經股動脈穿刺介入術後股動脈血管内縫合技術的回顧性分析

Efficacy and safety analysis of vascular closure device use in adult interventional procedures

目的探討經股動脈穿刺介入手術後使用動脈内縫合器裝置閉合止血的有效性和安全性,以及經標準化程式操作是否能提高止血成功率以及降低操作併發症發生的風險。方法對在本院2009年~2019年期間,所有接受腦神經血管介入性診斷或治療的神經内外科患者進行回顧性分析。記錄患者血管介入操作細節、止血狀態和相關併發症等情況。結果1399名患者(602名男性患者和797名女性患者),排除11名經橈動脈穿刺的患者,早期使用血管内外掛程式填充物裝置(FemoSeal,Terumo)248次,後期轉為使用血管内縫合器裝置(ProGlide,Abbott Vascular Devices)528次;平均年齡64.8±2.3歲。接受腦神經血管介入患者,右側股總動脈(Common Femoral Artery,CFA)是主要的穿刺部位,平均CFA直徑為7.3±0.9mm。診斷性血管造影佔全部76%。發生腎包膜下血腫1例,腹膜後血腫1例,假性動脈瘤2例,低血壓等迷走神經反應2例,穿刺點感染2例,局部血腫形成12例,使用血管内縫合器後仍出血,需進行手動壓迫止血100例。結論經股動脈穿刺介入手術後經標準化流程操作,使用血管内縫合器裝置(ProGlide,Abbott Vascular Devices)可以安全地應用於危急或擇期診治的神經血管疾病的介入治療患者,提高止血成功率和降低操作併發症發生機會。

Objective To assess the efficacy and safety of using the ProGlide arterial closure device in adult neuro-endovascular procedures where standardized procedure can increase the effective hemostasis success rate and reduce the chance of complications.Methods Retrospectively analysis of all neurosurgical patients undergoing diagnostic or interventional neurovascular therapy was performed from 2009 to 2019.Results A total of 1399 patients(602 male patients and 797 female patients,mean age 64.8±2.3 years)were included,11 patients were excluded from the diagnosis of radial artery puncture,early use of FemoSeal internal in-stent suture device about 248 times,later converted to the use of ProGlide intravascular stapler 528 patients and all patients receiving neurovascular therapy.The CFA on the right side is the main puncture site for diagnosis and treatment.The average CFA diameter is 7.3±0.9 mm.Diagnostic angiography accounts for 76%of the total.There were 1 case of subcapsular hematoma,1 case of retroperitoneal hematoma,2 cases of pseudoaneurysm,2 cases of vagus nerve reaction such as hypotension,2 cases of puncture infection,and 12 cases of local hematoma.100 cases were bleeding after endovascular suturing,and need manual compression and hemostasis.Conclusion The ProGlide intravascular stapler can be safely used in interventional treatment of critical or elective neurovascular diseases,improving the effective hemostasis success rate and reducing operational complication opportunity.