51
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Kintis K, Patsilinakos S, Koutouzis M, Kasiakogias A, Nikolaou N, Andrikou I, Tsioufis C. Successful left transradial coronary angiography in an elderly patient with dextrocardia and severe aortic stenosis. Hellenic J Cardiol 2017; 58:436-438. [PMID: 28529182 DOI: 10.1016/j.hjc.2017.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Revised: 05/03/2017] [Accepted: 05/11/2017] [Indexed: 11/18/2022] Open
Affiliation(s)
| | | | - Michael Koutouzis
- Second Cardiology Department, Red Cross General Hospital, Athens, Greece
| | | | - Nikolaos Nikolaou
- Department of Cardiology, Konstantopoulio General Hospital, Athens, Greece
| | - Ioannis Andrikou
- First Cardiology Clinic, University of Athens, Hippokration Hospital, Athens, Greece
| | - Costas Tsioufis
- First Cardiology Clinic, University of Athens, Hippokration Hospital, Athens, Greece
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52
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Shammas NW, Shammas GA, Jones-Miller S, Gumpert MR, Gumpert MJ, Harb C, Chammas MZ, Shammas WJ, Khalafallah RA, Barzgari A, Bou Dargham B, Daher GE, Rachwan RJ, Shammas AN. Predictors of common femoral artery access site complications in patients on oral anticoagulants and undergoing a coronary procedure. Ther Clin Risk Manag 2017; 13:401-406. [PMID: 28408835 PMCID: PMC5384737 DOI: 10.2147/tcrm.s130624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background It is unclear whether patients on oral anticoagulants (OAC) undergoing a procedure using common femoral artery access have higher adverse events when compared to patients who are not anticoagulated at the time of the procedure. Methods We retrospectively reviewed data from consecutive patients who underwent a cardiac procedure at a tertiary medical center. Patients were considered (group A) fully or partially anticoagulated if they had an international normalized ratio (INR) ≥1.6 on the day of the procedure or were on warfarin or new OAC within 48 h and 24 h of the procedure, respectively. The nonanticoagulated group (group B) had an INR <1.6 or had stopped their warfarin and new OAC >48 h and >24 h preprocedure, respectively. The index primary end point of the study was defined as the composite end point of major bleeding, vascular complications, or cardiovascular-related death during index hospitalization. The 30-day primary end point was defined as the occurrence of the index primary end point and up to 30 days postprocedure. Results A total of 779 patients were included in this study. Of these patients, 27 (3.5%) patients were in group A. The index primary end point was met in 11/779 (1.4%) patients. The 30-day primary composite end point was met in 18/779 (2.3%) patients. There was no difference in the primary end point at index between group A (1/27 [3.7%]) and group B (10/752 [1.3%]; P=0.3155) and no difference in the 30-day primary composite end point between group A (2/27 [7.4%]) and group B (16/752 [2.1%]; P=0.1313). Multivariable analysis showed that a low creatinine clearance (odds ratio [OR] =0.56; P=0.0200) and underweight patients (<60 kg; OR =3.94; P=0.0300) were independent predictors of the 30-day primary composite end point but not oral anticoagulation (P=0.1500). Conclusion Patients on OAC did not have higher 30-day major adverse events than those who were not anticoagulated at index procedure.
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Affiliation(s)
- Nicolas W Shammas
- Midwest Cardiovascular Research Foundation.,Cardiology Division, Genesis Heart Institute, Davenport, IA, USA
| | | | - Susan Jones-Miller
- Midwest Cardiovascular Research Foundation.,Cardiology Division, Genesis Heart Institute, Davenport, IA, USA
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53
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Pruski MJ, Blachut AM, Konkolewska M, Janas A, Hrycek E, Buszman PP, Kiesz RS. MynxGrip for Closure of Antegrade Puncture After Peripheral Interventions With Same-Day Discharge. Vasc Endovascular Surg 2017; 51:67-71. [DOI: 10.1177/1538574416689424] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: This was the first prospective study to assess the safety and efficiency of MynxGrip vascular closure device (VCD) in peripheral interventions with antegrade access. Methods and Results: We enrolled 66 consecutive patients from 1 center. All patients were discharged home on the day of procedure and were observed for adverse events at 1 and 30 days of follow-up. No major complications were observed. The rate of minor complications (conversion to manual or mechanical compression) was 7.6%. Postdischarge, 3% of patients experienced minor complications—small abscess, ipsilateral deep vein thrombosis. In 1 patient, a second VCD was deployed after device failure. The derived device failure rate was 5.9%. No patients required hospitalization. No late bleeding and no hematomas >6 cm were noted. The mean time to discharge was 4 hours and 5 minutes. Conclusion: The MynxGrip was safe and effective in sealing access sites after antegrade femoral artery puncture with same-day discharge.
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Affiliation(s)
- Maciej J. Pruski
- Center for Cardiovascular Research and Development, American Heart of Poland S.A., Katowice, Poland
| | - Aleksandra M. Blachut
- Center for Cardiovascular Research and Development, American Heart of Poland S.A., Katowice, Poland
| | - Magda Konkolewska
- Center for Cardiovascular Research and Development, American Heart of Poland S.A., Katowice, Poland
| | - Adam Janas
- Center for Cardiovascular Research and Development, American Heart of Poland S.A., Katowice, Poland
| | - Eugeniusz Hrycek
- Center for Cardiovascular Research and Development, American Heart of Poland S.A., Katowice, Poland
| | - Piotr P. Buszman
- Center for Cardiovascular Research and Development, American Heart of Poland S.A., Katowice, Poland
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54
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Kurisu K, Osanai T, Kazumata K, Nakayama N, Abumiya T, Shichinohe H, Shimoda Y, Houkin K. Ultrasound-guided Femoral Artery Access for Minimally Invasive Neuro-intervention and Risk Factors for Access Site Hematoma. Neurol Med Chir (Tokyo) 2016; 56:745-752. [PMID: 27194178 PMCID: PMC5221772 DOI: 10.2176/nmc.oa.2016-0026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Although ultrasound (US) guidance for venous access is becoming the “standard of care” for preventing access site complications, its feasibility for arterial access has not been fully investigated, especially in the neuro-interventional population. We conducted the first prospective cohort study on US-guided femoral artery access during neuro-interventional procedure. This study included 64 consecutive patients who underwent US-guided femoral artery access through 66 arterial access sites for diagnostic and/or neuro-interventional purposes. The number of attempts required for both the sheath insertion and the success of anterior wall puncture were recorded. In addition, the occurrence of major complications and hematoma formation on the arterial access site examined by US were statistically analyzed. The median number of attempts was 1 (1–2) and first-pass success rate was 63.6%. Anterior wall puncture was achieved in 98.5%. In one case (1.5%), a pseudoaneurysm was observed. In all cases, US clearly depicted a common femoral artery (CFA) and its bifurcation. Post-procedural hematoma was detected in 13 cases (19.7%), most of which were “tiny” or “moderate” in size. Low body mass index and antiplatelet therapy were the independent risk factors for access site hematoma. The US-guided CFA access was feasible even in neuro-interventional procedure. The method was particularly helpful in the patients with un-palpable pulsation of femoral arteries. To prevent arterial access site hematoma, special care should be taken in patients with low body mass index and who are on antiplatelet therapy.
