Webb J G, Carere R A, Dodek A A
Cardiology Division, St. Paul's Hospital, University of British Columbia, Vancouver, Canada.
Cathet Cardiovasc Diagn. 1993 Dec;30(4):314-6. doi: 10.1002/ccd.1810300412.
Recently a new adjunct to achieving arterial hemostasis has been developed. The device consists of a purified bovine collagen plug which when inserted adjacent to the arterial wall induces the formation of a hemostatic cap directly over the arterial puncture. We have utilized collagen plug hemostasis in 32 patients on 35 occasions undergoing implantation of intracoronary stents while attempting to maintain continuous full anticoagulation. Initial hemostasis was successfully achieved in all patients. Moderate sized (5 to 10 cm) hematomas were noted in 4 patients and large hematomas (> 10 cm) in 3, of whom 2 required vascular repair and transfusion. One patient developed a purulent discharge from the puncture site which resolved with a brief course of antibiotics. No patient suffered femoral arterial occlusion, distal embolization, or venous thrombosis. There were no long term access site problems at a mean follow up of 6 months. Repeat catheterization utilizing the same femoral artery was performed in 16 patients without difficulty. In five of these patients angiography was performed early after stent implantation without discontinuation of full anticoagulation and collagen closure was utilized a second time. Collagen plug hemostasis is feasible after coronary stenting, may allow more aggressive anticoagulation than might otherwise be achieved, and may facilitate angiographic restudy early after stenting without the need to discontinue anticoagulation.
最近，一种用于实现动脉止血的新辅助手段已被研发出来。该装置由一个纯化的牛胶原蛋白栓组成，当将其插入动脉壁附近时，可在动脉穿刺口正上方诱导形成一个止血帽。我们在32例患者35次进行冠状动脉内支架植入时使用了胶原蛋白栓止血法，同时试图维持持续的充分抗凝。所有患者均成功实现了初始止血。4例患者出现中等大小（5至10厘米）的血肿，3例出现大血肿（>10厘米），其中2例需要血管修复和输血。1例患者穿刺部位出现脓性分泌物，经短期抗生素治疗后消退。没有患者发生股动脉闭塞、远端栓塞或静脉血栓形成。平均随访6个月时，没有出现长期的穿刺部位问题。16例患者在使用同一条股动脉进行重复导管插入术时没有困难。在其中5例患者中，在支架植入后早期进行了血管造影，且未中断充分抗凝，第二次使用了胶原蛋白封闭法。冠状动脉支架植入术后，胶原蛋白栓止血法是可行的，可能比其他方法更能实现积极的抗凝，并且可能有助于在支架植入后早期进行血管造影复查，而无需中断抗凝。
