Bin Waleed Khalid, Leung Lisa Wm, Akhtar Zaki, Sohal Manav, Zuberi Zia, Gallagher Mark M
Department of Cardiology, St. George's University Hospital NHS Foundation Trust, London, United Kingdom.
Kardiol Pol. 2022;80(7-8):750-759. doi: 10.33963/KP.a2022.0148. Epub 2022 Jun 20.
Recent decades have seen a series of advances in percutaneous transvenous procedures for cardiac arrhythmias, including the implantation of leadless pacemakers. Many of these procedures require the insertion of large caliber sheaths in large veins, usually the femoral vein. Securing hemostasis efficiently and reliably at the access site is a key step to improving a procedure's safety profile. Traditionally, hemostasis was achieved by manual compression of venous access sites, but the trend toward larger sheaths and the increased use of uninterrupted anticoagulation has pushed the limits of this method. Achieving hemostasis by compression alone in these circumstances requires more attention and longer duration, leading to greater patient discomfort and prolonged immobility. In turn, manual compression may be more time-consuming for medical professionals and increase the number of occupied hospital beds. New approaches have been developed to facilitate early ambulation, decrease patient discomfort, and address the risk of access site complications. These approaches include vascular closure devices and subcutaneous suture techniques including figureof- eight and purse-string sutures. This article reviews the new approaches applied to achieve venous access site hemostasis in patients undergoing transvenous procedures for cardiac arrhythmias.
近几十年来，经皮静脉治疗心律失常的技术取得了一系列进展，包括无导线起搏器的植入。其中许多手术需要在大静脉（通常是股静脉）中插入大口径鞘管。在穿刺部位有效且可靠地实现止血是提高手术安全性的关键一步。传统上，通过手动压迫静脉穿刺部位来实现止血，但随着鞘管尺寸增大以及不间断抗凝治疗的使用增加，这种方法的局限性日益凸显。在这些情况下，仅靠压迫来实现止血需要更多关注且耗时更长，会给患者带来更大不适并导致长时间制动。反过来，手动压迫对医护人员来说可能更耗时，还会增加占用的医院病床数量。已开发出新方法来促进患者早期活动、减轻患者不适并应对穿刺部位并发症的风险。这些方法包括血管闭合装置和皮下缝合技术，如8字缝合法和荷包缝合法。本文综述了用于心律失常经静脉手术患者静脉穿刺部位止血的新方法。
