Perclose血管缝合器在老年患者冠状动脉介入治疗中的临床应用

目的评价Perclose血管缝合器在老年冠状动脉介入治疗患者中使用的安全性和可行性。方法将110例接受冠状动脉介入治疗的老年患者随机分为Perclose血管缝合器组(Perclose组)与人工按压组。观察Perclose血管缝合器的成功率与术后并发症的发生率。结果Perclose组止血成功率为96%,无并发症发生。人工按压组有2例血肿,1例假性动脉瘤发生。结论Perclose血管缝合器在老年患者介入治疗中使用有良好的可行性和安全性。     

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。     

冠状动脉介入治疗术后Perclose血管缝合器止血的临床研究

目的 :评价经皮冠状动脉介入治疗术 (PCI)后股动脉穿刺部位应用Perclose血管缝合器止血的安全性和有效性。方法 :对 2 5 6例PCI患者进行前瞻性研究 ,所有患者均接受阿司匹林、氯吡格雷以及肝素治疗 ,动脉鞘管均为F7,一组在完成PCI后立即拔除股动脉鞘管 ,选用Perclose血管缝合器对穿刺部位动脉进行止血 ,另一组为术后 4～ 6h测活化凝血时间 <180s后拔除鞘管采用手法压迫止血。结果 :Perclose血管缝合器止血的成功率为 95 % ,两组患者的主要并发症差异无统计学意义 ,但Perclose组并发症发生率有更低的趋势 (2 3.3%∶31.6 % )。Perclose组的止血时间 (5 .1± 3.4 )min ,手法压迫组 (2 8± 10 )min ;Perclose组制动时间 (6 .4± 1.7)h ,手法压迫组 (19± 6 .5 )h。二者Perclose组均明显较手法压迫组缩短。结论 :Perclose血管缝合器是一个迅速、有效的止血方法 ,值得临床上推广。     

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。     

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。     

国产血管封堵器与血管缝合器用于介入术后止血效果比较

将208例行冠状动脉造影或支架术患者随机分成对照组和观察组,分别于手术后使用血管缝合器Perclose和国产血管封堵器行股动脉穿刺部位止血,比较两组止血时间、制动时间和血管并发症发生率.结果 两组止血时间和制动时间与人工压迫相比均显著缩短(P＜0.05),两组间无统计学差异;血管并发症发生率无统计学差异(P均＞0.05).认为Perclose血管缝合器或封堵器均能显著缩短止血时间和制动时间,但封堵器适用范围更广.     

心导管术拔鞘管后应用经皮血管闭合器临床观察

目的　与人工压迫止血比较 ,观察心导管术拔鞘管后应用经皮血管闭合器 (Perclose)止血的疗效及安全性。方法　 189例病人在心导管术后 ,分为人工压迫止血组(95例 ,其中单纯冠脉造影 4 6例 ,行冠脉成形术 4 9例 )和Perclose止血组 (94例 ,其中单纯冠脉造影 2 5例 ,行冠脉成形术 70例 )。观察两组止血时间 ,下床活动时间 ,血管并发症。结果　Perclose止血组与人工压迫止血组相比 ,止血时间 ,下床活动时间明显缩短。Perclose止血组未见血管并发症 ,与人工压迫止血组相比差异有显著性 (P <0 0 1)。应用Per close止血成功率为 98 9%。结论　心导管术拔鞘管后应用经皮血管闭合器 (Perclose) ,缩短了止血时间和下床活动时间 ,并可减少血管穿刺点并发症及病人不适感。     

Perclose血管缝合器在股动脉特殊穿刺部位的应用

目的:探讨Perclose血管缝合器在经股动脉特殊穿刺部位冠状动脉(冠脉)介入诊疗术后止血的安全性和有效性。方法:180例冠脉造影(CAG)和/或介入治疗(PCI)术后用Perclose血管缝合器缝合股动脉止血,其中20例穿刺部位在股动脉分叉处或距分叉5mm以内(特殊穿刺部位),术前1～3天、术后3天用彩色多普勒B超测量穿刺部位及附近3cm内股动脉或股浅动脉或股深动脉最小内径(D,mm)、收缩期血流峰速度(V,cm/s)、股动脉有无血栓,术后2-6个月电话、门诊随访:有无穿刺部位疼痛、肿块及下肢活动障碍。结果:20例特殊穿刺部位患者术前、术后D、V均无显著变化(P>0.05),均未见血栓;术后随访,均无穿刺部位疼痛、肿块及下肢活动障碍。结论:Perclose血管缝合器可应用于穿刺部位在股动脉分叉及其附近者。     

