Hutchings David, Hayat Afzal, Karunakaran Arun, Malik Nadim
Stepping Hill Hospital, Stockport, Greater Manchester, United Kingdom.
J Invasive Cardiol. 2016 Mar;28(3):104-8.
Femoral artery closure device use following percutaneous cannulation allows earlier mobilization, reduced staff burden, and improved comfort for patients compared with manual compression. The Mynx device (Access Closure, Inc), a novel extravascular closure device, uses a water-soluble non-thrombogenic polyethylene glycol plug.
We report retrospective analysis of success, complication rates, and associated factors in 432 consecutive patients undergoing elective outpatient coronary angiography in a single United Kingdom center.
Six Fr sheaths were used in 62.1% and 5 Fr sheaths were used in 37.8%, with 100% successful deployment using a Mynx device. A total of 57.5% of patients were male. In 79.4%, this was the first procedure requiring femoral arteriotomy, while 20.6% had a previous procedure. Overall, 3.2% required conversion to manual compression/ FemoStop (St. Jude Medical) due to impending hematoma. In all, 99.5% of patients were discharged on the same day. Confirmed hematoma >5 cm was noted in 0.7% patients, with only 2 patients (0.5%) reporting "any discomfort" during deployment and the same requiring overnight hospitalization. Use of a 6 Fr sheath (compared with 5 Fr) was associated with conversion to manual compression and complications (P<.05), as was valvular heart disease as the indication for angiography (P<.05). Hematoma formation was associated with higher diastolic and mean arterial pressure (107.4 mm Hg vs 99.6 mm Hg; P<.01). There was no increase in complications associated with use of antiplatelet/anticoagulants, previous stroke, myocardial infarction/ischemic heart disease, peripheral vascular disease, diabetes, high body mass index, or previous angiographic procedure.
Postangiography use of the Mynx closure device is highly successful, safe, and well-tolerated with a low complication rate, allowing safe same-day discharge.
与手动压迫相比，经皮穿刺后使用股动脉闭合装置可使患者更早活动，减轻医护人员负担，并提高患者舒适度。Mynx装置（Access Closure公司）是一种新型血管外闭合装置，使用水溶性非血栓形成的聚乙二醇塞子。
我们报告了对英国一家中心432例连续接受择期门诊冠状动脉造影患者的成功情况、并发症发生率及相关因素的回顾性分析。
62.1%的患者使用6F鞘管，37.8%的患者使用5F鞘管，使用Mynx装置的成功率为100%。患者中男性占57.5%。79.4%的患者此次是首次需要股动脉切开的手术，20.6%的患者曾接受过此类手术。总体而言，3.2%的患者因即将出现血肿而需要转为手动压迫/FemoStop（圣犹达医疗公司）。所有患者中，99.5%在同一天出院。0.7%的患者确认血肿>5 cm，只有2例患者（0.5%）在装置置入过程中报告“有任何不适”，这2例患者需要过夜住院。使用6F鞘管（与5F鞘管相比）与转为手动压迫及并发症相关（P<0.05），以瓣膜性心脏病作为血管造影指征也与并发症相关（P<0.05）。血肿形成与较高的舒张压和平均动脉压相关（107.4 mmHg对99.6 mmHg；P<0.01）。使用抗血小板/抗凝药物、既往中风、心肌梗死/缺血性心脏病、外周血管疾病、糖尿病、高体重指数或既往血管造影手术与并发症增加无关。
血管造影术后使用Mynx闭合装置非常成功、安全且耐受性良好，并发症发生率低，可实现安全的当日出院。
