冠状动脉介入术后血管缝合的血管并发症分析

目的 分析冠状动脉介入术后Angioseal血管缝合器机械止血和人工压迫止血的血管并发症发生率。方法 947例冠状动脉介入诊治病例，179例术后使用Angioseal血管缝合器止血（机械组），另外768例进行人工压迫止血（人工组），比较二组的止血时间、制动时间和血管并发症发生率。结果 机械组显著缩短止血时间和制动时间(P<0.01)，但其与人工组的血管并发症发生率差异无统计学意义（P>0.05）。结论 使用Angioseal血管缝合器能显著缩短止血时间和制动时间，但不能减少股动脉穿刺并发症的发生率，不推荐介入术后常规使用机械止血装置。     

冠脉介入术后3种止血方法的比较

目的评价血管缝合器（Perclose和Angioseal）在冠状动脉造影（CAG）或经皮冠状动脉内介入术（PCI）后股动脉止血的临床应用价值。方法选择2004年12月至2005年12月在我院行CAG或PCI术的患者180例,分为A、B、C3组,每组60例。A组使用Perclose封闭股动脉穿刺点,B组使用Angioseal封闭股动脉穿刺点,C组使用常规人工压迫方法止血。观察止血时间、制动时间、及术后并发症的发生情况。结果使用Perclose和Angioseal的止血时间和下肢制动时间均较手法压迫止血显著缩短（均P<0.01）,其中使用Angioseal的止血时间还要略少于使用Perclose的止血时间,且操作更简单,但二者在止血时间和制动时间方面无统计学差异。3组在术后并发症方面无统计学差异。结论Perclose和Angioseal较常规压迫止血显著缩短止血时间和患者卧床时间。     

冠状动脉介入术后血管缝合器的血管并发症分析

目的分析冠状动脉介入术后Angioseal血管缝合器机械止血和人工压迫止血的血管并发症发生率。方法947例冠状动脉介入诊治病例，179例术后使用Angioseal血管缝合器止血（机械组），另外768例进行人工压迫止血（人工组），比较二组的止血时间、制动时间和血管并发症发生率。结果机械组显著缩短止血时间和制动时间（P〈0．01），但其与人工组的血管并发症发生率差异无统计学意义（P〉0．05）。结论使用Angioseal血管缝合器能显著缩短止血时间和制动时间，但不能减少股动脉穿刺并发症的发生率，不推荐介入术后常规使用机械止血装置。     

冠脉介入术后Boomerang血管封堵器与人工压迫止血的对比分析

目的评价在冠状动脉造影（CAG）术及经皮冠状动脉介入术（PCI）后应用人工压迫与Boomerang血管封堵器在股动脉径路止血中的安全性和有效性。方法300例经股动脉行CAG或PCI治疗的患者,分为人工压迫止血组160例,Boomerang血管封堵器组140例,对比观察两种止血方法的成功率、止血时间、制动时间及血管并发症。结果Boomerang血管封堵器止血成功率96.4%,与人工压迫法比较止血时间及下肢制动时间不论单纯CAG还是PCI均显著缩短,PCI组中,封堵器止血后总的血管并发症发生率5.2%,显著低于传统压迫组（14.7%）。结论Boomerang血管封堵器止血迅速、有效、安全,优于人工压迫止血,值得临床推广。     

经皮冠状动脉介入术后应用血管闭合器与人工压迫止血效果比较

目的:对比冠状动脉造影术（CAG）与冠脉介入治疗（PC I）术后,应用经皮血管闭合器（Angio-SealTM）与人工压迫止血对患者止血时间、制动时间及并发症的发生率,评价Angio-SealTM止血疗效及安全性,并对其操作要点进行归纳总结。方法:将接受CAG与PC I术的患者277例,分为Angio-SealTM组（107例）与人工压迫止血组（170例）,观察两组患者止血时间、卧床及制动时间、并发症的发生率。结果:Angio-SealTM止血组与人工压迫止血组相比,止血时间、卧床及制动时间显著缩短,血管并发症明显降低。应用Angio-SealTM止血成功率97%。结论:Angio-SealTM止血明显优于人工压迫止血。     