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Affiliation(s)
- Kota Kurisu
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine
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55
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Feldman T, Sarraf M. The Essentials of Femoral Vascular Access and Closure. Interv Cardiol 2016. [DOI: 10.1002/9781118983652.ch2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Ted Feldman
- NorthShore University HealthSystem; Evanston IL USA
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56
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Seto AH, Tyler J, Suh WM, Harrison AT, Vera JA, Zacharias SJ, Daly TS, Sparling JM, Patel PM, Kern MJ, Abu-Fadel M. Defining the common femoral artery: Insights from the femoral arterial access with ultrasound trial. Catheter Cardiovasc Interv 2016; 89:1185-1192. [PMID: 27566991 DOI: 10.1002/ccd.26727] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 05/16/2016] [Accepted: 08/01/2016] [Indexed: 11/06/2022]
Abstract
OBJECTIVE We sought to establish the typical location of the common femoral artery (CFA) bifurcation, the origin and most inferior reflection of the inferior epigastric artery (IEA) relative to the femoral head (FH) and whether patient demographics predicted anatomical variations. BACKGROUND In the absence of ultrasound guidance or prior imaging, the precise location of the CFA bifurcation and IEA can only be determined following access site angiography. Fluoroscopic landmarks are commonly used to estimate the location of the CFA bifurcation, but the position of the IEA is less well characterized. METHODS Prospectively collected data on 989 patients with femoral angiography in the FAUST trial were analyzed. The level of CFA bifurcation and the origin and most inferior reflection of the IEA were classified by angiography. Logistic regression was used to explore whether baseline demographics were associated with anatomic variations. RESULTS The CFA bifurcation occurs below the middle 1/3rd of the femoral head in 95% of patients, and no patient factors are predictive of a high bifurcation. The IEA origin has a more variable anatomically pattern, with high BSA, male gender, and white race associated with a low IEA origin. CONCLUSION Operators should attempt to access the CFA at the level of the middle 1/3rd of the FH to maximize the chance of CFA cannulation. However, this location carries an 11% risk of being at or above the IEA origin. Baseline demographics were of limited utility for predicting anatomic variants of the CFA bifurcation and the course of the IEA. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Arnold H Seto
- Department of Medicine, Veterans Affairs Long Beach Health Care System, Long Beach, California.,Department of Medicine, University of Califonia, Irvine Medical Center, Orange, California
| | - Jeffrey Tyler
- Department of Medicine, University of California, San Francisco Medical Center, San Francisco, California
| | - William M Suh
- Department of Medicine, University of California, Los Angeles Medical Center, Los Angeles, California
| | | | - Jesus A Vera
- Cardiothoracic Department, St Jude Medical Center, Fullerton, California
| | | | - Timothy S Daly
- Department of Cardiology, INTEGRIS Heart Hospital, Oklahoma City, Oklahoma
| | - Jeffrey M Sparling
- Department of Cardiology, INTEGRIS Heart Hospital, Oklahoma City, Oklahoma
| | - Pranav M Patel
- Department of Medicine, University of Califonia, Irvine Medical Center, Orange, California
| | - Morton J Kern
- Department of Medicine, Veterans Affairs Long Beach Health Care System, Long Beach, California.,Department of Medicine, University of Califonia, Irvine Medical Center, Orange, California
| | - Mazen Abu-Fadel
- Department of Medicine, Cardiovascular section, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
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58
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Perrin N, Ellenberger C, Licker M, Hachulla AL, Cikirikcioglu M, Frei A, Roffi M, Noble S. Management of vascular complications following transcatheter aortic valve implantation. Arch Cardiovasc Dis 2016; 108:491-501. [PMID: 26073229 DOI: 10.1016/j.acvd.2015.03.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Revised: 03/13/2015] [Accepted: 03/19/2015] [Indexed: 01/04/2023]
Abstract
BACKGROUND Vascular complications (VCs) after transcatheter aortic valve implantation (TAVI) are frequent and their management is challenging. AIM To report the incidence, predictors and management of VCs following percutaneous transfemoral TAVI (TF-TAVI) at a single centre. METHODS We analyzed 102 consecutive patients who underwent percutaneous TF-TAVI between August 2008 and December 2013. All endpoints were evaluated at 30 days and 6 months according to Valve Academic Research Consortium-2 criteria. VC percutaneous treatment success was defined as residual stenosis<30%, absence of blood extravasation and absence of surgical or repeat endovascular intervention at 30 days. RESULTS Twenty-two patients (22%) experienced VCs, including five patients (5%) with major VCs. Mortality at 30 days was significantly higher in patients with major VCs than in patients without major VCs (60% vs 3%; P=0.001). Patients with VCs had more life-threatening or major bleeding (23% vs 5%; P=0.02), but no difference in terms of need for blood transfusion was observed. Endovascular treatment was used in 13 of 22 patients with VCs (59%) and was successful in 11 of these 13 patients (85%). Primary surgical repair was necessary in only 1/22 (5%) patients, for a common femoral artery pseudoaneurysm 2 weeks after the TAVI procedure. CONCLUSIONS VCs following TF-TAVI are frequent. Major but not minor VCs are associated with increased mortality. Percutaneous management of VCs is feasible and safe, and surgery is rarely needed.
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Affiliation(s)
- Nils Perrin
- Cardiology Division, University Hospital of Geneva, 4, rue Gabrielle-Perret-Gentil, 1211 Geneva 14, Switzerland.
