Arterielle Zugangswegkomplikationen nach perkutanen Interventionen unter besonderer Berücksichtigung der Verwendung von Verschlusssystemen

Zusammenfassung

Durch die zunehmende Zahl an durchgeführten endovaskulären Verfahren, vor allem in der Behandlung der peripheren arteriellen Verschlusskrankheit und der koronaren Herzkrankheit, kommt es auch zu einer Zunahme der damit verbundenen Zugangswegkomplikationen. Dabei handelt es sich um Nachblutungen, Hämatome, Pseudoaneurysmen, arteriovenöse Fisteln und arterielle Thrombosen. Zur Reduktion der auftretenden Komplikationen wurden Mitte der 1990er-Jahre sogenannte Verschlusssysteme (VCD) auf den Markt gebracht, Studien konnten jedoch keinen Benefit dieser Devices, verglichen mit der konventionellen manuellen Kompression, nachweisen. Zur Auswertung unserer eigenen Erfahrungen führten wir eine retrospektive Analyse aller an unserer Klinik gefäßchirurgisch behandelten Zugangswegkomplikationen im Zeitraum von 2001 bis 2012 durch. Insgesamt wurden 522 Patienten behandelt, die Zahl der durchgeführten perkutanen Interventionen betrug 90 536 und somit betrug die gesamte Inzidenz 0,58 %. Eingeteilt wurden die Patienten in die Gruppen A–C, abhängig davon, wie häufig VCDs verwendet wurden. Gezeigt werden konnte eine Zunahme von Zugangswegkomplikationen seit der häufigeren Verwendung von VCDs, vor allem ischämische Komplikationen wurden häufiger. Somit bleibt die Anwendung von VCDs hinsichtlich der Vermeidung von Zugangswegkomplikationen umstritten und wird auch in Zukunft Anlass für Diskussionen bringen.

Abstract

Due to an increase in the number of performed endovascular procedures, the number of local access site complications is rising too. Used mainly for treatment of peripheral arterial disease and coronary heart disease, endovascular procedures are gaining importance. Access site complications include bleeding, haematoma, pseudoaneurysm, arteriovenous fistula and arterial thrombosis. Aiming to reduce immobilisation, length of hospital stay, costs and access site complications, vascular closure devices (VCD) were introduced in the mid 1990s, but current trials failed to demonstrate the superiority of these devices compared to conventional manual compression if it comes to access site complications. We retrospectively evaluated all patients who were treated surgically due to access site complications between 2001 and 2012 in our institution. In total, 522 patients needed vascular surgery to treat different access site complications. During this period, 90,538 percutaneous interventions were performed in our institution, leading to a total incidence of 0.58 % of access site complications. Depending on the frequency of application of VCDs, patients have been grouped in groups A–C. With the more frequent use of VCDs, the incidence of access site complications increased and, in particular, ischaemic complications were seen more often. In conclusion, the application of VCDs to prevent access site complications is questionable and not justified when looking at published data.

Schlüsselwörter

Zugangswegkomplikation - endovaskuläre Therapie - perkutane Punktion - Verschlusssystem - Pseudoaneurysmen

Key words

access site complications - endovascular treatment - percutaneous puncture - vascular closure device - pseudoaneurysms

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