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Lu YY, Tung YC, Ho MY, Yeh JK, Lee CH, Lee HF, Chou SH, Wang CY, Chen CC, Tsai ML. Access Site Complication Rates Following Peripheral Artery Revascularization in patients With End-Stage Renal Disease: A Comparison of Vascular Closure Devices and Manual Compression. Vasc Endovascular Surg 2024; 58:588-594. [PMID: 38477544 DOI: 10.1177/15385744241239492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024]
Abstract
OBJECTIVES Manual compression (MC) or vascular closure devices (VCDs) are used to achieve hemostasis after percutaneous transluminal angioplasty (PTA). However, limited data on the comparative safety and effectiveness of VCDs vs MC in patients with end-stage renal disease (ESRD) undergoing PTA are available. Accordingly, this study compared the safety and effectiveness of VCD and MC in patients with ESRD undergoing PTA. METHODS This single-center retrospective cohort study included the data of patients with ESRD undergoing peripheral intervention at Chang Gung Memorial Hospital, Taiwan, from January 1, 2019, to June 30, 2022. The patients were divided into VCD and MC groups. The primary endpoint was a composite of puncture site complications, including acute limb ischemia, marked hematoma, pseudoaneurysm, and puncture site bleeding requiring blood transfusion. RESULTS We included 264 patients with ESRD undergoing PTA, of whom 60 received a VCD and 204 received MC. The incidence of puncture site complications was 3.3% in the VCD group and 4.4% in the MC group (hazard ratio: .75; 95% confidence interval: .16-3.56 L P = 1.000), indicating no significant between-group difference. CONCLUSION VCDs and MC had comparable safety and effectiveness for hemostasis in patients with ESRD undergoing peripheral intervention.
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Affiliation(s)
- Yu-Ying Lu
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan
- College of Medicine and College of Management, Chang Gung University, Taoyuan City, Taiwan
| | - Ying-Chang Tung
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan
- College of Medicine and College of Management, Chang Gung University, Taoyuan City, Taiwan
| | - Ming-Yun Ho
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan
- College of Medicine and College of Management, Chang Gung University, Taoyuan City, Taiwan
| | - Jih-Kai Yeh
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan
- College of Medicine and College of Management, Chang Gung University, Taoyuan City, Taiwan
| | - Cheng-Hung Lee
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan
- College of Medicine and College of Management, Chang Gung University, Taoyuan City, Taiwan
| | - Hsin-Fu Lee
- College of Medicine and College of Management, Chang Gung University, Taoyuan City, Taiwan
- Division of Cardiology, Department of Internal Medicine, New Taipei Municipal TuCheng Hospital, New Taipei City, Taiwan
| | - Shing-Hsien Chou
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan
- College of Medicine and College of Management, Chang Gung University, Taoyuan City, Taiwan
| | - Chao-Yung Wang
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan
- College of Medicine and College of Management, Chang Gung University, Taoyuan City, Taiwan
| | - Chun-Chi Chen
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan
- College of Medicine and College of Management, Chang Gung University, Taoyuan City, Taiwan
| | - Ming-Lung Tsai
- College of Medicine and College of Management, Chang Gung University, Taoyuan City, Taiwan
- Division of Cardiology, Department of Internal Medicine, New Taipei Municipal TuCheng Hospital, New Taipei City, Taiwan
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Devasia T, Premchand RK, Sinha SK, Rewatkar A, Parikh K, Arneja J. Comparing Obtura Vascular Closure Device to Manual Compression for Achieving Hemostasis After Percutaneous Transfemoral Procedures: A Randomized Study. J Endovasc Ther 2024:15266028241258662. [PMID: 39044646 DOI: 10.1177/15266028241258662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2024]
Abstract
PURPOSE This trial was designed and aimed to compare safety and efficacy of Obtura™ vascular closure device (VCD) to manual compression (MC) among patients undergoing transfemoral catheterization. MATERIAL AND METHODS This prospective, randomized, controlled, multicenter trial of Obtura VCD against MC randomized patients in 1:1 (n=268; 134:134) ratio. Safety and efficacy were measured by primary endpoints (time to hemostasis [TTH] and deployment success) and secondary endpoints which included technical success, device-related adverse events, and time to ambulation (TTA). RESULTS The procedural access using right femoral artery was performed in 95.52% of patients in Obtura VCD versus 96.27% in standard MC method, whereas 2.99% of patients in each group underwent left femoral access. Bilateral access was performed in 1.49% (n=2) versus 0.75% (n=1) in Obtura VCD versus MC, respectively. Both the technical success and deployment success were 100%. Patients in Obtura VCD group had shorter TTH (3.26±3.39 vs 23.95±8.24 minutes; p<0.0001) and TTA (155.44±125.32 vs 723.84±197.98 minutes; p<0.0001) than MC group. No access site complications (re-bleeding, infection, arteriovenous fistula, and transient access site nerve injury) were noted at 2-week, 1-month, and 3-month follow-ups. There were 4 (3%) and 6 (4.5%) cases of hematoma, respectively, in Obtura VCD versus MC and 1 case (0.7%) of post-procedural arterial pseudoaneurysm each in both the groups which were successfully resolved and patients were discharged with no further complications. Further follow-up was without any adverse events. CONCLUSIONS The study demonstrated favorable safety and efficacy of Obtura™ VCD with a significantly short TTH and TTA compared to MC. CLINICAL IMPACT In patients undergoing cardiac catheterization, vascular closure devices (VCDs) can achieve hemostasis faster after successful implantation of the device with fewer complications such as bleeding and ambulation can be achieved faster. In terms of effectiveness, Obtura VCD was found to be better than manual compression in achieving early hemostasis and higher technical and deployment success was accomplished. Obtura VCD does not require enlargement of the route through the tissues, uses the same existing arterial sheath as its conduit, and does not cause patients' access sites to feel uncomfortable while it is being deployed.
