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Zentralbl Chir 2015; 140(05): 547-553
DOI: 10.1055/s-0034-1382962
Übersicht
Georg Thieme Verlag KG Stuttgart · New York

Arterielle Zugangswegkomplikationen nach perkutanen Interventionen unter besonderer Berücksichtigung der Verwendung von Verschlusssystemen

Arterial Access Site Complications after Percutaneous Interventions with Special Regard to the Application of Vascular Closure Devices
A. Gratl
1   Universitätsklinik für Gefäßchirurgie, Medizinische Universität Innsbruck, Österreich
,
J. Klocker
1   Universitätsklinik für Gefäßchirurgie, Medizinische Universität Innsbruck, Österreich
,
B. Glodny
2   Universitätsklinik für Radiologie, Medizinische Universität Innsbruck, Österreich
,
G. Fraedrich
1   Universitätsklinik für Gefäßchirurgie, Medizinische Universität Innsbruck, Österreich
› Author Affiliations
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Publication History

Publication Date:
21 October 2014 (online)

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Zusammenfassung

Durch die zunehmende Zahl an durchgeführten endovaskulären Verfahren, vor allem in der Behandlung der peripheren arteriellen Verschlusskrankheit und der koronaren Herzkrankheit, kommt es auch zu einer Zunahme der damit verbundenen Zugangswegkomplikationen. Dabei handelt es sich um Nachblutungen, Hämatome, Pseudoaneurysmen, arteriovenöse Fisteln und arterielle Thrombosen. Zur Reduktion der auftretenden Komplikationen wurden Mitte der 1990er-Jahre sogenannte Verschlusssysteme (VCD) auf den Markt gebracht, Studien konnten jedoch keinen Benefit dieser Devices, verglichen mit der konventionellen manuellen Kompression, nachweisen. Zur Auswertung unserer eigenen Erfahrungen führten wir eine retrospektive Analyse aller an unserer Klinik gefäßchirurgisch behandelten Zugangswegkomplikationen im Zeitraum von 2001 bis 2012 durch. Insgesamt wurden 522 Patienten behandelt, die Zahl der durchgeführten perkutanen Interventionen betrug 90 536 und somit betrug die gesamte Inzidenz 0,58 %. Eingeteilt wurden die Patienten in die Gruppen A–C, abhängig davon, wie häufig VCDs verwendet wurden. Gezeigt werden konnte eine Zunahme von Zugangswegkomplikationen seit der häufigeren Verwendung von VCDs, vor allem ischämische Komplikationen wurden häufiger. Somit bleibt die Anwendung von VCDs hinsichtlich der Vermeidung von Zugangswegkomplikationen umstritten und wird auch in Zukunft Anlass für Diskussionen bringen.

Abstract

Due to an increase in the number of performed endovascular procedures, the number of local access site complications is rising too. Used mainly for treatment of peripheral arterial disease and coronary heart disease, endovascular procedures are gaining importance. Access site complications include bleeding, haematoma, pseudoaneurysm, arteriovenous fistula and arterial thrombosis. Aiming to reduce immobilisation, length of hospital stay, costs and access site complications, vascular closure devices (VCD) were introduced in the mid 1990s, but current trials failed to demonstrate the superiority of these devices compared to conventional manual compression if it comes to access site complications. We retrospectively evaluated all patients who were treated surgically due to access site complications between 2001 and 2012 in our institution. In total, 522 patients needed vascular surgery to treat different access site complications. During this period, 90,538 percutaneous interventions were performed in our institution, leading to a total incidence of 0.58 % of access site complications. Depending on the frequency of application of VCDs, patients have been grouped in groups A–C. With the more frequent use of VCDs, the incidence of access site complications increased and, in particular, ischaemic complications were seen more often. In conclusion, the application of VCDs to prevent access site complications is questionable and not justified when looking at published data.

Schlüsselwörter

Zugangswegkomplikation - endovaskuläre Therapie - perkutane Punktion - Verschlusssystem - Pseudoaneurysmen

Key words

access site complications - endovascular treatment - percutaneous puncture - vascular closure device - pseudoaneurysms
 