| | | | - Marc Licker
- Anaesthesiology Department, University Hospital of Geneva, Geneva, Switzerland
| | - Anne-Lise Hachulla
- Radiology Department, University Hospital of Geneva, Geneva, Switzerland
| | | | - Angela Frei
- Cardiology Division, University Hospital of Geneva, 4, rue Gabrielle-Perret-Gentil, 1211 Geneva 14, Switzerland
| | - Marco Roffi
- Cardiology Division, University Hospital of Geneva, 4, rue Gabrielle-Perret-Gentil, 1211 Geneva 14, Switzerland
| | - Stéphane Noble
- Cardiology Division, University Hospital of Geneva, 4, rue Gabrielle-Perret-Gentil, 1211 Geneva 14, Switzerland
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59
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The Fuzzy Math of Anticoagulation and Access Site. JACC Cardiovasc Interv 2016; 9:1532-4. [DOI: 10.1016/j.jcin.2016.06.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Accepted: 06/16/2016] [Indexed: 11/20/2022]
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60
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Azzalini L, Jolicœur EM. The wise radialist's guide to optimal transfemoral access: Selection, performance, and troubleshooting. Catheter Cardiovasc Interv 2016; 89:399-407. [DOI: 10.1002/ccd.26577] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 04/22/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Lorenzo Azzalini
- Interventional Cardiology; San Raffaele Scientific Institute; Milan Italy
| | - E. Marc Jolicœur
- Dept. of Medicine; Montreal Heart Institute, Université de Montréal; Québec Canada
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61
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D'Ovidio C, Sablone S, Carnevale A. Death Due to an Unusual Angio-Seal-Related Complication: Case Report and Literature Review. J Forensic Sci 2016; 61:1364-8. [PMID: 27166882 DOI: 10.1111/1556-4029.13112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 10/30/2015] [Accepted: 11/08/2015] [Indexed: 11/28/2022]
Abstract
Angio-SealTM is a vascular closure device (VCD) that can be applied to the femoral artery following cardiac catheterization to achieve hemostasis. Although it has been demonstrated to be superior to conventional manual pressure and to reduce time to hemostasis and patient ambulation, the use of this VCD is not without its complications. In this report, we describe the case of a 55-year-old man who died due to an extremely rare event that occurred several hours after the deployment of an Angio-SealTM VCD: acute complete transverse laceration of the femoral artery that occurred because of the particular fragility of the vessel due to an unrecognized and asymptomatic arteriosclerotic disease. Few data are available in the literature about the incidence of such events, and much more remains to be done to determine how to prevent and manage its occurrence.
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Affiliation(s)
- Cristian D'Ovidio
- Section of Legal Medicine, Department of Medicine and Aging Sciences, 'G. d'Annunzio' University of Chieti-Pescara, Via dei Vestini, 31, Chieti, 66100, Italy.
| | - Sara Sablone
- Section of Legal Medicine, Department of Medicine and Aging Sciences, 'G. d'Annunzio' University of Chieti-Pescara, Via dei Vestini, 31, Chieti, 66100, Italy
| | - Aldo Carnevale
- Section of Legal Medicine, Department of Medicine and Aging Sciences, 'G. d'Annunzio' University of Chieti-Pescara, Via dei Vestini, 31, Chieti, 66100, Italy
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62
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Vascular access in critical limb ischemia. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2016; 17:190-8. [DOI: 10.1016/j.carrev.2016.02.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 02/04/2016] [Indexed: 11/22/2022]
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Iliescu CA, Grines CL, Herrmann J, Yang EH, Cilingiroglu M, Charitakis K, Hakeem A, Toutouzas KP, Leesar MA, Marmagkiolis K. SCAI Expert consensus statement: Evaluation, management, and special considerations of cardio-oncology patients in the cardiac catheterization laboratory (endorsed by the cardiological society of india, and sociedad Latino Americana de Cardiologıa intervencionista). Catheter Cardiovasc Interv 2016; 87:E202-23. [PMID: 26756277 DOI: 10.1002/ccd.26379] [Citation(s) in RCA: 127] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 11/28/2015] [Indexed: 12/24/2022]
Abstract
In the United States alone, there are currently approximately 14.5 million cancer survivors, and this number is expected to increase to 20 million by 2020. Cancer therapies can cause significant injury to the vasculature, resulting in angina, acute coronary syndromes (ACS), stroke, critical limb ischemia, arrhythmias, and heart failure, independently from the direct myocardial or pericardial damage from the malignancy itself. Consequently, the need for invasive evaluation and management in the cardiac catheterization laboratory (CCL) for such patients has been increasing. In recognition of the need for a document on special considerations for cancer patients in the CCL, the Society for Cardiovascular Angiography and Interventions (SCAI) commissioned a consensus group to provide recommendations based on the published medical literature and on the expertise of operators with accumulated experience in the cardiac catheterization of cancer patients.
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Affiliation(s)
- Cezar A Iliescu
- MD Anderson Cancer Center, University of Texas, Houston, Texas
| | - Cindy L Grines
- Detroit Medical Center, Cardiovascular Institute, Detroit, Michigan
| | - Joerg Herrmann
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Eric H Yang
- Division of Cardiology, University of California at Los Angeles, Los Angeles, California
| | - Mehmet Cilingiroglu
- School of Medicine, Arkansas Heart Hospital, Little Rock, Arkansas.,Department of Cardiology, Koc University, Istanbul, Turkey
| | | | - Abdul Hakeem
- Department of Cardiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | | | - Massoud A Leesar
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama
| | - Konstantinos Marmagkiolis
- Department of Cardiology, Citizens Memorial Hospital, Bolivar, Missouri.,Department of Medicine, University of Missouri, Columbia, Missouri
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64
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Mogi S, Maekawa Y, Fukuda K, Noma S. Retroperitoneal Bleeding and Arteriovenous Fistula after Percutaneous Coronary Intervention Successfully Treated with Intravascular Ultrasound-guided Covered Stent Implantation. Intern Med 2016; 55:1467-9. [PMID: 27250054 DOI: 10.2169/internalmedicine.55.6134] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The major puncture-site complications of the transfemoral approach are retroperitoneal bleeding (RPB), arteriovenous (AV) fistula, and arterial pseudoaneurysm. Although the management of RPB and AV fistula depends on individual cases, our experience shows that the use of a covered stent with intravascular ultrasound (IVUS) guidance can successfully manage percutaneous coronary intervention-associated RPB and AV fistula. IVUS guidance can therefore make it easy to use an optimal-size covered stent.
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Affiliation(s)
- Satoshi Mogi
- Department of Cardiology, Saisekai Utsunomiya Hospital, Japan
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66
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Behnes M, Ünsal M, Hoffmann U, Fastner C, El-Battrawy I, Lang S, Mashayekhi K, Lehmann R, Borggrefe M, Akin I. Design and Rationale of the Femoral Closure versus Radial Compression Devices Related to Percutaneous Coronary Interventions (FERARI) Study. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2015; 9:97-103. [PMID: 26568686 PMCID: PMC4635979 DOI: 10.4137/cmc.s31932] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 08/23/2015] [Accepted: 08/25/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Bleeding events after percutaneous coronary interventions (PCI) are associated with patients’ age, gender, and the presence of chronic kidney disease, antithrombotic treatment, as well as arterial access site. Patients being treated by PCI using radial access site are associated with an improved prognosis. However, the safety of femoral closure devices has never been compared to radial compression devices following PCI. Therefore, the aim of this study is to evaluate the safety of femoral closure compared to radial compression devices in patients treated by PCI envisaging access site bleedings as well as short- and long-term prognostic outcomes. METHODS The Femoral Closure versus Radial Compression Devices Related to Percutaneous Coronary Interventions (FERARI) study is a single-center observational study comparing 400 consecutive patients undergoing PCI either using radial compression devices (TR Band™) or femoral closure devices (Angio-Seal™) at the corresponding access site. The primary outcome consists of the occurrence of vascular complications at the arterial access site, including major bleedings as defined by common classification systems. Secondary outcomes consist of the occurrence of adverse cardiac events, including all-cause mortality, target lesion revascularization, and target vessel revascularization during 30 days and 12 months of follow-up. RESULTS Study enrollment was initiated in February 2014. The enrollment phase is expected to last until May 2015. CONCLUSIONS The FERARI study intends to comparatively evaluate the safety and prognostic outcome of patients being treated by radial or femoral arterial closure devices following PCI during daily clinical practice.
