ΧΕΙΡΙΣΜΟΣΑΝΤΙΠΗΚΤΙΚΗΣΚΑΙ ΑΝΤΙΑΙΜΟΠΕΤΑΛΙΑΚΗΣΣΤΙΣΕΜΦΥΤΕΥΣΕΙΣ ΣΥΣΚΕΥΩΝΚΑΡΔΙΑΚΟΥΡΥΘΜΟΥ Δρ.ΠΑΝΑΓΙΩΤΗΣΚΟΡΑΝΤΖΟΠΟΥΛΟΣ ΛέκτοραςΚαρδιολογίας ΙατρικήΣχολήΠανεπιστημίουΙωαννίνων
CONTINUOUSRISEOFEPDEVICES IMPLANTATIONS AmHeartJ2008May;155(5):896\903.
Pockethematomaa#erPPM/ICDimplanta2on1\5% REPLACEregistry:3.5%andupto4.3%forleadrevision procedures(circulaeon2010;122:1553o61). Clinicallysignificantcardiacperforagonisuncommon. Muchmorecommonissilentperfora2ondetectedbyCT(silent threat) Veinperfora2oninLVleadimplanta2on(CRT) Rare complica2on
Riskfactorsforhemorrhagic complica2onsinepdeviceimplanta2on Mostimportantfactors Experienceoftheoperator LowOvolumecenters Dualan2platelettherapy Strategyofbridgingwithheparin KorantzopoulosP,etal.Europace2011;13:1669O80.
Unadjusted,pooledratesof bleedingcomplicagons Data:13studies,5978pts Forestplotofpargallogodds ragosofbleedingcomplicagons for6angcoagulantand angplateletstrategies BernardML,etal.CircArrhythm Electrophysiol.2012;5:468O474.
Otherfactorsassociatedwithhemorrhagicrisk Cephalicvssubclavianvein(cephalicveinisconsideredsafer andthebleedingcanbemoreeasilycontrolled) Typeofoperagon(upgradeprocedures/leadrevisionsare consideredhighrisk generatorreplacements/ilrplacement arelowriskprocedures) Numberofimplantedleads Increasedproceduregme KorantzopoulosP,etal.Europace2011;13:1669O80.
Otherfactorsassociatedwithhemorrhagicrisk Obesity increasedbmiisprotec2ve(abundantfat2ssue compressesbleedingsitesorsimplyhideshematoma) Prepectoral/Subpectoralpocket? Acgvefixagonleads/Temporaryleads(riskforperfora2on) Gender(conflicgngresults)? KorantzopoulosP,etal.Europace2011;13:1669O80.
Measuresforprevengonof bleedingcomplicagons Pargcularlyimportantinhighriskproceduressuchas upgradeandleadrevisionsandinopera2ons performedunderdualan2platelettherapyor con2nuingoralan2coagula2on Theseproceduresshouldbeperformedinhigh\ volumecentersbyexperiencedoperators
Cephalicveinvs.Subclavianvein Therearenosubstangaldifferencesiftheimplantagonis performedbyanexperiencedoperator ProblemforsubclavianveinistheslowOflowbleedingfrom theleadsinser2onpoint Theliga2onofcephalicveinalongwiththeleadscan rela2velyeasycontrolthebleeding
Measurestoreducebleeding inlargeveinpuncture Punctureunderfluoroscopy Punctureunder echooguidance/punctureof axillary,subclavianvein Venographytomaptheexactvein anatomybeforepuncture KorantzopoulosP,etal.Europace2011;13:1669O80.
Potengalmeasurestoreducebleeding inlargeveinpuncture Micropuncturetechnique Thesemeasuresreducetherepeatedpuncturesandinadvertent arterialpuncture Useof1punctureforbothleads(TheoreEcalvalue) KorantzopoulosP,etal.Europace2011;13:1669O80.
Electrocautery(Diathermy) ElectrocauteryhasbeenusedinmanystudiesofEPdevice implanta2onbut It svalueinpreven2ngpockethematomaisnotclear. In1study(KuEnskyIB,etal.RiskofhematomacomplicaEonsaoerdeviceimplant intheclopidogrelera.circarrhythmiaelectrophysiol2010;3:312o8) electrocauterywasnotassociatedwithdecreasedriskfor hematoma.
Otherpoten2almeasures. Wounddrainageandapplica2onofavacuumdrainage systemhaveyieldedfavorableoutcomesbuttheirwidespread usepossiblyisnotfeasibleandwidelyaccepted. Perhaps,drainagesystemsshouldbereservedforcasesof extensiveintraoopera2vebleeding. KorantzopoulosP,etal.Europace2011;13:1669O80.
