胸主动脉腔内修复术左肱动脉穿刺点使用血管缝合器处理的临床效果

doi:10.19723/j.issn.1671-167X.2026.02.025

摘要/Abstract

摘要：

目的: 探讨胸主动脉腔内修复术(thoracic endovascular aortic repair，TEVAR)左肱动脉穿刺点使用血管缝合器处理的有效性和安全性。方法: 回顾分析北京大学人民医院2021年1月至2023年5月接受TEVAR并行左肱动脉穿刺置鞘的91例患者的临床资料，其中，肱动脉直径大于5 mm的患者27例，其左肱动脉穿刺点使用血管缝合器处理，另外64例患者的肱动脉直径小于5 mm，对其左肱动脉穿刺点行单纯压迫。对比两种穿刺点处理方法的围术期并发症以及长期结果。结果: 术后，血管缝合器组加压绷带的压迫时间显著减少(P＜0.001)，压迫相关的肢体麻木、疼痛、肿胀等不适症状的比例显著低于单纯压迫组(3.70% vs. 42.19%，P＜0.001)。血管缝合组住院期间发生急性肱动脉闭塞1例，需行肱动脉切开修复；单纯压迫组住院期间发生肱动脉穿刺点并发症4例，其中单纯血肿3例，行保守治疗，假性动脉瘤1例，需再次手术。两组早期穿刺点相关并发症的发生率差异无统计学意义(3.70% vs. 6.25%，P=0.625)。所有患者平均随访(14±6)个月，两组患者均未发生左肱动脉穿刺点相关并发症。结论: TEVAR左肱动脉穿刺点采用血管缝合器处理是有效的，且长期效果满意，尤其适合用于血管直径大于5 mm的患者。

关键词: 血管闭合装置, 胸主动脉腔内修复术, 肱动脉, 治疗结果

Abstract:

Objective: To evaluate the feasibility and safety of the suture-mediated vascular closure device in the closure of the left brachial artery access site after thoracic endovascular aortic repair (TEVAR). Methods: Data from 91 patients receiving TEVAR with left brachial artery puncture from January 2021 to May 2023 were retrospectively collected and analyzed. In 27 cases whose brachial artery was over 5 mm, a suture-mediate vascular closure device (Perclose ProGlide, Abbott) was used to deal with the left brachial artery access, and in the other 64 cases with brachial artery < 5 mm, manual compression was used. The primary outcomes were the incidence of perioperative access-related complications and long-term outcomes. Results: In the suture-mediate device group, the access-site compression time was significantly reduced than that in the manual compression group (P < 0.001). The proportion of discomforts, such as numbness, pain, and swelling of the compression-related limbs was significantly lower than that in the compression-alone group (3.70% vs. 42.19%, P < 0.001). One case with brachial artery access-related complications occurred in the suture-mediate device group during hospitalization, which was acute brachial artery occlusion and required reinterventions. In the manual compression group, 4 cases of brachial artery puncture point complications occurred during hospitalization, including 3 cases of pure hematoma with conservative management and 1 case of pseudoaneurysm requiring reintervention. There was no significant difference in the incidence of early puncture point complications between the two groups (3.70% vs. 6.25%, P=0.625). During an average follow-up of (14±6) months, no access-related complications of the left brachial artery occurred. Conclusion: It is effective to use the suture-mediated vascular closure in the left brachial artery access site after TEVAR, and the long-term effect is satisfactory. For patients with >5 mm brachial artery, it is reasonable to use suture-mediated vascular devices to deal with brachial artery access.

Key words: Vascular closure device, Thoracic endovascular aortic repair, Brachial artery, Treatment outcome

中图分类号:

R654.3

李伟浩, 张学民, 李伟, 张韬, 张小明. 胸主动脉腔内修复术左肱动脉穿刺点使用血管缝合器处理的临床效果[J]. 北京大学学报（医学版）, 2026, 58(2): 388-392.

Weihao LI, Xuemin ZHANG, Wei LI, Tao ZHANG, Xiaoming ZHANG. Outcomes of suture-mediated vascular closure device in the closure of left brachial artery access site after thoracic endovascular aortic repair[J]. Journal of Peking University (Health Sciences), 2026, 58(2): 388-392.

图/表 3

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参考文献 10

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9	刘玉龙, 李承志, 王晓白, 等. ExoSeal血管封堵器在肱动脉高位穿刺点止血中的临床应用[J]. 介入放射学杂志, 2020, 29 (6): 560- 563.
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Items	Suture-mediate device group (n=27)	Compression-alone group (n=64)	Statistic	P
Gender (male)	22 (81.48)	53 (82.81)		>0.999^a
Age/years	47.3±13.6	54.2±13.2	-2.255	0.027
BMI/(kg/m²)	24.2±3.6	26.5±5.7	-1.071	0.287
Smoking history	12 (44.44)	30 (46.88)	0.045^a	0.832
Hypertension	19 (70.37)	53 (82.81)	1.779^a	0.182
Diabetes	2 (7.41)	5 (7.81)		>0.999^a
Coronary heart disease	2 (7.41)	8 (12.50)		0.732^a
Peripheral arterial disease	0 (0)	3 (4.69)		0.552^a
ASA grade				0.941^a
Ⅰ	1 (3.70)	5 (7.81)
Ⅱ	13 (48.15)	26 (40.62)
Ⅲ	11 (40.74)	27 (42.19)
Ⅳ	2 (7.41)	6 (9.38)

Items	Suture-mediate device group (n=27)	Compression-alone group (n=64)	Statistic	P
Brachial artery diameter/mm	5.4±0.3	4.2±0.4	14.7	＜0.001
Vascular sheath				0.077^a
5F	0 (0)	5 (7.81)
6F	19 (70.37)	52 (81.25)
7F	6 (22.22)	7 (10.94)
8F	2 (7.41)	0 (0)
Compression time/h	6 (6, 7)	22 (20, 25)	-7.537^b	＜0.001^b
Oppression-related discomfort	1 (3.70)	27 (42.19)		＜0.001^a
Puncture point complication	1 (3.70)	4 (6.25)		0.625^a
Thrombopoiesis	1 (3.70)	0 (0)
Hematoma/pseudoaneurysm	0 (0)	4 (6.25)