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Affiliation(s)
- Michael Behnes
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany
| | - Melike Ünsal
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany
| | - Ursula Hoffmann
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany
| | - Christian Fastner
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany
| | - Ibrahim El-Battrawy
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany
| | - Siegfried Lang
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany
| | - Kambis Mashayekhi
- Internal Medicine Clinic II, Helios Vogtland Klinikum Plauen, Academic Teaching Hospital of Leipzig University, Plauen, Germany
| | - Ralf Lehmann
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany
| | - Martin Borggrefe
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany
| | - Ibrahim Akin
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany
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Ge BH, Copelan A, Scola D, Watts MM. Iatrogenic percutaneous vascular injuries: clinical presentation, imaging, and management. Semin Intervent Radiol 2015; 32:108-22. [PMID: 26038619 DOI: 10.1055/s-0035-1549375] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Vascular interventional radiology procedures are relatively safe compared with analogous surgical procedures, with overall major complication rates of less than 1%. However, major vascular injuries resulting from these procedures may lead to significant morbidity and mortality. This review will discuss the etiology, clinical presentation, diagnosis, and management of vascular complications related to percutaneous vascular interventions. Early recognition of these complications and familiarity with treatment options are essential skills for the interventional radiologist.
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Affiliation(s)
- Benjamin H Ge
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alexander Copelan
- Department of Radiology, William Beaumont Hospital, Royal Oak, Michigan
| | - Dominic Scola
- Department of Radiology, William Beaumont Hospital, Royal Oak, Michigan
| | - Micah M Watts
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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Abstract
The hybrid algorithim approach, together with innovative new technologies, has lead to increased interest in chronic total occlusion (CTO) percutaneous coronary intervention (PCI) and increasing procedural success rates. Unlike non-CTO PCI, there is an increased rate of femoral access. When considering arterial access in CTO PCI, a balance is needed between anticipated procedural difficulty, planned CTO strategy and the desire to minimise the risk of vascular access-related complications. We review the evidence for best practice with respect to femoral puncture technique and also assess the technologies and techniques available to place larger inner diameter catheters into the radial artery.
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Affiliation(s)
- David Smith
- Regional Cardiac Centre, Morriston Hospital, Swansea, UK
| | - Ahmed Hailan
- Regional Cardiac Centre, Morriston Hospital, Swansea, UK
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70
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Abstract
Common femoral artery (CFA) access is an important step of many vascular interventional procedures such as peripheral arterial, aortic, and endovascular oncologic interventions. The anatomical location of the CFA as it crosses over the femoral head provides a unique location to establish a relatively large arterial access to a vessel that is conveniently located near the aorta and its major branches. A proper access helps the interventionist with the remainder of the procedure and diminishes the risk of severe complications leading to surgery, thrombolysis, patient morbidity, or occasionally mortality. On the contrary, a suboptimal access can jeopardize the entire procedure and may lead to limb and life-threatening complications. With the introduction of ultrasonography-assisted CFA access, the process has become more predictable and possibly less adventurous; however, there remain tips and tricks that can guarantee a safe and proper start for any arterial procedure. We review the preprocedural evaluation, procedural techniques, and postprocedural care to optimize CFA access.
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Affiliation(s)
- Hamid Rajebi
- Department of Diagnostic Radiology, Upstate Medical University, Syracuse, NY.
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Abstract
There are an estimated 1.6 million traumatic injuries to vascular structures encountered every year at trauma centers across the country. The diagnosis and treatment of these injuries has been constantly evolving over the last 50 years. The advent of endovascular techniques, which were initially trialed and evaluated in the setting of atherosclerotic diseases, has revolutionized the way these injuries are managed. Certain injuries, such as blunt thoracic aortic injuries, are now almost exclusively treated via endovascular methods. In recent years, there has been a tremendous interest in applying endovascular technology to the treatment of vascular injuries in virtually every location in the body. With the expanded use of endovascular methods, complications have also been noted and are important for the trauma practitioner to be familiar with and identify. Herein, we will discuss the beginnings of endovascular techniques, its application, and complications.
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Affiliation(s)
- Khanjan H Nagarsheth
- R Adams Cowley Shock Trauma Center, University of Maryland Medical System, Baltimore, MD, USA
| | - Joseph J DuBose
- R Adams Cowley Shock Trauma Center, University of Maryland Medical System, Baltimore, MD, USA
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72
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Yun SJ, Nam DH, Ryu JK. Femoral Artery Access Using the US-Determined Inguinal Ligament and Femoral Head as Reliable Landmarks: Prospective Study of Usefulness and Safety. J Vasc Interv Radiol 2015; 26:552-9. [DOI: 10.1016/j.jvir.2014.12.613] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2014] [Revised: 12/17/2014] [Accepted: 12/22/2014] [Indexed: 10/23/2022] Open
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73
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Arevalos CA, Nathan J, Razavi M. Use of a functionalized introducer sheath and bioimpedance spectroscopy for real-time detection of vascular access complications. J Med Eng Technol 2015; 39:191-7. [DOI: 10.3109/03091902.2015.1019650] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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74
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Kim M, Chu A, Khan Y, Malik S. Predicting and preventing vascular complications following percutaneous coronary intervention in women. Expert Rev Cardiovasc Ther 2015; 13:163-72. [PMID: 25553577 DOI: 10.1586/14779072.2015.995635] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The development of vascular complications is associated with increased morbidity and mortality in patients undergoing percutaneous coronary intervention. While the incidence of percutaneous coronary intervention-related vascular complications has greatly improved over time, female sex still persists as a significant and independent predictor of periprocedural vascular complications, which in turn is associated with a greater risk of short- and long-term mortality. This review provides a contemporary overview of the data on the important issues regarding the risk of percutaneous coronary intervention in women. It examines the intrinsic sex-related factors that may be contributing to women's heightened bleeding risk while also examining the various pharmacologic and procedural bleeding avoidance strategies currently in the literature, with a focus on their potential role and benefit in women specifically.
