Cardiovascular Department, Clinique Rhône Durance, Avignon, France.
Can J Cardiol. 2013 Nov;29(11):1448-53. doi: 10.1016/j.cjca.2013.06.005. Epub 2013 Aug 26.
Lower extremity ischemia after the use of vascular closure devices (VCDs) after transfemoral percutaneous coronary and peripheral interventions is an infrequent though relevant clinical entity. We aimed to assess immediate and midterm outcomes of a systematic endovascular approach for the treatment of VCD-related lower limb ischemia.
Between 2006 and 2008, all the patients who developed lower limb ischemia after the use of a VCD in a high volume French institution were systematically managed percutaneously and constituted the study population. Clinical characteristics, immediate, and midterm outcomes are reported.
Of 2944 consecutive patients undergoing VCD placement after femoral access, 18 (3 men and 15 women) had VCD-related lower limb ischemia and were all managed percutaneously. Median age was 66.5 years. Devices were Angio-Seal (St Jude Medical) in 12 cases, StarClose (Abbott Vascular Devices) in 3 cases, and Perclose (Abbott Vascular Devices) in 3 cases. Limb ischemia occurred with a median delay of 2 days after device placement. Index procedures were coronary interventions in 14 cases and peripheral in 4 cases. The occlusion site was successfully crossed in all cases. Twelve patients were treated with balloon angioplasty and 6 with stent implantation. Angiographic success was obtained in all cases. After a median 32-month follow-up, only 2 patients initially treated using percutaneous transluminal angioplasty needed reintervention consisting of a balloon angioplasty in 1 case and stent implantation in the second case. At final follow-up, all the patients were asymptomatic.
Endovascular treatment for VCD-related limb ischemia is a feasible and effective approach resulting in excellent immediate and midterm outcomes.
经股动脉行经皮冠状动脉和外周介入治疗后使用血管闭合装置（VCD）后出现下肢缺血是一种罕见但相关的临床病症。我们旨在评估系统血管内方法治疗 VCD 相关下肢缺血的即刻和中期结果。
在 2006 年至 2008 年期间，法国一家高容量机构中所有使用 VCD 后出现下肢缺血的患者均通过系统的经皮方法进行了治疗，这些患者构成了研究人群。报告了临床特征、即刻和中期结果。
在 2944 例连续接受股动脉入路 VCD 放置的患者中，18 例（3 名男性和 15 名女性）出现了 VCD 相关的下肢缺血，并且所有患者均接受了经皮治疗。中位年龄为 66.5 岁。装置为 Angio-Seal（St Jude Medical）12 例，StarClose（Abbott Vascular Devices）3 例，Perclose（Abbott Vascular Devices）3 例。肢体缺血发生在装置放置后中位 2 天。索引手术为 14 例冠状动脉介入治疗和 4 例外周介入治疗。所有病例均成功穿过闭塞部位。12 例患者接受球囊血管成形术治疗，6 例患者接受支架植入术治疗。所有病例均获得了血管造影成功。中位随访 32 个月后，最初接受经皮腔内血管成形术治疗的 2 例患者需要再次介入治疗，1 例患者接受球囊血管成形术，另 1 例患者接受支架植入术。最终随访时，所有患者均无症状。
VCD 相关肢体缺血的血管内治疗是一种可行且有效的方法，可获得极好的即刻和中期结果。
