血管缝合器系统预缝合技术处理大口径动脉鞘穿刺点的有效性及安全性

目的 探讨血管缝合器系统预缝合技术处理大口径动脉鞘穿刺点的有效性及安全性。方法 收集2021年1—12月于国家心血管病中心中国医学科学院阜外医院就诊的52例腹主动脉瘤患者的临床资料,均采用血管缝合器系统（ProGlide）预缝合技术处理股动脉穿刺点,评估手术即刻、术后早期及随访时的穿刺点情况。结果 52例腹主动脉瘤患者共104处穿刺点,整体成功率为98.1%(102/104),其中,双把ProGlide预缝合技术处理了88处穿刺点,平均动脉鞘14.9 F,需压迫止血1处,整体成功率为98.9%(87/88);单把ProGlide预缝合处理了16处穿刺点,均为12 F动脉鞘。需压迫止血1处,成功率为93.8%(15/16)。术后未出现穿刺点有意义狭窄或闭塞,术前、术后踝肱指数（ABI）比较,差异无统计学意义（P>0.05）。平均随访11.5个月,期间无新发穿刺点并发症。结论 血管缝合器系统预缝合技术是一种安全有效的处理大口径动脉鞘穿刺点的方法,术前评估穿刺点、精准穿刺、规范化操作等可提高其成功率。     

穿刺缝合技术在主动脉疾病腔内介入治疗中的应用

目的 探讨采用Perclose ProGlide血管缝合器经皮穿刺缝合技术在主动脉夹层及动脉瘤等主动脉疾病血管腔内介入治疗中的应用.方法 回顾性分析2011年4月至2012年6月采用血管缝合器辅助下主动脉疾病腔内介入治疗的23例患者(30处动脉入路)的资料,主动脉夹层11例,主动脉穿透性溃疡2例,胸主动脉真性动脉瘤2例,腹主动脉瘤6例,胸主动脉缩窄1例,腹主动脉狭窄1例.统计技术成功率及并发症.结果 技术操作成功率为93.3％ (28/30),失败2例中1例为股动脉并发重度狭窄(24Fr),1例并发出血(22Fr),行股动脉切开修补术.共应用缝合器55把,缝合27条股动脉,其支架输送器外径1例为24Fr,12例为22Fr,2例为20Fr,1例为18Fr,2例为16Fr,4例为14Fr,1例为10Fr,4例为6Fr,另3例为左颈动脉及左锁骨下动脉6Fr鞘.成功缝合的21例患者均获随访,随访时间2 ～13个月,平均随访(8±4)个月未见出血、血肿、假性动脉瘤、血栓形成、动脉严重狭窄等并发症.结论 经皮穿刺缝合技术缝合大直径支架输送器穿刺点是安全而有效的.缝合技术除用于股动脉入路外,还可用于主动脉弓上分支.     

腹主动脉瘤腔内修复术中血管缝合器与手术切开缝合临床应用对比研究

目的 探讨Perclose Proglide血管缝合器在腹主动脉瘤腔内修复手术中的应用及意义。方法 回顾性分析2013年3月至2015年2月,首都医科大学附属安贞医院血管外科临床确诊腹主动脉瘤并实施腔内修复术的130例病人资料。术中采用穿刺股动脉方法建立入路并使用Perclose Proglide 血管缝合器缝合69例（A组）,手术切开股动脉并缝合61例（B组）。分析两组在缝合成功率、手术时间、术中出血量、住院时间、手术费用、伤口愈合情况、有无下肢缺血等因素,探讨Perclose Proglide 血管缝合器在腹主动脉瘤腔内修复手术中的应用效果。结果 在130例病人中,与手术切开组（B组）相比,使用缝合器组（A组）手术时间更短、术中出血量少、且住院时间较短,且差异均有统计学意义（P<0.05）。结论 在腹主动脉瘤腔内修复手术中,经皮穿刺建立股动脉入路并使用Perclose Proglide 血管缝合器处理穿刺点,该方法安全有效,且创伤小,病人术后恢复更快,值得推广使用。     

