Department of Neurosurgery, Nara Medical University, Nara, Japan.
Department of Neurosurgery, Nara Medical University, Nara, Japan.
World Neurosurg. 2024 Aug;188:e305-e311. doi: 10.1016/j.wneu.2024.05.100. Epub 2024 May 23.
Puncture-site complications in interventional radiology sometimes cause severe conditions. Vascular closure devices play an important role in preventing puncture-site complications. Vascular closure devices are divided into 2 types, the directly suturing or clipping type (active approximators) and adherent sealant types (passive approximators). However, which types of vascular closure device are the safest and most effective for achieving hemostasis remains unclear. We analyzed the efficacy of each type of vascular closure device and risk factors for puncture-site complications.
This study investigated 327 consecutive cases of neuroendovascular surgery using a transfemoral procedure during a 2-year study period. Passive approximators (Angioseal [St Jude Medical, Saint Paul, MN] and Exoseal [Cordis Corporation, Miami, FL]) were mainly used in the first half and active approximators (Perclose [Abbot Vascular, Santa Clara, CA]) in the second. We compared groups and estimated risk factors for puncture-site complications.
All procedures were successful. Comparing groups with and without puncture-site complications, use of passive approximators and ≥3 antithrombotic medications tended to be more frequent and distance from skin to femoral artery and body mass index tended to be lower in the group with complications without significance. The cutoff for femoral artery depth calculated from a receiver operating characteristic curve was 16.43 mm. Multivariate analysis revealed ≥3 antithrombotic medications (P = 0.002, OR 15.29, 95% CI 2.76-85.76) and passive approximator use in patients with femoral artery depth <16.43 mm (P < 0.001, OR 17.08, 95% CI 2.95-57.80) were significantly higher in the group with puncture-site complications.
Passive approximator use in patients with shallow femoral artery depth increases puncture-site complications in neuroendovascular treatment.
介入放射学中的穿刺部位并发症有时会导致严重的情况。血管闭合装置在预防穿刺部位并发症方面起着重要作用。血管闭合装置分为 2 种类型，直接缝合或夹闭型（主动闭合器）和黏附密封型（被动闭合器）。然而，哪种类型的血管闭合装置在实现止血方面最安全、最有效尚不清楚。我们分析了每种类型的血管闭合装置的疗效和穿刺部位并发症的危险因素。
本研究调查了在 2 年的研究期间，通过股动脉入路进行的 327 例连续神经血管内手术。在研究的前半段，主要使用被动闭合器（Angioseal[圣犹达医疗用品公司，明尼苏达州圣保罗]和 Exoseal[柯迪斯公司，佛罗里达州迈阿密]），在后半段使用主动闭合器（Perclose[雅培血管公司，加利福尼亚州圣克拉拉]）。我们比较了各组，并估计了穿刺部位并发症的危险因素。
所有手术均成功。比较有和无穿刺部位并发症的组，使用被动闭合器和≥3 种抗血栓药物的比例较高，穿刺部位并发症组的股动脉到皮肤的距离和体重指数较低，但无统计学意义。从受试者工作特征曲线计算得出的股动脉深度临界值为 16.43mm。多变量分析显示，≥3 种抗血栓药物（P=0.002，OR 15.29，95%CI 2.76-85.76）和股动脉深度<16.43mm 的患者使用被动闭合器（P<0.001，OR 17.08，95%CI 2.95-57.80）在穿刺部位并发症组中显著较高。
在股动脉较浅的患者中使用被动闭合器会增加神经血管内治疗中的穿刺部位并发症。
