Section of Interventional Radiology, Department of Radiology, Penn Presbyterian Medical Center, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA, 19104, USA.
Cardiovasc Intervent Radiol. 2020 May;43(5):714-720. doi: 10.1007/s00270-020-02431-7. Epub 2020 Feb 10.
Upper extremity and tibiopedal arterial access are increasingly used during endovascular therapies. Balloon compression hemostasis devices in these anatomic locations have been described, but most utilize a compression surface extending well beyond the puncture site. We report single-center experience with an arterial puncture-focused compression device following upper extremity and tibiopedal access.
A series of 249 focused compression hemostasis devices (VasoStat, Forge Medical, Bethlehem, Pennsylvania, USA) were used in 209 patients following lower extremity (n = 63) and upper extremity (n = 186; radial: 90%) arterial access procedures using 4-7 French sheaths. Demographic, operative, and follow-up data were collected. Logistic regression was used to evaluate potential association between patient/operative variables and time to hemostasis.
Primary hemostasis was achieved in 97.2% (242/249) following sheath removal; in 7 cases (2.8%) puncture site oozing occurred after initial device removal and required reapplication. Secondary hemostasis was 100% (249/249). Seven complications (2.8%) were recorded: 5 minor hematomas (2%) and 2 transient access artery occlusions (0.8%). Mean time to hemostasis enabling device removal was 55 ± 28 min. Elevated body mass index (BMI) was not associated with increased time to hemostasis (p = 0.31). Accessed artery, sheath size, and heparin dose were also not associated with time to hemostasis (p = 0.64; p = 0.74; p = 0.75, respectively).
The focused compression hemostasis device enabled rapid hemostasis with a low complication rate. Time to hemostasis was independent of BMI, access site, sheath size, or heparin dose.
在上肢和胫腓动脉血管腔内治疗中，越来越多地使用上肢和胫腓动脉入路。在这些解剖部位已经描述了球囊压迫止血装置，但大多数都使用了超出穿刺部位的压缩面。我们报告了一种在使用上肢和胫腓动脉入路后专注于动脉穿刺的压迫止血装置的单中心经验。
使用了 249 个专注于压迫止血装置（VasoStat，Forge Medical，宾夕法尼亚州伯利恒），在 209 例下肢（n=63）和上肢（n=186；桡动脉：90%）动脉入路手术后使用 4-7 French 鞘。收集了人口统计学、手术和随访数据。使用逻辑回归评估了患者/手术变量与止血时间之间的潜在关联。
在 249 例患者中，242 例（97.2%）在鞘管拔出后实现了主要止血；在 7 例（2.8%）中，初始装置移除后出现穿刺部位渗血，需要重新应用。249 例（100%）患者实现了二级止血。记录了 7 例并发症（2.8%）：5 例小血肿（2%）和 2 例短暂的动脉入路阻塞（0.8%）。实现止血以允许移除装置的平均时间为 55±28 分钟。BMI 升高与止血时间延长无关（p=0.31）。血管入路、鞘管大小和肝素剂量也与止血时间无关（p=0.64；p=0.74；p=0.75，分别）。
专注于压迫止血装置能够快速止血，并发症发生率低。止血时间与 BMI、入路部位、鞘管大小或肝素剂量无关。