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Affiliation(s)
- Melvie Kim
- University of California, Irvine, CA, USA
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75
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Barbetta I, van den Berg JC. Access and hemostasis: femoral and popliteal approaches and closure devices-why, what, when, and how? Semin Intervent Radiol 2014; 31:353-60. [PMID: 25435661 DOI: 10.1055/s-0034-1393972] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This article reviews the arterial access sites used in the treatment of peripheral arterial disease, including common femoral, superficial femoral, and popliteal arterial puncture. The optimal approach and techniques for arterial puncture will be described and technical tips and tricks will be discussed. An overview of the currently available vascular closure devices will also be presented. Indications, contraindications, and complications will be discussed. Results of the use of vascular closure devices compared with manual compression will be presented.
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Affiliation(s)
- Iacopo Barbetta
- Service of Interventional Radiology, Ospedale Regionale di Lugano, Lugano, Switzerland
| | - Jos C van den Berg
- Service of Interventional Radiology, Ospedale Regionale di Lugano, Lugano, Switzerland
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76
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Ahn HY, Lee HJ, Lee HJ, Yang JH, Yi JS, Lee IW. Assessment of the optimal site of femoral artery puncture and angiographic anatomical study of the common femoral artery. J Korean Neurosurg Soc 2014; 56:91-7. [PMID: 25328644 PMCID: PMC4200372 DOI: 10.3340/jkns.2014.56.2.91] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 05/05/2014] [Accepted: 08/16/2014] [Indexed: 11/29/2022] Open
Abstract
Objective The purpose of this study was to evaluate demographic and clinical factors affecting the common femoral artery diameter and length, and anatomical relationship between the femoral head and the common femoral artery during angiography. Methods We retrospectively reviewed 109 femoral angiograms. We collected the clinical data of the patients and estimated the common femoral artery diameter and length. We divided the areas in the angiogram from cephalic to caudal direction (zone 0 to 5). The lowest levels of the inferior epigastric artery loop and points of the common femoral artery bifurcation were checked. Results The luminal diameter of the common femoral artery was 6.19±1.20 mm. Height, weight, body surface area, as well as common femoral artery diameter were significantly greater in men than in women (p<0.005). The length of the common femoral artery was 27.59±8.87 mm. Height, weight and body surface area showed strong positive relationships with common femoral artery diameter. All of the inferior epigastric artery loops were located above the center of the femoral head. The point of common femoral artery bifurcation was above the center of the femoral head in 4.59% of femoral angiograms. Conclusions Males and patients with a high body surface area have a larger common femoral artery diameter. The cumulative probability of optimal targeting between the lowest margin of the inferior epigastric artery loop and the common femoral artery bifurcation is the highest in zone 3 puncture.
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Affiliation(s)
- Ho-Young Ahn
- Department of Neurosurgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
| | - Hyung-Jin Lee
- Department of Neurosurgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
| | - Hong-Jae Lee
- Department of Neurosurgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
| | - Ji-Ho Yang
- Department of Neurosurgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
| | - Jin-Seok Yi
- Department of Neurosurgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
| | - Il-Woo Lee
- Department of Neurosurgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
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77
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Pradhan A, Abbott JD. Improvements in transfemoral catheterization access techniques. Cardiology 2014; 129:36-8. [PMID: 25012629 DOI: 10.1159/000362924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 04/17/2014] [Indexed: 11/19/2022]
Affiliation(s)
- Anay Pradhan
- Division of Cardiology, Rhode Island Hospital, Brown Medical School, Providence, R.I., USA
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78
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Affiliation(s)
- Amy E. Burchell
- From the CardioNomics Research Group, Clinical Research & Imaging Centre-Bristol, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust (A.E.B., J.F.R.P.) and School of Clinical Sciences (A.E.B.), University of Bristol, UK; William Harvey Heart Centre, NIHR Cardiovascular Biomedical Research Unit, Centre for Clinical Pharmacology, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, UK (M.D.L.); Barts Hypertension Clinic, Department of
| | - Melvin D. Lobo
- From the CardioNomics Research Group, Clinical Research & Imaging Centre-Bristol, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust (A.E.B., J.F.R.P.) and School of Clinical Sciences (A.E.B.), University of Bristol, UK; William Harvey Heart Centre, NIHR Cardiovascular Biomedical Research Unit, Centre for Clinical Pharmacology, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, UK (M.D.L.); Barts Hypertension Clinic, Department of
| | - Neil Sulke
- From the CardioNomics Research Group, Clinical Research & Imaging Centre-Bristol, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust (A.E.B., J.F.R.P.) and School of Clinical Sciences (A.E.B.), University of Bristol, UK; William Harvey Heart Centre, NIHR Cardiovascular Biomedical Research Unit, Centre for Clinical Pharmacology, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, UK (M.D.L.); Barts Hypertension Clinic, Department of
| | - Paul A. Sobotka
- From the CardioNomics Research Group, Clinical Research & Imaging Centre-Bristol, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust (A.E.B., J.F.R.P.) and School of Clinical Sciences (A.E.B.), University of Bristol, UK; William Harvey Heart Centre, NIHR Cardiovascular Biomedical Research Unit, Centre for Clinical Pharmacology, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, UK (M.D.L.); Barts Hypertension Clinic, Department of
| | - Julian F.R. Paton
- From the CardioNomics Research Group, Clinical Research & Imaging Centre-Bristol, Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust (A.E.B., J.F.R.P.) and School of Clinical Sciences (A.E.B.), University of Bristol, UK; William Harvey Heart Centre, NIHR Cardiovascular Biomedical Research Unit, Centre for Clinical Pharmacology, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, UK (M.D.L.); Barts Hypertension Clinic, Department of
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79
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Rao SV, McCoy LA, Spertus JA, Krone RJ, Singh M, Fitzgerald S, Peterson ED. An updated bleeding model to predict the risk of post-procedure bleeding among patients undergoing percutaneous coronary intervention: a report using an expanded bleeding definition from the National Cardiovascular Data Registry CathPCI Registry. JACC Cardiovasc Interv 2014; 6:897-904. [PMID: 24050858 DOI: 10.1016/j.jcin.2013.04.016] [Citation(s) in RCA: 204] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Revised: 04/18/2013] [Accepted: 04/18/2013] [Indexed: 12/19/2022]
Abstract
OBJECTIVES This study sought to develop a model that predicts bleeding complications using an expanded bleeding definition among patients undergoing percutaneous coronary intervention (PCI) in contemporary clinical practice. BACKGROUND New knowledge about the importance of periprocedural bleeding combined with techniques to mitigate its occurrence and the inclusion of new data in the updated CathPCI Registry data collection forms encouraged us to develop a new bleeding definition and risk model to improve the monitoring and safety of PCI. METHODS Detailed clinical data from 1,043,759 PCI procedures at 1,142 centers from February 2008 through April 2011 participating in the CathPCI Registry were used to identify factors associated with major bleeding complications occurring within 72 h post-PCI. Risk models (full and simplified risk scores) were developed in 80% of the cohort and validated in the remaining 20%. Model discrimination and calibration were assessed in the overall population and among the following pre-specified patient subgroups: females, those older than 70 years of age, those with diabetes mellitus, those with ST-segment elevation myocardial infarction, and those who did not undergo in-hospital coronary artery bypass grafting. RESULTS Using the updated definition, the rate of bleeding was 5.8%. The full model included 31 variables, and the risk score had 10. The full model had similar discriminatory value across pre-specified subgroups and was well calibrated across the PCI risk spectrum. CONCLUSIONS The updated bleeding definition identifies important post-PCI bleeding events. Risk models that use this expanded definition provide accurate estimates of post-PCI bleeding risk, thereby better informing clinical decision making and facilitating risk-adjusted provider feedback to support quality improvement.