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Affiliation(s)
- Tom Devasia
- Department of Cardiology, Kasturba Medical College Manipal Academy of Higher Education, Manipal, Karnataka, India
| | | | - Santosh K Sinha
- LPS Institute of Cardiology and Cardiac Surgery, Kanpur, Uttar Pradesh, India
| | - Atul Rewatkar
- Pulse Clinic and Hospital, Nagpur, Maharashtra, India
| | - Keyur Parikh
- Care Institute of Medical Sciences (CIMS) Hospital, Ahmedabad, Gujarat, India
| | - Jaspal Arneja
- Arneja Heart and Multispeciality Hospital, Nagpur, Maharashtra, India
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Meijers TA, Nap A, Aminian A, Schmitz T, Dens J, Teeuwen K, van Kuijk JP, van Wely M, Bataille Y, Kraaijeveld AO, Roolvink V, Dambrink JHE, Gosselink ATM, Hermanides RS, Ottervanger JP, Tsilingiris I, van den Buijs DMF, van Royen N, van Leeuwen MAH. Ultrasound-guided versus fluoroscopy-guided large-bore femoral access in PCI of complex coronary lesions: the international, multicentre, randomised ULTRACOLOR Trial. EUROINTERVENTION 2024; 20:e876-e886. [PMID: 38742577 PMCID: PMC11228538 DOI: 10.4244/eij-d-24-00089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 04/10/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Transfemoral access is often used when large-bore guide catheters are required for percutaneous coronary intervention (PCI) of complex coronary lesions, especially when large-bore transradial access is contraindicated. Whether the risk of access site complications for these procedures may be reduced by ultrasound-guided puncture is unclear. AIMS We aimed to show the superiority of ultrasound-guided femoral puncture compared to fluoroscopy-guided access in large-bore complex PCI with regard to access site-related Bleeding Academic Research Consortium 2, 3 or 5 bleeding and/or vascular complications requiring intervention during hospitalisation. METHODS The ULTRACOLOR Trial is an international, multicentre, randomised controlled trial investigating whether ultrasound-guided large-bore femoral access reduces clinically relevant access site complications compared to fluoroscopy-guided large-bore femoral access in PCI of complex coronary lesions. RESULTS A total of 544 patients undergoing complex PCI mandating large-bore (≥7 Fr) transfemoral access were randomised at 10 European centres (median age 71; 76% male). Of these patients, 68% required PCI of a chronic total occlusion. The primary endpoint was met in 18.9% of PCI with fluoroscopy-guided access and 15.7% of PCI with ultrasound-guided access (p=0.32). First-pass puncture success was 92% for ultrasound-guided access versus 85% for fluoroscopy-guided access (p=0.02). The median time in the catheterisation laboratory was 102 minutes versus 105 minutes (p=0.43), and the major adverse cardiovascular event rate at 1 month was 4.1% for fluoroscopy-guided access and 2.6% for ultrasound-guided access (p=0.32). CONCLUSIONS As compared to fluoroscopy-guided access, the routine use of ultrasound-guided access for large-bore transfemoral complex PCI did not significantly reduce clinically relevant bleeding or vascular access site complications. A significantly higher first-pass puncture success rate was demonstrated for ultrasound-guided access. CLINICALTRIALS gov identifier: NCT04837404.
