血管缝合器与传统缝合在股动脉入路心血管介入术中的应用效果比较

Vascular closure devices versus conventional suture for endovascular interventional surgery via femoral route

背景近年来,血管缝合器在国内逐步应用于临床并获得良好的临床效果。血管缝合器在血管外科经常使用,但心脏外科医生往往习惯于选择外科切开,使用血管缝合器的经验并未见太多报道。目的探讨血管缝合器在心血管介入手术中的应用价值。方法总结2019年6月-2020年12月于南京医科大学第二附属医院心血管病中心进行心血管介入手术的122例患者资料。依据手术方式将患者分为血管缝合组(60例)和外科切开组(62例)。比较两组在技术成功率、入路建立时间、术中出血量、术后卧床时间、术后住院时间、总费用和并发症方面的情况。结果所有122例次心血管介入手术均顺利完成,其中胸主动脉夹层腔内修复术93例,腹主动脉瘤腔内修复术24例,经皮主动脉瓣置换5例。使用血管缝合器144把,共缝合72根动脉。外科切开74根动脉。血管缝合组成功率98.33%(59/60),外科切开组成功率100%。血管缝合组在入路建立时间[(15.2±2.0)min vs(30.2±4.9)min]、术后卧床时间[(22.5±15.5)h vs(45.2±22.3)h]、术后住院时间[5(2)d vs 7(2.3)d]和术中出血量[(103.3±53.2)mL vs(246.3±69.0)mL]方面明显优于外科切开组(P<0.001)。血管缝合组与外科切开组花费相当[(12.3±2.3)万元vs(12.8±2.5)万元],差异无统计学意义(P>0.05)。血管缝合组切口并发症发生率低于外科切开组(0 vs9.6%,P=0.028)。结论在心血管介入手术中应用血管缝合器安全有效,能减少入路建立时间、术中出血量、术后卧床时间、术后住院时间和切口并发症的发生。严格把握适应证,术前评估到位,一定时间的训练可减少相关并发症的发生。

Background In recent years,vascular suture devices have gradually gained popularity in China and proved itself valuable in daily clinical practice.Commonly used by vascular surgeons,vascular closure devices are less favored by cardiac surgeons.More frequently,cardiac surgeons choose a cut-down approach to expose the common femoral artery during endovascular interventions.Experiences with vascular closure devices are rarely shared by cardiac surgeons.Objective To summarize the clinical value of vascular closure devices(VCD)in endovascular interventions by cardiac surgeons.Methods The current study included 122 patients undergoing endovascular intervention at the Cardiovascular Center in the Second Affiliated Hospital of Nanjing Medical University from June 2019 to December 2020.The choice of vascular closure method was based on the preoperative agreement reached between the surgeon and the patients.Patients were divided into the VCD group(n=60)and the surgical incision(SI)group(n=62).The technical success rate,time from puncture/incision to vascular access,intraoperative blood loss,bed rest time after surgery,time of postoperative hospital stay,the total cost of hospital stays,and complication rates were analyzed.Results Of all the 122 cases,endovascular repair of thoracic aortic dissection was performed in 93 patients,endovascular repair of the abdominal aortic aneurysm was completed in 24 patients,and percutaneous aortic valve replacement was done in 5 patients.All patients underwent successful endovascular intervention.A total of 146 VCD were used,and 72 femoral arteries were sutured surgically.The technical success rate was 98.33%(59/60)in the VCD group,in contrast to the 100%in the SI group.The vascular access time(15.2±2.0 min vs 30.2±4.9 min),postoperative time to ambulation(22.5±15.5 h vs 45.2±22.3 h),time of postoperative hospital stay(Md[IQR],5[2]d vs7[2.3]d),amount of intraoperative blood loss(103.3±53.2 mL vs 246.3±69.0 mL)in the VCD group were all significantly less than those in the SI group(P<0.001).No significant difference was found between the VCD group and SI group in terms of the total cost of hospital stay(123±23 thousand yuan vs 128±25 thousand yuan,P>0.05).Compared with the surgical incision group,the complication rate was significantly lower in the VCD group(0[0/60]vs 9.6%[6/62],P=0.028).Conclusion The application of VCD in endovascular intervention is safe and effective.It significantly decreases the vascular access time,amount of intraoperative blood loss,postoperative bed rest time,time of postoperative hospital stay and the incidence of incisional complications.Strictly following the indications,throughout pre-operative evaluations,and pre-application practice can reduce the rate of complications.