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Affiliation(s)
- Sunil V Rao
- Duke Clinical Research Institute, Durham, North Carolina.
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80
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Lee MS, Applegate B, Rao SV, Kirtane AJ, Seto A, Stone GW. Minimizing femoral artery access complications during percutaneous coronary intervention: a comprehensive review. Catheter Cardiovasc Interv 2014; 84:62-9. [PMID: 24677734 DOI: 10.1002/ccd.25435] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 01/11/2014] [Accepted: 02/11/2014] [Indexed: 11/10/2022]
Abstract
Major bleeding complications after percutaneous coronary intervention (PCI) increase patient morbidity, prolong the hospital stay and costs, and are associated with reduced survival. Transfemoral access is still preferred at many centers given its familiarity and ease of use and is necessary in cases where large bore access is needed. Multimodality imaging with fluoroscopy, ultrasonography, and angiography can facilitate proper puncture of the common femoral artery. A proper technique (which includes femoral artery puncture and vascular access site closure) associated with adequate pharmacotherapy (both during PCI and peri-procedural, for the treatment of the underlying coronary artery disease) has been shown to reduce the risk of bleeding and vascular complications associated with femoral artery access. Avoiding the use of arterial sheaths >6 French may further reduce the risk of bleeding. Data with vascular closure devices as a bleeding avoidance strategy are evolving but when used appropriately may further reduce the risk of bleeding and vascular access complications, and in this regard are synergistic with bivalirudin. Randomized trials to confirm these recommendations are needed.
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Affiliation(s)
- Michael S Lee
- Division of Cardiology, UCLA Medical Center, Los Angeles, California
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81
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Feldman R. Precise Location of Ideal Common Femoral Artery Puncture Site. JACC Cardiovasc Interv 2014; 7:229. [DOI: 10.1016/j.jcin.2013.09.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 09/13/2013] [Indexed: 11/15/2022]
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82
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Anatomía angiográfica femoral y complicaciones derivadas del cateterismo cardiaco. ANGIOLOGIA 2014. [DOI: 10.1016/j.angio.2013.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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83
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Turi ZG. Ultrasound versus palpation and fluoroscopy for femoral access-sibling rivalry in the face of the radial onslaught. Catheter Cardiovasc Interv 2013; 82:1193-4. [PMID: 24255035 DOI: 10.1002/ccd.25257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 10/10/2013] [Indexed: 11/11/2022]
Affiliation(s)
- Zoltan G Turi
- Division of Cardiology, Cooper University Hospital, Camden, New Jersey
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84
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Nguyen CT, Lee E, Luo H, Siegel RJ. Echocardiographic guidance for diagnostic and therapeutic percutaneous procedures. Cardiovasc Diagn Ther 2013; 1:11-36. [PMID: 24282682 DOI: 10.3978/j.issn.2223-3652.2011.09.02] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Accepted: 09/24/2011] [Indexed: 11/14/2022]
Abstract
Echocardiographic guidance has an important role in percutaneous cardiovascular procedures and vascular access. The advantages include real time imaging, portability, and availability, which make it an effective imaging modality. This article will review the role of echocardiographic guidance for diagnostic and therapeutic percutaneous procedures, specifically, transvenous and transarterial access, pericardiocentesis, endomyocardial biopsy, transcatheter pulmonary valve replacement, pulmonary valve repair, transcatheter aortic valve implantation, and percutaneous mitral valve repair. We will address the ways in which echocardiographic guidance provides these procedures with detailed information on anatomy, adjacent structures, and intraprocedural instrument position, thus resulting in improvement in procedural efficacy, safety and patient outcomes.
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Affiliation(s)
- Cam Tu Nguyen
- Cedars Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, USA
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85
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Nie SP, Lopes Lao EP, Wang X, Liu XM, Qiao Y, Li J, Luo TY, Zhang Y, Jia CQ, Ma CS. Angiographic evaluation of a new technique for common femoral artery access: the inguinal ligament-guided approach. Int J Cardiol 2013; 168:1542-4. [PMID: 23290952 DOI: 10.1016/j.ijcard.2012.12.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 12/08/2012] [Indexed: 10/27/2022]
Affiliation(s)
- Shao-Ping Nie
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing 100029, China
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86
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Gedikoglu M, Oguzkurt L, Gur S, Andic C, Sariturk C, Ozkan U. Comparison of ultrasound guidance with the traditional palpation and fluoroscopy method for the common femoral artery puncture. Catheter Cardiovasc Interv 2013; 82:1187-92. [PMID: 23592533 DOI: 10.1002/ccd.24955] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Revised: 03/16/2013] [Accepted: 04/09/2013] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To compare the success and complication rates of ultrasound-guided or palpation-guided punctures of the common femoral artery in a prospective randomized study. BACKGROUND Percutaneous femoral arterial access is sometimes difficult to perform and is the source of complications. It has not been established whether ultrasound-guided puncture of the common femoral artery is the standard practice for angiography. MATERIALS AND METHODS Two hundred and eight patients were randomized into two groups. One had ultrasound-guided puncture and the other had palpation-guided puncture of the common femoral artery. The technical success, first pass success rate, total number of attempts required for access, time to sheath insertion, pain during puncture, and access-related complication were compared. RESULTS Technical success tended to be higher and the complication rates tended to be lower in the ultrasound-guided group but the difference did not reach statistical significance (P = 0.052 and P = 0.052). The first pass success rate was higher, total number of attempts required for access and time to sheath insertion were lower in the ultrasound-guided group. Atheromatous plaques on the common femoral artery, iliac artery obstructive lesion, previous ipsilateral puncture of the common femoral artery, obesity, and blood pressure during puncture did not change the outcome. CONCLUSIONS Ultrasound guidance improves secondary outcomes of the common femoral artery puncture when compared to palpation-guided puncture. Technical success and complication rates seem lower in the presence of ultrasound guidance but larger study populations are needed to verify the result.