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Affiliation(s)
- Tom A Meijers
- Department of Cardiology, Isala Heart Center, Zwolle, the Netherlands
| | - Alexander Nap
- Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Adel Aminian
- Department of Cardiology, Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium
| | - Thomas Schmitz
- Department of Cardiology, Elisabeth Krankenhaus, Essen, Germany
| | - Joseph Dens
- Department of Cardiology, Hospital Oost-Limburg, Genk, Belgium
| | - Koen Teeuwen
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands
| | - Jan-Peter van Kuijk
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Marleen van Wely
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Yoann Bataille
- Department of Cardiology, Jessa Hospital, Hasselt, Belgium
| | - Adriaan O Kraaijeveld
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Vincent Roolvink
- Department of Cardiology, Isala Heart Center, Zwolle, the Netherlands
| | | | | | | | | | | | | | - Niels van Royen
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
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Di Giorgio A, Carnuccio C, Nesci A, D'Alessandro A, Santoliquido A. Letter to the Editor re: "Systematic review and meta-analysis comparing Manta device and Perclose device for closure of large bore arterial access." J Vasc Access. 2024 Jan 8:11297298231222314. J Vasc Access 2024:11297298241254255. [PMID: 38822619 DOI: 10.1177/11297298241254255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2024] Open
Affiliation(s)
- Angela Di Giorgio
- Department of Cardiovascular Sciences, Angiology and Non-invasive Vascular Diagnostics Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Lazio, Italy
| | - Claudia Carnuccio
- Department of Cardiovascular Sciences, Angiology and Non-invasive Vascular Diagnostics Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Lazio, Italy
- Catholic University of the Sacred Heart, Rome, Italy
| | - Antonio Nesci
- Department of Cardiovascular Sciences, Angiology and Non-invasive Vascular Diagnostics Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Lazio, Italy
| | - Alessia D'Alessandro
- Department of Cardiovascular Sciences, Angiology and Non-invasive Vascular Diagnostics Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Lazio, Italy
| | - Angelo Santoliquido
- Department of Cardiovascular Sciences, Angiology and Non-invasive Vascular Diagnostics Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Lazio, Italy
- Catholic University of the Sacred Heart, Rome, Italy
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Khirul Ashar NA, Ismail II, Lingam R, Mazlan NF, Azmi NS. A case series of forearm compartment syndrome complicating transradial cardiac catheterization. Egypt Heart J 2024; 76:68. [PMID: 38819489 PMCID: PMC11143145 DOI: 10.1186/s43044-024-00498-y] [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: 07/26/2021] [Accepted: 05/24/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Acute compartment syndrome following a transradial coronary approach is rare. However, as the incidence of coronary arterial disease increases due to lifestyle factors and multiple comorbidities, transradial coronary angiography has become more common for diagnostic and therapeutic purposes in cardiovascular centers. Despite its rarity, we encountered two cases of acute compartment syndrome within a 1-week interval in the cardiology unit of a tertiary hospital. CASE PRESENTATION The first case involved a 75-year-old woman diagnosed with non-ST elevation myocardial infarction (NSTEMI). A coronary angiogram was performed via an uncomplicated right radial artery puncture. Following the procedure, the patient experienced significant swelling in the right forearm. An emergency fasciotomy release of the right forearm was conducted, revealing a gushing hematoma upon entering the flexor compartment. Fortunately, the wound healed well two months postoperatively with no functional deficits. In the second case, an 80-year-old man presented with severe angina pectoris upon exertion and was diagnosed with NSTEMI. The following day, he developed compartment syndrome in the left forearm, necessitating an emergency fasciotomy. Intraoperative examination revealed muscle bulging within the forearm compartments accompanied by extensive hematoma. Postoperatively, a deranged coagulation profile caused oozing from the wound. However, since there was no arterial bleeding, a compression dressing was applied. This led to a gradual drop in hemoglobin levels and worsened his heart condition. Despite resuscitative efforts and attempts to correct the coagulopathy, the patient experienced cardiorespiratory arrest and succumbed to ischemic heart disease in failure. CONCLUSION Clinicians must remain vigilant in identifying this potentially limb-threatening condition. Patients with pre-existing anticoagulant therapy and underlying atherosclerotic disease are at a higher risk of bleeding complications. Implementing effective hemostasis techniques and promptly managing swelling can help prevent the occurrence of compartment syndrome. Timely assessment and maintaining a high level of clinical suspicion are paramount. If necessary, early consideration of decompressive fasciotomy is essential to avert catastrophic outcomes.