血管缝合器的临床使用价值

目的:对比研究应用Perclose血管缝合器与人工压迫止血的效果,评价血管缝合器的疗效、安全性和临床使用价值.方法:486例经股动脉行冠状动脉介入诊治术的患者,术后按是否接受血管缝合器止血分为缝合组(n=228)和常规组(n=258),比较止血时间、制动时间、血管并发症发生率.结果:缝合组操作成功率为97.34%;缝合组较常规组止血时间、制动时间均明显缩短[(5.4±2.2)min比(22.3±8.1)min,P＜0.001;(5.3±2.1)h比(20.5±9.6)h,P＜0.001];血管并发症发生率明显降低(2.63%比6.98%,P＜0.05).结论:冠状动脉介入诊治术后应用血管缝合器(Perclose)止血是安全、有效的,能明显缩短止血时间和制动时间,减少血管并发症的发生,但费用较昂贵.     

冠状动脉造影和治疗术后应用血管缝合器的研究

目前，冠状动脉造影和治疗术常规经股动脉途径，术后股动脉鞘一般处理方法为拔除后徒手压迫，然后绷带包扎制动12—24h，患痛苦大，并发症多。而应用血管缝合器缝合动脉穿刺点，术后4h即可下床活动，大大减少了卧床时间，患痛苦少，该技术国内使用过程中的出现的各种情况报道不多，我们自2003年以来累计使用Perclose(亚培公司生产)在冠状动脉造影和治疗术后实施血管缝合400余例，     

人工压迫和Perclose血管缝合器的股动脉止血疗效比较

目的：观察Perclose血管缝合器在经股动脉途径行室上速射频消融治疗中止血疗效比较。方法：199例经股动脉途径室上速射频消融治疗的患者被分为Perclose血管缝合组（Perclose组,98例）与人工按压组（101例）,观察两组即刻成功率,止血时间,制动时间与术后并发症的发生率。结果：即刻止血成功率比较两组无统计学差异（98％比100％, P＞0.05）。与人工按压组比较, Perclose组止血时间[（18.9±9.1） min比（2.7±0.7） min]和制动时间[（21.6±3.4） min比（6.3±2.4） min]明显缩短,并发症总发生率（16.8％比4.1％）明显降低（P＜0.05, P＜0.01）。两组并发症发生的具体情况：迷走反射 Perclose组明显低于人工按压组（0比7.9％, P＜0.05）,其他并发症两组无统计学差异（P均＞0.05）结论：Perclose血管缝合器止血时间、制动时间短,并发症少,可作为经股动脉途径室上速射频消融治疗后股动脉止血的优先选择。     

老年冠状动脉介入治疗患者术后2种血管闭合器止血的临床观察

目的:探讨血管闭合器Angio-Seal和Perclose在老年冠状动脉介入治疗患者应用的临床效果。方法:共682例老年(>60岁)经股动脉行冠状动脉介入治疗患者,分为3组,A、B 2组分别使用Angio-Seal和Perclose闭合器进行股动脉穿刺点止血,C组采用徒手压迫法止血,观察3组患者止血时间、卧床制动时间以及并发症的情况。结果:A组、B组及C组的止血成功率分别为99.6%,98.6%,100%,差异无统计学意义,P>0.05;止血时间分别为(1.5±0.8)min、(1.9±1.2)min和(19.5±5.8)min,卧床制动时间分别为(5.1±1.5)h、(6.2±1.7)h和(17.8±4.4)h,A组和B组明显短于C组,P<0.05;血管并发症发生率3组分别为4.6%、6.5%和9.7%,A组和B组亦明显少于C组,P<0.05。结论:对于60岁以上的老年冠状动脉介入治疗患者,术后应用Angio-Seal和Perclose血管闭合装置同样安全有效,优于徒手压迫止血法。     

A randomized trial comparing compression,perclose proglide™ and Angio‐Seal VIP™ for arterial closure following percutaneous coronary intervention: The cap trial

