Kamusella P, Wissgott C, Andresen R
Universitäten Kiel, Lübeck und Hamburg, Esmarschstr. 50, 25746 Heide.
Rofo. 2012 Apr;184(4):311-5. doi: 10.1055/s-0031-1299098. Epub 2012 Jan 24.
The safety and effectiveness of a percutaneous suture-mediated closure system for achieving hemostasis using a transarterial femoral approach were investigated.
A percutaneous suture closure system (Perclose/Proglide, Abbott Vascular, Redwood City, California) was used in 2200 patients (average age 67.5 ± 12.5 years) who had undergone an angiographic intervention. Vascular access sites (1331 retrograde, 869 antegrade) with a sheath size of between 6F and 8F were closed. Platelet aggregation was inhibited with 100 mg/d ASA and all patients additionally received 5000 IU heparin peri-interventionally. After application of the suture-mediated closure system and achievement of sufficient hemostasis, a light compression bandage was applied in all patients and 6 hours of bed rest were recommended. The puncture site of all patients was checked using color-coded duplex sonography post-interventionally (following day and after 6 weeks).
Immediate hemostasis was achieved in 2103/2200 patients (95.6 %). In the remaining 97/2200 cases, correct development of the suture was not possible, because of calcifications. In such cases, hemostasis was achieved by manual compression. Major complications (0.4 %) involved 3 infections that required vascular surgical debridement with the use of an interposition graft. In addition, there were 5 cases of secondary bleeding requiring transfusion. Minor complications (15.6 %) involved 3 (0.14 %) pseudoaneurysms, 256 (11.6 %) groin hematomas (up to max. 3 cm) and 85 (3.9 %) palpable suture granulomas.
At a puncture size of 6 - 8F, safe and effective hemostasis is possible with the percutaneous suture-mediated closure system.
研究经股动脉途径使用经皮缝线介导闭合系统实现止血的安全性和有效性。
对2200例接受血管造影介入治疗的患者（平均年龄67.5±12.5岁）使用经皮缝线闭合系统（Perclose/Proglide，雅培血管，加利福尼亚州红木城）。闭合鞘管尺寸为6F至8F的血管穿刺部位（1331例逆行，869例顺行）。每日服用100mg阿司匹林抑制血小板聚集，所有患者在介入治疗期间还额外接受5000IU肝素。应用缝线介导闭合系统并实现充分止血后，所有患者均应用轻质加压绷带，并建议卧床休息6小时。介入治疗后（次日和6周后）使用彩色编码双功超声检查所有患者的穿刺部位。
2103/2200例患者（95.6%）实现了即时止血。在其余97/2200例病例中，由于钙化无法正确形成缝线。在这种情况下，通过手动压迫实现止血。主要并发症（0.4%）包括3例感染，需要使用间置移植物进行血管外科清创。此外，有5例继发性出血需要输血。次要并发症（15.6%）包括3例（0.14%）假性动脉瘤、256例（11.6%）腹股沟血肿（最大3cm）和85例（3.9%）可触及的缝线肉芽肿。
对于6-8F的穿刺尺寸，经皮缝线介导闭合系统可实现安全有效的止血。
