Maeda Koji, Ohki Takao, Kanaoka Yuji, Baba Takeshi, Shukuzawa Kota, Takizawa Reo, Omori Makiko
Department of Vascular Surgery, Jikei University School of Medicine, Minato-ku, Tokyo, Japan -
Department of Vascular Surgery, Jikei University School of Medicine, Minato-ku, Tokyo, Japan.
J Cardiovasc Surg (Torino). 2020 Feb;61(1):78-83. doi: 10.23736/S0021-9509.18.10595-7. Epub 2018 Aug 29.
Percutaneous endovascular aortic repair (PEVAR) is widespread for the treatment of abdominal aortic aneurysm (AAA). The purpose of this study was to present outcomes of PEVAR using simultaneous angiography via microsheath.
There were 100 punctures in 50 patients undergoing PEVAR for AAA. All cases used the ProGlide closure device (Abbot Vascular, Santa Clara, CA, USA) for PEVAR, and another puncture with microsheath placed on the common femoral artery for a second insertion point of the ProGlide. Basically, a single ProGlide was used for each puncture in the PEVAR. Hemostasis, stenosis, dissection, and distal embolization were confirmed in angiography via the adjunctive microsheath after removal of the delivery system. Since the PEVAR for AAA requires at least two punctures, this procedure was applied to both sites. Primary outcome was technical success and occurrence rates of access-related complications in PEVAR. Technical success was defined as complete hemostasis without surgical intervention and the need for conversion to general anesthesia.
Technical success was achieved in 98% (98/100) of the cases. Access-related complications on perioperative periods were identified in two cases. One case involved a tip of the microsheath being transected by the ProGlide that led to a distal embolization, which is why a cut down was required to retrieve the tip of the sheath. Another case required a cut down due to persistent hemorrhage from the puncture site of the microsheath. Although persistent hemorrhage was identified in five punctures (5.0%) via the adjunctive microsheath angiography, additional manual compression or ProGlide achieved complete hemostasis. Both stenosis and dissection following PEVAR were not identified in any case.
A supporting angiography via microsheath in confirming the absence of hemorrhage, stenosis, dissection, and distal embolization may be worthwhile to selectively use for cases of PEVAR.
经皮血管腔内主动脉修复术（PEVAR）广泛应用于腹主动脉瘤（AAA）的治疗。本研究的目的是介绍通过微鞘同步血管造影进行PEVAR的结果。
50例接受AAA的PEVAR患者共穿刺100次。所有病例均使用ProGlide闭合装置（美国加利福尼亚州圣克拉拉市雅培血管公司）进行PEVAR，并在股总动脉处用微鞘进行另一次穿刺，作为ProGlide的第二个插入点。基本上，PEVAR中的每次穿刺都使用单个ProGlide。在移除输送系统后，通过辅助微鞘血管造影确认止血、狭窄、夹层和远端栓塞情况。由于AAA的PEVAR至少需要两次穿刺，该操作应用于两个部位。主要结局是PEVAR的技术成功率和与穿刺相关并发症的发生率。技术成功定义为无需手术干预即可完全止血且无需转为全身麻醉。
98%（98/100）的病例取得技术成功。围手术期发现两例与穿刺相关的并发症。一例是微鞘尖端被ProGlide切断，导致远端栓塞，因此需要切开以取出鞘尖端。另一例因微鞘穿刺部位持续出血而需要切开。尽管通过辅助微鞘血管造影在5次穿刺（5.0%）中发现了持续出血，但额外的手动压迫或ProGlide实现了完全止血。PEVAR后未发现任何狭窄和夹层病例。
通过微鞘进行辅助血管造影以确认无出血、狭窄、夹层和远端栓塞，对于PEVAR病例选择性使用可能是值得的。
