Department of Surgical Sciences, Section of Vascular Surgery, Uppsala University, Uppsala, Sweden; Department of Surgery, Sundsvall County Hospital, Sundsvall, Sweden.
Eur J Vasc Endovasc Surg. 2013 Nov;46(5):558-63. doi: 10.1016/j.ejvs.2013.08.009. Epub 2013 Sep 3.
To investigate the technical success rate of Prostar XL for closure of large (≥20F) femoral vascular access sites in thoracic endovascular aortic repair (TEVAR) procedures.
This was a single-center consecutive case series. All TEVAR procedures at Uppsala University Hospital 2006-2010 were registered prospectively. Reoperations and cases with open closure technique were excluded. Primary (early) technical failure was defined as closure failure requiring immediate (on-table) open surgical repair; late access-related complication occurred thereafter. The medical records, pre- and postoperative computed tomography images were reviewed retrospectively.
A total of 164 TEVAR procedures were identified, of which 118 (71%) had a median 22F (range 20-26F) access site sealed with tandem Prostar XL. The indications for TEVAR were dissection (47%), aneurysm (42%), trauma (8%), and miscellaneous (3%). Median follow-up time was 10 months (range 1-62). Primary technical failure occurred in 10 of 118 (8%). These cases were converted to cut-downs and surgical repair (n = 7), femoral fascia suturing (n = 2), and external compression with the Femo-Stop device (n = 1). Hypertension was associated with primary failure (p = .005), and a trend was observed for high age (p = .078) and increased groin subcutaneous fat layer (p = .077). Late access-related complications included pseudo-aneurysms (n = 12), small hematomas (n = 7), superficial groin infections (n = 2), and deep venous thrombosis (n = 1). None of the late complications required surgical treatment.
The access closure technique with tandem Prostar XL for large access sites during TEVAR is safe, in experienced hands. Few technical failures and few late complications occur, and they are usually benign.
研究 Prostar XL 在胸主动脉腔内修复术（TEVAR）中用于闭合较大（≥20F）股血管入路的技术成功率。
这是一项单中心连续病例系列研究。乌普萨拉大学医院 2006 年至 2010 年所有的 TEVAR 手术均前瞻性登记。排除再次手术和采用开放闭合技术的病例。主要（早期）技术失败定义为闭合失败需要立即（手术台上）进行开放手术修复；此后出现晚期与血管通路相关的并发症。回顾性审查病历、术前和术后计算机断层扫描图像。
共确定 164 例 TEVAR 手术，其中 118 例（71%）采用串联 Prostar XL 闭合 22F（范围 20-26F）股血管入路。TEVAR 的适应证为夹层（47%）、动脉瘤（42%）、创伤（8%）和其他（3%）。中位随访时间为 10 个月（范围 1-62）。118 例中有 10 例（8%）发生主要技术失败。这些病例转为切开和手术修复（n = 7）、股筋膜缝合（n = 2）和使用 Femo-Stop 装置外部压迫（n = 1）。高血压与主要失败相关（p =.005），年龄较高（p =.078）和股部皮下脂肪层较厚（p =.077）呈趋势相关。晚期与血管通路相关的并发症包括假性动脉瘤（n = 12）、小血肿（n = 7）、浅表腹股沟感染（n = 2）和深静脉血栓形成（n = 1）。无晚期并发症需要手术治疗。
在经验丰富的手中，使用 Prostar XL 串联技术闭合 TEVAR 中较大的血管入路是安全的。技术失败和晚期并发症很少见，且通常为良性。