Objective: This prospective randomized trial compared the Angio‐Seal VIP? with Perclose Proglide? and to manual compression with respect to time to hemostasis and ambulation, patient satisfaction, and vascular complications following percutaneous coronary intervention (PCI). Background: The use of arterial closure devices for the reduction of vascular complications following PCI remains controversial. There have been no head to head trials comparing these most commonly used arterial closure devices following PCI. Methods: Two hundred patients undergoing PCI were randomized to manual compression, Perclose Proglide? or Angio‐Seal VIP?. Ambulation was allowed 3 hr after Perclose Proglide? or Angio‐Seal VIP? and 6 hr after compression. Results: There were 10 failures to deploy Perclose Proglide? and none for Angio‐Seal? (P < 0.01). Time to hemostasis was significantly shorter with Angio‐Seal VIP? compared with Perclose Proglide? (5.3 vs. 46.8 min, P < 0.01). Time to ambulation was shorter with Angio‐Seal VIP? than with Perclose Proglide? (261 vs. 334 min, P < 0.05) and the time to ambulation, as expected, was longest with compression (943 min, P < 0.01 vs. Angio‐Seal VIP? and Perclose Proglide?). Delay in ambulation was higher with Perclose Proglide? than with Angio‐Seal VIP? (18 vs. 9, P < 0.01). There was no significant difference in major vascular complications between groups. Compared with compression, patient discomfort was significantly improved with Angio‐Seal? (1.5 vs. 2.0, P < 0.01), but not with Perclose Proglide?. Conclusion: The Angio‐Seal VIP? device has a high rate of deployment success, which is significantly better than that of Perclose Proglide?. Angio‐Seal VIP? allows for earlier hemostasis and ambulation compared with both compression and Perclose Proglide? and is associated with greater patient satisfaction compared with compression. © 2008 Wiley‐Liss, Inc.     

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。     

经肱动脉路径开展经皮冠状动脉介入治疗术后复查冠状动脉造影的可行性与安全性

目的评价经皮冠状动脉介入治疗（PCI）术后复诊经肱动脉路径开展冠状动脉造影的可行性与安全性。方法回顾分析2010年1月至2012年12月在广东医学院附属医院PCI术后复诊的患者,按血管路径分为经肱动脉组（1000例）和经桡动脉组（1000例）进行冠状动脉造影复查。主要观察指标包括造影成功率、导管插入时间、X线曝光时间、对比剂用量、血管路径并发症（包括血肿、假性动脉瘤、骨筋膜室综合征、动脉痉挛和闭塞）及不良事件（包括死亡、心肌梗死、靶病变血运重建、冠状动脉痉挛、冠状动脉穿孔、冠状动脉夹层）。结果两组患者的导管插入时间、X线曝光时间、对比剂用量比较,差异均无统计学意义。与经桡动脉组比较,经肱动脉组血肿以及动脉痉挛血管路径并发症发生率显著降低（1.5%比6.0%,0.1%比24.7%,均P〈0.05）;经肱动脉组冠状动脉造影的操作成功率显著高于经桡动脉组（98.8%比87.0%,P〈0.05）。经桡动脉组骨筋膜室综合征、桡动脉闭塞、假性动脉瘤和冠状动脉痉挛发生率分别为0.1%、0.1%、0.2%和0.2%,而经肱动脉组未见以上不良事件。结论在PCI术后的患者中开展经肱动脉冠状动脉造影检查安全、可行,经肱动脉行冠状动脉造影可降低患者血管路径并发症的发生率,提高冠状动脉造影操作的成功率。     

Use of vascular sealing devices (VasoSeal and Perclose) versus assisted manual compression (Femostop) in transcatheter coronary interventions requiring Abciximab (ReoPro)

Transcatheter coronary interventions requiring abciximab (ReoPro) are associated with vascular access site complications. Several devices have been developed to aid in the closure of the femoral arteriotomy, including collagen plug devices (VasoSeal, Angio-Seal), percutaneous suture closure (Perclose), and aids to manual compression (Femostop). In 185 patients who received abciximab plus aspirin and heparin for transcatheter coronary interventions, we compared femoral arteriotomy closure by three different methods: VasoSeal, Perclose, and Femostop. A composite endpoint of late complications defined as an access site-related bleed or hematoma that required blood transfusion or an extended hospital stay, pseudoaneurysm, arteriovenous fistula, arterial or venous thrombosis was compared. VasoSeal was initially successful in 41/52 patients (78.8%). The 11 patients who failed to have adequate hemostasis with VasoSeal required manual compression aided by Femostop, but had no late complications. There was one access site infection and one fatal retroperitoneal hematoma unrelated to the vascular access site (surgically explored). There were no late complications. Perclose was successful in 48/56 patients (85.7%). One Perclose failure required surgical repair for an extensive arteriotomy. The other Perclose failure required manual compression aided by Femostop, but had no late complications. There were no access site infections requiring intravenous antibiotics. There was one retroperitoneal bleed that extended the patient's hospital stay and for which a blood transfusion was required. Femostop was successful in 77/77 patients (100%). There were no infections. Late complications occurred in four patients. These included three episodes of bleeding or hematomas requiring blood transfusion, and one pseudoaneurysm. Conclusion: In patients receiving abciximab in addition to aspirin and heparin, VasoSeal and Perclose are at least as safe as Femostop when used to achieve homeostasis after sheath removal. VasoSeal and Perclose have a significantly lower initial rate of successful hemostasis than Femostop. The numbers of late complications between the VasoSeal, Perclose, and Femostop groups were not significantly different. In those patients in whom VasoSeal or Perclose failed, no late complications occurred. Access site infections were no different between VasoSeal, Perclose, and Femostop. Cathet. Cardiovasc. Intervent. 47:143–147, 1999. © 1999 Wiley-Liss, Inc.     