经皮穿刺腹主动脉瘤腔内修复术单中心经验总结

目的总结经皮穿刺腹主动脉瘤腔内修复术(pEVAR)中应用Perclose ProGlide血管缝合器的经验,并评估该缝合器的可行性及安全性。方法回顾性分析本中心自2012年12月至2013年7月完成的57例pEVAR患者的临床资料,观察围手术期并发症发生的情况。结果 57例患者腹主动脉瘤腔内治疗的手术即刻技术成功率为100%(57/57),手术平均时间(93.5±17.8)min。ProGlide共缝合106处股动脉入路,其中缝合20F~22 F血管鞘36例次,18 F以下血管鞘70例次。血管缝合器一次成功率88.7%(94/106),二次成功率91.5%(97/106)。缝合失败导致穿刺点出血5例,其中2例行手术探查止血,3例局部压迫并加压包扎止血;入路动脉闭塞4例,均行手术探查并重新缝合。术后蓝趾综合征(垃圾脚)6例,发生率5.7%(6/106)。围手术期无死亡等严重并发症,患者均顺利出院。结论 pEVAR术中使用Perclose ProGlide缝合器安全有效,加强术者经验并挑选合适患者有助于降低手术并发症发生率。     

改良穿刺缝合技术在腹主动脉瘤腔内修复术中的应用

目的总结改良穿刺缝合技术在腹主动脉瘤腔内修复术中的应用经验,并评估其可行性及安全性。方法回顾性分析2017年8月至2019年1月采用改良穿刺缝合技术行腹主动脉瘤腔内修复术的42例患者临床资料,分析手术成功率、手术时间、出血量、术后住院时间及围术期并发症发生情况。结果手术成功率100%,平均手术时间(3.2±1.5)h,术中平均出血量(126±90)ml,术后平均住院时间(7.2±2.6)d。共缝合84处股动脉入路,一次成功率95.2%,二次成功率98.8%(83/84)。患者随访1～12个月,未见出血、血肿、假性动脉瘤、动脉狭窄等并发症。结论改良穿刺缝合技术在腹主动脉瘤腔内修复术中的应用是安全有效的。     

完全穿刺与股动脉切开在主动脉疾病腔内修复术的疗效对比

目的 对比完全穿刺技术与股动脉切开技术在主动脉疾病腔内修复术中的临床疗效.方法 选取2015年12月至2018年12月赤峰市医院88例行腔内修复术治疗的主动脉疾病患者,利用随机数字表法分为实验组和对照组各44例.对照组采用股动脉切开技术,实验组采用完全穿刺技术,比较两组技术成功率、手术时间、术后住院时间、术中出血量和并...     

INCRAFT腹主动脉覆膜支架系统治疗腹主动脉瘤

目的探讨INCRAFT腹主动脉覆膜支架系统腔内修复治疗腹主动脉瘤的效果。方法回顾性分析2017年2月～2018年4月使用INCRAFT腹主动脉覆膜支架系统治疗腹主动脉瘤20例资料,其中18例存在超适应证的不良瘤颈因素。局麻强化手术15例,气管插管全麻手术5例。均采用预置缝合器的经皮腹主动脉腔内修复手术。结果技术成功率100%。1例术中腹主动脉近端夹层,保守观察;其余19例无围术期不良事件。术后随访6～20(12. 0±4. 6)月,1例术后15个月出现Ⅰb型内漏,再次腔内修复,其余19例无不良事件。生存分析显示免于再干预率为术后12个月100%,术后18个月85. 7%。结论 INCRAFT腹主动脉支架系统可用于不良瘤颈腹主动脉瘤腔内修复手术,近期效果显示良好的有效性和安全性。     

经皮胸主动脉腔内修复术中使用Perclose ProGlide血管缝合器行预先埋置缝合技术的学习曲线∗

目的 探讨经皮胸主动脉腔内修复术时应用Perclose ProGlide血管缝合器行预先埋置缝合技术的学习曲线.方法 回顾性分析2016年9月～2020年5月同一手术团队连续完成的应用Perclose ProGlide血管缝合器行预先埋置缝合技术实施经皮胸主动脉腔内修复术93例的临床资料,使用累积和(cumulativ...     