经皮血管缝合器的临床安全性评价

目的:评价冠状动脉造影和介入治疗后Perclose血管缝合器止血的临床安全性。方法:对264例接受冠状动脉造影或支架术患者,在术后使用血管缝合器Perclose 132例(Perclose组)或人工压迫止血132例(人工组)作股动脉穿刺部位止血。比较2组的止血时间、制动时间和血管并发症发生率。结果:Perclose组显著缩短止血时间和制动时间(P<0.01),但其与人工组的血管并发症发生率差异无统计学意义(5.3%∶6.1%,P>0.05)。结论:使用Perclose血管缝合器能显著缩短止血时间和制动时间,但不减少股动脉穿刺并发症的发生。     

经皮缝合装置在经皮冠状动脉介入术中的应用价值

目的评价经皮缝合装置(Percloser缝合器)止血的安全性、有效性及临床应用价值。方法选取2002年4月～2005年3月所做的经皮冠状动脉介入治疗患者504例。按止血方法不同分为传统压迫止血组254例和血管缝合组250例,分析两组在止血时间、制动时间、总卧床时间及各种并发症的差异。结果缝合法与压迫法比较,止血时间:压迫组为(25±6)分钟,血管缝合组为:(6.0±0.4)分钟(P<0.001):下肢制动时间:压迫组为(26±4)小时,血管缝合组为(4.0±1.2)小时(P<0.001);总卧床时间:压迫组为(25.2±4.5)小时,血管缝合组(6.0±1_3)小时(P<0.001)。压迫组术后并发症如出血、血肿、迟发出血(第3日-1周)、迷走反射、皮肤溃烂等,明显高于缝合组(P<0.001)。结论Percloser缝合器止血用于冠状动脉造影及经皮腔内冠状动脉成形术或支架术后患者,止血时间与卧床制动时间明显缩短,并发症少,安全有效,操作简便,止血效果可靠。     

冠脉介入术后Angioseal血管缝合与压迫止血的对比研究

目的　评价Angioseal缝合器止血的实用性。方法　 2 0 0 2 - 10～ 2 0 0 3- 0 7所做的冠状动脉造影或介入治疗病例共 2 6 0例 ,其中冠状动脉造影 15 0例 ,介入治疗 110例。按止血方法不同分为传统压迫止血组和血管缝合组。结果　 (1)缝合法与压迫法止血时间及下肢制动时间的比较。单纯冠状动脉造影止血时间分别为 :缝合法(1 8± 0 9)min ,压迫法 (2 5 3± 13 4 )min ,两者差异有非常显著性 (P <0 0 0 1) ;下肢制动时间分别为 :缝合法 (3 8± 0 8)h ,压迫法 (13 4± 2 2 )h ,两者差异有非常显著性 (P <0 0 0 1) ;介入治疗后止血时间 :缝合法与压迫法分别为 (2 0± 1 1)min及 (2 9 5± 14 3)min ,两者差异有非常显著性 (P <0 0 0 1) ;下肢制动时间缝合法与压迫法分别为(4 3± 1 5 )h及 ,(2 4 3± 3 2 )h ,两者差异有非常显著性 (P <0 0 0 1)。 (2 )压迫法术后各类并发症如出血、血肿、迟发出血 (第 3天以后 ,至 1周 )、迷走反射、皮肤溃烂等 ,明显高于缝合法 (P <0 0 0 1)。结论　Angioseal缝合器止血简便、实用、安全。     

