Pracon Radoslaw, Bangalore Sripal, Henzel Jan, Cendrowska-Demkow Iwona, Pregowska-Chwala Barbara, Tarnowska Agnieszka, Dzielinska Zofia, Chmielak Zbigniew, Witkowski Adam, Demkow Marcin
Coronary and Structural Heart Diseases Department, Institute of Cardiology, Warsaw, Poland.
New York University School of Medicine, New York.
Catheter Cardiovasc Interv. 2018 Jan 1;91(1):105-112. doi: 10.1002/ccd.27003. Epub 2017 Mar 17.
To compare subcutaneous "Z"-stitch versus manual compression in attaining hemostasis after large bore femoral venous access, and to assess its impact on venous patency.
Structural interventions increasingly require large caliber venous access, for which convenient, safe, and effective method of postprocedural hemostasis is needed. "Z"-stitch has been introduced for this purpose in some centers but systematic data on its performance is limited.
This single center study randomized consecutive patients with femoral venous access sites requiring ≥10F sheaths to the "Z"-stitch or manual compression for hemostasis in a 2:1 fashion. There were three co-primary endpoints: time to hemostasis, time to ambulation, and a composite safety endpoint comprising vascular access site complications. Groin Doppler-Duplex was performed with the stitch in place and after its removal.
86 consecutive patients with 90 access sites were randomized. Mean age was 61.7 ± 19.1 years, 33.3% were men. Median sheath size was 14 F (range 10-22 F). Patients randomized to "Z"-stitch achieved hemostasis quicker [<1 min vs. 12.0 (IQR 10.0-15.0) min, P < 0.001] and ambulated sooner [7.0 (IQR 4.0-12.0) vs. 16.0 (IQR 11.8-20.3) hr post procedure, P < 0.001] when compared with manual compression alone. The "Z"-stitch reduced rates of access site complications (OR = 0.27, 95%CI 0.09-0.76, P = 0.01). All imaged veins were patent before and after stitch removal.
The "Z"-stitch is a safe and effective method of achieving hemostasis after large bore femoral venous sheath removal and results in faster hemostasis, early patient ambulation and less access site complications, without compromising vein patency when compared with manual compression alone. © 2017 Wiley Periodicals, Inc.
比较皮下“Z”形缝合法与手法压迫法在大口径股静脉穿刺后实现止血的效果，并评估其对静脉通畅性的影响。
结构性干预越来越需要大口径静脉通路，因此需要便捷、安全且有效的术后止血方法。一些中心已引入“Z”形缝合法用于此目的，但关于其性能的系统数据有限。
这项单中心研究将连续的股静脉穿刺部位需要≥10F鞘管的患者以2:1的比例随机分为“Z”形缝合法或手法压迫法进行止血。有三个共同主要终点：止血时间、下床活动时间以及包括血管穿刺部位并发症的综合安全终点。在缝合时及拆除后进行腹股沟多普勒 - 双功超声检查。
86例连续患者共90个穿刺部位被随机分组。平均年龄为61.7±19.1岁，男性占33.3%。鞘管中位尺寸为14F（范围10 - 22F）。与单纯手法压迫相比，随机接受“Z”形缝合法的患者止血更快[<1分钟 vs. 12.0（四分位间距10.0 - 15.0）分钟，P < 0.001]且下床活动更早[术后7.0（四分位间距4.0 - 12.0）小时 vs. 16.0（四分位间距11.8 - 20.3）小时，P < 0.001]。“Z”形缝合法降低了穿刺部位并发症的发生率（比值比 = 0.27，95%置信区间0.09 - 0.76，P = 0.01）。在拆除缝线前后，所有成像的静脉均通畅。
与单纯手法压迫相比，“Z”形缝合法是大口径股静脉鞘管拔除后实现止血的一种安全有效的方法，能实现更快止血、患者更早下床活动且穿刺部位并发症更少，同时不影响静脉通畅性。© 2017威利期刊公司
