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开发、临床前评估和验证一种新型快速血管闭合装置,用于经腔、心脏和放射学动脉导管插入术。

Development, preclinical evaluation and validation of a novel quick vascular closure device for transluminal, cardiac and radiological arterial catheterization.

机构信息

German Institutes of Textile and Fiber Research (DITF), Denkendorf, Germany.

ITV Denkendorf Produktservice GmbH, Denkendorf, Germany.

出版信息

J Mater Sci Mater Med. 2018 Jun 11;29(6):83. doi: 10.1007/s10856-018-6092-y.

Abstract

Following percutaneous coronary intervention, vascular closure devices (VCDs) are increasingly used to reduce time to ambulation, enhance patient comfort, and reduce potential complications compared with traditional manual compression. Newer techniques include complicated, more or less automated suture devices, local application of pads or the use of metal clips and staples. These techniques often have the disadvantage of being time consuming, expensive or not efficient enough. The VCD failure rate in association with vascular complications of 2.0-9.5%, depending on the type of VCD, is still not acceptable. Therefore, the aim of this study is to develop a self-expanding quick vascular closure device (QVCD) made from a bioabsorbable elastic polymer that can be easily applied through the placed introducer sheath. Bioabsorbable block-co-polymers were synthesized and the chemical and mechanical degradation were determined by in vitro tests. The best fitting polymer was selected for further investigation and for microinjection moulding. After comprehensive haemocompatibility analyses in vitro, QVCDs were implanted in arterial vessels following arteriotomy for different time points in sheep to investigate the healing process. The in vivo tests proved that the new QVCD can be safely placed in the arteriotomy hole through the existing sheath instantly sealing the vessel. The degradation time of 14 days found in vitro was sufficient for vessel healing. After 4 weeks, the remaining QVCD material was covered by neointima. Overall, our experiments showed the safety and feasibility of applying this novel QVCD through an existing arterial sheath and hence encourage future work with larger calibers.

摘要

经皮冠状动脉介入治疗后,血管闭合装置(VCD)越来越多地被用于减少活动时间、增强患者舒适度,并减少与传统手动压缩相关的潜在并发症。较新技术包括复杂的、或多或少自动化的缝合装置、局部应用的垫子或使用金属夹和订书钉。这些技术往往具有耗时、昂贵或效率不够高的缺点。VCD 的血管并发症发生率为 2.0-9.5%,具体取决于 VCD 的类型,这仍然是不可接受的。因此,本研究的目的是开发一种由可生物吸收弹性聚合物制成的自扩张快速血管闭合装置(QVCD),可以通过放置的导入鞘轻松应用。合成了可生物吸收的嵌段共聚物,并通过体外试验确定了其化学和机械降解情况。选择最佳的聚合物进行进一步研究和微注射成型。在体外进行了全面的血液相容性分析后,将 QVCD 植入羊的动脉血管中,在不同的时间点进行动脉切开术,以研究愈合过程。体内试验证明,新的 QVCD 可以通过现有的护套安全地放置在动脉切开孔中,立即密封血管。在体外发现的 14 天降解时间足以使血管愈合。4 周后,剩余的 QVCD 材料被新生内膜覆盖。总的来说,我们的实验表明,通过现有的动脉护套应用这种新型 QVCD 是安全且可行的,因此鼓励未来使用更大口径进行进一步研究。

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