Subscribe to RSS
DOI: 10.1055/s-2007-970385
© Georg Thieme Verlag KG Stuttgart · New York
Strategie und Ergebnisse der pneumatischen Kompression nach transfemoraler Katheterisierung
Strategy and results of pneumatic compression following transfemoral catheterizationPublication History
eingereicht: 14.12.2006
akzeptiert: 20.2.2007
Publication Date:
14 March 2007 (online)

Zusammenfassung
Hintergrund und Fragestellung: Der transfemorale arterielle Zugangsweg bei invasiver Untersuchung des Herzens und der Gefäße erfordert eine Methode zur Blutstillung, die universell, einfach und schnell anwendbar ist. Sie sollte zudem geringe Kosten mit einem minimalen Komplikationsrisiko und hohem Patientenkomfort verbinden. Die verfügbaren Methoden und Systeme erfüllen diese Forderungen nur partiell. Das pneumatische, druckkontrollierte FemoStopTM-Kompressionssystem ist als einfach und sicher beschrieben worden. Das klassische Vorgehen besteht jedoch darin, die primäre Blutstillung mit dem FemoStopTM zu erzielen und dann auf einen Druckverband zu wechseln. Wir stellen unser Schema mit alleiniger FemoStopTM-Anwendung für die gesamte Dauer der Kompression vor und vergleichen die Ergebnisse mit denen der manuellen Kompression.
Patienten und Methoden: In dieser Registerstudie verglichen wir in zwei verschiedenen Zeiträumen die manuelle (MC) und die pneumatische Methode (FS) zur Kompression der arteriellen Punktionsstelle. Gruppe MC umfasste 1085 Patienten (63,3±10,5 Jahre, 29,8 % weiblich) mit manueller Kompression und nachfolgendem Druckverband. Gruppe FS beinhaltete 1087 konsekutiv behandelte Patienten (64,6±10,7 Jahre, 35,1 % weiblich) mit alleiniger pneumatischer Kompression. Es wurde die Häufigkeit von Pseudoaneurysmata und AV-Fisteln untersucht.
Ergebnisse: Während die Inzidenz von AV-Fisteln relativ unverändert blieb, war die Rate an Pseudoaneurysmata bei diagnostischer Herzkatheterisierung in der FS-Gruppe geringer als in Gruppe MC. Bei Angioplastiepatienten fanden sich vergleichbare Resultate bei verkürzter Liegezeit in der FS-Gruppe. Eine multivariate Analyse erbrachte das weibliche Geschlecht als unabhängigen Risikofaktor für das Auftreten der untersuchten Komplikationen.
Schlussfolgerungen: Die Benutzung des FemoStopTM-Systems für die gesamte Kompressionsphase nach transfemoraler Katheterisierung erlaubt eine Zeiteinsparung gegenüber der manuellen Kompression bei tendenziell geringerem Komplikationsrisiko.
Summary
Background and objective: Transfemoral arterial access of catheterization requires a method of hemostasis that is allways easily and quickly applicable, but also safe, inexpensive and comfortabel for the patient. Current methods meet these requirements only in part. The pneumatic pressure-controlled FemoStopTM system has been described as straightforward and safe. But the conventional procedure has been to achieve primary hemostasis with FemoStopTM and then switch to a pressure bandage. We here present our method of using FemoStopTM alone for the entire duration of the compression and compare the results with those of manual compression.
Patients and methods: The preferred methods of managing the arterial puncture site in our center were compared for two different periods. Group MC (manual compression) comprised 1,085 patients (mean age 63.310.5 years, 29.8% females) in whom manual compression had been applied followed by a pressure bandage. Group FS (pneumatic compression) comprised 1,087 consecutive patients (mean age 64.610.7%, 35.1% females) in whom pneumatic compression only had been applied. The incidence of pseudoaneurysms, a-v fistulas and bleeding requiring transfusion were compared.
Results: The incidence of pseudoaneurysms after diagnostic cardiac catheterizationin the FS group was lower than in the MC group. In patients after an angioplasty the results were similar other than the time the patient has to remain in bed. The incidence of a-v fistulas was similar in the two groups. There was only one episode pf bleeding that required transfusion (MC group). A multivariate analysis indicated that female gender is an independent risk factor for the occurrence of pseudoaneurysms and a-v fistulas.
Conclusions: The FemoStopTM system used by itself took less time than manual compression and was associated with a slightly lower risk of complications.
Schlüsselwörter
Punktionsstellenverschluss - Pseudoaneurysma - AV-Fistel
Key words
puncture site closure - pseudoaneurysm - av-fistula
Literatur
- 1
Amin F R, Yousufuddin M, Stables R. et al .
Femoral haemostasis after transcatheter therapeutic intervention: a prospective randomized
study of the angio-seal device vs the femostop device.
Intern J Cardiol.
2000;
76
235-240
MissingFormLabel
- 2
Chamberlin J R, Lardi A B, McKeever L S. et al .
Use of vascular sealing devices (VasoSeal and Perclose) versus assisted manual compression
(FemoStop) in transcatheter coronary interventions requiring abciximab (ReoPro).
Catheter Cardiovasc Intervent.