  • Literatur

  • 1 Cronenwett JL, Johnston W. Rutherfordʼs Vascular Surgery. 7th ed. Philadelphia: Saunders; 2010
    Google Scholar
  • 2 Jolly SS, Amlani S, Hamon M et al. Radial versus femoral access for coronary angiography or intervention and the impact on major bleeding and ischemic events: a systematic review and meta-analysis of randomized trials. Am Heart J 2009; 157: 132-140
    CrossrefPubMedGoogle Scholar
  • 3 Biancari F, DʼAndrea V, Di Marco C et al. Meta-analysis of randomized trials on the efficacy of vascular closure devices after diagnostic angiography and angioplasty. Am Heart J 2010; 159: 518-531
    CrossrefPubMedGoogle Scholar
  • 4 Koreny M, Riedmüller E, Nikfardjam M et al. Arterial puncture closing devices compared with standard manual compression after cardiac catheterization: systematic review and meta-analysis. JAMA 2004; 291: 350-357
    CrossrefPubMedGoogle Scholar
  • 5 Nikolsky E, Mehran R, Halkin A et al. Vascular complications associated with arteriotomy closure devices in patients undergoing percutaneous coronary procedures: a meta-analysis. J Am Coll Cardiol 2004; 44: 1200-1209
    PubMedGoogle Scholar
  • 6 Nasser TK, Mohler ER, Wilensky RL et al. Peripheral vascular complications following coronary interventional procedures. Clin Cardiol 1995; 18: 609-614
    CrossrefPubMedGoogle Scholar
  • 7 Applegate RJ, Grabarczyk MA, Little WC et al. Vascular closure devices in patients treated with anticoagulation and II b/III a receptor inhibitors during percutaneous revascularization. J Am Coll Cardiol 2002; 40: 78-83
    CrossrefPubMedGoogle Scholar
  • 8 Waksman R, King 3rd SB, Douglas JS et al. Predictors of groin complications after balloon and new-device coronary intervention. Am J Cardiol 1995; 75: 886-889
    CrossrefPubMedGoogle Scholar
  • 9 Omoigui NA, Califf RM, Pieper K et al. Peripheral vascular complications in the Coronary Angioplasty Versus Excisional Atherectomy Trial (CAVEAT-I). J Am Coll Cardiol 1995; 26: 922-930
    CrossrefPubMedGoogle Scholar
  • 10 Pongratz J, Reeps C, Eckstein HH. Frequency and causes of vascular complications requiring surgery in patients without primary vascular disease. Zentralbl Chir 2011; 136: 485-490
    Article in Thieme ConnectPubMedGoogle Scholar
  • 11 Tavris DR, Gallauresi BA, Lin B et al. Risk of local adverse events following cardiac catheterization by hemostasis device use and gender. J Invasive Cardiol 2004; 16: 459-464
    PubMedGoogle Scholar
  • 12 Schömig A, Neumann FJ, Kastrati A et al. A randomized comparison of antiplatelet and anticoagulant therapy after the placement of coronary-artery stents. N Engl J Med 1996; 334: 1084-1089
    CrossrefPubMedGoogle Scholar
  • 13 Schömig A, Kastrati A, Dirschinger J et al. Coronary stenting plus platelet glycoprotein II b/III a blockade compared with tissue plasminogen activator in acute myocardial infarction. Stent versus Thrombolysis for Occluded Coronary Arteries in Patients with Acute Myocardial Infarction Study Investigators. N Engl J Med 2000; 343: 385-391
    CrossrefPubMedGoogle Scholar
  • 14 Lumsden AB, Miller JM, Kosinski AS et al. A prospective evaluation of surgically treated groin complications following percutaneous cardiac procedures. Am Surg 1994; 60: 132-137
    PubMedGoogle Scholar
  • 15 Olsen DM, Rodriguez JA, Vranic M et al. A prospective study of ultrasound scan-guided thrombin injection of femoral pseudoaneurysm: a trend toward minimal medication. J Vasc Surg 2002; 36: 779-782
    CrossrefPubMedGoogle Scholar
  • 16 Abu-Yousef MM, Wiese JA, Shamma AR. The “to-and-fro” sign: duplex Doppler evidence of femoral artery pseudoaneurysm. AJR Am J Roentgenol 1988; 150: 632-634
    CrossrefPubMedGoogle Scholar
  • 17 Coley BD, Roberts AC, Fellmeth BD. Postangiographic femoral artery pseudoaneurysms: further experience with US-guided compression repair. Radiology 1995; 194: 307-311
    CrossrefPubMedGoogle Scholar
  • 18 Schneider C, Malisius R, Küchler R et al. A prospective study on ultrasound-guided percutaneous thrombin injection for treatment of iatrogenic post-catheterisation femoral pseudoaneurysms. Int J Cardiol 2009; 131: 356-361
    CrossrefPubMedGoogle Scholar
  • 19 Gürel K, Gür S, Özkan U et al. US-guided percutaneous thrombin injection of postcatheterization pseudoaneurysms. Diagn Interv Radiol 2012; 18: 319-325
    PubMedGoogle Scholar
  • 20 Vlachou PA, Karkos CD, Bains S et al. Percutaneous ultrasound-guided thrombin injection for the treatment of iatrogenic femoral artery pseudoaneurysms. Eur J Radiol 2011; 77: 172-174
    CrossrefPubMedGoogle Scholar
  • 21 Kang SS, Labropoulos N, Mansour MA et al. Expanded indications for ultrasound-guided thrombin injection of pseudoaneurysms. J Vasc Surg 2000; 31: 289-298