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Affiliation(s)
- Nur Ayuni Khirul Ashar
- Orthopaedic Surgery & Traumatology Department, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia.
| | - Imma Isniza Ismail
- Orthopaedic Department, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Rahul Lingam
- Orthopaedic Department, Hospital Serdang, Serdang, Selangor, Malaysia
| | | | - Nur Syahirah Azmi
- Orthopaedic Department, Hospital Serdang, Serdang, Selangor, Malaysia
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6
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Jones J, Deveikis J. Pediatric Interventional Neuroradiology: "How I Do It" v. I - Diagnostic Angiography. Interv Neuroradiol 2024:15910199241255154. [PMID: 38803217 DOI: 10.1177/15910199241255154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024] Open
Abstract
Pediatric neurointervention differs from the adult in several important respects. Here we describe a modern approach to readily acquire diagnostic quality images of children. Preparation, access, angiogragraphy and closure have evolved along with new knowledge and technology. This timely "how I do it" series addresses each topic utilizing literature review and our own experience over 35 years.
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Affiliation(s)
- Jesse Jones
- Radiology and Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - John Deveikis
- Radiology and Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Oliny A, Bosse C, Charbonneau P, Haulon S, Fabre D. Closure Device Migration: An Unusual Cause of Acute Limb Ischaemia Following a Simple Endovascular Procedure. EJVES Vasc Forum 2024; 61:113-115. [PMID: 38884075 PMCID: PMC11177045 DOI: 10.1016/j.ejvsvf.2024.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 03/16/2024] [Accepted: 05/08/2024] [Indexed: 06/18/2024] Open
Abstract
Introduction Acute limb ischaemia resulting from foreign body embolisation is an infrequent yet critical complication associated with vascular closure devices (VCDs). Despite the widespread use of VCDs, rare complications such as fragment emboli pose unique challenges, necessitating heightened clinical awareness. This case report presents a case of acute limb ischaemia caused by a VCD malfunction following an endovascular procedure. Report A 70 year old male who was diagnosed with a severe claudication of the lower extremity (Rutherford III) due to right common iliac stenosis, underwent angioplasty using a FemoSeal (Terumo Ltd., Surrey, UK) to close the right femoral artery access. Two weeks later, the patient presented with acute lower limb ischaemia due to a right popliteal-tibial occlusion. Emergency surgical thrombo-embolectomy was successfully performed from a medial popliteal approach, and the thrombus, which contained a polymer disc from the VCD at its distal end, was completely removed. Discussion Despite VCDs being proven safe and efficient, rare complications such as fragment emboli can occur, and physicians should be aware of the possible delayed onset of symptoms. Moreover, the radiolucent nature of the polymer disc in a FemoSeal complicates diagnostic imaging. While endovascular approaches exist, open surgery is a safe and effective strategy for retrieving fragments and treating the patient in acute limb ischaemia cases. Conclusion Physicians should remain vigilant for embolic risks associated with vascular closure devices, even with suitable anatomy and following guidelines, especially considering the trend toward early ambulation and discharge.
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Affiliation(s)
- Alexandre Oliny
- Aortic Centre, Marie Lannelongue Hospital, Le Plessis Robinson, France
| | - Côme Bosse
- Aortic Centre, Marie Lannelongue Hospital, Le Plessis Robinson, France
| | - Philippe Charbonneau
- Vascular Surgery Department, CHUM, Montreal, QC, Canada
- University of Montreal, Montréal, QC, Canada
| | - Stephan Haulon
- Aortic Centre, Marie Lannelongue Hospital, Le Plessis Robinson, France
- University of Paris-Saclay, Bâtiment Bréguet, Gif-sur-Yvette, France
| | - Dominique Fabre
- Aortic Centre, Marie Lannelongue Hospital, Le Plessis Robinson, France
- University of Paris-Saclay, Bâtiment Bréguet, Gif-sur-Yvette, France
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Kirov H, Caldonazo T, Runkel A, Fischer J, Tasoudis P, Mukharyamov M, Cancelli G, Dell’Aquila M, Doenst T. Percutaneous Versus Surgical Femoral Cannulation in Minimally Invasive Cardiac Surgery: A Systematic Review and Meta-Analysis. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2024; 19:247-253. [PMID: 38604983 PMCID: PMC11385621 DOI: 10.1177/15569845241241534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
