[Reduction of puncture-induced complications after heart catheterization by optimized compression technique despite reduced compression time. A prospective, duplex ultrasound and pressure controlled study]. / Reduktion der punktionsbedingten Komplikationen nach Herzkatheterismus mittels optimierter Kompressionstechnik trotz Verkürzung der Kompressionsbehandlung. Eine prospektive, duplexsonographisch und druckkontrollierte Studie.

The number of local complications after heart catheterization by transfemoral approach can be lowered by optimized compression technique in spite of shortened compression time. It requires a long-term (> 30 minutes) acute compression after removing the sheaths and stable pressure during the following compression period. To achieve this issue the deployment of a novel compression device is superior to the combination of manual compression and conventional pressure dressing. A pressure of 40 to 45 mmHg is sufficient and well tolerated. Local complications as pseudoaneurysms and arteriovenous fistulas are detected by duplexsonography with high sensitivity. Only about 50 percent of pseudoaneurysms are identified by physical examination in contrast to arteriovenous fistulas which are rarely missed because of their characteristic murmur. The early ultrasound-guided compression therapy is considered to be a safe treatment of pseudoaneurysms but is not effective in arteriovenous fistulas. Risk factors of local complications are high blood pressure, multiple arterial puncture and local-anatomical conditions. Compression-related factors are short acute compression (phi 14.3 minutes) and loss of pressure during the following compression period.

[Duplex ultrasound control of the effectiveness of a newly developed combined pressure clamp for acute and long-term pressure dressings of the femoral artery and vein after heart catheterization]. / Duplexsonographische Effektivitätskontrolle einer neuentwickelten Kombination aus Druckpresse zur Akutkompression und Dauerkompressionsverband von A. and V. fermoralis nach Herzkatheterismus.

After transfemoral angiography the artery has to be manually compressed in order to stop acute bleeding. Then, to prevent retarded bleeding, a continuous pressure dressing has to be fixed for up to 24 h. To simplify this procedure, we developed a novel compression device and tested it in 133 patients. Color-flow-ultra-sonography was used to scan gross alterations such as hematomas, AV-fistulas or pseudoaneurysms, and changes in tissue consistency as well. By the new device it is possible to perform femoral artery compression and to substitute pressure dressing safely and with significantly less expenditure than by the combination of manual compression and pressure dressing. We found a reduction from 18 to 3 min time requirement for primary sealing of the puncture site. Moreover, 86% of patients experienced in both methods--the conventional and the new device--would prefer the new equipment in recatheterization. It is better tolerated than the combination of pressure dressing and manual compression. The device is reusable and the compression is easily and exactly adjustable in a wide pressure range. In comparison with previously described mechanical compression systems the remarkable advantage of our device is to merge the function of compression for sealing of the puncture site and pressure dressing for prevention of retarded bleeding.