Szpotan Tomasz, Czernik Maciej, Majos Agata
Pirogow Voivodeship Hospital, Lodz, Poland.
Central Teaching Hospital of the Medical University of Lodz, Poland.
Pol J Radiol. 2023 Jan 25;88:e47-e52. doi: 10.5114/pjr.2023.124682. eCollection 2023.
Endovascular procedures such as endovascular aneurysm repair or transcatheter aortic valve implantation have become very common because of reduced patient traumatisation and the ability to use shorter or local anaesthesia. In these procedures large-bore sheath devices are used. Access with percutaneous closure is an alternative method to surgical cutdown in groins. The aim of the study was to assess the correlation between sheath size and unsuccessful haemostasis. In addition, the effectiveness of haemostasis after a percutaneous procedure and the number and type of complications were evaluated.
There were 202 patients included in the study. Patients with abdominal aortic aneurysm were qualified to percutaneous aortic stentgraft implantation with Perclose Proglide preclosure technique.
There were 384 access sites performed with 12F to 22F sheaths during aortic stentgraft implantation with Perclose Proglide (Abbott Vascular, Santa Clara, CA, USA) preclosure technique. High effectiveness of haemostasis (98%), low percentage of short- and mid-term complications (2.6%), and infinitesimal number of surgical conversions ( = 5) were stated in the study. There was no correlation between diameter of used introducer sheath and lack of haemostasis observed (Fisher-Freeman-Halton test; = 0.122). No relationship between diameter of introducer sheath and number of closure devices was observed (c = 2.436; df = 5; = 0.786).
Large-bore device percutaneous procedures with closure devices are effective and safe. High effectiveness of haemostasis (98%) was observed in the study group, with a low percentage of complications (2.6%). There was no correlation between size of the vascular access and the lack of haemostasis found in the study.
血管内手术，如血管内动脉瘤修复术或经导管主动脉瓣植入术，由于减少了患者创伤以及能够采用较短时间的麻醉或局部麻醉，已变得非常普遍。在这些手术中会使用大口径鞘管装置。经皮闭合穿刺入路是腹股沟区手术切开的一种替代方法。本研究的目的是评估鞘管尺寸与止血失败之间的相关性。此外，还评估了经皮手术后止血的有效性以及并发症的数量和类型。
本研究纳入了202例患者。腹主动脉瘤患者符合采用Perclose Proglide预闭合技术进行经皮主动脉覆膜支架植入术的条件。
在采用Perclose Proglide（美国加利福尼亚州圣克拉拉市雅培血管公司）预闭合技术进行主动脉覆膜支架植入术期间，使用12F至22F鞘管进行了384个穿刺入路操作。研究表明止血效果高（98%）、短期和中期并发症发生率低（2.6%）且手术转换率极低（=5）。未观察到所用导入鞘管直径与止血失败之间存在相关性（Fisher-Freeman-Halton检验；=0.122）。未观察到导入鞘管直径与闭合装置数量之间存在关系（c=2.436；自由度=5；=0.786）。
使用闭合装置的大口径器械经皮手术是有效且安全的。研究组观察到止血效果高（98%），并发症发生率低（2.6%）。本研究未发现血管入路尺寸与止血失败之间存在相关性。