OBJECTIVE Minimally invasive cardiac surgery (MICS) is increasing worldwide. In most cases, the surgical technique includes cannulation of the groin for the establishment of cardiopulmonary bypass, requiring a second surgical incision (SC) for exposure and cannulation of the femoral vessels. With the introduction of arterial closure devices, percutaneous cannulation (PC) of the groin has become a possible alternative. We performed a meta-analysis and systematic review to compare clinical endpoints between the patients who underwent PC and SC for MICS. METHODS Three databases were assessed. The primary outcome was any access site complication. Secondary outcomes were perioperative mortality, any wound complication, any vascular complication, lymphatic complications, femoral/iliac stenosis, stroke, procedural duration, and hospital length of stay (LOS). A random effects model was performed. RESULTS A total of 5 studies with 2,038 patients were included. When compared with PC, patients who underwent SC showed a higher incidence of any access site complication (odds ratio [OR] = 3.09, 95% confidence interval [CI]: 1.87 to 5.10, P < 0.01), any wound complication (OR = 10.10, 95% CI: 3.31 to 30.85, P < 0.01), lymphatic complication (OR = 9.37, 95% CI: 2.15 to 40.81, P < 0.01), and longer procedural duration (standardized mean difference = 0.31, 95% CI: 0.12 to 0.51, P < 0.01). There was no significant difference between the 2 groups regarding perioperative mortality, any vascular complication, femoral/iliac stenosis, stroke, or hospital LOS. CONCLUSIONS The analysis suggests that surgical groin cannulation in MICS is associated with a higher incidence of any access site complication (especially wound complication and lymphatic fistula) and with a longer procedural time compared with PC. There was no difference in perioperative mortality.
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Affiliation(s)
- Hristo Kirov
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, Germany
| | - Tulio Caldonazo
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, Germany
| | - Angelique Runkel
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, Germany
| | - Johannes Fischer
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, Germany
| | - Panagiotis Tasoudis
- Division of Cardiothoracic Surgery, University of North Carolina at Chapel Hill, NC, USA
| | - Murat Mukharyamov
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, Germany
| | - Gianmarco Cancelli
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Michele Dell’Aquila
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Torsten Doenst
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, Germany
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Izawa D, Matsumoto H, Nishiyama H, Nakayama Y, Maeshima K. Factors related to insufficient hemostasis using the EXOSEAL vascular closure device with five-minutes compression for femoral artery punctures after neuro-endovascular therapy: A retrospective, single-center experience. Interv Neuroradiol 2024; 30:255-263. [PMID: 36357980 PMCID: PMC11095341 DOI: 10.1177/15910199221138367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 10/25/2022] [Indexed: 02/17/2024] Open
Abstract
OBJECTIVES The aim was to identify the factors related to inadequate hemostasis with five minutes of manual compression using the EXOSEAL vascular closure device (VCD), and to evaluate the optimal time to hemostasis (TTH). METHODS A total of 119 consecutive patients who underwent neuro-endovascular therapy via common femoral arterial puncture between February 2019 and August 2021 were included. These patients underwent hemostasis using an EXOSEAL with manual compression for five minutes. In this retrospective study, the 119 patients were divided into two groups: (1) achieved hemostasis with five minutes (n = 76); and (2) required more than five minutes to achieve hemostasis (n = 43, Add group). In both groups, patient's characteristics, endovascular procedures, and closure procedures were assessed. RESULTS On univariable analysis, activated clotting time (ACT), multiple antiplatelets, closure with an under-sized EXOSEAL VCD (U-VCD), endovascular procedure, and use of a 7Fr. VCD were significantly associated with additional compression (p < 0.05). On multivariate logistic regression analysis, the following three factors were found to be associated with additional compression: pre-closure ACT (adjusted OR, 0.136; 95% CI, 1.017-1.056; p < 0.001); multiple antithrombotics (adjusted OR, 12.843; 95% CI, 3.458-47.693; p < 0.001); and closure with a U-VCD (adjusted OR, 5.653; 95% CI, 1.751-18.151; p = 0.004). On the receiver-operating characteristic curve analysis for prediction of the need for additional compression, the cutoff point for pre-closure ACT was calculated to be 268 s. In the Add group, mean TTH was 9.8 ± 1.5 min. CONCLUSION Multiple antiplatelets and closure with a U-VCD may increase the risk of insufficient hemostasis with five-minutes compression using an EXOSEAL VCD for femoral puncture sites if the pre-closure ACT is greater than 268 s. In these patients, mean TTH was 9.8 ± 1.5 min.