经左桡动脉路径对矮小患者行冠脉造影的可行性

探讨经左桡动脉路径对矮小患者行冠脉造影的可行性及安全性。方法：选择2009年2月至2013年2月在我院住院,经左桡动脉路径行冠脉造影的患者898例,分成矮小患者组（449例）和正常身高患者组（对照组,449例）,矮小定义为：男性身高≤160cm、女性身高≤150cm。矮小患者均为Allen试验阳性,使用5F或6F桡动脉专用穿刺鞘组穿刺左桡动脉,使用5FTIG造影导管或Judkins型造影导管行冠脉造影检查,对比两组冠脉造影完成率、导丝导管交换率、X线曝光时间、血管并发症。结果：矮小患者组和对照患者组经左桡动脉路径行冠脉造影完成率均为96.2%,超滑导丝更换率（9.6%比8.6%）、X线曝光时间[（3.6±2.7）min比（3.4±2.7）min]、并发症[桡动脉闭塞（0.4%比0.4%）,易控性前臂出血或血肿（2.7%比1.8%）]等差异均无显著性（P〉0.05）。结论：经左桡动脉路径对矮小患者行冠脉造影检查是安全可行的,值得临床推广。     

A modified “Preclosure” technique after percutaneous aortic valve replacement

Objectives: To evaluate the feasibility, safety and efficacy of suture‐mediated closure devices using a modified “preclosure” technique for access site management after percutaneous aortic valve replacement (PAVR). Background: PAVR using a retrograde transfemoral approach has recently evolved to an endovascular alternative to open surgery in high‐risk patients. However, large‐bore femoral artery access is required, commonly demanding surgical closure and general anesthesia. A truly percutaneous intervention would be desirable to reduce procedural complexity and diminish the need of vascular surgery and general anaesthesia. Methods: After direct puncture of the common femoral artery, three conventional suture‐mediated closure devices (6F Perclose) were deployed. The preloaded sutures were tied at the end of the procedure. If no immediate hemostasis was achieved, an additional device was deployed thereafter. Results: PAVR with percutaneous access site closure was attempted in 15 consecutive patients and could successfully be achieved in all patients allowing conscious sedation in all but three cases. Following complications occurred: one retroperitoneal bleeding caused by removal of the valve delivery sheath requiring surgical repair, as well as two cases of femoral and iliac artery dissection caused by delivery sheath introduction and treated by stenting and vascular surgery, respectively. Vascular surgery became only necessary due to total vessel occlusion after suture closure and remains the only closure‐related complication. However, treatment led to recovery in all patients. Conclusions: The modified “preclosure” technique is a feasible and safe method for hemostasis after PAVR improving procedural management and diminishing the need for general anesthesia. © 2008 Wiley‐Liss, Inc.     

老年女性患者经鼻烟壶桡动脉与经典桡动脉行冠状动脉诊疗的对比性研究

目的探讨老年女性患者经鼻烟壶处桡动脉行冠状动脉造影和PCI的可行性和安全性。方法选择行冠状动脉造影和(或)PCI的老年女性患者100例,根据穿刺部位不同随机分为鼻烟壶组50例(穿刺鼻烟壶部位)及经典组50例(穿刺常规桡动脉)。观察2组穿刺时间、穿刺成功率、手术时间、手术成功率、置入支架、穿刺部位出血、血肿、动脉瘤及桡动脉闭塞率等情况。结果 2组血管内径、穿刺时间、穿刺成功、手术成功、手术时间、置入支架、术后血肿、动脉瘤和动静脉瘘发生率比较,差异无统计学意义(P>0.05)。鼻烟壶组桡动脉痉挛、闭塞和总并发症发生率较经典组明显降低(2%vs 8%,2%vs 10%,6%vs 20%,P<0.05)。结论老年女性患者经鼻烟壶桡动脉途径的桡动脉痉挛发生率及闭塞率更低,安全性好,可以作为常规桡动脉的替代途径应用于冠状动脉诊疗。