PCI术后不同止血方案的临床评价

314例冠状动脉介入治疗（PCI）患者随机分为3组,A组在经股动脉PCI后应用Angioseal闭合器止血,B组经桡动脉途径行PCI,C组经股动脉PCI后行传统徒手压迫。结果止血时间A、B组较C组明显缩短;下肢制动时间A组较C组明显缩短,B组无需下肢止动;总卧床时间A组明显少于C组,B组无需严格卧床。A、B组术后并发症如出血、血肿、迷走反射、假性动脉瘤和动静脉瘘等明显低于C组。提示Angioseal闭合器是一种安全、可靠的止血方法,操作简单;经桡动脉途径行PC I能提高手术患者的舒适度,减少血管并发症。     

两种血管闭合器在冠状动脉介入治疗中的应用比较

目的评价并比较Angioseal和Perclose两种血管闭合器在经皮冠状动脉造影(CAG)及介入治疗(PCI)中应用的有效性和安全性。方法1020例行冠脉造影及介入治疗的患者(男672例,女348例,年龄57.8±2.4岁)经髂动脉造影证实无血管闭合器使用禁忌,术后随机分为Angioseal组(CAG380例,PCI120例)和Perclose组(CAG392例,PCI128例),比较两组患者使用血管闭合器的成功率及局部并发症的发生率。结果Angioseal和Perclose两组成功率均较高(94%比96%),差异无统计学意义。Angioseal组发生局部血肿5例,无假性动脉瘤发生;Perclose组发生局部血肿4例,假性动脉瘤3例,两组间并发症的发生率差异亦无统计学意义。结论CAG及PCI术后,Angioseal和Perclose血管闭合器均能有效止血,并发症较低,安全性好。     

老年冠状动脉介入治疗患者三种动脉止血方法术后舒适度的比较

目的比较冠状动脉介入治疗(PCI)三种动脉止血方法对老年患者术后舒适度的影响,探讨适宜的护理方案。方法 396例接受冠状动脉介入治疗的老年患者,按股动脉穿刺点止血方法分为手工压迫组(A组,n=162),Femostop压迫组(B组,n=106),和Perclose组(C组,n=128),监测各组患者入院时、术前、术后6h、术后1d内心率、血压变化,睡眠困难、胃肠道症状、躯体疼痛以及出血血栓事件的发生率。结果与手工压迫组比较,Per-close组患者术后生命体征波动小,睡眠困难、排尿障碍、胃肠道症状、躯体疼痛发生程度较轻;Femostop组术后舒适度各指标与手工压迫组相比无差异;Perclose组出血并发症明显低于Femostop压迫组及手工压迫组。三组血栓事件的发生率无明显差异。结论对接受PCI治疗的老年患者,Perclose止血方法可明显改善患者术后舒适程度;对接受不同止血方法的患者应采取不同的护理方案,以改进护理效率及质量。     

Intracoronary autologous bone marrow cell transplantation beneficially modulates heart rate variability

Antegrade femoral artery access is commonly used for percutaneous transluminal revascularization of ipsilateral lower limbs in patients with critical limb ischemia. While hemostasis at the end of the procedure can be achieved by manual compression, this may lead to an increase in local vascular complications. Femoral artery closure devices, such as the Angioseal collagen plug and anchor device, have been approved and shown of benefit after retrograde femoral artery catheterization. To date, there are however no data on the use of such arteriotomy closure device after antegrade femoral access. We hereby report a case series of five patients in whom Angioseal was successfully used after antegrade femoral puncture and below-the-knee percutaneous transluminal angioplasty. In all cases the device enabled immediate and complete hemostasis without major complications, despite the intense antithrombotic regimen, including heparin, aspirin, and clopidogrel in all patients, as well as glycoprotein IIb/IIIa inhibitors (in two patients) and fibrinolytic therapy (in one).     

