Background In recent years, vascular suture devices have gradually gained popularity in China and proved itself valuable in daily clinical practice. Commonly used by vascular surgeons, vascular closure devices are less favored by cardiac surgeons. More frequently, cardiac surgeons choose a cut-down approach to expose the common femoral artery during endovascular interventions. Experiences with vascular closure devices are rarely shared by cardiac surgeons.
Objective To summarize the clinical value of vascular closure devices (VCD) in endovascular interventions by cardiac surgeons.
Methods The current study included 122 patients undergoing endovascular intervention at the Cardiovascular Center in the Second Affiliated Hospital of Nanjing Medical University from June 2019 to December 2020. The choice of vascular closure method was based on the preoperative agreement reached between the surgeon and the patients. Patients were divided into the VCD group (n=60) and the surgical incision (SI) group (n=62). The technical success rate, time from puncture/incision to vascular access, intraoperative blood loss, bed rest time after surgery, time of postoperative hospital stay, the total cost of hospital stays, and complication rates were analyzed.
Results Of all the 122 cases, endovascular repair of thoracic aortic dissection was performed in 93 patients, endovascular repair of the abdominal aortic aneurysm was completed in 24 patients, and percutaneous aortic valve replacement was done in 5 patients. All patients underwent successful endovascular intervention. A total of 146 VCD were used, and 72 femoral arteries were sutured surgically. The technical success rate was 98.33% (59/60) in the VCD group, in contrast to the 100% in the SI group. The vascular access time (15.2±2.0 min vs 30.2±4.9 min), postoperative time to ambulation (22.5±15.5 h vs 45.2±22.3 h), time of postoperative hospital stay (MdIQR, 52 d vs 72.3 d), amount of intraoperative blood loss (103.3±53.2 mL vs 246.3±69.0 mL) in the VCD group were all significantly less than those in the SI group (P＜0.001). No significant difference was found between the VCD group and SI group in terms of the total cost of hospital stay (123±23 thousand yuan vs 128±25 thousand yuan, P＞0.05). Compared with the surgical incision group, the complication rate was significantly lower in the VCD group (0 0/60 vs 9.6% 6/62, P=0.028).
Conclusion The application of VCD in endovascular intervention is safe and effective. It significantly decreases the vascular access time, amount of intraoperative blood loss, postoperative bed rest time, time of postoperative hospital stay and the incidence of incisional complications. Strictly following the indications, throughout pre-operative evaluations, and pre-application practice can reduce the rate of complications.
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