Majid K, Anwar M A, Shepherd A, Malina M, Hussain T
Northwick Park Hospital , London , UK.
Ann R Coll Surg Engl. 2019 Jan;101(1):14-16. doi: 10.1308/rcsann.2018.0200. Epub 2018 Nov 28.
Percutaneous access and closure is commonly performed for patients undergoing endovascular aneurysm repair (EVAR). It has proven to be a safe and successful method of closure associated with fewer complications when compared with the traditional open technique. Fascial closure is an alternative technique that can be used for closure reducing the risks associated with the open technique. The aim of this study was to assess the safety and durability of fascial closure for failed percutaneous closure device following EVAR.
Over a 12-month period, 49 patients who had undergone EVAR were identified via our EVAR register. Retrospective analysis of the clinical records was undertaken. We identified all the patients who had fascial closure of the groins following a failed percutaneous closure device. Patients had a computed tomography angiogram one month postoperatively, with duplex imaging and clinic follow-up three months later.
Fascial closure was performed in 14 groins. It failed in three groins and these patients had traditional open repair. Fascial closure was successful in 11 groins (7 patients). Of these seven patients, one was female (6%). The mean age was 80 years (range 68-92 years). Two patients died and one was lost to follow-up. One pseudoaneurysms were seen on computed tomography angiogram, which was managed conservatively and had resolved on follow-up imaging.
Fascial closure is a very good alternative to open repair after failure of the closure device.
对于接受血管内动脉瘤修复术（EVAR）的患者，经皮穿刺入路和闭合术是常用的操作。与传统开放技术相比，它已被证明是一种安全且成功的闭合方法，并发症较少。筋膜闭合术是一种可用于闭合的替代技术，可降低与开放技术相关的风险。本研究的目的是评估在EVAR术后经皮闭合装置失败后筋膜闭合术的安全性和耐久性。
在12个月的时间里，通过我们的EVAR登记册确定了49例接受过EVAR的患者。对临床记录进行回顾性分析。我们确定了所有在经皮闭合装置失败后进行腹股沟筋膜闭合的患者。患者术后1个月进行计算机断层血管造影，3个月后进行双功超声成像和临床随访。
对14个腹股沟进行了筋膜闭合。其中3个腹股沟闭合失败，这些患者接受了传统的开放修复。11个腹股沟（7例患者）筋膜闭合成功。在这7例患者中，1例为女性（6%）。平均年龄为80岁（范围68 - 92岁）。2例患者死亡，1例失访。计算机断层血管造影显示1例假性动脉瘤，采取保守治疗，随访成像时已消退。
在闭合装置失败后，筋膜闭合是开放修复的一种非常好的替代方法。