A randomized comparison of a percutaneous suture device versus manual compression for femoral artery hemostasis after PTCA

BACKGROUND: The prolonged bed rest following femoral sheath removal after PTCA is a source of discomfort for the patient. We designed a randomized study to evaluate the efficacy and safety of an arterial suture device developed to percutaneously close the vascular access site after PTCA, allowing immediate sheath removal and early ambulation, compared to manual compression. METHODS: After successful PTCA, patients were randomized to manual compression or immediate femoral percutaneous closure. Exclusion criteria were arteritis, age > 80 years and > 3 previous femoral punctures on the same side. The two-needle device was used for the 6F sheath removal and the four-needle device for the 8F sheath. Ambulation was allowed 4 hours after the arterial suture. RESULTS: One hundred and sixty-seven patients (59 +/- 10 years, 81% males) were randomized to suture device (n = 91) or to manual compression (n = 76). The two groups were similar in terms of age, sex, size of sheath, number of patients with stent implantation (62 vs 61%), procedural anticoagulation. Procedural duration was 8 +/- 6 minutes with percutaneous suture versus 25 +/- 11 minutes with manual compression (P < 0.0001). Procedural success with percutaneous suture was 93% whereas six technical failures were treated with prolonged manual compression. Nonsurgical hematoma occurred in five patients (5%) with the suture device and in two (3%) with manual compression with no need for blood transfusion (P = NS). Uneventful blood oozing occurred in 11 patients (12%) with percutaneous suture and in only 2 (3%) with manual compression (P < 0.06). The tolerance of the hemostasis procedure and the length of post-procedure hospital stay (40 +/- 32 hours) were similar in the two groups. CONCLUSION: Percutaneous suture of the femoral artery, allows immediate closure of femoral puncture sites after PTCA, without increasing the incidence of vascular complications. The use of this device should allow earlier discharge and subsequent cost savings.     

血管封堵器在心导管术后的应用

血管封堵器被广泛应用于心导管术后股动脉穿刺部位止血。与传统的手工压迫止血相比 ,血管封堵器止血更安全有效 ,缩短患者卧床时间。本文比较了几种不同类型的血管封堵器的特点 ,供临床参考。     

Complications of femoral artery closure devices.

We have examined our prospectively collected experience with femoral artery closure devices. Vasoseal (n = 937), Angioseal (N-742), and Techstar (n = 1001) were utilized consecutively in our laboratory for diagnostic and interventional femoral artery closures. Complications were compared to a similar number of closures with manual compression (MC; n = 1019) before closure devices were utilized. The incidence of surgical repair, acute femoral closure, transfusion due to groin complications, readmission for groin complications, infection, and total complications were examined. We found that the Vasoseal and Angioseal devices were associated with higher rates of total complications than manual compression. The Techstar and manual compression had similar total complication rates. Acute femoral artery occlusion was a potentially serious complication with the Angioseal device. Groin infection occurred with each of the closure devices but not with manual compression.     

Early deambulation following cardiac catheterization by the use of 6 Fr Angio-Seal, a new hemostatic percutaneous puncture closure device]

INTRODUCTION AND OBJECTIVES: Efficacy of the hemostatic puncture closure 8 Fr Angio-Seal device for percutaneous puncture closure after a catheterism has been previously demonstrated, but the experience provided has been obtained with 8 Fr devices. At present the device has been modified and its size reduced to 6 Fr. In this pilot study we evaluate the efficacy of the new hemostatic 6 Fr Angio-Seal device and its safety when early deambulation post-diagnostic and/or therapeutic catheterization is established. PATIENTS AND METHODS: Prospective study of 150 consecutive patients randomized either for application of the 6 Fr Angio-Seal device (group A; n = 75), in which early ambulation was indicated, or manual compression (group B; n = 75), with ambulation 12 h after cardiac catheterization. Basal data, including clinical and angiographic characteristics and previous treatment with heparin and platelet aggregation inhibitors were similar in both groups. RESULTS: The time of hemostasia was significantly shorter in group A than in group B (118 +/- 210 s in A vs 1320 +/- 370 s in B; p (3/4) 0,001), and with early ambulation (3,1 +/- 0,4 h in A vs 12,3 +/- 3,1 h in B; p (3/4) 0,001) no local complications were observed. CONCLUSIONS: The 6 Fr Angio-Seal hemostatic device diminished the hemostasia time and early ambulation could be achieved. In this pilot study no complications due to early movilization were observed, but the safety of the new hemostatic device after diagnostic or therapeutic catheterizations needs to be evaluated in greater series.     

