室性心律失常导管消融术后的血管通路并发症：血管闭合装置的影响
Vascular access complications after catheter ablation of ventricular arrhythmias: Impact of vascular closure devices.
作者信息
Tabaja Chadi, Hight Nolan, Younis Arwa, Jadam Shada, Demian Joe, Hussein Ayman, Sroubek Jakub, Saliba Walid, Kanj Mohamed, Bhargava Mandeep, Baranowski Bryan, Callahan Thomas, Chung Mina, Dresing Thomas, Lee Justin, Higuchi Koji, Liuba Ioan, Martin David, Nakhla Shady, Rickard John, Varma Niraj, Taigen Tyler, Wazni Oussama, Santangeli Pasquale
机构信息
Cardiac Electrophysiology Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio.
Cardiac Electrophysiology Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio.
出版信息
Heart Rhythm. 2025 Mar;22(3):685-692. doi: 10.1016/j.hrthm.2024.09.001. Epub 2024 Sep 6.
BACKGROUND
Vascular access site complications are the most frequent complications of percutaneous catheter ablation (CA) of ventricular arrhythmias (VAs). Whether arterial/venous vascular closure devices (VCDs) prevent vascular complications is unknown.
OBJECTIVE
We investigated the benefit of VCDs in patients undergoing CA of VAs.
METHODS
Consecutive CA of VAs were included (2018-2022). Vascular accesses were obtained with ultrasound guidance. At the discretion of the operator, arterial and/or venous VCDs were used. Cases were divided into 3 groups: no use of VCDs for any arterial/venous accesses (manual compression [MC]), use of VCDs for some but not all accesses (Partial-VCDs), and use of VCDs for all accesses (Complete-VCDs). Vascular complications were classified as minor if they did not require intervention or major if they required intervention.
RESULTS
A total of 1016 procedures were performed in 872 patients (mean age 62 ± 13 years; mean body mass index 30 ± 6 kg/m; 27% female) during the study period. Femoral arterial access was obtained in 887 procedures (875 single access: 7.4 ± 1.5 F size; 12 two accesses: 7.3 ± 3 and 6.9 ± 1.8 F). Femoral venous access was obtained in 1014 procedures (unilateral in 17%; bilateral in 83%; mean number of access sites per patient 2.6 ± 0.7; mean size 8.4 ± 1.3 F). Hemostasis was achieved with MC in 192 procedures (19%), with Partial-VCD in 275 (27%), and with Complete-VCD in 549 (54%). A vascular complication occurred in 52 procedures (5.1%), including a minor hematoma in 3.9% and/or a major complication in 1.7%. The rate of vascular complications was 6.8% (5.2% minor and 1.6% major) in the MC group, 7.6% (5.1% minor and 3.3% major) in the Partial-VCD group, and 3.3% (2.9% minor and 0.9% major) in the Complete-VCD group (P = .014 for comparison). In multivariable analysis, Complete-VCD remained independently associated with a lower risk of vascular complications (odds ratio 0.69; 95% confidence interval 0.48-0.96; P = .036).
CONCLUSION
In patients undergoing CA of VAs, Complete-VCD is associated with lower rates of vascular-related complications compared with MC or Partial-VCD.
背景
血管穿刺部位并发症是室性心律失常（VA）经皮导管消融（CA）最常见的并发症。动脉/静脉血管闭合装置（VCD）能否预防血管并发症尚不清楚。
目的
我们研究了VCD在接受VA-CA治疗的患者中的益处。
方法
纳入连续的VA-CA病例（2018 - 2022年）。在超声引导下进行血管穿刺。由操作者决定是否使用动脉和/或静脉VCD。病例分为3组：所有动脉/静脉穿刺均不使用VCD（手动压迫[MC]），部分但非全部穿刺使用VCD（部分-VCD），所有穿刺均使用VCD（完全-VCD）。血管并发症若无需干预则分类为轻微并发症，若需要干预则分类为严重并发症。
结果
在研究期间，共对872例患者进行了1016例手术（平均年龄62±13岁；平均体重指数30±6 kg/m²；27%为女性）。887例手术采用股动脉穿刺（875例单次穿刺：尺寸7.4±1.5F；12例两次穿刺：尺寸分别为7.3±3F和6.9±1.8F）。1014例手术采用股静脉穿刺（17%为单侧；83%为双侧；每位患者平均穿刺部位数2.6±0.7；平均尺寸8.4±1.3F）。192例手术（19%）采用MC止血，275例（27%）采用部分-VCD止血，549例（54%）采用完全-VCD止血。52例手术（5.1%）发生血管并发症，包括3.9%的轻微血肿和/或1.7%的严重并发症。MC组血管并发症发生率为6.8%（轻微并发症5.2%，严重并发症1.6%），部分-VCD组为7.6%（轻微并发症5.1%，严重并发症3.3%），完全-VCD组为3.3%（轻微并发症2.9%，严重并发症0.9%）（比较P = 0.014）。多变量分析显示，完全-VCD与较低的血管并发症风险独立相关（比值比0.69；95%置信区间0.48 - 0.96；P = 0.036）。
结论
在接受VA-CA治疗的患者中，与MC或部分-VCD相比，完全-VCD与较低的血管相关并发症发生率相关。
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