1.Brief introduction of vascular closure device
Hongkun QING ; Xiaoming ZHANG ; Jingjun JIANG ; Xuemin ZHANG
Journal of Interventional Radiology 2015;(6):548-552
A vascular closure device (VCD) is a medical apparatus which is used for stopping bleeding at the puncture point after percutaneous vascular puncturing management. According to its principles , these devices can be categorized into active closure device, compression-assisted device and local hemostatic plaster. The use of these devices can shorten the time of hemostasis, the time of limb immobilization, and the time of hospitalization; it can also reduce the damage to the patient, improve patient’s comfort, and reduce the work load of the medical staff as well. But each VCD has its own applicable scope and learning curve , thus it might cause serious complications when it is improperly used. Therefore , in using VCD the interventional physicians should be familiar with the characteristics of each special VCD and have enough knowledge concerning the treatment of the common complications. This paper aims to make a comprehensive review of the closure device manufacturer data and the relevant literatures recently published so as to make a brief introduction of the principle, characteristics, scope of application and practical tips of several common vascular closure devices.
2.Control study of total percutaneous access with preclose technique versus open femoral artery exposure for endovascular aneurysm repair
Jingjun JIANG ; Hongkun QING ; Xiaoming ZHANG ; Xuemin ZHANG ; Wei LI ; Chenyang SHEN ; Qingle LI ; Yang JIAO
Journal of Peking University(Health Sciences) 2016;48(5):850-854
Objective:To compare total percutaneous access using preclose technique with femoral ar-tery cut-down in endovascular aneurysm repair (EVAR)and assess the safety and feasibility of preclose technique.Methods:In the study,81 cases undergoing EVAR from Dec.2011 to Nov.2014 in Peking University People’s Hospital were retrospectively reviewed.Preoperative CT angiography (CTA)showed presence of infrarenal abdominal aortic aneurysm or descending aortic aneurysm in all the cases.The maximum diameter of aneurysm >4.5 cm met the indications for surgical treatment.The conditions of bi-lateral femoral artery and iliac artery CTA showed were good,and there was no moderate or severe steno-sis,nor was there any severe calcification in anterior wall of femoral artery.Not only were the cases fit for percutaneous endovascular aortic aneurysm repair (PEVAR),but also feasible with open endovascular aneurysm repair (OEVAR).According to the intention of the patients about the surgical incision,the ca-ses were divided into group PEVAR and group OEVAR.The data of the general situation,operation time,blood loss,technical success rate,length of hospital stay after procedure and wound complications were analyzed statistically.Results:In the study,44 cases (78 incisions)were enrolled in group PEVAR and 37 cases (65 incisions)in group OEVAR.There was no significant difference between the two groups in age,gender,body mass index (BMI),accompanying diseases,average number of stents and outer diameter of stent delivery system.Average operation time of group PEVAR was less than that of group OEVAR [(119.1 ±102.0)min vs.(163.6 ±61.9)min,P =0.025].The blood loss in group PEVAR was less than that in group OEVAR [(64.7 ±97.0)mL vs.(98.6 ±88.3)mL],but there was no significant difference (P =0.106).There was no difference in the technical success rate (94.9% vs. 95.4%,P =1.000).The average length of hospital stay after procedure was significantly shorter in group PEVAR [(7.8 ±2.8)d vs.(12.3 ±7.2)d,P <0.001].There were 2 cases with subcutaneous hematoma of wound in group PEVAR and 7 cases of wound complications that occurred in group OEVAR including 3 cases with lymphatic leakage,3 cases with lower limb ischemia and 1 case with subcutaneous hematoma.The analysis showed that PEVAR could reduce the wound complications (2.6%vs.10.8%), but there was no significant difference between the two groups (P =0.079).Conclusion:Using preclose technique in EVAR is safe and effective.It can shorten the operation time and length of hospital stay after procedure.
3.Endovascular repair of an iliac artery aneurysm after endovascular aneurysm repair with handmade iliac branch device:a case report
Hongkun QING ; Xuemin ZHANG ; Jingjun JIANG ; Xiaoming ZHANG ; Changshun HE ; Zhanguo SUN
Journal of Peking University(Health Sciences) 2015;(5):888-890
SUMMARY An involved internal iliac artery is usually embolized when performing endovascular aneu -rysm repair for aortoiliac or isolated iliac artery aneurysm .This can lead to complications such as buttock claudication ,colon ischaemia and erectile dysfunction .Iliac branch device ( IBD ) is an endograft de-signed specifically for iliac bifurcation to preserve internal iliac flow .It was performed with high technical success rates and encouraging mid-term patency .Here we report a case of right iliac aneurysm developed 3 years after endovascular aneurysm repair for an aortoiliac aneurysm , with the patient ’ s left internal ar-tery been sacrificed then .Using a handmade IBD , we excluded the aneurysm without occlusion of the ip-silateral internal iliac artery or any type of endoleak .Both the design and deployment of this IBD are dis-tinctive that we would like to share our experience with all the colleagues .
4.Application of Commando and Hemi-Commando procedures in the reconstruction of intervalvular fibrous body
Weiteng WANG ; Hongkun QING ; Oudi CHEN ; Lixi GAN ; Fanyu CHEN ; Xin LI ; Xuhua JIAN
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery 2024;31(07):991-999
Objective To analyze the short- and mid-term outcomes of patients undergoing reconstruction of intervalvular fibrous body (IVFB) via double valve replacement (Commando procedure) or aortic valve replacement and mitral valve repair (Hemi-Commando procedure). Methods The patients who underwent Commando or Hemi-Commando procedure between September 2014 and September 2022 in Guangdong Provincial People’s Hospital were collected. The perioperative and follow-up data were reviewed and analyzed for the assessment of short- and mid-term outcomes. Results Eleven patients received Commando procedure (a Commando group), including 4 males and 7 females with a median age of 61 (33, 68) years; 7 patients received Hemi-Commando procedure (a Hemi-Commando group), including 5 males and 2 females with a median age of 50 (36, 58) years. Two patients died in the postoperative 30 days (1 patient in the Commando group and 2 patients in the Hemi-commando group). Low cardiac output syndrome complicated with multiple organ dysfunction syndrome was the main cause of death. Fifteen patients were discharged and followed up for 13 (6, 42) months, with a survival rate of 100%. The rates of free from recurrent endocarditis or re-operation were both 100%. Conclusion Commando and Hemi-Commando procedures are effective strategies for IVFB reconstruction, and can achieve excellent mid-term outcomes if patients survive from the frailest period of early postoperative stage.