不同止血方式在腹主动脉瘤介入治疗中的临床效果比较

目的比较不同止血方式在腹主动脉瘤介入治疗中的安全性、有效性及临床应用价值。方法前瞻性收集新疆维吾尔自治区人民医院血管外科2014年6月至2014年11月因腹主动脉瘤入院患者临床资料,共45例,穿刺肢体64条,其中Pro Glide联合Angioseal缝合股动脉穿刺孔19条;Pro Glide交叉缝合股动脉穿刺孔20条;股动脉开放缝合25条。比较术中止血时间、出血量、制动时间、以及术后舒适度和早期并发症发生情况。结果 Proglide联合Angioseal组止血时间低于Proglide交叉缝合组和常规切开组(P0.05);出血量、下肢制动时间和术后舒适度方面两组间差异无统计学意义(P0.05),但均优于切开组(P0.05)。各组均无大血管并发症发生,在皮下淤血或血肿等小血管并发症方面差异无统计学意义(P0.05)。结论血管闭合器能有效缩短止血时间、出血量、制动时间及减轻术后疼痛;Proglide联合Angioseal闭合大孔径穿刺口与Proglide交叉缝合相比可能更有优势。     

一体化分叉型支架在肾下型腹主动脉瘤腔内治疗中的应用

目的 探讨一体化支架在肾下型腹主动脉瘤治疗中的应用.方法回顾分析 2010 年3 月至 2013 年 2 月采用一体化支架腔内修复术治疗肾下型腹主动脉瘤15例,对其临床资料进行分析总结.结果 所有病例均腔内修复成功,术后随访3～36个月复查CTA,瘤体均被完全隔绝,支架位置良好,无移位、扭曲及内漏现象.结论 术前准确评估、测量后,一体化支架治疗肾下性腹主动脉瘤效果良好,安全性高,操作简单并发症少.     

Mid-term follow-up of percutaneous access for standard and complex EVAR using the ProGlide device

ObjectivesEndovascular Aneurysm Repair is an established treatment for abdominal aortic aneurysm which requires arterial access via the groin. Most centres perform percutaneous ultrasound-guided access into the common femoral artery for delivery of the stent graft. The profile of endovascular devices necessitates large sheath sizes, therefore formal closure of the arterial puncture site is required. Various percutaneous devices are available, with data lacking on efficacy and mid-term safety profile. We present outcomes from a single centre with the Perclose ProGlide? (Abbott Vascular Devices, CA, USA) suture-mediated system, using the well described “pre-close” technique.Materials & methodsData were collected from operative records and electronic medical records. Patients undergoing standard (EVAR) or complex (F/B-EVAR) aneurysm repair between March 2015 and September 2019 were included. Complications were recorded per-patient and per-groin procedure.Results266 patients were included; 182 (68.4%) standard infrarenal EVAR, 84 (31.6%) F/B-EVAR. There were a total of 484 groin procedures performed. Intraoperative Perclose ProGlide? success was 98.1% (per patient) or 99.0% (per groin procedure). 30-day groin complication rate was 6.1% (per patient) or 3.1% (per groin procedure). There were no pre- or peri-operative factors which predicted the occurrence of groin complications. The rate of groin complications was not related to sheath size.ConclusionsOur data support the use of percutaneous access with a pre-close technique for a variety of endovascular aneurysm repair procedures with both large- and small-bore access. The Perclose ProGlide? system provides excellent mid-term complication-free and reintervention-free outcomes for groin procedures.     

Percutaneous thoracic and abdominal aortic aneurysm repair: techniques and outcomes

Endovascular repair of infrarenal abdominal aortic aneurysms (EVAR) has become a widely accepted treatment modality. The conventional approach of an EVAR involves bilateral groin incisions to expose the femoral arteries followed by introducer sheath placement, which is typically performed with the use of general or epidural anesthesia. As technology trends toward less invasive methods and sheath sizes become smaller, the use of a total percutaneous approach to endovascular repair of aortic pathology is becoming more common. In this review, we present a brief history of percutaneous closure devices for common femoral artery access, factors important in patient selection, the technique of performing a percutaneous EVAR procedure, early and late complications, and overall outcomes of percutaneous approaches for the endovascular treatment of aortic pathology.     