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Affiliation(s)
- Murat Gedikoglu
- Department of Radiology, Baskent University Faculty of Medicine, Adana, Turkey
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87
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Xu X, Hong T, Li B, Liu W, Zheng C, He X. Retroperitoneal hematoma after manual reduction of indirect inguinal hernia. Am J Emerg Med 2013; 31:1151.e1-2. [PMID: 23602759 DOI: 10.1016/j.ajem.2013.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Accepted: 02/15/2013] [Indexed: 11/29/2022] Open
Abstract
This report presents the case of a 59-year-old man with sudden severe pain in the right lower abdomen after manually reducing the right indirect inguinal hernia who had bilateral indirect inguinal hernia for 5 years. A subsequent contrast computed tomography scan with contrast of the abdomen and pelvis revealed a significant extensive retroperitoneal hematoma at the abdomen and pelvis of the right side. There was contrast leaked out, which was suspected from inferior epigastric artery. He underwent successful laparotomy. The bleeding ruptured inferior epigastric artery at the interior side of the deep inguinal ring was found, the deep inguinal ring was avulsed, ligature of the inferior epigastric artery and removal of the retroperitoneal hematoma were done, and the patient was discharged from hospital on the seventh postoperative day. This is the first report in the literature on retroperitoneal hematoma caused by manual reduction of indirect inguinal hernia.
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Affiliation(s)
- Xiequn Xu
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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88
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Sajnani N, Bogart DB. Retroperitoneal hemorrhage as a complication of percutaneous intervention: report of 2 cases and review of the literature. Open Cardiovasc Med J 2013; 7:16-22. [PMID: 23569466 PMCID: PMC3617546 DOI: 10.2174/1874192401307010016] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 09/01/2012] [Indexed: 11/22/2022] Open
Abstract
Retroperitoneal hemorrhage (RPH) is an infrequent but serious complication of transfemoral percutaneous procedures. We present 2 cases and review the literature regarding the incidence, risk factors, clinical features and complications of RPH. We propose a management strategy for this problem emphasizing an anatomical based interventional approach if the patient does not stabilize with volume resuscitation.
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Affiliation(s)
- Nitin Sajnani
- Truman Medical Center, University of Missouri-Kansas City, 2301 Holmes, Kansas City, Missouri, USA
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Abstract
OPINION STATEMENT The incidence of vascular access site related complications ranges between 0.8 % to 1.8 % of diagnostic cardiac catheterization and up to 9 % of percutaneous coronary interventions (PCI) [1]. The femoral vessels at the groin are used as the access site for the majority of percutaneous coronary, peripheral arterial and venous, and electrophysiologic interventions. With emergence of endovascular abdominal aortic aneurysm repair (EVAR), thoracic endovascular aneurysm repair (TEVAR), and transcatheter aortic valve replacement (TAVR), larger access sheaths (up to 18Fr-24Fr) are required, which further increases the potential for access site complications. The true incidence of access site complications arising from non-coronary interventions is unknown; hence it is likely that the total incidence of vascular access site complications is greatly underestimated. Vascular closure devices (VCDs), radial artery access, fluoroscopic guidance, and ultrasound guidance have all been used with a hope to minimize these complications. Despite these attempts, vascular access complications have not been eliminated. Cardiovascular specialists must promptly identify these complications and manage them appropriately.
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90
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Turi ZG. Pitfalls everywhere: 60 years and still poking blindly. Catheter Cardiovasc Interv 2013; 81:680-1. [PMID: 23436484 DOI: 10.1002/ccd.24831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 01/16/2013] [Indexed: 11/10/2022]
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Vavuranakis M, Kalogeras K, Vrachatis D, Kariori M, Voudris V, Aznaouridis K, Moldovan C, Vaina S, Lazaros G, Masoura K, Thomopoulou S, Stefanadis C. Inferior epigastric artery as a landmark for transfemoral TAVI. Optimizing vascular access? Catheter Cardiovasc Interv 2013. [PMID: 23197467 DOI: 10.1002/ccd.24765] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES This study sought to investigate whether the site of common femoral artery (CFA) cannulation in regard to the inferior epigastric artery (IEA) is associated with the incidence of vascular complications in patients undergoing transfemoral aortic valve implantation (TAVI). BACKGROUND Vascular access complications are a main issue during TAVI and have been associated with significant increase of morbidity and mortality. The need for establishment of reliable predictors for these serious events remains important. METHODS A total of 90 patients, who had undergone TAVI, were retrospectively studied. Vascular complications were defined as major and minor according to the Valve Academic Research Consortium (VARC) criteria. Patients were divided into high cannulation site (CS) group and low CS group depending on the common femoral artery puncture site position, in regards to the most inferior border of the IEA. RESULTS Vascular complications were significantly more frequent in the high CS group versus the low CS group (32.3% vs. 11.9%, P = 0.039). High cannulation remained an independent predictor of vascular complications after adjustment for known risk factors (OR: 4.827, CI: 1.441-16.168; P = 0.011). CONCLUSIONS In patients undergoing transfemoral TAVI, arterial puncture above the most inferior border of the IEA is associated with vascular complications.
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Affiliation(s)
- Manolis Vavuranakis
- Department of Cardiology, Hippokration Hospital, Medical School, National & Kapodistrian University of Athens, Greece
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92
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Kim M, Lee JY, Lee CW, Lee SW, Kang SJ, Yoon YH, Om SY, Kim YH. Deep Vein Thrombosis Due to Hematoma as a Rare Complication after Femoral Arterial Catheterization. Yeungnam Univ J Med 2013. [DOI: 10.12701/yujm.2013.30.1.31] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Minsoo Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong-Young Lee
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Cheol Whan Lee
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung-Whan Lee
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Soo-Jin Kang
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yong Hoon Yoon
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang Yong Om
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young-Hak Kim
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Ahmed B, Lischke S, De Sarno M, Holterman LA, Straight F, Dauerman HL. Gender related differences in predictors of vascular complications: role of vessel size and BMI. J Thromb Thrombolysis 2012; 36:84-90. [DOI: 10.1007/s11239-012-0847-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Treatment of infected pseudoaneurysm of femoral artery after vascular closure device deployment: a practical solution. Case Rep Vasc Med 2012; 2012:292945. [PMID: 23119221 PMCID: PMC3483687 DOI: 10.1155/2012/292945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2012] [Accepted: 09/30/2012] [Indexed: 11/18/2022] Open
Abstract
Like other invasive procedures, percutaneous coronary interventions are associated with complications. Most common access site for these procedures is common femoral artery. Complications such as groin and retroperitoneal hematoma can be encountered as well as pseudoaneurysms, arteriovenous fistulas, acute arterial occlusion, and infection. When infected pseudoaneurysm occurs, surgical treatment can be extremely difficult. We present a case of the patient in whom infected pseudoaneurysm of common femoral artery developed after percutaneous coronary intervention and was successfully treated by surgical excision and autoarterial graft insertion.
