome, Italy.
Interact Cardiovasc Thorac Surg. 2011 Mar;12(3):400-3. doi: 10.1510/icvts.2010.252486. Epub 2010 Dec 20.
Arterial percutaneous closure devices (APCD) could lead to severe vascular complications, like acute lower limb ischemia. The aim of this study was to evaluate retrospectively our personal series of acute lower limb ischemia following the use of APCD. From January 2004 to June 2009 the Angio-Seal percutaneous closure devices was deployed in 198 patients. Eight (4%) acute lower limb ischemia required urgent surgical repair. The device was removed in all cases. A thromboembolectomy was performed in five patients (62.5%) and in three (37.5%) an endarterectomy with patch closure was carried out (two saphenous vein and one Dacron). Limb salvage rate was 87.5%. We compared Angio-Seal complications group (A) with the 190 patients in which the Angio-Seal was successfully used without complications (group B) by means of Student's t-test. At 36-month follow-up with color-coded duplex ultrasounds, no chronic limb ischemia or other complications requiring surgical repair occurred. Diabetes, obesity, severe femoral atherosclerotic involvement, use of sheath size >7 Fr and time-consuming procedures were significant risk factors for ischemic APCD complications. Despite vascular injuries being uncommon after APCD deployment, generally a complex surgical repair is necessary. A more careful patient selection would be advisable.
动脉穿刺闭合装置（APCD）可能导致严重的血管并发症，如急性下肢缺血。本研究的目的是回顾性评估我们个人系列中使用APCD后发生的急性下肢缺血情况。从2004年1月至2009年6月，198例患者使用了血管封堵器（Angio-Seal）经皮闭合装置。8例（4%）发生急性下肢缺血，需要紧急手术修复。所有病例均取出了该装置。5例患者（62.5%）进行了血栓切除术，3例（37.5%）进行了动脉内膜切除术并补片修补（2例使用大隐静脉，1例使用涤纶补片）。肢体挽救率为87.5%。我们通过学生t检验将血管封堵器并发症组（A组）与190例成功使用血管封堵器且无并发症的患者（B组）进行了比较。在36个月的彩色编码双功超声随访中，未发生慢性肢体缺血或其他需要手术修复的并发症。糖尿病、肥胖、严重的股动脉粥样硬化累及、使用大于7F的鞘管以及耗时的操作是缺血性APCD并发症的重要危险因素。尽管在APCD置入后血管损伤并不常见，但通常仍需要进行复杂的手术修复。建议进行更谨慎的患者选择。
