Complications associated with the Angio-Seal arterial puncture closing device: intra-arterial deployment and occlusion by dissected plaque

The Angio-Seal arterial closure device is widely used to prevent bleeding and facilitate early ambulation after arterial puncture. We had referred to us three female patients in whom this device had been used; its sponge had been unintentionally deployed in the arterial lumen. In a fourth female patient, a dissected plaque underneath the device occluded the femoral artery. Severe lower extremity ischemia occurred in each case. One intraluminal sponge was detected only after 20 days, when the patient had developed severe symptoms due to microembolization; in another patient, ischemia occurred 9 days after intraluminal deployment. In two, or possibly three, of the cases, the superficial femoral artery had been punctured. The device should not be used when the superficial femoral artery has been punctured, in which case complications are more likely to occur. Lower limb ischemia within several months after deployment of these devices should be investigated with duplex ultrasound scanning to examine the possibility that the ischemia may be caused by the device or by device-related thrombus. It is important to register the use of such devices in the procedural reports to make it possible to link their use to eventual later ischemic events.     

下肢急性缺血的救治

下肢急性缺血(acutelimbischemia,ALI)一直是血管外科具有挑战性的问题,目前仍有较高的死亡率和截肢率。ALI的成功救治有赖于良好的综合医疗条件,要求医生充分理解其病理生理,还要具备丰富的血管外科手术治疗、腔内治疗、药物治疗经验和扎实的内科疾病处理经验。一、ALI的病因和病理生理动脉栓塞和血栓形成是ALI两个常见的病因。心脏是栓子最常见的来源,以往多见于风湿性心脏病,现在则以冠心病房颤更多见,心肌梗塞引起的心脏附壁血栓也越来越多,心房黏液瘤,肺部恶性肿瘤侵犯肺静脉、癌栓脱落偶尔也能遇到。深静脉血栓有时也可成为动脉…     

下肢慢性缺血合并急性血栓形成的外科治疗

目的 探讨治疗下肢慢性缺血合并急性血栓形成的最佳外科治疗手段.方法 回顾性分析2000年1月～2010年10月我科收治的26例下肢慢性缺血合并急性血栓形成患者的临床资料,比较单纯采用股动脉切开导管取栓术组(10例)与股-腘动脉切开取栓联合动脉重建手术组(16例)的疗效.结果随访时间1～114个月,单纯股动脉切开术组中的...     

急性下肢缺血的外科治疗

人体下肢动脉因各种原因导致管腔的突然狭窄或闭塞,出现肢体供血不足,循环障碍被称为急性下肢缺血。急性下肢缺血是血管外科的常见急症,也是一个对临床具有挑战性的课题,因为它不仅危及患肢的生存,同时也危及病人的生命。由于低灌注带来酸碱平衡失调、电解质紊乱以及血管再通后组织自由基的释放,极大的损伤了心、肺、肾功能。该病导致病人死亡的原因通常不是缺血本身,而是由此产生的并发症。国外文献报道:每年急性下肢缺血发生率为1 7/万,占血管外科总病例数的10 %～16 %。Blaidell统计美国35所医疗单位30 0 0例病人,病死率为2 5 % ,截肢率…     

急性下肢动脉缺血的治疗策略

急性下肢动脉缺血(acute lower limb ischemia, ALLI )指病程短于2周,由各种原因导致的急性下肢动脉灌注不足.ALLI是血管外科常见急症,如不及时处理可能会造成患者截肢或死亡的严重后果,其年发病率为1.0‰～1.5‰[1],30 d截肢率为10％～30％,30 d死亡率为15％[2].一旦确...     

Aspirin withdrawal and acute lower limb ischemia

Aspirin is used mainly to prevent arterial events in patients with arteriopathy. Myocardial infarction and cerebrovascular events have been described after recent aspirin withdrawal. Experimental data suggest rebound platelet activity after aspirin discontinuation. Among a retrospective cohort of 181 patients admitted for acute lower limb ischemia for 4 yr, we studied 11 patients who had recently stopped taking aspirin. Aspirin was administered for vascular event prevention. The median duration of aspirin treatment without vascular events was 12 mo (range, 6-60 mo). The median time between aspirin withdrawal and lower limb ischemia was 23 days (range, 7-60 days). Four of the 11 patients stopped aspirin before a surgical procedure, without any substitution. In five patients, a recent diagnosis of neoplasia was observed. This study should alert clinicians to the risk of discontinuing chronic aspirin therapy in patients with severe peripheral vascular disease.     