1999;
47
143-147
MissingFormLabel
- 3
Exaire J E, Tcheng J E, Kereiakes D J, Kleiman A S, Applegate R J, Moliterno D J.
Closure devices and vascular complications among percutaneous coronary intervention
patients receiving enoxaparin, glycoprotein IIb/IIIa inhibitors, and clopidogrel.
Catheter Cardiovasc Interv.
2005;
64
369-372
MissingFormLabel
- 4
Goldberg S, Savage M P, Fischman D L.
Coronary artery stents.
Lancet.
1995;
345
15523-15524
MissingFormLabel
- 5
Gonze M D, Sternbergh W C, Salartash K, Money S R.
Complications associated with percutaneous closure devices.
Am J Surg.
1999;
178
209-211
MissingFormLabel
- 6
Janerot-Sjöberg B, Broqvist M, Fransson S G.
Femoral artery haemostasis with a pneumatic compression device versus a clamp after
coronary angiography.
Scand Cardiovasc J.
1998;
32
281-284
MissingFormLabel
- 7
Jaspers L, Benit E.
Immediate sheath removal after PCI unsing a FemostopTM is feasible and safe: Results of a registry.
Acta Cardiol.
2003;
58
535-537
MissingFormLabel
- 8
Johnson L W, Esente P, Giambartolomei A. et al .
Peripheral vascular complications of coronary angioplasty by the femoral and brachial
techniques.
Catheter Cardiovasc Diagn.
1994;
31
165-172
MissingFormLabel
- 9
Jones T, McCutcheon H.
Effectiveness of mechanical compression devices in attaining hemostasis after femoral
sheath removal.
Am J Crit Care.
2002;
11
155-162
MissingFormLabel
- 10
Knight C G, Healy D A, Thomas R L.
Femoral artery pseudoaneurysms: risk factors, prevalence, and treatment options.
Ann Vasc Surg.
2003;
17
503-508
MissingFormLabel
- 11
Kunert M, Gremmler B, Schleiting H, Ulbricht L J.
Use of FemoStop TM system for arterial puncture site closure after coronary angioplasty.
J Invas Cardiol.
2004;
16
240-242
MissingFormLabel
- 12
Lehmann K, Heath-Lange S J, Ferris S T.
Randomized comparison of hemostasis techniques after invasive cardiovascular procedures.
Am Heart J.
1999;
138
1118-1125
MissingFormLabel
- 13
Lim R, Anderson H, Walters M I, Kaye G C, Norell M S, Caplin J L.
Femoral complications and bed rest duration after coronary arteriography.
Am J Cardiol.
1997;
80
222-223
MissingFormLabel
- 14
Logemann T, Luetmer P, Kaliebe J, Olson K, Murdock D K.
Two versus six hours of bed rest following left-sided cardiac catheterization and
a meta-analysis of early ambulation trials.
Am J Cardiol.
1999;
84
486-488
MissingFormLabel
- 15
Nasser T K, Mohler E R III, Wilensky R L, Hathawy D R.
Peripheral vascular complications following coronary interventional procedures.
Clin Cardiol.
1995;
18
609-614
MissingFormLabel
- 16
Nordrehaug J A, Chronos N AF, Priestley K A. et al .
Randomized evaluation of an inflatable femoral artery compression device after cardiac
catheterization.
J Interven Cardiol.
1996;
9
381-387
MissingFormLabel
- 17
Ogawa K, Aizawa T, Ogasawara K. et al .
A new inflatable femoral artery compression device „ FemoStopTM” and a new protocol
for hemostasis using Femostop after percutaneous vascular procedures.
Jpn J Interv Cardiol.
1995;
10
280-285
MissingFormLabel
- 18
Popma J J, Satler L F, Pichaaard A D. et al .
Vascular complications after balloon and new device angioplasty.
Circulation.
1993;
88
1569-1578
MissingFormLabel
- 19
Resnic F S, Blake G J, Ohno-Machado L, Selwyn A P, Popma J J, Rogers C.
Vascular closure devices and the risk of vascular complications after percutaneous
coronary intervention in patients receiving glycoprotein IIb-IIIa inhibitors.
Am J Cardiol.
2001;
88
493-496
MissingFormLabel
- 20
Rosenstein G, Cafri C, Weinstein J M. et al .
Simple clinical risk stratification and the safety of ambulation two hours after 6
french diagnostic heart catheterization.
J Invas Cardiol.
2004;
16
126-128
MissingFormLabel
- 21
Silber S.
Hemostasis success rates and local complications with collagen after femoral access
for cardiac catheterization: analysis of 6007 published patients.
Am Heart J.
1998;
135
152-156
MissingFormLabel
- 22
Sridhar K, Fischman D, Golddberg S. et al .
Peripheral vascular complications after intracoronary stent placement: prevention
by use of a pneumatic vascular compression device.
Catheter Cardiovasc Diag.
1996;
39
224-229
MissingFormLabel
Priv.-Doz. Dr. Frank Weber
Frankenwaldklinik Kronach
Abteilung für Innere Medizin
Friesener Straße 41
96317 Kronach
Phone: +49/9261/597510
Fax: +49/9261/597519
Email: frank.weber@frankenwaldklinik.de