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

Effectiveness and safety of the preclose technique of vascular suture system in the treatment of large aperture arterial sheath puncture points

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。

Objective To explore the effectiveness and safety of the preclose technique of vascular suture system in the treatment of large aperture arterial sheath puncture points.Method Clinical data of 52 patients with abdominal aortic aneurysms who were treated in National Center for Cardiovascular Diseases,Fuwai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College from January to December 2021 were collected.The femoral artery puncture sites were all treated with the preclose technique of vascular suture system(ProGlide).The effectiveness and safety of puncture points immediately after surgery,early after surgery and follow-up were evaluated.Result 52 patients with abdominal aortic aneurysm had 104 puncture points,the overall success rate was 98.1%(102/104).Among them,the double pronged ProGlide pre suture technique treated 88 puncture points,the average arterial sheath thickness was 14.9 F,one site requiring compression and hemostasis,the overall success rate was 98.9%(87/88);the single ProGlide pre suture was used to treat 16 puncture points,all of which were 12 F arterial sheaths,one site needs to be compressed for hemostasis,the success rate was 93.8%(15/16).There was no significant narrowing or occlusion of the puncture site after surgery,and there was no statistically significant difference in ankle brachial index(ABI)between preoperative and postoperative(P﹥0.05).The average follow-up period was 11.5 months,during which there were no new complications at the puncture site.Conclusion The application of the preclose technique of vascular suture system is a safe and effective method for large-bore introducer sheath vascular closure.Preoperative assessment of the puncture site,precise puncturing,and standardized operation can improve the success rate.