Surgical treatment of complications associated with the Angio-Seal vascular closure device

Vascular closure devices are used to provide quick hemostasis and early ambulation after percutaneous interventions. The Angio-Seal (AS) vascular closure device forms a mechanical seal by closing the puncture site located between a bioabsorbable anchor within the lumen and a collagen sponge on the adventitia. Although morbidities associated with AS are reportedly infrequent, even the slightest inaccuracy in device implantation may result in displacement of these device components, leading to sudden and severe complications. We report the surgical treatment of complications associated with the use of AS in four patients, including acute limb ischemia, pseudoaneurysm formation, significant hemorrhage, and hypovolemic shock. A common factor in all these cases was that the components of the AS device were displaced from their original site of implantation, stressing the importance of proper device placement. All patients underwent successful surgical vascular repair. Our report highlights the need for exercising extreme care during device implantation, and also the requirement for vigilant inspection for any associated vascular complications commencing immediately after device implantation. It is vital that these device components are actively looked for and removed during surgical exploration so as to prevent future complications.     

Pulsed Doppler angiography in lower limb arterial ischemia.

A 30-channel pulsed Doppler vessel imaging system (MAVIS, GEC Medical, Middlesex, England), was used to obtain images and maximal Doppler velocity time waveforms in the diagnosis of stenosis of the origin of the profunda femoris artery (PFA) and in the detection of structural changes within Dacron arterial grafts. In PFA scans of 33 limbs in 22 patients (mean age, 52 years), PFA stenosis of more than 50% at operation was invariably associated with a damping factor of the maximal Doppler velocity-time waveform of greater than 1.5 (eight limbs). In 12 limbs with a normal PFA at operation, the damping factor was always less than 1.4, and in 13 limbs of normal patients without arterial disease, the damping factor was always less than 1.34. In studies of 10 mm arterial grafts, the internal diameter of 14 iliopopliteal grafts scanned just above the popliteal anastomosis was strikingly reduced as compared with the femoral anastomosis of 14 aortoiliofemoral grafts and seven axillobifemoral grafts. These preliminary results suggest that MAVIS studies can be used noninvasively to detect PFA stenosis and to identify luminal narrowing of iliopopliteal grafts.     

69例急性下肢缺血的诊治分析

目的探讨急性下肢缺血的治疗方法及预后。方法回顾性分析我科2007年1月～2012年1月治疗69例急性下肢缺血患者的临床资料,其中急性动脉栓塞14例,动脉硬化闭塞基础上继发急性血栓形成50例,血栓闭塞性脉管炎3例,不明原因2例。根据病情采用:动脉切开Fogarty导管取栓8例,人工血管旁路17例;球囊扩张成形/支架置入15例;置管溶栓后进一步行腔内治疗12例;低位静脉动脉化2例;单纯药物治疗9例;I期截肢6例。结果 12例(17.4%)治疗成功,50例(72.5%)治疗好转,1例(1.4%)治疗无效。57例(82.6%)患者获得随访,随访时间3～62(平均26.4)个月,42例症状不同程度改善,7例Ⅱ期截肢,5例死于心、肺疾病。结论急性下肢缺血早期诊断与及时采用合适的治疗方法是治疗成功的关键。     

股动脉穿刺介入治疗Angio-Seal血管闭合器应用并发症预测模型的构建与验证

目的 探讨股动脉穿刺后采用Angio-Seal血管闭合器发生并发症的危险因素并建立预测模型,为临床护理提供参考.方法 收集经股动脉入路行介入治疗、采用Angio-Seal血管闭合器的611例患者资料,行单因素和多因素Logistic回归分析并发症危险因素,建立风险预测模型进行验证.结果 体重指数、低分子肝素、鞘管尺寸、...     

