Guilleminot Pierre, Mourot Mathieu, Lorgis Luc, Didier Romain, Ferrand Benjamin, Laurent Gabriel, Vergely Catherine, Guenancia Charles, Pommier Thibaut
Department of Cardiology, Dijon University Medical Centre, Dijon, France.
Pathophysiology and Epidemiology of Cerebro-cardiovascular diseases (PEC2, EA 7460), Faculty of Health Sciences, Université de Bourgogne, Université de Bourgogne Franche-Comté, Dijon, France.
Catheter Cardiovasc Interv. 2025 May;105(6):1427-1433. doi: 10.1002/ccd.31479. Epub 2025 Mar 4.
In selected patient populations, percutaneous closure of patent foramen ovale has been shown to be beneficial in preventing cerebral ischaemic events. In most cases, this procedure requires echocardiographic guidance, which may be transesophageal, transthoracic or intracardiac. Intracardiac echocardiography (ICE) has the advantage of not requiring general anaesthesia but usually requires a second vascular access.
The aim of this study was to evaluate the safety and efficacy of the single femoral vein puncture technique for double veinous access compared to conventional bilateral double puncture during patent foramen ovale (PFO) closure under intracardiac echocardiography (ICE) guidance.
A retrospective study including all patients who underwent PFO closure under ICE guidance between January 2018 and April 2024 in University Hospital of Dijon, comparing the single puncture technique, defined as a single vascular hole for two sheaths, with those who underwent bilateral puncture. We collected baseline patient characteristics as well as intra- and post-procedural data, especially significant vascular complications (bleeding, false aneurysm, deep vein thrombosis, arteriovenous fistula) and procedural success (defined as successful placement of the prosthesis, meeting stability criteria, without embolization). In addition, patients were asked to rate the comfort of the procedure on a scale of 0 to 10 after the procedure.
We analyzed 179 consecutive patients, of whom 126 received a femoral vein approach using the two-in-one technique and 53 received a bilateral femoral vein puncture. PFO closure was successful in all cases regardless of group. No tamponade, device migration, or death was observed during hospitalization. Vascular complication rate was comparable (3 (1.6%) vs. 2 (3.8%); p = 0.582). In addition, the single puncture technique was associated with an increased comfort score compared with the bilateral puncture technique (9.20 ± 1.55 vs. 8.44 ± 1.93; p = 0.044), shorter procedure time (40 min [32; 50] vs. 60 min [48; 70]; p < 0.001), hospital stay duration (0.82 ± 1.02 days vs. 2.04 ± 0.83 days; p < 0.001) and fluoroscopy time (5.71 min [4.28; 8.33] vs. 9.57 min [7.42; 13.11]; p < 0.001).
The single femoral vein puncture technique for double femoral vein access is safe and effective for PFO closure under ICE guidance. It is also associated with increased patient comfort and reduced fluoroscopy time, although large multicenter studies are needed to confirm these results.
在特定患者群体中，经皮闭合卵圆孔未闭已被证明有助于预防脑缺血事件。在大多数情况下，该手术需要超声心动图引导，可经食管、经胸或心内进行。心内超声心动图（ICE）的优势在于无需全身麻醉，但通常需要额外的血管通路。
本研究旨在评估在心内超声心动图（ICE）引导下，与传统双侧双穿刺相比，单股静脉穿刺技术用于双静脉通路在卵圆孔未闭（PFO）闭合术中的安全性和有效性。
一项回顾性研究，纳入2018年1月至2024年4月在第戎大学医院接受ICE引导下PFO闭合术的所有患者，比较单穿刺技术（定义为一个血管孔用于两个鞘管）与双侧穿刺患者。我们收集了患者的基线特征以及术中及术后数据，尤其是严重血管并发症（出血、假性动脉瘤、深静脉血栓形成、动静脉瘘）和手术成功率（定义为假体成功置入、符合稳定性标准且无栓塞）。此外，术后要求患者对手术舒适度进行0至10分的评分。
我们分析了179例连续患者，其中126例采用二合一技术经股静脉入路，53例采用双侧股静脉穿刺。无论采用何种分组，所有病例的PFO闭合均成功。住院期间未观察到心包填塞、装置移位或死亡。血管并发症发生率相当（3例（1.6%）对2例（3.8%）；p = 0.582）。此外，与双侧穿刺技术相比，单穿刺技术的舒适度评分更高（9.20 ± 1.55对8.44 ± 1.93；p = 0.044），手术时间更短（40分钟[32；50]对60分钟[48；70]；p < 0.001），住院时间更短（0.82 ± 1.02天对2.04 ± 0.83天；p < 0.001），透视时间更短（5.71分钟[4.28；8.33]对9.57分钟[7.42；13.11]；p < 0.001）。
在心内超声心动图（ICE）引导下，单股静脉穿刺技术用于双股静脉通路在PFO闭合术中是安全有效的。它还能提高患者舒适度并减少透视时间，但仍需要大型多中心研究来证实这些结果。
