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目的评价徒手压迫与Perclose血管缝合器处理对股动脉介入术后股动脉假性动脉瘤(PSA)发生率的影响。方法回顾性分析2000年3月至2006年7月共3 586例经股动脉介入患者的资料,根据术后处理穿刺伤口方法的不同分为徒手压迫组(3 060例)和Perclose血管缝合器组(526例)。比较两组患者术后形成股动脉假性动脉瘤(PSA)的概率及其预后。结果徒手压迫组的股动脉PSA发生率为1．3％(41／3 060例),Perclose血管缝合器组为0．8％(4／526例),两组的差异无统计学意义(P=0．20)。徒手压迫组41例股动脉PSA患者均采用改良超声引导下徒手压迫法,压迫30-150 min,成功闭合37例,总成功率为90．2％,均无复发;再压迫失败者中3例转外科行PSA修补术,1例拒绝手术出院随访。Perclose血管缝合器组4例股动脉PSA患者采用徒手压迫法均将PSA闭合,无复发。结论Perclose缝合器不能明显降低股动脉PSA的发生率,该器械尚有待于进一步改进,提高股动脉穿刺技术可能降低PSA的发生率。
Objective To evaluate the effects of unilateral hand compression and perclose vascular stapler treatment on the incidence of femoral artery pseudoaneurysm (PSA) after femoral artery intervention. Methods The data of 3 586 patients who underwent transcatheter arterial intervention from March 2000 to July 2006 were retrospectively analyzed. According to the methods of postoperative wound management, there were 3 060 cases (manual compression group) and Perclose vascular stapler group (526 cases). The probability of postoperative femoral artery pseudoaneurysm (PSA) formation and its prognosis were compared between the two groups. Results The prevalence of PSA in the femoral artery was 1.3% (41/3 060) in the uncoated group and 0.8% (4/526) in the Perclose vascular stapler group, with no significant difference between the two groups (P = 0.20). 41 cases of PSA in the femoral artery of the hand-free group were treated with modified ultrasound-guided manual compression. The compression was performed for 30-150 minutes. 37 cases were successfully closed with a total success rate of 90.2% Surgery to PSA repair, 1 case refused to hospitalized follow-up. Perclose vascular stapler group of 4 cases of femoral artery PSA patients with unilateral hand compression method will be closed PSA, no recurrence. Conclusion Perclose suture can not significantly reduce the incidence of PSA in femoral artery. The device needs to be further improved. Increasing femoral artery puncture technique may reduce the incidence of PSA.