Martins-Fernandes Diana, Rocha-Neves João, Ferreira Ana Rita, Martins Hélio, Gaião Sérgio, Paiva José Artur
Department of Emergency and Intensive Care Medicine, São João University Hospital Centre, Porto, Portugal.
Department of Biomedicine - Unity of Anatomy, Faculty of Medicine, University of Porto, Porto, Portugal.
J Vasc Access. 2025 Sep;26(5):1651-1660. doi: 10.1177/11297298241300119. Epub 2024 Nov 24.
Despite the evidence supporting the use of Perclose Proglide (PP) suture-mediated vascular closure devices in various clinical scenarios, limited evidence exists regarding its role in percutaneous arterial closure of the femoral artery after venoarterial extracorporeal membrane oxygenation (VA-ECMO). Compared to conventional methods, this study evaluates the effectiveness and complications of bedside percutaneous femoral artery closure using Perclose ProGlide (PP) for VA-ECMO decannulation.
Retrospective cohort of consecutive patients managed with mechanical circulatory support VA-ECMO for refractory cardiogenic shock, who survived decannulation between January 2017 and August 2023. A comparison between PP and other decannulation strategies was established to evaluate the effectiveness and procedure-related complications of bedside percutaneous femoral artery closure using a PP with a post-closure technique compared to conventional approaches of surgical and manual decannulation.
Among 122 patients decannulated from VA-ECMO with a mean age of 48.6 ± 13.1 and 78 (63.9) males, 49.2% comprised the PP group. Despite the older age ( = 0.021) and higher prevalence of arterial hypertension ( = 0.045), the PP group had a larger number of patients free from decannulation-related adverse events. Additionally, a higher haemoglobin level 24 h post decannulation ( = 0.047), with no difference in terms of transfusion of red blood cells between groups ( = 0.263) was found. The pseudoaneurysm was the most frequently reported complication, while the arterial cannulation surgical wound site infection was only documented in the open repair subgroup. A trend towards reduced Intensive Care (ICU) and hospital length of stay after decannulation was noted, although it did not reach statistical significance. There was no difference in mortality between both groups and no procedure-related deaths occurred. A mean of 2.7 PP devices were required to achieve complete haemostasis in the PP cohort, where technical failure was documented in four cases (6.7%).
Bedside Percutaneous decannulation of VA-ECMO using a PP device with a post-closure technique is safe and reliable for achieving effective haemostasis, with fewer vascular complications than conventional approaches and a low device failure rate.
尽管有证据支持在各种临床场景中使用Perclose Proglide（PP）缝合介导的血管闭合装置，但关于其在静脉-动脉体外膜肺氧合（VA-ECMO）后经皮股动脉闭合中的作用，证据有限。与传统方法相比，本研究评估了使用Perclose ProGlide（PP）进行床边经皮股动脉闭合以拔除VA-ECMO导管的有效性和并发症。
对2017年1月至2023年8月期间因难治性心源性休克接受机械循环支持VA-ECMO治疗且成功拔除导管的连续患者进行回顾性队列研究。比较PP与其他拔除导管策略，以评估使用PP并采用闭合后技术进行床边经皮股动脉闭合与传统手术和手动拔除导管方法相比的有效性和与操作相关的并发症。
在122例从VA-ECMO拔除导管的患者中，平均年龄为48.6±13.1岁，男性78例（63.9%），49.2%属于PP组。尽管PP组患者年龄较大（P=0.021）且动脉高血压患病率较高（P=0.045），但该组无导管拔除相关不良事件的患者数量更多。此外，拔除导管后24小时血红蛋白水平更高（P=0.047），两组之间红细胞输注情况无差异（P=0.263）。假性动脉瘤是最常报告的并发症，而动脉插管手术伤口部位感染仅在开放修复亚组中有记录。尽管未达到统计学意义，但拔除导管后重症监护病房（ICU）和住院时间有缩短趋势。两组死亡率无差异，且未发生与操作相关的死亡。PP队列中平均需要2.7个PP装置来实现完全止血，其中4例（6.7%）记录有技术失败。
使用带有闭合后技术的PP装置对VA-ECMO进行床边经皮导管拔除术对于实现有效止血是安全可靠的，与传统方法相比血管并发症更少，且装置故障率低。