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Affiliation(s)
- Daisuke Izawa
- Department of Neurological Surgery, Kishiwada Tokushukai Hospital, Osaka, Japan
| | - Hiroyuki Matsumoto
- Department of Neurological Surgery, Kishiwada Tokushukai Hospital, Osaka, Japan
| | - Hirokazu Nishiyama
- Department of Neurological Surgery, Kishiwada Tokushukai Hospital, Osaka, Japan
| | - Yukie Nakayama
- Department of Neurological Surgery, Kishiwada Tokushukai Hospital, Osaka, Japan
| | - Kazuhide Maeshima
- Department of Neurological Surgery, Kishiwada Tokushukai Hospital, Osaka, Japan
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Abou Diwan R, Kaadi L, Hachem S, Smayra T, Slaba S, Chalhoub B, Hachem K. Pseudoaneurysms: Different ultrasound patterns, aetiologies and locations. Australas J Ultrasound Med 2023; 26:258-266. [PMID: 38098621 PMCID: PMC10716566 DOI: 10.1002/ajum.12348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023] Open
Abstract
Pseudoaneurysms are frequent vascular anomalies. This review article aims to describe the unique specific aspect of pseudoaneurysm (PSA) that allows to make the diagnosis using different modalities: colour Doppler ultrasound, computed tomographic angiography, magnetic resonance angiography and conventional angiography. It is essential to know the various aetiologies of PSA: iatrogenic, traumatic, dissecting and anastomotic; different locations and the possible complications, information to help clinicians choose the best treatment. Our review is supported by illustrated series of cases.
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Affiliation(s)
- Ralph Abou Diwan
- Medical Imaging Department, Hôtel‐Dieu de FranceAlfred Naccache BoulevardBeirutLebanon
| | - Lea Kaadi
- Medical Imaging Department, Hôtel‐Dieu de FranceAlfred Naccache BoulevardBeirutLebanon
| | - Samir Hachem
- Faculty of MedicineUniversity of Saint JosephBeirutLebanon
| | - Tarek Smayra
- Medical Imaging Department, Hôtel‐Dieu de FranceAlfred Naccache BoulevardBeirutLebanon
| | - Sami Slaba
- Medical Imaging Department, Hôtel‐Dieu de FranceAlfred Naccache BoulevardBeirutLebanon
| | - Berthe Chalhoub
- Laboratory Department, Hôtel‐Dieu de FranceAlfred Naccache BoulevardBeirutLebanon
| | - Kamal Hachem
- Medical Imaging Department, Hôtel‐Dieu de FranceAlfred Naccache BoulevardBeirutLebanon
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Ghozy S, El-Qushayri AE, Reda A, Oussama Kacimi SE, Kobeissi H, Mouffokes A, Awad DM, Kadirvel R, Kallmes DF. Off-Label Use of the 8-F Angio-Seal for Closure of Greater than 8-F Common Femoral Arterial Access: A Systematic Review and Meta-Analysis. J Vasc Interv Radiol 2023; 34:1946-1954.e5. [PMID: 37468092 DOI: 10.1016/j.jvir.2023.05.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 04/07/2023] [Accepted: 05/01/2023] [Indexed: 07/21/2023] Open
Abstract
PURPOSE To evaluate the safety of >8-F access closures using 8-F Angio-Seal. MATERIALS AND METHODS An electronic search was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines using Web of Science, Embase, Scopus, and PubMed databases from inception until January 17, 2022. Actionable and nonactionable bleeding events were defined in conjugation with the Bleeding Academic Research Consortium definition. Prevalence rates with corresponding 95% CIs were calculated using R software version 4.2.2. Eight articles, with 422 patients, were included in the analysis. RESULTS The overall groin adverse event rate was 5.92% (95% CI, 3.01-11.34). The most commonly reported adverse events were any bleeding (5.74%; 95% CI, 3.23-10.00) (nonactionable bleeding, 0.96% [95% CI, 0.10-8.30]; actionable bleeding, 2.30% [95% CI, 0.89-5.84]), pseudoaneurysm (1.18%; 95% CI, 0.49-2.81), and groin hematoma (1.28%; 95% CI, 0.23-6.79). The least commonly reported adverse events were device failure and vessel occlusion/stenosis, with rates 0.29% (95% CI, 0.01-7.41) and 0.45% (95% CI, 0.02-7.74), respectively. No studies recorded events regarding the following adverse events: mortality, infection, deep venous thrombosis, and retroperitoneal hematoma. Moreover, the results showed significant differences, based on the sheath size used, in actionable bleeding (P = .04) and the rate of need for surgical repair (P < .01). CONCLUSIONS Common femoral artery access of >8-F can be effectively closed with the Angio-Seal with comparable outcomes to those of <8 F; however, larger access approaching 14 F is associated with a significant increase in morbidity. Further safety is needed, especially for the larger access sizes.
