Publication: Efectividad y seguridad de tres dispositivos de cierre arterial percutáneo frente a compresión manual en procedimientos endovasculares sobre territorio arterial periférico. Ensayo clínico aleatorizado
Loading...
Official URL
Full text at PDC
Publication Date
2017-10-04
Authors
Advisors (or tutors)
Editors
Journal Title
Journal ISSN
Volume Title
Publisher
Universidad Complutense de Madrid
Citations
Exportar
Abstract
El intervencionismo endovascular se ha convertido en los últimos años en el procedimiento de elección para el diagnóstico y tratamiento de la Enfermedad Arterial Periférica (EAP) en cualquier territorio en muchos casos. En España se realizan anualmente más de 5000 procedimientos endovasculares motivados por la EAP. La realización de estos procedimientos requiere la obtención de un acceso arterial. Si bien en los inicios de la era endovascular este acceso requería la disección quirúrgica de la arteria, este paso se ha conseguido evitar con el desarrollo de las técnicas percutáneas, que se han establecido como el método de obtención de acceso arterial más empleado en la actualidad. Pese a las ventajas que ofrece la ausencia de disección quirúrgica de la arteria, estas técnicas plantean otros problemas asociados, como son los relacionados con la punción arterial y la consecución de la hemostasia al finalizar el procedimiento. Se han desarrollado diferentes técnicas para el guiado de la punción arterial, como son la localización por referencias anatómicas y palpación de pulso, el guiado radiológico y la punción mediante visualización directa por ultrasonidos...
Endovascular intervention has recently become the procedure of choice, in most a cases, for the diagnosis and treatment of peripheral arterial disease (PAD) in any territory. Over 5,000 endovascular procedures are performed annually in Spain for diagnosis and treatment of PAD. An arterial access is required to perform these procedures. Initially, it was obtained by surgical dissection, but nowadays this step is avoided in most of cases thanks to the development of percutaneous techniques. Despite the advantages of the absence of arterial surgical dissection, these techniques pose other associated problems such as those related to the arterial puncture and the achievement of hemostasis at the end of the procedure. Different techniques have been described for guiding arterial puncture, such as anatomical landmarks and palpation of pulse, radiographic guidance and puncture under direct ultrasound visualization. Regarding the postprecedural arterial closure, there are different strategies that include direct manual compression over the puncture site, the use of mechanical devices to assist compression and, more recently, the employment of percutaneous arterial closure devices (PACD). There are several mechanisms of action for these devices, being the widest experience of use stablished for the collagen plug, percutaneous sutures and hemostatic clips. The use of these systems implies risk for specific complications resulting from lack of hemostatic effectiveness and inadequate delivery of the device. The available scientific evidence concerning these devices is scarce and of poor methodological quality in many cases, being the vast majority of results based on diagnostic procedures performed on the coronary arteries, which are not applicable to peripheral interventions...
Endovascular intervention has recently become the procedure of choice, in most a cases, for the diagnosis and treatment of peripheral arterial disease (PAD) in any territory. Over 5,000 endovascular procedures are performed annually in Spain for diagnosis and treatment of PAD. An arterial access is required to perform these procedures. Initially, it was obtained by surgical dissection, but nowadays this step is avoided in most of cases thanks to the development of percutaneous techniques. Despite the advantages of the absence of arterial surgical dissection, these techniques pose other associated problems such as those related to the arterial puncture and the achievement of hemostasis at the end of the procedure. Different techniques have been described for guiding arterial puncture, such as anatomical landmarks and palpation of pulse, radiographic guidance and puncture under direct ultrasound visualization. Regarding the postprecedural arterial closure, there are different strategies that include direct manual compression over the puncture site, the use of mechanical devices to assist compression and, more recently, the employment of percutaneous arterial closure devices (PACD). There are several mechanisms of action for these devices, being the widest experience of use stablished for the collagen plug, percutaneous sutures and hemostatic clips. The use of these systems implies risk for specific complications resulting from lack of hemostatic effectiveness and inadequate delivery of the device. The available scientific evidence concerning these devices is scarce and of poor methodological quality in many cases, being the vast majority of results based on diagnostic procedures performed on the coronary arteries, which are not applicable to peripheral interventions...
Description
Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Cirugía, leída el 02-02-2017