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Purpose: Endovascular procedures such as endovascular aneurysm repair or transcatheter aortic valve implantation have become very common because of reduced patient traumatisation and the ability to use shorter or local anaesthesia. In these procedures large-bore sheath devices are used. Access with percutaneous closure is an alternative method to surgical cutdown in groins. The aim of the study was to assess the correlation between sheath size and unsuccessful haemostasis. In addition, the effectiveness of haemostasis after a percutaneous procedure and the number and type of complications were evaluated. Material and methods: There were 202 patients included in the study. Patients with abdominal aortic aneurysm were qualified to percutaneous aortic stentgraft implantation with Perclose Proglide preclosure technique. Results: There were 384 access sites performed with 12F to 22F sheaths during aortic stentgraft implantation with Perclose Proglide (Abbott Vascular, Santa Clara, CA, USA) preclosure technique. High effectiveness of haemostasis (98%), low percentage of short- and mid-term complications (2.6%), and infinitesimal number of surgical conversions (n = 5) were stated in the study. There was no correlation between diameter of used introducer sheath and lack of haemostasis observed (Fisher-Freeman-Halton test; p = 0.122). No relationship between diameter of introducer sheath and number of closure devices was observed (c2 = 2.436; df = 5; p = 0.786). Conclusions: Large-bore device percutaneous procedures with closure devices are effective and safe. High effectiveness of haemostasis (98%) was observed in the study group, with a low percentage of complications (2.6%). There was no correlation between size of the vascular access and the lack of haemostasis found in the study.
RESUMEN
INTRODUCTION: Haemorrhagic complications are commonly reported in the course of acute pancreatitis (AP). The most dangerous are pseudoaneurysms secondary to wall erosion of the vessels crossing the inflammation area. AIM: To evaluate the efficacy of different embolisation techniques of pseudoaneurysms secondary to AP. MATERIAL AND METHODS: The treatment outcomes in 10 AP patients were analysed in a follow-up period of 1 to 10 months (most frequently: splenic or gastroduodenal artery aneurysms). A total of 12 endovascular procedures were performed (thrombin embolisation, coil embolisation or combined). The efficacy of aneurysm sac exclusion and the patency of the treated vessel were compared. RESULTS: The follow-up examination on postprocedural day 7 revealed aneurysm refilling in 3 out of 11 cases. Three patients showed an occlusion of the aneurysm-parent vessel. One month after the procedures, involving 10 patients, a vessel occlusion was confirmed in 3 and aneurysm sac refilling in another 2 patients. Taking into consideration the type of the procedure performed, treatment failure in the form of sac refilling was observed in half of thrombin-based procedures, 25% of coil embolisations and 33% of sandwich technique procedures. Similar failure distribution was noted for vessel occlusion. CONCLUSIONS: It seems that thrombin injection was least successful, whereas thrombin injection into the sac and implantation of coils into the aneurysm neck seems to be the optimal procedure, in respect to both the cost-effectiveness of the procedure and late outcomes.