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Affiliation(s)
- Sherief Ghozy
- Department of Radiology, Mayo Clinic, Rochester, Minnesota; Nuffield Department of Primary Care Health Sciences and Department for Continuing Education (Evidence-Based Healthcare Program), Oxford University, Oxford, United Kingdom.
| | | | | | | | - Hassan Kobeissi
- College of Medicine, Central Michigan University, Mount Pleasant, Michigan
| | | | | | - Ramanathan Kadirvel
- Department of Radiology, Mayo Clinic, Rochester, Minnesota; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota
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12
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Joodi G, Palimar S, Press MC. Percutaneous Coronary Interventions in Women. Curr Atheroscler Rep 2023; 25:829-837. [PMID: 37815649 PMCID: PMC10618306 DOI: 10.1007/s11883-023-01150-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2023] [Indexed: 10/11/2023]
Abstract
PURPOSEOF REVIEW Cardiovascular disease is the leading cause of morbidity and mortality among women globally. Numerous studies show ongoing disparities in diagnosis, management, and outcomes of ischemic heart disease in women compared to men. We aim to review the factors contributing to sex-based differential outcomes of percutaneous coronary interventions in women. RECENT FINDINGS Hormonal influence on coronary arteries and progression of atherosclerosis in women results in distinct coronary plaque characteristics and unique pathological process such as spontaneous coronary artery dissection and myocardial infarction with non-obstructive coronary arteries. During the presentation of acute coronary syndromes, women are older and have higher burden of comorbidities, with higher short- and long-term mortality. Awareness of differences in vascular biology and unique risk factors for cardiovascular disease in women is essential for sustained improvement in cardiovascular mortality. Better representation of women in trials is crucial to address the gaps in knowledge and allow for individualized treatment approaches in women.
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Affiliation(s)
- Golsa Joodi
- Department of Medicine, Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Sristi Palimar
- Institute for Society and Genetics, UCLA, Los Angeles, CA, USA
| | - Marcella Calfon Press
- Department of Medicine, Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
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13
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Desai KR. Off-label Use of 8-F Angio-Seal for Large-Bore Arterial Closure: Clinical Confidence from Pooled Data? J Vasc Interv Radiol 2023; 34:1955-1956. [PMID: 37473860 DOI: 10.1016/j.jvir.2023.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 07/11/2023] [Indexed: 07/22/2023] Open
Affiliation(s)
- Kush R Desai
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
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14
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Parco C, Tröstler J, Brockmeyer M, Hoss A, Lin Y, Quade J, Heinen Y, Schulze V, Jung C, Icks A, Kelm M, Wolff G. Risk-adjusted management in catheterization procedures for non-ST-segment elevation myocardial infarction: A standard operating procedure pilot study. Int J Cardiol 2023; 388:131111. [PMID: 37302420 DOI: 10.1016/j.ijcard.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 05/23/2023] [Accepted: 06/02/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND The effects of standardized risk-adjusted periprocedural management of cardiac catheterization procedures in Non-ST segment elevation myocardial infarction (NSTEMI) remain unknown. We implemented a standard operating procedure (SOP) specifying risk assessment (RA, using National Cardiovascular Data Registry (NCDR) risk models) and risk-adjusted management (RM, e.g. intensified monitoring) in 2018 and aimed to investigate staff SOP adherence and associations with patient outcomes. METHODS AND RESULTS All 430 invasively managed NSTEMI patients (mean age 72y; 70.9% male) in 2018 were analyzed for staff SOP adherence and in-hospital clinical outcomes. 207 patients (48.1%; RM+) received both RA and RM; 92 patients (21.4%; RM-) received RA but no RM; 131 patients (30.5%; RA-) received neither RA nor RM. Lower staff adherence to RA was associated with emergency settings (51.9% (RA-) vs. 22.1% (RA+); p<0.01), presentation in cardiogenic shock (17.6% (RA-) vs. 6.4% (RA+); p<0.01) and invasive mechanical ventilation (12.2% (RA-) vs. 3.3% (RA+); p<0.01). Early sheath removal (87.9% (RM+) vs. 56.5% (RM-); p<0.01) and intensified monitoring (p<0.01) were more frequent in the RM+ group. All-cause mortality was not different (1.4% (RM+) vs. 4.3% (RM-); p=0.13), but there were fewer major bleeding events with associated with RM (2.4% (RM+) vs. 12% (RM-); p<0.01), which remained independently associated with RM in a multivariate logistic regression model correcting for confounders (p<0.01). CONCLUSION In an all-comer patient cohort with NSTEMI, staff adherence to risk-adjusted periprocedural management was independently associated with fewer major bleeding events. Staff adherence to SOP-specified risk assessment was frequently neglected in more critical clinical situations.
