Clinical Analysis Of Vasovagal Reflex Related To Interventional Diagnosis And Treatment Of Peripheral Artery Diseases

Objective:To investigate the incidence rate,mechanism,risk factors and preventive measures of vasovagal reflex(VVR)associated with interventional diagnosis and treatment in patients with peripheral arterial disease(PAD).Method:A retrospective analysis of clinical data of 487 PAD patients with interventional diagnosis and treatment admitted to the Department of Lymphatic and Vascular Surgery,China-Japan Union Hospital of Jilin University from October 2016 to October 2018,24 patients had VVR.Patients with VVR were considered as the occurrence group,while 463 patients without VVR were naturally in the control group.The puncture site is divided into the femoral artery and the iliac artery.The hemostasis mode is divided into direct compression,suturing under direct vision in small incision and the suture with arterial suture device.By analyzing the occurrence time of VVR,the incidence of VVR in different puncture sites and different hemostasis methods was compared,and the possible mechanisms,risk factors and preventive measure of VVR were summarized.Results:In addition to one of the 24 patients who died without successful rescue,the other 23 patients were rescued successfully and had a good prognosis.All patients were given routine treatment to improve circulation and alleviate symptoms,and double antiplatelet drugs were taken.Some patients were treated with short-term anticoagulation according to their condition.There were no significant differences in age,sex,hypertension,diabetes,hyperlipidemia,coronary heart disease,smoking history,ankle brachial index(ABI)between the two groups(P > 0.05).VVR occurred at different times: 13 cases(54.17%)occurred during extubation and compression hemostasis after operation;4 cases(16.67%)occurred during balloon dilatation of target vessels during operation;3 cases(12.50%)occurred during suturing with vascular suture device;2 cases(8.33%)occurred during arterial puncture;1 case(4.17%)occurred after self-activity of the indwelling femoral artery sheath;1 case(4.17%)occurred during the suturing of femoral artery under direct vision in small incision.VVR occurred in 22 of 351 femoral artery puncture patients(6.27%)and 2 of 136 brachial artery puncture patients(1.65%).The difference was statistically significant(P < 0.05).Among 351 femoral artery puncture patients,11 of 61 patients with direct compression hemostasis had VVR(18.03%),1 of 204 patients with the suturing of femoral artery under direct vision in small incision had VVR(0.49%).There was significant difference between the two groups(P < 0.05).Among 351 femoral artery puncture patients,3 of 86 patients sutured with vascular suture device had VVR(3.49%).Compared with direct compression of femoral artery,there was significant difference between the two groups(P < 0.05).There was no significant difference in in femoral artery suture between suturing of femoral artery under direct vision in small incision and arterial suture device(P > 0.05).Conclusion:VVR usually occurs in the process of sheath removal and compression hemostasis;femoral artery puncture has a higher incidence of VVR than brachial artery puncture;suture with arterial suture device and suturing of femoral artery under direct vision in small incision after femoral artery puncture can significantly reduce the incidence of VVR compared with direct compression hemostasis.Strict selection of puncture site and hemostasis according to the indication and patient's condition,reducing unnecessary operation in interventional diagnosis and treatment,and paying more attention to perioperative management and psychological nursing of patients,are important measures to prevent VVR.