VascularCloserDevice-MEETCONGRESS：血管闭合装置满足国会.ppt

Peripheral vessel: mechanical or chemical closure Manual compression: the gold standard Seldinger technique, introduced in 1951, obtained the hemostasis at the end of the procedure by manual pressure for 10-15 minutes, followed by 6-8 hours of bed rest, in patients with normal coagulation parameters. Seldinger SI. Catheter placement of needles in percutaneous arteriography; a new technique. Acta Radiol 1953; 39: 368-76. Vascular closure device The new interventional tecniques have increased the use of new devices that require large sheaths, periprocedural anticoagulation and most important double antiplatelet therapy with a consequent increase in the access site related complication of up to 17%. Waksman et Al. Predictors of groin complication after balloon and new device coronary intervention. Am J Cardiol 1995; 75: 886-889. Ideal closure device Easy device application High successful rate with short time to hemostasis Low rates of complications Possibility of repeated vascular access Major complications of VCD Hematoma requiring trasfusion or surgery Pseudoaneurysm Arteriovenous fistula Retroperitoneal hematoma Femoral artery thrombosis Access site infection Device embolization Failure Predictors of vascular complications Age and Gender Severe PVD Diabetes Sheath size Final ACT level Peri PCI pharmacotherapy (thrombolitics, GP IIb/IIIa inhibitors) Multiple arterial puncture attempts Operator learning curve AngioSeal The AngioSeal device was introduced in Europe 1994. It consists of an anchor, a collagen plug, and a suture. The biodegradable collagen plug induces platelet activation and aggregation, and releases coagulation factors. AngioSeal produces a sandwich closure of the arteriotomy site between the anchor and collagen plug Angiography of the femoral artery access site The routine use of a femoral angiogram through the original procedure sheath prior to puncture closure with a closure device can prevent complicatio