Jabori Sinan, Jimenez Juan Carlos, Gabriel Viktor, Quinones-Baldrich William J, Derubertis Brian G, Farley Steven, Gelabert Hugh A, Rigberg David A
Division of Vascular Surgery, University of California-Los Angeles Gonda (Goldschmied) Vascular Center, Los Angeles, CA.
Ann Vasc Surg. 2013 Nov;27(8):1049-53. doi: 10.1016/j.avsg.2013.04.008. Epub 2013 Sep 5.
Percutaneous endovascular aneurysm repair (PEVAR) can be performed with high technical success rates and low morbidity rates. Several peer-reviewed papers regarding PEVAR have routinely combined heparin reversal with protamine before sheath removal. The risks of protamine reversal are well documented and include cardiovascular collapse and anaphylaxis. The aim of this study is to review outcomes of patients who underwent PEVAR without heparin reversal.
All patients who underwent percutaneous femoral artery closure after PEVAR between 2009-2012 without heparin reversal were reviewed. Only patients who underwent placement of large-bore (12- to 24-French) sheaths were included. Patient demographics, comorbidities, operative details, and complications were reported.
One hundred thirty-one common femoral arteries were repaired using the Preclose technique in 76 patients. Fifty-five patients underwent bilateral repair and 21 underwent unilateral repair. The mean age was 73.9±9.1 years. The mean heparin dose administered was 79±25.4 U/kg. The mean patient body mass index was 27.5±4.8 kg/m2. Ultrasound-guided arterial puncture was performed in all patients. Average operative times were 196.5±103.3 min, and the mean estimated blood loss was 277.6 mL. Four femoral arteries (3%) required open surgical repair after failed hemostasis with ProGlide closure (Abbott Vascular, Abbott Park, IL). Two patients required deployment of a third ProGlide device with successful closure. Two patients had small (<3 cm) groin hematomas that had resolved at the time of the postoperative computed tomography scan. No pseudoaneurysms or arteriovenous fistulas developed in our patient cohort. No early or late thrombotic complications were noted. One patient (1.3%) with a ruptured aneurysm died 48 hours after endovascular repair unrelated to femoral closure.
PEVAR may be performed with low patient morbidity after therapeutic heparinization without heparin reversal. Femoral artery repair after the removal of large-diameter sheaths using the Preclose technique can be performed in this setting with minimal rates of early and late bleeding or thrombosis.
经皮血管腔内动脉瘤修复术（PEVAR）的技术成功率高，发病率低。几篇关于PEVAR的同行评审论文在拔除鞘管前常规将肝素与鱼精蛋白联合使用以进行肝素逆转。鱼精蛋白逆转的风险已有充分记录，包括心血管虚脱和过敏反应。本研究的目的是回顾未进行肝素逆转而接受PEVAR的患者的结局。
回顾了2009年至2012年间在PEVAR后未进行肝素逆转而接受经皮股动脉闭合术的所有患者。仅纳入接受大口径（12至24法式）鞘管置入的患者。报告了患者的人口统计学、合并症、手术细节和并发症。
76例患者使用Preclose技术修复了131条股总动脉。55例患者接受双侧修复，21例接受单侧修复。平均年龄为73.9±9.1岁。肝素平均给药剂量为79±25.4 U/kg。患者平均体重指数为27.5±4.8 kg/m²。所有患者均进行了超声引导下动脉穿刺。平均手术时间为196.5±103.3分钟，平均估计失血量为277.6 mL。4条股动脉（3%）在使用ProGlide闭合器（雅培血管，雅培公园，伊利诺伊州）止血失败后需要进行开放手术修复。2例患者需要置入第三个ProGlide装置并成功闭合。有2例患者出现小的（<3 cm）腹股沟血肿，术后计算机断层扫描时已消退。我们的患者队列中未出现假性动脉瘤或动静脉瘘。未观察到早期或晚期血栓形成并发症。1例动脉瘤破裂患者在血管内修复术后48小时死亡，与股动脉闭合无关。
在治疗性肝素化后不进行肝素逆转的情况下，PEVAR可以使患者发病率较低。在这种情况下，使用Preclose技术在拔除大口径鞘管后进行股动脉修复，早期和晚期出血或血栓形成的发生率极低。
