Khaldi Ahmed, Waldau B, Skowlund C, Velat G J, Mocco J, Hoh B L
Department of Neurosurgery, George Washington University Hospital, Washington, DC 20037, USA.
Interv Neuroradiol. 2011 Dec;17(4):495-500. doi: 10.1177/159101991101700417. Epub 2011 Dec 16.
Percutaneous vascular closure devices are being increasingly used as alternatives to manual compression for the closure of femoral arteriotomy after endovascular procedures as they appear to reduce time to ambulate, improve patient's comfort, and are implicated with cost saving. However, vascular closure devices have been associated with an increased risk of complications including hematoma formation, local bleeding, arteriovenous fistula formation, pseudoaneurysm and arterial leg ischemia. To our knowledge, if the above complications occur it is usually within the first 30 days after the procedure. None have been reported in a delayed fashion ten months or longer after closure. We describe a 30-year-old man with a history of a giant basilar trunk aneurysm. He was placed on aspirin and clopidogrel prior to the procedure. He had bilateral femoral access with 6 French sheaths. Following the procedure, 6 French Angio-Seals (St. Jude Medical, St. Paul, MN, USA) were used for closure of bilateral femoral arteriotomies. Ten months after the procedure, the patient kicked a metal cart and developed a large right retroperitoneal iliopsoas hematoma. There was no evidence of pseudoaneurysm. The patient was managed conservatively and his serial hematocrit stayed stable. He did not require surgical intervention. Use of percutaneous vascular closure devices is associated with complications including risk of hematoma, pseudoaneurysm, intravenous fistula, rectal peritoneal hemorrhage, limb ischemia and possible surgical repair. Most complications occur peri-procedure or within 30 days post-procedure. This is the first reported case of a delayed complication at ten months after the initial procedure. Site-related complications associated with percutaneous vascular closure devices may occur in a delayed fashion, even ten months post-procedure, so should be considered in the management of patients.
经皮血管闭合装置越来越多地被用作血管内手术后股动脉切开术闭合的手动压迫替代方法，因为它们似乎能减少下床活动时间，提高患者舒适度，并能节省成本。然而，血管闭合装置与并发症风险增加有关，包括血肿形成、局部出血、动静脉瘘形成、假性动脉瘤和下肢动脉缺血。据我们所知，如果上述并发症发生，通常在手术后的前30天内。尚未有在闭合后10个月或更长时间延迟发生并发症的报道。我们描述了一名30岁有巨大基底动脉干动脉瘤病史的男性。术前给予阿司匹林和氯吡格雷治疗。手术中使用6F鞘管进行双侧股动脉穿刺。术后，使用6F血管封堵器（美国明尼苏达州圣保罗市圣犹达医疗公司）闭合双侧股动脉切开处。术后10个月，患者踢到金属推车，出现右侧巨大腹膜后髂腰肌血肿。无假性动脉瘤证据。患者接受保守治疗，连续血细胞比容保持稳定。无需手术干预。使用经皮血管闭合装置会伴有并发症，包括血肿、假性动脉瘤、静脉瘘、直肠腹膜出血、肢体缺血以及可能需要手术修复的风险。大多数并发症发生在手术期间或术后30天内。这是首次报道初始手术后10个月出现延迟并发症的病例。与经皮血管闭合装置相关的部位相关并发症可能会延迟发生，甚至在术后10个月，因此在患者管理中应予以考虑。