    CrossrefPubMedGoogle Scholar
  • 22 Kresowik TF, Khoury MD, Miller BV et al. A prospective study of the incidence and natural history of femoral vascular complications after percutaneous transluminal coronary angioplasty. J Vasc Surg 1991; 13: 328-333
    CrossrefPubMedGoogle Scholar
  • 23 Ricci MA, Trevisiani GT, Pichler DB. Vascular complications of cardiac catheterization. Am J Surg 1994; 167: 375-378
    CrossrefPubMedGoogle Scholar
  • 24 Kelm M, Perings SM, Jax T et al. Incidence and clinical outcome of iatrogenic femoral arteriovenous fistulas: implications for risk stratification and treatment. J Am Coll Cardiol 2002; 40: 291-297
    CrossrefPubMedGoogle Scholar
  • 25 Perings SM, Kelm M, Jax T et al. A prospective study on incidence and risk factors of arteriovenous fistulae following transfemoral cardiac catheterization. Int J Cardiol 2003; 88: 223-228
    CrossrefPubMedGoogle Scholar
  • 26 Debus ES, Gross-Fengels W. Operative und interventionelle Gefäßmedizin. Berlin, Heidelberg: Springer; 2012
    CrossrefGoogle Scholar
  • 27 Onal B, Kosar S, Gumus T et al. Postcatheterization femoral arteriovenous fistulas: endovascular treatment with stent-grafts. Cardiovasc Intervent Radiol 2004; 27: 453-458
    PubMedGoogle Scholar
  • 28 Dregelid E, Jensen G, Daryapeyma A. Complications associated with the Angio-Seal arterial puncture closing device: intra-arterial deployment and occlusion by dissected plaque. J Vasc Surg 2006; 44: 1357-1359
    CrossrefPubMedGoogle Scholar
  • 29 Wille J, Vos JA, Overtoom TT et al. Acute leg ischemia: the dark side of a percutaneous femoral artery closure device. Ann Vasc Surg 2006; 20: 278-281
    CrossrefPubMedGoogle Scholar
  • 30 Kadner A, Schmidli J, Schwegler I et al. Complications associated with the arterial puncture closure device–Angio-Seal. Vasc Endovascular Surg 2008; 42: 225-227
    CrossrefPubMedGoogle Scholar
  • 31 Klocker J, Gratl A, Chemelli A et al. Incidence and treatment of local stenosis or occlusion at the vascular access site leading to limb ischemia and new-onset intermittent claudication after percutaneous interventions: implications of vascular closure devices. Catheter Cardiovasc Interv 2012; 79: 938-943
    CrossrefPubMedGoogle Scholar
  • 32 Klocker J, Gratl A, Chemelli A et al. Influence of use of a vascular closure device on incidence and surgical management of access site complications after percutaneous interventions. Eur J Vasc Endovasc Surg 2011; 42: 230-235
    CrossrefPubMedGoogle Scholar
  • 33 Van der Steeg HJ, Berger P, Krasznai AG et al. Acute arterial occlusion after deployment of the Angio-Seal closure device: is it as uncommon as we think?. Eur J Vasc Endovasc Surg 2009; 38: 715-717
    CrossrefPubMedGoogle Scholar
  • 34 Bechara CF, Annambhotla S, Lin PH. Access site management with vascular closure devices for percutaneous transarterial procedures. J Vasc Surg 2010; 52: 1682-1696
    CrossrefPubMedGoogle Scholar
  • 35 Kussmaul 3rd WEG, Buchbinder M, Whitlow PL et al. Rapid arterial hemostasis and decreased access site complications after cardiac catheterization and angioplasty: results of a randomized trial of a novel hemostatic device. J Am Coll Cardiol 1995; 25: 1685-1692
    CrossrefPubMedGoogle Scholar
  • 36 Dauerman HL, Applegate RJ, Cohen DJ. Vascular closure devices: the second decade. J Am Coll Cardiol 2007; 50: 1617-1626
    CrossrefPubMedGoogle Scholar
  • 37 Carey D, Martin JR, Moore CA et al. Complications of femoral artery closure devices. Catheter Cardiovasc Interv 2001; 52: 3-7
    CrossrefPubMedGoogle Scholar
  • 38 Jang JJ, Kim M, Gray B et al. Claudication secondary to Perclose use after percutaneous procedures. Catheter Cardiovasc Interv 2006; 67: 687-695
    CrossrefPubMedGoogle Scholar
  • 39 Warren BS, Warren SG, Miller SD. Predictors of complications and learning curve using the Angio-Seal closure device following interventional and diagnostic catheterization. Catheter Cardiovasc Interv 1999; 48: 162-166
    CrossrefPubMedGoogle Scholar
  • 40 Stock U, Flach P, Gross M et al. Intravascular misplacement of an extravascular closure system: StarClose. J Interv Cardiol 2006; 19: 170-172
    CrossrefPubMedGoogle Scholar
  • 41 Applegate RJ, Sacrinty M, Kutcher MA et al. Vascular complications with newer generations of angioseal vascular closure devices. J Interv Cardiol 2006; 19: 67-74
    CrossrefPubMedGoogle Scholar
  • 42 Goodney PP, Chang RW, Cronenwett JL. A percutaneous arterial closure protocol can decrease complications after endovascular interventions in vascular surgery patients. J Vasc Surg 2008; 48: 1481-1488
    CrossrefPubMedGoogle Scholar