Saleem-Talib Shmaila, Hoevenaars Crispijn P R, van Driel Vincent J, van Wessel Harry, van der Heijden Jeroen, Ramanna Hemanth, de Groot Natasja M S
Department of Cardiology, Haga Teaching Hospital, 2545AA The Hague, The Netherlands.
University of Applied Sciences of The Hague, 2521EN The Hague, The Netherlands.
Rev Cardiovasc Med. 2024 Dec 16;25(12):440. doi: 10.31083/j.rcm2512440. eCollection 2024 Dec.
Achieving hemostasis of large bore venous access sites can be challenging and time consuming. Closure devices have proven to be superior in achieving hemostasis, reducing time to ambulation and improving patient comfort, compared to manual hemostasis techniques after femoral venous and arterial access. The closure of the jugular vein following large bore access has not been investigated in previous studies. In addition, scar formation of the neck after large bore access of the jugular vein has not been investigated. In this study, the safety and feasibility of the double Perclose ProGlide (PP), for achieving hemostasis of the internal jugular vein (IJV) following large bore access with 27 French Micra Transcatheter Pacemaker System (TPS) was examined. Also, the scar formation in the neck after IJV closure was examined during follow-up.
136 consecutive patients from May 2018 until June 2024, in whom the IJV was closed with a double PP, following Micra TPS implantation were included. All patients were examined for hemostasis of the IJV and vascular complications, resulting in additional interventions. Time to ambulation, discharge and patient discomfort were also assessed. During follow-up the scar formation of the neck was examined.
In all patients, the double PP was successful in achieving acute hemostasis of the IJV after large bore access. In all patients, 2 PP were deployed without device failure. One patient required additional manual pressure due to a minor hematoma. Ultrasound guided examination did not reveal any vascular complications. All patients were ambulated immediately. During follow-up, the scar in the neck was hardly visible.
Although the PP was designed as a closure device for femoral venous and arterial access, our data suggest that the PP can be used safely as a closure device for the IJV to achieve acute hemostasis, facilitate direct ambulation and improve patient comfort.
实现大口径静脉穿刺部位的止血可能具有挑战性且耗时。与股静脉和动脉穿刺后采用手动止血技术相比，封堵装置已被证明在实现止血、缩短下床活动时间和提高患者舒适度方面更具优势。以往研究尚未对大口径颈静脉穿刺后的封堵情况进行调查。此外，大口径颈静脉穿刺后颈部瘢痕形成情况也未得到研究。在本研究中，我们检验了双Perclose ProGlide（PP）封堵器用于在使用27F美敦力Micra无导线起搏器系统（TPS）进行大口径颈内静脉（IJV）穿刺后实现止血的安全性和可行性。同时，在随访期间观察了IJV封堵后颈部的瘢痕形成情况。
纳入2018年5月至2024年6月期间连续136例在植入Micra TPS后使用双PP封堵器封闭IJV的患者。所有患者均接受IJV止血及血管并发症检查，统计导致额外干预的情况。评估下床活动时间、出院时间和患者不适情况。随访期间检查颈部瘢痕形成情况。
所有患者中，双PP封堵器在大口径穿刺后均成功实现了IJV的急性止血。所有患者均使用了2个PP封堵器，无器械故障。1例患者因轻微血肿需要额外手动按压。超声引导检查未发现任何血管并发症。所有患者均立即能下床活动。随访期间，颈部瘢痕几乎不可见。
尽管PP封堵器设计用于股静脉和动脉穿刺部位的封闭，但我们的数据表明，PP封堵器可安全地用于IJV封闭以实现急性止血、促进直接下床活动并提高患者舒适度。
