Saadi Eduardo Keller, Saadi Marina, Saadi Rodrigo, Tagliari Ana Paula, Mastella Bernardo
Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.
Universidade Luterana do Brasil (ULBRA), Canoas, RS, Brazil.
Braz J Cardiovasc Surg. 2017 Jan-Feb;32(1):43-48. doi: 10.21470/1678-9741-2016-0065.
To evaluate our experience following the introduction of a percutaneous program for endovascular treatment of aortic diseases using Perclose Proglide® assessing efficacy, complications and identification of potential risk factors that could predict failure or major access site complications.
A retrospective cohort study during a two-year period was performed. All the patients submitted to totally percutaneous endovascular repair (PEVAR) of aortic diseases and transcatheter aortic valve implantation since we started the total percutaneous approach with the preclosure technique from November 2013 to December 2015 were included in the study. The primary endpoint was major ipsilateral access complication, defined according to PEVAR trial.
In a cohort of 123 patients, immediate technical success was obtained in 121 (98.37%) patients, with only two (0.82%) cases in 242 vascular access sites that required intervention immediately after the procedure. Pairwise comparisons revealed increased major access complication among patients with >50% common femoral artery (CFA) calcification vs. none (P=0.004) and > 50% CFA calcification vs. < 50% CFA calcification (P=0.002). Small artery diameter (<6.5 mm) also increased major access complication compared to bigger diameters (> 6.5 mm) (P=0.027).
The preclosure technique with two Perclose Proglide® for PEVAR is safe and effective. Complications occur more often in patients with unfavorable access site anatomy and the success rate can be improved with proper patient selection.
采用Perclose Proglide®评估经皮血管腔内治疗主动脉疾病方案的疗效、并发症，并识别可能预测失败或主要穿刺部位并发症的潜在风险因素，从而评估我们的经验。
进行了一项为期两年的回顾性队列研究。自2013年11月至2015年12月我们开始采用预闭合技术的完全经皮方法以来，所有接受主动脉疾病完全经皮血管腔内修复术（PEVAR）和经导管主动脉瓣植入术的患者均纳入研究。主要终点是主要同侧穿刺并发症，根据PEVAR试验定义。
在123例患者队列中，121例（98.37%）患者即刻获得技术成功，在242个血管穿刺部位中只有2例（0.82%）在术后需要立即干预。两两比较显示，股总动脉（CFA）钙化>50%的患者与无钙化患者相比主要穿刺并发症增加（P = 0.004），CFA钙化>50%的患者与CFA钙化<50%的患者相比主要穿刺并发症增加（P = 0.002）。与较大动脉直径（>6.5 mm）相比，小动脉直径（<6.5 mm）也增加了主要穿刺并发症（P = 0.027）。
用于PEVAR的双Perclose Proglide®预闭合技术安全有效。在穿刺部位解剖结构不利的患者中并发症更常发生，通过适当的患者选择可以提高成功率。
