VCD

[mizin1]

Еще было бы интересно обсудить целесообразность применения в такой ситуации атерэктомического устройства или режущего баллона. Насколько безопасно их применять в месте только что наложенной нитки?

А вот последние рекомендации (SIR) по использованию различных VCD. Краткое резюме:
- Further study of the safety and efficacy of VCDs in patients undergoing interventional radiologic procedures is needed.
- Femoral angiography should be considered before deployment of a VCD.
- The use of VCDs maybe considered a safe method to reduce time to hemostasis and duration of bedrest following transarterial intervention. The potential benefits of these devices should be balanced by a carefule valuation of patient-related riskf actors, vascular anatomy, body habitus, and bleeding risk. The appropriate duration of bedrest and manual compression following VCD use vary among different devices, and the individual manufacturer’s recommendations should be followed.
- Institutional complication rates for VCDs should be, at minimum, equivalent to the complication rates of manual compression.
- VCDs should not be used for the explicit goal of reducing vascular complications.
- There is insufficient evidence to support the routine use of VCDs in arterial grafts or stents.
- There is insufficient evidence to support the routine use of VCDs for the explicit purpose of health care cost reduction.
- Some institutions regard the use of VCDs as an independent procedure, requiring separate informed consent, repeat preparation of the sterile field, and/or use of prophylactic antibiotic agents. This document neither endorses nor discourages such practices, though discussing the unique risks and benefits of VCDs with patients before the initiation of any procedure in which such devices maybe used is recommended.

[drserg]

Сообщение от mizin1

Разве кровоток в ПБА для пациента хуже чем в ГБА?

Придерживаюсь мнения, что ГБА самая важная артерия для коллатерального кровоснабжения ноги. При любом вмешательстве стараюсь всегда сохранить устье ГБА СВОБОДНЫМ, за исключением явного диффузного ее поражения, например, как бывает при диабете.

[drserg]

Спасибо за рекомендации по VCD!
Есть чем ответить продавцам

[mizin1]

Готовясь к одному мероприятию, обнаружил интересную статью авторов с севера США:
Access Site Сomplications After Peripheral Vascular Interventions. Incidence, Predictors, and Outcomes. Daniel Ortiz, MD .......Circ Cardiovasc Interv. 2014;7:00-00.

Вот, что там изучали.
"This retrospective study analyzed data on 22 226 patients who underwent 27 048 PVI procedures from August 2007 to May 2013 in >130 centers participating in the Society for Vascular Surgery’s Vascular Quality Initiative (VQI)."

PVI это периферические сосудистые интервенции.

"ASC is defined by the VQI as the presence of a hematoma at the procedural puncture site associated with or without pseudoaneurysm, before discharge and classified as 1 of 4 types: minor with no therapy used, moderate necessitating blood transfusion, moderate necessitating thrombin injection, or major for which an operation was performed."

ASC это осложнения в месте доступа.

Там много интересного. Но, что важно:

[Ссылки доступны только зарегистрированным пользователям ]

И вот какой авторы вывод делают:
"The results of this study suggest that access site hematoma requiring transfusion or operation had a significant, independent, negative impact on mortality in patients undergoing PVI. ASCs also were associated with prolonged hospitalization and more adverse discharge status. Several patient and procedural variables independently predict ASC, including treatment with heparin rather than bivalirudin and the nonuse of a vascular closure device. Risk assessment for the potential development of ASC with knowledge of these findings could facilitate the appropriate selection of antithrombotic therapy and the use of closure devices to improve post-PVI outcomes."

Это большое исследование дает хорошую надежду на рутинное использование VCD при периферических ангиопластиках.

[mizin1]

Интересное недавно опубликованное сравнение Prostar и ProGlide на большой группе пациентов с большими доступами в пользу последнего.

- Propensity matching identified 944 well-matched patients (472 patient pairs). Composite primary end point of major vascular complications or inhospital mortality occurred more frequently in Prostar group when compared with ProGlide group (9.5 vs. 5.1%, P=0.016), and was driven by higher rates of major vascular complication (7.4 vs. 1.9%, P<0.001) in the Prostar group. However, in-hospital mortality was similar between groups (4.9 vs. 3.5%, P=0.2). Femoral artery stenosis occurred less frequently in the Prostar group (3.4 vs. 0.5%, P=0.004), but overall, Prostar use was associated with higher rates of major bleeding (16.7 vs. 3.2%, P<0.001), acute kidney injury (17.6 vs. 4.4%, P<0.001) and with longer hospital stay (median 6 vs. 5 days, P=0.007).

[mizin1]

Еще один интересный способ гемостаза больших отверстий нашел.

"Augmenting the Preclose Technique with a Collagen-Based Closure Device for Percutaneous Endovascular Aneurysm Repair."

Обычная Preclose Technique с помощью prostar или proglide. После операции затягиваем шов на проводнике. Если значительное подтекание остается берем angioseal и дополняем гемостаз. Авторы пишут о 95% успехе. Очень хорошо! Можно было и самому до этого дойти.