External transabdominal manipulation of vessels: a useful adjunct with endovascular abdominal aortic aneurysm repair

During endovascular abdominal aortic aneurysm repair, a severely angulated aortic neck or tortuous iliac arteries can make delivery of endografts difficult. We describe a simple adjunct in which transabdominal manipulation of vessels is used, which can greatly facilitate delivery of these devices in patients with challenging anatomy.     

Total percutaneous access for endovascular aortic aneurysm repair ("Preclose" technique)

OBJECTIVE: Percutaneous access during endovascular aneurysm repair has been difficult owing to the large size of the delivery catheters. This study reports a single-center experience of totally percutaneous access during endovascular abdominal and thoracic aortic repairs using the Preclose Proglide device (Abbott Vascular, Redwood City, Calif). METHODS: Between December 2004 and August 2006, 262 endovascular aortic aneurysm repairs were performed. Percutaneous access was used for the introduction of 12F to 24F sheaths (4.4-mm to 8.6-mm outer diameter). The technique involved deployment of two Proglide devices before insertion of the sheath ("Preclose" technique) with the sutures left extracorporeally for closure after conclusion of the procedure. A prospectively maintained endovascular database and medical records were retrospectively reviewed. Rates of technical success, failure modes, and the overall duration of the endovascular repair compared with a similar cohort using open femoral exposures were examined. RESULTS: A total of 559 Proglide devices were used to close 279 femoral arteries, and 175 (63%) required the insertion of 18F to 24F sheaths. There were 16 failures, mainly due to obesity, device malfunction, severe calcific disease, and faulty arterial punctures, for a technical success rate of 94.3%. The success rates for 12F to 16F size sheaths were significantly higher than for the larger 18F to 24F sheaths (99.0% vs 91.4%, P<.01). For both endovascular abdominal (EVAR) and thoracic (TEVAR) aortic repairs, the Preclose technique resulted in shorter overall procedure times compared with a similar cohort in which open femoral exposures were used (EVAR, 115 vs 128 min, P<.001; TEVAR, 80 vs 112, P=.019). Despite this reduction of procedure time, the savings on the cost of operating room time was negated by the cost of the Proglide devices ($295 per device). CONCLUSIONS: Percutaneous access for endovascular aortic repair is safe and feasible using the Proglide device. Although the success rates are higher for smaller size sheaths, successful closures may be obtained for up to 24F sheaths. Percutaneous access may result in shorter overall procedure times and potentially lower operating room costs, but this appears to be offset by the cost of the closure devices.     

Total percutaneous cardiopulmonary bypass with Perclose ProGlide

Suture-mediated closure devices have been previously described as an interesting alternative to femoral cutdown during endovascular aortic procedures. The insertion of two or three devices before the cannulation (preclose technique) permits successful percutaneous access also with a large sheath up to 24 Fr diameter. The main benefit of percutaneous access is a lower rate of complication at the groin. The same technique can be applied to cardiac procedures where femoral cannulation for cardiopulmonary bypass (CPB) is required. We report a series of 12 patients in whom total percutaneous CPB was successfully established using a Perclose ProGlide for the arterial access.     

