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一种新型基于缝线的血管闭合装置,用于在静脉或动脉穿刺后实现止血且不留任何异物:技术评估与早期临床结果综述

A Novel Suture-Based Vascular Closure Device to Achieve Hemostasis after Venous or Arterial Access While Leaving Nothing behind: A Review of the Technological Assessment and Early Clinical Outcomes.

作者信息

Yazdani Saami K, Shedd Omer, Christy George, Teeslink Rex

机构信息

Department of Engineering, Wake Forest University, Winston-Salem, NC 27101, USA.

Department of Cardiology and Electrophysiology, CaroMont Regional Medical Center, Gastonia, NC 28054, USA.

出版信息

J Clin Med. 2024 Aug 7;13(16):4606. doi: 10.3390/jcm13164606.

DOI:10.3390/jcm13164606
PMID:39200748
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11354790/
Abstract

Vascular hemostasis after venous and arterial access in cardiovascular procedures remains a challenge. As sheath size gets larger for structural heart and vascular procedures, no dedicated closure devices exist that can overcome all the challenges of achieving vascular hemostasis, in particular on the venous side. Efficiently and reliably ensuring hemostasis at the access point is crucial for enhancing the safety of a procedure. Historically, hemostasis relied on manually compressing venous access sites. However, the shift towards larger sheaths and the more frequent use of continuous anticoagulation has strained this approach. Achieving hemostasis solely through compression in these scenarios demands heightened vigilance and prolonged application, resulting in increased patient discomfort and extended immobility. Consequently, manual compression may consume more time for healthcare providers and contribute to bed occupancy in hospitals. This review article summarizes the development of the SiteSeal Vascular Closure Device, a novel leave-nothing-behind approach to achieve hemostasis. The introduction of this technology has provided clinicians with a safer and more effective way to achieve immediate hemostasis, facilitate early ambulation, and enable earlier discharges with fewer access site complications compared with traditional manual compression.

摘要

在心血管手术中,静脉和动脉穿刺后的血管止血仍然是一项挑战。随着用于结构性心脏和血管手术的鞘管尺寸增大,目前尚无专门的闭合装置能够克服实现血管止血的所有挑战,尤其是在静脉方面。有效且可靠地确保穿刺点止血对于提高手术安全性至关重要。从历史上看,止血依赖于手动压迫静脉穿刺部位。然而,向更大鞘管的转变以及持续抗凝的更频繁使用使这种方法受到了限制。在这些情况下仅通过压迫来实现止血需要更高的警惕性和更长时间的应用,从而导致患者不适增加和活动受限延长。因此,手动压迫可能会为医护人员消耗更多时间,并增加医院的床位占用率。这篇综述文章总结了SiteSeal血管闭合装置的发展,这是一种实现止血的新型无残留方法。与传统手动压迫相比,这项技术的引入为临床医生提供了一种更安全、更有效的方式来实现即时止血、促进早期活动,并减少穿刺点并发症,实现更早出院。

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本文引用的文献

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2024 European Heart Rhythm Association/Heart Rhythm Society/Asia Pacific Heart Rhythm Society/Latin American Heart Rhythm Society expert consensus statement on catheter and surgical ablation of atrial fibrillation.2024 年欧洲心律协会/心律学会/亚太心律学会/拉丁美洲心律学会专家共识声明:关于心房颤动的导管和手术消融。
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Safety of multi-access site venous closure following catheter ablation of atrial fibrillation and flutter.多部位静脉入路封堵导管消融治疗心房颤动和扑动的安全性。
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New approaches to achieving hemostasis after venous access in cardiovascular patients.心血管疾病患者静脉穿刺后实现止血的新方法。
Kardiol Pol. 2022;80(7-8):750-759. doi: 10.33963/KP.a2022.0148. Epub 2022 Jun 20.
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Comparative outcomes of vascular access closure methods following atrial fibrillation/flutter catheter ablation: insights from VAscular Closure for Cardiac Ablation Registry.房颤/房扑导管消融术后血管闭合方法的比较结果:来自血管闭合用于心脏消融登记处的见解。
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A comparison of figure-of-8-suture versus manual compression for venous access closure after cardiac procedures: An updated meta-analysis.经导管心脏介入术后,采用 8 字缝合与手动压迫两种方法关闭血管通路的比较:一项更新的荟萃分析。
Pacing Clin Electrophysiol. 2020 Aug;43(8):856-865. doi: 10.1111/pace.14008. Epub 2020 Jul 20.
8
Feasibility of the Figure-of-8-Suture as Venous Closure in Interventional Electrophysiology: One Strategy for All?Figure-of-8 缝合作为介入电生理学中静脉闭合的可行性:一种策略适用于所有情况吗?
Int J Med Sci. 2020 Apr 6;17(7):965-969. doi: 10.7150/ijms.42593. eCollection 2020.
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