Otherpoten2almeasures. Forma2onofdevicepocketpriortoimplanta2onofleadsmay allowabe[erbleedingcontrolespeciallyatintraopocketsites. Also,thetemporaryplacementofgauzesintothepocket duringtheopera2oncompressesthe2ssuesandeliminates intraopocketbleedinginmostinstances. Applica2onofsterilepressuredressingsonthewoundisalso acommonpreven2veprac2cealthoughitsidealdura2onand exacteffec2venesshasnotbeentested. KorantzopoulosP,etal.Europace2011;13:1669O80.
SEALANTS(Αιμοστατικά) Sealants(biologicalmaterialssuchasthrombin,fibrin,collagen) injectedintothepocketbeforewoundclosurethatfacilitate haemostasis Controversialprac2ce Inves2gatorshaveraisedconcerns aboutpoten2alinfec2onrisk, allergicreac2ons,costoeffec2veness
D\Stat: thrombin,collagen
ΔΙΑΧΕΙΡΙΣΗΑΝΤΙΠΗΚΤΙΚΗΣ/ΑΝΤΙΑΙΜΟΠΕΤΑΛΙΑΚΗΣΑΓΩΓΗΣ ΣΤΙΣΕΜΦΥΤΕΥΣΕΙΣΗΛΕΚΤΡΟΦΥΣΙΟΛΟΓΙΚΩΝΣΥΣΚΕΥΩΝ
ΕμφύτευσηEPDDevices Θεωρείται Minorsurgical procedure ΑΥΞΗΜΕΝΟΣΚίνδυνοςαιμορραγικώνεπιπλοκώνυπόDAP/ Heparinbridging ΚίνδυνοςΘρόμβωσηςstent Μεγαλύτεροςκίνδυνος:1 ος μήνας(bms)/τοπρώτο6μηνο \12μηνο(DES)
ΔΙΠΛΗΑΝΤΙΑΙΜΟΠΕΤΑΛΙΑΚΗΑΓΩΓΗ Βραχείαδιακοπήτηςκλοπιδογρέληςσυνεχίζοντας ασπιρίνηφαίνεταιναέχειμικρόκίνδυνοθρόμβωσης τουstent(des),τουλάχιστοόσοναφοράτηνόψιμη (late)θρόμβωση (>30μέρεςμετάτηνεμφύτευσηstent) EisenbergMJ,RichardPR,LibersanD,FilionKB. SafetyofshortOtermdiscon2nua2onofan2platelettherapyinpa2entswith drugoelu2ngstents.circula2on2009;119:1634o42. AbualsaudAO,EisenbergMJ. Periopera2vemanagementofpa2entswithdrugOelu2ngstents.JACCCardiovasc Interv2010;3:131O42. ΠΑΡΟΛΑΑΥΤΑΕΞΑΙΡΕΤΙΚΑΑΣΦΑΛΗΣΘΕΩΡΕΙΤΑΙΗBRAXEIA ΔΙΑΚΟΠΗΚΛΟΠΙΔΟΓΡΕΛΗΣ(5ΜΕΡΕΣΠΡΙΝ+2ΜΕΡΕΣΜΕΤΑ) ΜΕΤΑΤΟΝ1 Ο ΜΗΝΑΣΕBMSΉ6ΜΗΝΕΣΜΕΤΑΣΕDES
ΑΝΤΙΠΗΚΤΙΚΗΑΓΩΓΗΣΤΙΣΕΜΦΥΤΕΥΣΕΙΣ ΣΕΧΑΜΗΛΟΥΚΙΝΔΥΝΟΥΑΣΘΕΝΕΙΣ Παροδικήβραχείαδιακοπήαπότουστόματος αντιπηκτικών ΣΕΥΨΗΛΟΥΚΙΝΔΥΝΟΥΑΣΘΕΝΕΙΣ ΣυνέχισηαπότουστόματοςαντιπηκτικώνμεINR:2O2.5 ΟΧΙ«Γέφυρα»(Bridging)μεηπαρίνη
Simplifiedalgorithmforthemanagementofangthrombogctherapy inimplantagonofelectrophysiologicaldevices KorantzopoulosPetal.Europace2011;13:1669780. PublishedonbehalfoftheEuropeanSocietyofCardiology.Allrightsreserved. TheAuthor 2011.Forpermissionspleaseemail:journals.permissions@oup.com.
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