外科治疗非创伤急性下肢缺血154例

目的 探讨非创伤急性下肢缺血的外科治疗方法及影响预后的因素,对比急性动脉栓塞和急性动脉血栓形成的发病率和预后.方法 回顾性分析1999年7月至2007年12月手术治疗的154例急性下肢缺血病例,所有病例均行股动脉或胭动脉切开、Fogarty导管取栓术.单纯取栓128例,Fogarty导管取栓+内膜剥脱术8例,Fogarty导管取栓+人工血管或自体大隐静脉转流术13例,Fogarty导管取栓+一期截肢术5例.按照病因将病例分为急性动脉栓塞组(99例)和急性动脉血栓形成组(55例),对比两组发病率、截肢率、病死率及截肢高危因素.结果 急性动脉栓塞组男性发病率(39.4%)低于女性(60.6%)(P<0.05);急性动脉血栓形成组男性发病率(72.7%)高于女性(27.3%)(P<0.05).所有患者的截肢率为9.7%,院内病死率为11.7%.急性动脉栓塞组截肢率(5.1%)低于急性动脉血栓形成组(18.2%)(P<0.05),急性动脉栓塞组院内病死率(11.1%)与急性动脉血栓形成组(12.7%)相当(P>0.05).两组病例截肢的共同高危因素是肢体缺血时间,急性动脉血栓形成组截肢风险还与吸烟和糖尿病有关.结论 急性动脉栓塞男性发病率高于女性,急性动脉血栓形成女性发病率高于男性,急性动脉栓塞截肢率低于急性动脉血栓形成,而急性动脉血栓形成比急性动脉栓塞具有更高截肢风险.     

大隐静脉原位转流术重建下肢血液循环

目的:评价大隐静脉原位转流术治疗下肢动脉硬化闭塞症的疗效.方法:运用自制瓣膜切除器开展大隐静脉原位转流术治疗下肢动脉硬化闭塞症38例共40例肢体.患者术前踝肱指数(ABI)为0-0.58(平均0.29),均经动脉造影证实.术后移植物均可扪及搏动,有28条肢体足背或胫后动脉搏动恢复,17例同时行输入输出道动脉重建术,溃疡清创术6例,4例于术后3天内出现移植物搏动消失,行第2次重建术,结果:ABI平均值同术前0.29上升至0.84,严惩缺血肢体挽救率为100%,经寿命表统计分析,1-5年的血管累积通畅率分别为92%,87%,82%,72%和65%,结论:大隐静脉原位转流术是治疗下肢动脉硬化闭塞症的理想方法之一,同时行输入功输出道动脉重建术,对保证移植血管的通畅有着重要的意义.     

下肢动脉硬化闭塞症治疗后再闭塞的处理

目的 总结下肢动脉硬化闭塞症治疗后再闭塞的治疗经验.方法 回顾性分析2007年1月至2011年12月70例患者的临床资料,其中30例单纯股-腘动脉旁路术、15例单纯腔内成形术、25例联合治疗后下肢单侧动脉再次闭塞.70例患者共发生98次动脉闭塞.10例次在发生末次闭塞时保守治疗(组),余88例次行手术治疗[包括单纯股或人工血管取栓15例次(单纯取栓组),取栓+局部动脉微导管置入(组)抗凝溶栓13例次,取栓+远端动脉成形+微导管置入抗凝溶栓60例次].结果 保守治疗组膝上截肢5例,失访2例.单纯取栓组膝上、下截肢各1例,失访2例.取栓+微导管置入组膝下截肢1例,死亡2例.取栓+动脉成形+微导管置入组急性肾衰转透析后失访1例.本组63例患者获得随访,随访时间8～60个月,平均(24±5)个月.其中44例血管通畅,通畅率69.8％.8例患者血管闭塞后截肢,总截肢率为12.7％.结论 对于动脉硬化闭塞症治疗后再闭塞的患者,取栓+腔内血管成形+微导管置入局部抗凝溶栓近期效果较好.