Endovascular suture versus cutdown for endovascular aneurysm repair: a prospective randomized pilot study

PURPOSE: To evaluate safety and cost benefits of the percutaneous technique for treatment of aortic aneurysm, a prospective randomized study was performed that compared the endovascular suture technique with conventional cutdown access and repair. Materials and Methods: From January 2002 through July 2002, 30 endografts, including 14 Talent stent-grafts (Medtronic, Sunrise, Fla) and 16 Zenith endografts (Cook, Bloomington, Ind) were implanted in 30 patients for endovascular aneurysm treatment. The patients were randomized to either percutaneous technique (group A) or conventional cutdown (group B). Fifty-five femoral arteries were cannulated with large-bore (14F-25F) introducers and were included in the study. Safety and efficiency of both techniques were assessed by recording the complication rates, operation time, discharge, and time to ambulation. Comparison of selected estimated costs included both variable and fixed costs for femoral access and expenses for treatment of complications. RESULTS: No operative deaths occurred. The complication rates were similar and included 1 arterial thrombosis in each group, 3 lymphoceles in group B, and 1 conversion to cutdown because of bleeding in group A. Mean surgery time (86.7 +/- 27 minutes vs 107.8 +/- 38.5 minutes; P <.05) and time to ambulation (20.1 +/- 4.3 hours vs 33.1 +/- 18.4 hours; P <.001) were significantly shorter in the group treated percutaneously. Because of the cost of the closure device, total cost of the percutaneous technique averaged 99.2 euro; more than cutdown. CONCLUSIONS: The percutaneous technique decreases the invasiveness of endovascular therapy of aortic aneurysm and reduces operative time and time to ambulation. Complications were roughly equivalent in severity. The additional cost for the device appears to justify its use for this form of aneurysm treatment.     

Midterm outcomes of femoral arteries after percutaneous endovascular aortic repair using the Preclose technique

OBJECTIVE: Percutaneous access during endovascular aortic repair has been shown to be feasible and safe using a suture-mediated closure device ("Preclose" technique) for closure of up to 24F introducer sheaths. The purpose of this study is to examine the late outcomes of those femoral arteries repaired in this manner. METHODS: The Preclose technique has been previously described. Briefly, the technique involves two Perclose Proglide devices deployed in the femoral artery prior to insertion of the large diameter introducer sheath and then closure of the arteriotomy by tying down knots of the Proglide following removal of the sheath. The medical records of all patients who underwent endovascular aortic repairs using the Preclose technique between December 2004 and August 2007 were reviewed. Follow-up protocol consisted of computed tomography (CT) angiograms performed at 1, 6, and 12 months, and annually thereafter. All Preclose patients who had at least a 6-month postoperative scan were included in the study. For each patient, the most recent postoperative scan was compared with the preoperative scan for evidence of any new anatomic abnormalities of the femoral artery such as dissection, stenosis, or pseudoaneurysm. Three-dimensional post processing with multiplanar reconstructions was also performed as necessary to confirm axial scan findings. RESULTS: A total of 292 patients underwent percutaneous endovascular aortic repairs (TEVAR-125, EVAR-167). Four hundred thirty-two femoral arteries were closed with 870 devices. Four hundred eighteen vessels were approximated with two devices, while 30 arteries required three devices for hemostasis and an additional four vessels only required a single device. Two hundred seventy-eight (64.3%) vessels were accessed with sheaths 18 to 24F. Four hundred eight femoral arteries (94.4%) were closed successfully with the Preclose technique. There were 100 patients (TEVAR-35, EVAR-65) who had adequate postoperative CT scan at 6-months or later. The mean follow up was 11.6 +/- 5.0 months. Of the 156 femoral arteries in these 100 patients repaired using the Preclose technique, there were 3 late complications in 3 patients, 1 asymptomatic femoral artery dissection, and 2 femoral artery pseudoaneurysms requiring surgical repair, resulting in a late complication rate of 1.92% (3/156). CONCLUSION: Percutaneous closure of femoral arteries after large diameter introducer sheaths using the Preclose technique has a low incidence of early and late complications related to the closure site.     