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Stone PA, Campbell JE. Complications Related to Femoral Artery Access for Transcatheter Procedures. Vasc Endovascular Surg 2012; 46:617-23. [DOI: 10.1177/1538574412457475] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Percutaneous-based procedures continue to increase as endovascular techniques improve and provide a less morbid approach than the open vascular procedures. The most common complications associated with either cardiac interventions or peripheral interventions involve the access point of the procedure. The retrograde femoral access has and is currently the most frequently used arterial access. Vascular surgeons have been responsible for management of complications following femoral-based procedures and now are a significant contributor to catheter-based diagnostic and interventional procedures. This review provides in-depth review of the literature on specific complications encountered during percutaneous femoral artery puncture. This review includes access complications related to the method of obtaining access (ie, best pulse fluoroscopic guided), direction of access either retrograde or antegrade, risk factors and incidence of complications based on best literature sources, and management strategies for specific complications.
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Affiliation(s)
- Patrick A. Stone
- Division of Vascular & Endovascular Surgery, WVU, Charleston, WV, USA
| | - John E. Campbell
- Division of Vascular & Endovascular Surgery, WVU, Charleston, WV, USA
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96
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Jacobi JA, Schussler JM, Johnson KB. Routine femoral head fluoroscopy to reduce complications in coronary catheterization. Proc (Bayl Univ Med Cent) 2012; 22:7-8. [PMID: 19169390 DOI: 10.1080/08998280.2009.11928457] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
We tested whether routine preprocedure fluoroscopy of the femoral head would improve sheath placement or reduce the incidence of groin complications. Patients were randomized to receive either fluoroscopy or "blind" sheath placement using palpation alone. The location of the femoral sheath was established by femoral artery angiography. Sheath placement in relation to the femoral head, arterial location, and complication rates were compared. Placement was considered "ideal" if the sheath was in the common femoral artery and in the top or middle third of the femoral head. A total of 256 patients were enrolled. There was no difference in average age, body mass index (BMI), or rate of anticoagulation between the groups. There was no major bleeding in either group. The overall risk of minor bleeding was not statistically different. The treatment group showed higher "ideal" placement relative to the femoral head. In patients who had a BMI ≥30 kg/m(2), the difference between the groups was statistically significant (treatment 69% vs control 50%). In conclusion, routine femoral fluoroscopy prior to sheath placement in coronary angiography and angioplasty did not significantly alter bleeding or complication rates but did increase the likelihood of ideal placement, especially in obese patients.
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Affiliation(s)
- Joshua A Jacobi
- Division of Cardiology, Department of Internal Medicine, Baylor University Medical Center and Baylor Jack and Jane Hamilton Heart and Vascular Hospital, Dallas, Texas
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97
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Moza A, Taleb M, Cooper CJ, Burket MW. Percutaneous coronary intervention through unintentional sheath placement in the inferior epigastric artery. Cardiovasc Interv Ther 2012; 28:98-100. [PMID: 22875748 DOI: 10.1007/s12928-012-0121-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Accepted: 07/04/2012] [Indexed: 11/25/2022]
Abstract
A 64 year old female underwent percutaneous coronary intervention (PCI) with stent placement through the femoral approach. On femoral angiography after the PCI, the arterial sheath insertion site was found to be in the inferior epigastric artery and not in the common femoral artery. We used an Angioseal vascular closure device for management and there were no access site complications.
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Affiliation(s)
- Ankush Moza
- Division of Internal Medicine, University of Toledo Medical Center at Toledo, 3000 Arlington Ave, Toledo, OH, USA.
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98
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Turi ZG. Can't get much higher--one more step to ending the "poke until you get a gusher" method of vascular access. Catheter Cardiovasc Interv 2012; 80:43-4. [PMID: 22736585 DOI: 10.1002/ccd.24489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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99
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Tremmel JA, Tibayan YD, O'Loughlin AJC, Chan T, Fearon WF, Yeung AC, Lee DP. Most accurate definition of a high femoral artery puncture: aiming to better predict retroperitoneal hematoma in percutaneous coronary intervention. Catheter Cardiovasc Interv 2012; 80:37-42. [PMID: 22511409 DOI: 10.1002/ccd.23175] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2010] [Accepted: 03/26/2011] [Indexed: 11/09/2022]
Abstract
BACKGROUND Retroperitoneal hematoma (RPH) increases morbidity and mortality in percutaneous coronary intervention (PCI). High femoral arteriotomy is an independent predictor of RPH, but the optimal angiographic criterion for defining a high puncture is unknown. METHODS We retrospectively identified 557 consecutive PCI cases with femoral angiograms. Arteriotomy sites were categorized as high based on three angiographic criteria: at or above the proximal third of the femoral head (criterion A), at or above the most inferior border of the inferior epigastric artery (criterion B), and at or above the origin of the inferior epigastric artery (criterion C). Cases of RPH were then identified. RESULTS Of the 557 PCI patients, 26 had a high femoral arteriotomy by criterion A, 17 by criterion B, and 6 by criterion C. Among these patients with a high arteriotomy, RPH occurred in four with criterion A, in three with criterion B, and in one with criterion C. Of the three criteria, criterion A most strongly correlated with RPH (odds ratio [OR] 96, 95% confidence interval [CI] 10.3-898.4; p < 0.0001) compared with criterion B (OR 58, 95% CI 8.9 to 372.6; p < 0.0001) or C (OR 27, 95% CI 2.6 to 290.1; p = 0.053). All criteria had high specificity (A, 96%; B, 97%; C, 99%), but the sensitivity was higher with criterion A (80%) than criterion B (60%) or C (20%), and statistically, the use of criterion A led to the most accurate risk-stratification for RPH (A, κ = 0.79; B, κ = 0.59; C, κ = 0.19). CONCLUSIONS Among the three common definitions of high arteriotomy, femoral artery puncture at or above the proximal third of the femoral head is the landmark that most accurately risk stratifies PCI patients for development of RPH.
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Affiliation(s)
- Jennifer A Tremmel
- Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, California 94305, USA.
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Freilich MI, Gossman DE, Applegate RJ, Werns SW, Gips SJ, Turi ZG. The “Bladder sign”-An important early marker of retroperitoneal hemorrhage. Catheter Cardiovasc Interv 2012; 79:158-65. [DOI: 10.1002/ccd.23141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2010] [Accepted: 03/19/2011] [Indexed: 11/10/2022]
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