血管缝合器在经皮行主动脉腔内修复术应用中的早期经验

Preliminary experiences with PercloseTM devices during percutaneous endovascular aortic repair

目的评估在股动脉穿刺部位采用预先缝合技术实施经皮主动脉腔内修复术的可行性、安全性和有效性。方法 2009年10月到11月,共有9名主动脉瘤或夹层患者的11处股动脉穿刺部位接受这种技术管理,术前根据CTA和彩色超声检查证实股动脉入路解剖适合此种术式。造影、麻醉与覆膜支架置入按照标准方法进行,覆膜支架系统包括ZenithTX2(Cook,美国)4例,Valiant(Medtronic,美国)3例,Hercules(Microport,中国)2例,对术后所有患者进行生命体征、穿刺部位、同侧下肢血运的密切观察。结果患者包括5例DebakeyⅢ夹层,3例腹主动脉瘤和1例弓降部胸主动脉瘤,年龄为(61.2±11.6)岁(男性例7例);9例患者全患有高血压病;5例患有冠心病;3例有糖尿病。器械外径有16Fr2例,20Fr2例,22Fr3例,24Fr4例;9处穿刺口使用2套PerclosePro-GlideTM(Abbott,美国)血管缝合器,另2处使用3套,技术成功率为100%;无围术期的血管并发症发生。结论在实施主动脉腔内修复术中,使用经皮穿刺、预先PercloseProGlideTM缝合器缝合穿刺口的技术,是替代股动脉切开安全可行的方法 。

Objective To assess the feasibility,safety and effectiveness of full percutaneous endovascular aortic repair using a Preclose technique for puncture and closure of femoral access sites.Methods From Oct 2009 to Nov 2009,this technique was applied to 11 femoral sites in 9 patients.Preprocedural CTA or ultrasound was performed to assess the suitability of common femoral artery anatomy.Endografts used included Zenith TX2 （Cook,USA） （n=4）,Valiant（Medtronic,USA） （n=3） and Hercules （Microport,China） （n=2）.Vital signs,femoral sites and limb circulation were examined immediately after suture and during hospitalization.Technical success and complication rates were evaluated.Results The 9 patients （7 males;mean age：61.2±11.6 years） included 5 Debakey Ⅲ aortic dissections,3 abdominal aortic aneurysms and 1 thoracic anearysm.The commonest comorbidities were hypertension,followed by CAD and diabetes.Profiles of stent-graft delivery devices used were 16Fr （n=2）,20Fr （n=2）,22 Fr （n=3）,24 Fr （n=4）.Two Perclose ProGlideTM（Abbott,USA）devices were used to close 9 femoral puncture sites and 3 sets were used for other 2 sites.All procedures were carried out technically successful with no related complications.Conclusion This study confirms that full percutaneous endovascular aortic repair using the Preclose technique using Perclose ProGlideTM is safe and effective which can be adopted as an alternative technique of surgically cut-down EVAR.