From puncture to closure of the common femoral artery in endovascular aortic repair

In all fields of surgery there is a trend towards less invasive procedures reducing hospital stay, complications and mortality. Open surgery in the treatment of aortic diseases is gradually less applied, and instead endovascular aortic repair - EVAR - is a widely accepted treatment modality of today. The traditional approach in EVAR involves surgical exposure of the femoral arteries with bilateral groin incisions. Through the groin access, and under fluoroscopy, a special insertion sheath introducer is used to position a stent graft in the desired location with the patient in general or epidural anesthesia. The evolving stent-technology with smaller sheath sizes has broadened the scenario for alternative approaches for access and closure of the common femoral arteries. The following review presents an introduction on technical aspects of puncture of the femoral artery and closure of the arterial wall using percutaneous closure devices. We also aim to discuss three important approaches to expose and close the femoral arteries during endovascular aortic repair: The cut down approach, the true percutaneous technique, and the femoral fascial closure. Finally, factors important in the choice of techniques will be discussed in relation to early and late complications. We suggest that a percutaneous femoral approach should initially be considered for all endovascular aortic procedures, but with a low threshold to convert to traditional cut-down technique when complications such as bleeding, stenosis, ischemia, or femoral artery injury occur. The choice of the optimal femoral approach depends on the unique anatomy of each patient.     

Percutaneous repair of aortic aneurysms: a prospective study of suture-mediated closure devices.

PURPOSE: To evaluate prospectively the safety and efficacy of totally percutaneous placement of abdominal and thoracic aortic endografts using the Prostar XL suture-mediated closure system. METHODS: From January 2002 to January 2005, we attempted to insert percutaneously all bifurcated abdominal aortic and thoracic endografts. Consecutive patients (25 men, four women), with mean age 74.9 years (range 44-84), underwent endovascular repair for 20 abdominal aortic aneurysms (AAA) and nine thoracic aortic aneurysms (repeat operation in one case). Endografts used included 21 Zenith (Cook), eight Talent (Medtronic), one AneuRx (Medtronic). For the technique, two Prostar XL 8F were used to close 22-24F access sites and one Prostar XL 10F to close 16F access sites. RESULTS: Procedural success was achieved in 21/29 (72.4%) patients and in 39/47 access sites (83%). Closure of 22-24F access sites with tandem 8F Prostar devices was successful in 23/29 (79.3%) cases. Closure of 16F access sites with 10F Prostar device was successful in 16/18 (88.8%) cases. There were seven peri-procedural failures requiring surgery to repair the femoral artery in three cases. Four access complications healed without intervention. Overall 25/29 (86.2%) patients had complete percutaneous repair. No late complications were detected during follow-up (median 17.5 months). CONCLUSIONS: Percutaneous treatment of patients with AAA and thoracic aneurysms is feasible in most cases, with a very low risk of access-related complication, providing that the operator has sufficient practical experience of this technique.     

Collective experience with hybrid procedures for suprarenal and thoracoabdominal aneurysms

Not every patient is fit for open thoracoabdominal aortic aneurysm (TAAA) repair, nor is every TAAA or juxtarenal abdominal aortic aneurysm suitable for branched or fenestrated endovascular exclusion. The hybrid procedure consists of debranching of the renal and visceral arteries followed by endovascular exclusion of the aneurysm and might be an alternative in these patients. Between May 2004 and March 2006, 16 patients were treated with a hybrid procedure. The indications were recurrent suprarenal or thoracoabdominal aneurysms after previous abdominal and/or thoracic aortic surgery (n = 8), type I to III TAAAs (n = 3), proximal type I endoleak after endovascular repair (n = 2), penetrating ulcer of the juxtarenal aorta (n = 1), visceral patch aneurysm after type IV open repair (n = 1), and primary suprarenal aneurysm (n = 1). Eight (50%) of 16 patients were judged to be unfit for open TAAA repair. The hospital mortality rate was 31% (5 of 16). Four of five deceased patients were unfit for thoracophrenic laparotomy. Two patients died from cardiac complications and three from visceral ischemia. No spinal cord ischemia was detected, and temporary renal failure occurred in four patients (25%). The mean follow-up was 13 months (range 6-28 months). During follow-up, no additional grafts occluded and no patients died. Hybrid procedures are technically feasible but have substantial mortality (31%), especially in patients unfit for open repair (80%). They might be indicated when urgent TAAA surgery is required or when vascular anatomy is unfavorable for fenestrated endografts in patients with extensive previous open aortic surgery.