Abstract:

Introduction: vascular closure devices (VCD) for over 20 years have been used as an alternative to manual compression to achieve hemostasis. Despite the fact that clinical efficacy and safety of occlusive type VCD have been confirmed in a number of studies, their use remains controversial due to the formation of complications at the access site when using these devices.

Aim: was to estimate possible advantages and limitations of vascular closure devices of occlusive type (Angio-Seal) in patients, who had underwent percutaneous coronary interventions (PCI) via femoral access in comparison with traditional manual hemostasis.

Material and methods: data of 231 adult patients who underwent therapeutic endovascular procedures in the City Hospital named after M.P. Konchalovsky, Research and Development Center for Preventive Medicine were selected for retrospective research. The main group, with hemostasis after PCI with Angio-Seal (Terumo) obturating device, consisted of 113 patients, control group - included 118 patients with manual hemostasis. Subjective sensations (pain, numbness, etc.), complication rate, hemostasis time, immobilization and hospitalization duration were evaluated.

Results: success of using VCD was 98.23%, complication rate in the main group was 4.37%, in the control group - 6.78% (however, it was not reliable). The time of hemostasis (2.1 min versus 22.25 min), immobilization (3.5 hours versus 20.6 hours) and hospitalization (4 days versus 8 days) significantly decreased, and the patient comfort level was significantly higher in the main group.

Conclusions: the use of Angio-Seal VCD in patients after percutaneous transfemoral therapeutic endovascular procedures is an effective way to reduce hemostasis time in comparison with using of manual compression; allows to reduce patient's immobilization period, significantly increases patient comfort, and reduces patient's hospital stay.

Along with this procedure, it should be considered as an independent surgical intervention and surgeon should follow all necessary rules and stages of its implementation, should control result of hemostasis.

References

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Abstract:

Background: the use of vascular closure devices (VCD) reduces the time of hemostasis, accelerates activation and discharge of the patient. Suture-mediated closure devices are closest in it's structure to the traditional surgical method of hemostasis. Advantages and disadvantages of these devices are mainly associated with design features. Stenoses, atherosclerosis, calcification and scars at the site of access are predictors of complications in the use of suturing devices. Although the effectiveness of these devices has been proven in several foreign studies, their data are not sufficient to draw clear conclusions.

Aim: was to evaluate advantages and disadvantages of using the suture-mediated closure devices after PCI.

Material and methods: study enrolled 208 adult patients, who underwent PCI in City Clinical Hospital named after M.P Konchalovsky, Moscow; FSBI «3 Central clinical military hospital n.a. A. A. Vishnevsky» Defense Ministry RF and SMRC preventive medicine of Department of Healthcare. Study group, where hemostasis after PCI was achieved by means of suture-mediated closure devices Perclose Pro Glide (Abbott Vascular), consisted of 90 patients, control group - 118 patients with manual hemostasis. Subjective feelings (pain, numbness, etc.) were assessed using a rating scale. The incidence of complications in the study group was 5.56%, in the control group - 6.78%. The comfort level of patients was higher in the study group

Results of the study: showed that the use of the Perclose device to achieve hemostasis after PC does not increase the frequency of regional vascular complications in compatison with manual hemostasis. But, at the same time, the use of VCD is an effective way to reduce the time of hemostasis, reduces the period of immobilization of the patient, which increases the patient's comfort and reduces patient's hospital stay.

References

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Abstract:

Aim. Was to analyze atherosclerotic disease dynamics and long-term results (up to 5 years) after implantation of bare-metal stents (BMS) and sirolimus-eluting stents (SES) in patients with multivascular coronary disease

Methods and results. We have analyzed clinicaland angiographic results data of percutaneous coronary interventions (PCI) of 585 patients with multivascular coronary disease during 5-years of follow-up period. 264 patients were treated with BMS, 321 - with SES We used Cypher drug-eluting stents (sirolimus-eluting stents) in the first group and BX Velocity bare-metal stents in the second group of patients

During first year of follow-up the incidence of symptoms reoccurrence in BMS and SES groups was 22,3% and 11,8% (р < 0,05) repeated PCI was performed in 15,6% and 3,9% (р < 0,05), CABG - 2,8% and 0,3% (р < 0,05), the incidence of myocardial infarction (MI) was 1,4% and 0,9%. The restenosis rate in BMS and SES groups was 19,7% and 2,3% (р < 0,05), late thrombosis (LT) - 0,3% and 1,4% The survival without MACE was higher in SES group

During 5 years of follow-up the cumulative incidence of symptoms reoccurrence in BMS and DES groups was 30,7% and 22,7% repeated PCI was performed in 23,9% and 18,1% (р < 0,05), CABG - 6,4% and 4,7%, the incidence of myocardial infarction (MI) was 6,5% and 7,8%. The progression of atherosclerosis in early stented segments in BMS and SES groups was 6,6% and 10,1%, late thrombosis (LT) - 0,4% and 2,1%. There was no difference in survival without MACE between groups

Conclusions. By the end of the first year of follow-up the incidence of angina reoccurrence and repeat revascularization in patients with multivascular coronary disease was higher in BMS group compared with SES group. The survival without MACE was also higher in SES group. By the end of the fifth year of follow-up there was no difference in angina reoccurrence, repeated revascularization and surviva without MACE because the late thrombosis and atherosclerosis progression in early stented segments was more common in DES group. 

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Abstract:

Aim. Was to study long-term results of drug eluting stents implantation: angiographic frequency of prolong stenosis, frequency of restenosis, endotelization dynamics, and other morphological indicators on the base of intravascular ultrasound (IV-US)

Materials and methods. The research consisted of 220 patients with angina pectoris or/and myocardial ischemic indexes: all of them were after drug eluting stents implantation. 174 patients on the first year and 82 on the second were underwent coronaroventriculography Double antiaggregant theraphy was given on the first year to 198(90%) patients, on the second - 21(9,5%)

Results. The whole angiographic success was 89,5%. 44% patients were underwent of lateral arterial branches defense. Unsuccessfu stenting was due to technical impossibility of movement threw variated coronar arteries segment in 5%; 1,8% was due to incomplete disclosing of stent; 2,7% - occlusion of lateral arterial branch

Conclusions. On the base of IV-US, at the end of the 1st year, 40% stents had full endotelization, at the end of the 2nd - 91%. Double antiaggregant theraphy was given to 99,1% patients on the first year. All coronary situations (morbidity, heart stroke, restenosis) was much more ess, than on the 2nd years, on which drug therapy was given only to 9,6% patients.

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