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Interventionelle Radiologie Scan 2016; 04(02): 141-157
DOI: 10.1055/s-0042-106154
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© Georg Thieme Verlag KG Stuttgart · New York

Perkutane Verschlusssysteme in der vaskulären Interventionsradiologie[*]

Thomas Jahnke
,
Stefan Müller-Hülsbeck
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Publikationsverlauf

Publikationsdatum:
03. Juni 2016 (online)

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Fazit

Das Management der Punktionsstelle nach arterieller Gefäßintervention ist nach wie vor eine Herausforderung, denn nicht selten verlängert sich der Eingriff durch den Verschluss des Zugangswegs erheblich. Die manuelle Kompression der Punktionsstelle in der Leiste mit Anlage eines Druckverbands, gefolgt von einer Phase der Immobilisation des Patienten, ist vielerorts Goldstandard. Aufgrund der doch beachtlichen Schleusengrößen (EVAR: 20 Fr, Atherektomie: 6 – 9 Fr, Stentgrafts: 7 – 10 Fr), die – trotz eines permanenten Trends zur Miniaturisierung – für neue und spezielle Techniken und Indikationen erforderlich sind, und wegen der sich vielerorts durchsetzenden periinterventionellen Antikoagulation werden heute sichere Alternativen zur manuellen Kompression des Zugangswegs nach Gefäßinterventionen gefordert.

Vaskuläre Verschlusssysteme können das Verschlussmanagement einschließlich der Nachsorge auch bei größeren Zugängen deutlich vereinfachen und den Patientenkomfort verbessern. Allerdings ist ein GVS auch mit zusätzlichen Kosten verbunden.

Viele Studien mit unterschiedlichen aktiven GVS haben gezeigt, dass diese die Zeit vom Entfernen der arteriellen Schleuse bis zum Erreichen der Hämostase und die Dauer der Immobilisation reduzieren können. Hinsichtlich der Einfachheit der Anwendung, des Patientenkomforts und des Sicherheitsprofils gibt es aber deutliche Unterschiede zwischen den zur Verfügung stehenden Systemen. Technischer Erfolg und Komplikationsraten hängen immer auch von der Erfahrung und dem Geschick des Anwenders und der dem System immanenten Lernkurve ab. Grundsätzlich ist es empfehlenswert, sich für ein GVS zu entscheiden, denn je routinierter der Anwender, desto seltener ist mit Komplikationen zu rechnen.

* Dieser Artikel ist ein adaptierter Zweitabdruck des Beitrags in: Radiologie up2date 2013; 13: 15 – 30


 

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