Cikirikcioglu Mustafa, Cherian Sanjay, Keil Vera, Manzano Norman, Gemayel Gino, Theologou Thomas, Kalangos Afksendiyos
Division of Cardiovascular Surgery, University Hospitals, Geneva, Switzerland.
Ann Vasc Surg. 2011 May;25(4):557.e1-4. doi: 10.1016/j.avsg.2011.01.004.
Vascular closure devices are used to provide quick hemostasis and early ambulation after percutaneous interventions. The Angio-Seal (AS) vascular closure device forms a mechanical seal by closing the puncture site located between a bioabsorbable anchor within the lumen and a collagen sponge on the adventitia. Although morbidities associated with AS are reportedly infrequent, even the slightest inaccuracy in device implantation may result in displacement of these device components, leading to sudden and severe complications. We report the surgical treatment of complications associated with the use of AS in four patients, including acute limb ischemia, pseudoaneurysm formation, significant hemorrhage, and hypovolemic shock. A common factor in all these cases was that the components of the AS device were displaced from their original site of implantation, stressing the importance of proper device placement. All patients underwent successful surgical vascular repair. Our report highlights the need for exercising extreme care during device implantation, and also the requirement for vigilant inspection for any associated vascular complications commencing immediately after device implantation. It is vital that these device components are actively looked for and removed during surgical exploration so as to prevent future complications.
血管闭合装置用于在经皮介入治疗后实现快速止血和早期活动。血管封堵器（Angio-Seal，AS）通过封闭位于管腔内的生物可吸收锚定物与外膜上的胶原海绵之间的穿刺部位形成机械密封。尽管据报道与AS相关的并发症并不常见，但即使装置植入过程中最轻微的不准确也可能导致这些装置组件移位，从而引发突然且严重的并发症。我们报告了4例使用AS后相关并发症的手术治疗情况，包括急性肢体缺血、假性动脉瘤形成、大量出血和低血容量性休克。所有这些病例的一个共同因素是AS装置的组件从其原始植入部位移位，强调了正确放置装置的重要性。所有患者均成功接受了手术血管修复。我们的报告强调了在装置植入过程中要格外小心，以及在装置植入后立即开始对任何相关血管并发症进行警惕检查的必要性。在手术探查期间积极寻找并移除这些装置组件以防止未来并发症至关重要。
