Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK.
Liverpool Heart & Chest Hospital NHS Foundation Trust, Thomas Drive, Liverpool, L14 3PE, UK.
J Cardiovasc Electrophysiol. 2024 Nov;35(11):2119-2127. doi: 10.1111/jce.16417. Epub 2024 Sep 4.
Methods for femoral venous haemostasis following electrophysiology (EP) procedures include manual compression (MC) and suture-based techniques such as a figure-of-eight suture secured with a hand-tied knot (Fo8) or a modified figure-of-eight suture secured with a 3-way stopcock (Fo8). We hypothesised that short-term bleeding outcomes using the Fo8 approach would be superior to MC. We additionally compared outcomes between Fo8 and Fo8 approaches.
We studied consecutive patients undergoing EP procedures at our institution between March and December 2023. Patients were categorised into three haemostasis groups: MC, Fo8 and Fo8. Access site complications were classified as major (requiring intervention or blood transfusion, delaying discharge or resulting in death) or minor (bleeding/haematoma requiring additional compression).
1089 patients were included: MC 718 (65.9%); Fo8 105 (9.6%); Fo8 266 (24.4%). Procedures were most commonly for atrial fibrillation (52.4%), atrial flutter (10.9%), and atrioventricular nodal re-entrant tachycardia (10.1%). In patients receiving periprocedural anticoagulation (865, 79.4%), Fo8 associated with fewer complications than MC or Fo8 (major: MC 2.2%, Fo8 6.0%, Fo8 0.8%, p = .01; minor: MC 16.5%, Fo8 12.0%, Fo8 7.4%, p = .002). In patients not receiving periprocedural anticoagulation, complications did not differ between haemostasis methods (total major and minor complications 5.8%, p = .729 for between groups rates). On multivariable logistic regression, Fo8 was associated with a significantly lower risk of access site complications (OR 0.29 [95% CI 0.17-0.48], p < .001), whilst intraprocedural heparinisation (OR 5.25 [2.88-9.69], p < .001) and larger maximal sheath size (OR 1.06 [1.00-1.11], p = .04) were associated with a higher risk of complications.
Femoral haemostasis with Fo8 associates with fewer access site complications than MC and Fo8 following EP procedures that need periprocedural anticoagulation.
电生理 (EP) 程序后股静脉止血的方法包括手动压迫 (MC) 和基于缝合的技术，例如使用手动打结的 8 字缝合线 (Fo8) 或使用三通阀固定的改良 8 字缝合线 ( Fo8)。我们假设使用 Fo8 方法的短期出血结果会优于 MC。我们还比较了 Fo8 和 Fo8 方法之间的结果。
我们研究了 2023 年 3 月至 12 月期间在我们机构接受 EP 程序的连续患者。患者分为三组止血：MC、Fo8 和 Fo8。将入路部位并发症分为主要（需要干预或输血、延迟出院或导致死亡）或次要（需要额外压迫的出血/血肿）。
共纳入 1089 例患者：MC 718 例（65.9%）；Fo8 105 例（9.6%）；Fo8 266 例（24.4%）。手术最常见的是心房颤动（52.4%）、心房扑动（10.9%）和房室结折返性心动过速（10.1%）。在接受围手术期抗凝治疗的患者中（865 例，79.4%），Fo8 与 MC 或 Fo8 相比，并发症较少（主要：MC 2.2%，Fo8 6.0%，Fo8 0.8%，p=0.01；次要：MC 16.5%，Fo8 12.0%，Fo8 7.4%，p=0.002）。在未接受围手术期抗凝治疗的患者中，止血方法之间的并发症无差异（总主要和次要并发症 5.8%，p=0.729 用于组间比较）。多变量逻辑回归显示，Fo8 与入路部位并发症的风险显著降低相关（OR 0.29 [95%CI 0.17-0.48]，p<0.001），而术中肝素化（OR 5.25 [2.88-9.69]，p<0.001）和更大的最大鞘尺寸（OR 1.06 [1.00-1.11]，p=0.04）与并发症风险增加相关。
在需要围手术期抗凝的 EP 程序后，与 MC 和 Fo8 相比，使用 Fo8 进行股静脉止血与较少的入路部位并发症相关。
