Silber S, Schön N, Seidel N, Heiss-Bogner J
Klinik Dr. Müller, München.
Z Kardiol. 1998 Jan;87(1):51-5. doi: 10.1007/s003920050155.
Removal of the arterial sheath immediately after PTCA is desirable for patients, reduces the medical staff's workload, and may decrease hospital costs due to a shortened length of stay. Although the safety and efficacy of the hemostatic systems used especially for the above purpose have been sufficiently documented, inadvertent intraluminal vascular occlusion is theoretically possible. While partial or complete arterial occlusion in conjunction with the VasoSeal collagen prototype device has been previously reported, similar complications occurring with the Angio-Seal device were not published. In this report, we describe a 54-year old female patient (height: 150 cm, weight: 42.5 kg) who was transferred for PTCA following an acute anterior wall myocardial infarction. Immediately after PTCA, the Angio-Seal device was deployed utilizing standard technique. No difficulties were encountered during device deployment, however, immediately following device placement active arterial bleeding occurred. Due to the inadequacy of hemostasis, heparin was reversed with protamine to avoid further hemorrhagic complications. Following this, the desired hemostasis quickly occurred, but the patient soon complained about symptoms suggestive of an acute occlusion of the right femoral artery. Unsatisfactory attempts at lysis resulted in the patient being transferred to vascular surgery. The complete Angio-Seal system (anchor including collagen) was located intravascularly, and removed during surgery. This case report demonstrates that even an experienced examiner can inadvertently deploy the Angio-Seal completely intraarterially. In addition to the known contraindication, "peripheral arterial occlusive disease", we recommend that the Angio-Seal device not be utilized in patients of small physical size.
PTCA术后立即拔除动脉鞘管对患者有益，可减轻医护人员的工作量，且因住院时间缩短可能降低医院成本。尽管专门用于上述目的的止血系统的安全性和有效性已有充分记录，但理论上仍有可能发生意外的管腔内血管闭塞。虽然此前已有关于VasoSeal胶原蛋白原型装置导致部分或完全动脉闭塞的报道，但未发表过与Angio-Seal装置相关的类似并发症。在本报告中，我们描述了一名54岁女性患者（身高：150 cm，体重：42.5 kg），她在急性前壁心肌梗死后被转来接受PTCA治疗。PTCA术后立即采用标准技术部署了Angio-Seal装置。装置部署过程中未遇到困难，然而，装置放置后立即出现了动脉活动性出血。由于止血不充分，用鱼精蛋白逆转肝素以避免进一步的出血并发症。此后，实现了预期的止血，但患者很快抱怨出现了提示右股动脉急性闭塞的症状。溶栓尝试效果不佳，患者被转至血管外科。完整的Angio-Seal系统（包括胶原蛋白的锚定器）位于血管内，并在手术中取出。本病例报告表明，即使是经验丰富的检查者也可能无意中将Angio-Seal完全部署在动脉内。除了已知的禁忌症“外周动脉闭塞性疾病”外，我们建议不要在体型较小的患者中使用Angio-Seal装置。
