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DOI: 10.1055/s-2005-868709
© Georg Thieme Verlag Stuttgart · New York
Perkutane endoprothetische Therapie des Aortenaneurysmas ohne Arteriotomie
Percutaneous endovascular aneurysm repair without arteriotomy (Perclose system)Publication History
eingereicht: 28.12.2004
akzeptiert: 14.4.2005
Publication Date:
12 May 2005 (online)

Zusammenfassung
Hintergrund: Bei der Implantation von Endoprothesen zur Behandlung infrarenaler und thorakaler Aortenaneurysmen ist eine Arteriotomie üblich. Um die Invasivität der Behandlung weiter zu reduzieren, haben wir untersucht, ob stattdessen die Femoralarterien ohne vorherige Freilegung punktiert und die Punktionsstellen nach dem Eingriff mit dem Perclose-System verschlossen werden können.
Patienten und Methodik: Das Perclose-System ist ein perkutanes Naht-System zur Erzielung der Hämostase nach arteriellen Punktionen. Es besteht aus 4 Nadeln und 2 Fäden. Vor Einführung der Prothese (Durchmesser 12 - 27 F = 4 - 9 mm) wurde eine perkutane Naht gelegt, mit der postinterventionell die Punktionsstelle verschlossen wurde. Insgesamt wurden 104 Femoralarterien bei 60 Patienten (weiblich: 7, mittleres Alter: 69 ± 12 Jahre) auf diese Weise versorgt. Der mittlere Femoralarteriendurchmesser betrug 10 ± 2 mm.
Ergebnisse: Die perkutane Implantation der Prothese konnte bei 58 von 60 Patienten erfolgreich durchgeführt werden. In zwei Fällen war das Einführen des Grafts wegen kalzifizierter Beckenarterien nicht möglich. Das Perclose-System konnte in 97 Fällen erfolgreich eingesetzt werden. In 2 Fällen kam es zu behandlungsbedürftigen lokalen Komplikationen (1 × Nachblutung, 1 × Aneurysma spurium). Eine zusätzliche manuelle Kompression war bei sieben Femoralarterien notwendig, eine chirurgische Versorgung der Punktionsstelle in keinem Fall. Der postinterventionelle mediane Klinikaufenthalt betrug 18 Stunden (4,5 Stunden-32 Tage), nur 20 Patienten verblieben länger als 24 Stunden in der Klinik, davon nur 2 wegen Komplikationen an der Punktionsstelle.
Folgerung: Die perkutane Gefäßnaht mit dem Perclose-System zur Erzielung der Hämostase nach perkutaner Implantation von Aortenendoprothesen ist technisch möglich und effektiv bei der Verwendung von großen Schleusen und Einführsystemen (bis 27 F = 9 mm). Durch die geringe Invasivität der Methode können Aneurysmen endoprothetisch im Rahmen eines sehr kurzen Klinikaufenthaltes oder sogar ambulant versorgt werden.
Summary
Background and objective: It is common clinical practice to perform an arteriotomy for the endovascular treatment of infrarenal and thoracic aortic aneurysms. Instead we used the percutaneous endovascular Perclose device to perform the aneurysm repair without arterial cut-down.
Patients and methods: The Perclose device contains four needles with two suture loops for closing the femoral artery access site. The sutures were deployed after the arterial puncture, before introduction of sheaths (diameter 12 - 27 F = 4 - 9 mm). After the procedure the sutures were used to close the puncture site. We attempted to achieve hemostasis with the Perclose system in 104 femoral arteries in 60 patients (7 females, mean age 69 ± 12 years). The mean vessel diameter was 10 ± 2 mm.
Results: The percutaneous graft implantation was successfully achieved in 58 of 60 patients. The graft could not be forwarded into the aorta in two cases because of calcified iliac arteries. The Perclose suture technique was succesfully used in 97 femoral arteries. In one case a false aneurysm developed and in another case a secondary hemorrhage occurred. Seven patients needed additional manual compression to achieve complete hemostasis. A surgical repair was not necessary. The time to hospital discharge ranged from 4.5 hours to 32 days (median: 18 hours). 20 patients stayed longer than 24 h in the hospital, only 2 of them for reasons related to the puncture site.
Conclusion: Closing the access site with the Perclose system is technically feasible and effective, even with large sheaths up to 27 F = 9 mm. This technique reduces the invasiveness of the endovascular repair of aortic aneurysms and decreases the length of hospital stay, i. e. it allows treatment in outpatients.
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Prof. Dr. Horst Sievert
CardioVasculäres Centrum Frankfurt, Sankt Katharinen
Seckbacher Landstraße 65
60389 Frankfurt
Phone: 069/46031344
Fax: 069/46031343
Email: horstsievertMD@aol.com