Mobilization Within Thirty Minutes of Elective Diagnostic Coronary Angiography: A Feasibility Study Using a Hemostatic Femoral Puncture Closure Device

The standard procedure for obtaining hemostasis following coronary angiography is manual or mechanical compression of the femoral artery followed by 4–6 hours supine rest. The patient is then mobilized and later discharged. This consumes time and resources and may be uncomfortable for the patient. The aim of this pilot study was to determine if the Angio-Seal^TM hemostatic puncture closure device (the Angio-Seal device) allows safe, early mobilization of patients undergoing elective coronary angiography. Selected patients were randomly allocated to the the Angio-Seal device (study group, n = 24) or standard compression techniques (control group, n = 26) after completion of the diagnostic coronary angiogram. Study group patients were mobilized 25–30 minutes after sheath removal and deployment of the Angio-Seal device. After hemostasis in control patients, a pressure bandage was applied, and the patient was placed on bed rest for 4–6 hours. There was no age or sex difference between the study group and the control group. There were more patients with hypertension, diabetes mellitus, or obesity in the control group. Time to hemostasis was 0.5 ± 1.4 min for the study group and 42.9 ± 20.6 min for the control group (P < 0.0001). Time to mobilization was 32.5 ± 6.9 min for the study group and 322.7 ± 41.8 for the control group (P < 0.0001), with 83% and 92% (P = NS) of patients in respective groups being fully mobilized according to protocol. Complications requiring clinical intervention were seen in three patients (12.5%) in the study group and in one patient (4%) in the control group. We have shown that mobilization of patients within 30 minutes of diagnostic coronary angiography via the femoral artery is feasible using the Angio-Seal device. The safety of this approach needs to be addressed in a larger randomized study.     

Percutaneous suture closure for management of large French size arterial puncture in aortic valvuloplasty

Percutaneous aortic valvuloplasty produces acute hemodynamic and clinical improvement in patients with aortic stenosis who are poor candidates for surgical valve replacement. The benefits of this procedure are mitigated by the high restenosis rates and 1--2 year mortality, in addition to significant vascular complications associated with the large arterial puncture necessary for retrograde arterial approaches. We describe the use of suture closure techniques to reduce the vascular morbidity associated with this procedure. We reviewed 31 consecutive patients who underwent percutaneous aortic valvuloplasty and suture closure with the Perclose device between April 1998 and September 2000. After diagnostic catheterization using 6--8 French (Fr) sheaths, an 8 or 10 Fr Perclose device was preloaded into the artery and the untied sutures left in place. A 12.5 or 14 Fr sheath was passed over the wire, through the sutures. The sutures were tied at the conclusion of the procedure, in conjunction with sheath removal. Twenty-seven out of 31 patients (87%) had successful suture closure of the arteriotomy and did not require prolonged bed rest, manual compression or a compression device. There were 4 failures of percutaneous suture closure, requiring conventional manual compression and bed rest for hemostasis. No patient required surgical repair of the arteriotomy, nor were there any limb complications. Compared to 39 consecutive prior patients who had their arterial puncture managed with manual compression, length of stay was shorter (2.2 days versus 5.3 days) and fewer patients received blood transfusions (0% versus 29%). Preloaded suture closure of the arterial puncture is a useful technique for achieving hemostasis after removal of the large sheaths used for percutaneous valvuloplasty, and reduces the post-procedure patient discomfort and prolonged bed rest associated with this procedure.