Use of Suture-Mediated Closure Devices for Closure of Punctures in Prosthetic Patches or Grafts is Associated With High Rates of Technical Success and Low Complication Rates

Objectives Despite the increasing use of endovascular techniques in the management of peripheral vascular disease, there is little data on the safety of percutaneous closure devices in punctures of synthetic vascular material. Our paper sought to address this paucity in the literature by reviewing the incidence of complications occurring in patients in whom the ProGlide device was utilised to achieve haemostasis post-percutaneous puncture of vascular patches and graft materials. Methods A retrospective review of patient records was conducted at a tertiary referral centre. Patients who had undergone percutaneous punctures of prosthetic bypass grafts or patch angioplasties between January 2011 and December 2020 were identified from a prospectively collected database. Medical records and post-procedural imaging were reviewed to assess the occurrence of post-procedural complications such as pseudoaneurysms, puncture site stenosis and further interventions for access complications. Results A total of 73 punctures of prosthetic material were performed in 42 patients, of which 39 utilised ProGlides. Median age of included patients was 72 years. There was male predominance in the cohort (69.8%), and most punctures (87.3%) were through polyurethane patches. Device success rate was 95%, and no patients required open repair. There was a low incidence of complications, with no patients developing pseudoaneurysms, arteriovenous fistulas, ischaemic limbs or > 50% stenosis when either manual pressure or the ProGlide device was used to achieve haemostasis. Furthermore, there were no returns to theatre or further interventions performed for access site complications. Conclusion The use of the ProGlide closure device has a low incidence of complications and its safety appears to be equivalent to manual compression when used to achieve haemostasis in percutaneous punctures of synthetic vascular material in select patients. To our knowledge, this is the only article to date to assess the safety of the ProGlide in this setting.

MODERN POSSIBILITIES OF INTERVENTION RADIOLOGY IN THE TREATMENT OF ACUTE PANCREATITIS AND ITS COMPLICATIONS (literature review)

Wide use of interventional radiology methods is one of the promising trends in the improvement of the treatment of patients with severe pancreatitis. The minimally invasive interferences carried out under beam rider guidance, such as percutaneous punctures and percutaneous drainage, endovascular hemostasis and endovascular catheterization of celiac trunk, are effective at all stages of the course of severe pancreatitis, and make it possible to avoid open operational interference in 40-90 % cases and to decrease mortality up to 8-9 %. The article presents the review of national and foreign publications dealing with controversial questions of surgical tactics in sharp liquid formations of the pancreas and omental bursa, effectiveness of the use of percutaneous draining operational interference in infected pancreatic necrosis and parapancreatitis. The world experience of endovascular stoppage of major haemorrhagic complications in patients with acute and chronic inflammatory diseases of the pancreas has been summarized. Questions of the selective intra-arterial infusion of medicines in severe pancreatitis have been studied.

Method of treatment of post-necrotic cysts of pancreas

Aimed at obliteration, percutaneous punctures under control of ultrasound examination with inserting of 2—4 mg of cyclophosphan in 10—20 ml of 0,9% of NACl solution with exposure of 15 minutes were performed in 18 patients having postnecrotic cysts of pancreas. Mean size of the cysts was 12,6 mm. Obliteration of the cysts occurred in 10—14 days. Together with cytostatic action, e obliteration effect of cyclophosphan was due to its influence on exudation and proliferation processes unlike spirit and iodine. The method is more effective in non-formed cysts.