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Affiliation(s)
- Claudio Parco
- Department of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Medical Faculty of the Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Jennifer Tröstler
- Department of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Medical Faculty of the Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Maximilian Brockmeyer
- Department of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Medical Faculty of the Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Alexander Hoss
- Department of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Medical Faculty of the Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Yingfeng Lin
- Department of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Medical Faculty of the Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Julia Quade
- Department of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Medical Faculty of the Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Yvonne Heinen
- Department of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Medical Faculty of the Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Volker Schulze
- Department of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Medical Faculty of the Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Christian Jung
- Department of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Medical Faculty of the Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Andrea Icks
- Institute for Health Services Research and Health Economics, German Diabetes Center, Leibniz Center for Diabetes Research at the Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Malte Kelm
- Department of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Medical Faculty of the Heinrich Heine University Düsseldorf, Düsseldorf, Germany; CARID, Cardiovascular Research Institute Düsseldorf, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
| | - Georg Wolff
- Department of Cardiology, Pulmonology, and Vascular Medicine, University Hospital Düsseldorf, Medical Faculty of the Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
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15
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d'Entremont MA, Marquis-Gravel G, Paradis JM, Bérubé S, Seto AH, Nguyen P, Mehta SR, Couture ÉL, Jolly SS. Strategies to Reduce Transfemoral Access Complications in Contemporary Interventional Cardiology. Can J Cardiol 2023; 39:1392-1396. [PMID: 37211041 DOI: 10.1016/j.cjca.2023.04.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 04/11/2023] [Accepted: 04/20/2023] [Indexed: 05/23/2023] Open
Affiliation(s)
- Marc-André d'Entremont
- Centre Hospitalier Universitaire de Sherbrooke (CHUS), Sherbrooke, Quebec, Canada; Population Health Research Institute, Hamilton, Ontario, Canada
| | | | | | - Simon Bérubé
- Centre Hospitalier Universitaire de Sherbrooke (CHUS), Sherbrooke, Quebec, Canada
| | - Arnold H Seto
- Long Beach VA Medical Center, Long Beach, California, USA
| | - Phong Nguyen
- Western Sydney University, Campbelltown, New South Wales, Australia; University of New South Wales, Liverpool, New South Wales, Australia
| | - Shamir R Mehta
- Population Health Research Institute, Hamilton, Ontario, Canada; Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Étienne L Couture
- Centre Hospitalier Universitaire de Sherbrooke (CHUS), Sherbrooke, Quebec, Canada
| | - Sanjit S Jolly
- Population Health Research Institute, Hamilton, Ontario, Canada; Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada.
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16
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Noory E, Böhme T, Krause L, Ruile P, Salm J, Beschorner U, Bollenbacher R, Westermann D, Zeller T. Evaluation of the MYNX CONTROL™ Arterial Closure System for Achieving Primary Hemostasis after Arterial Femoral Access Following Peripheral Arterial Interventions, Compared to the FemoSeal TM Closure System. J Clin Med 2023; 12:5255. [PMID: 37629297 PMCID: PMC10455888 DOI: 10.3390/jcm12165255] [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: 07/16/2023] [Revised: 08/08/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023] Open
Abstract
Background: In addition to manual compression, various vascular closure devices (VCD) are available to seal the puncture site following arterial vascular procedures. Purpose: To evaluate the efficacy and safety of the extravascular MYNX CONTROL closure system for achieving primary hemostasis after femoral arterial access following peripheral arterial procedures, compared to the intravascular FemoSeal Aclosure system. Patients and Methods: A retrospective analysis of consecutive patients who underwent endovascular intervention between April and November 2022 was performed. The primary endpoint was the incidence of significant puncture site complication defined as a complication resulting in medical treatment. Secondary endpoints included peri-interventional incidence of hematoma, peri-interventional changes in hemoglobin, incidence of emergency diagnostics and predictors for closure system failure. Results: Five hundred and forty-eight patients were included in this analysis. False aneurysm occurred in 18/273 cases (6.6%) following the use of the MYNX closure system, compared to 6/275 cases after using the FemoSeal closure system (2.2%, p = 0.006). The incidence of post-interventional hematoma was not significantly different (28 (10.3%) in the MYNX group versus 32 (11.6%) in the FemoSeal group, p = 0.358). Peri-interventional hemoglobin drop did not differ between groups (p = 0.449). Emergency diagnostics were not significantly performed more often in the MYNX group (14 (5.1%) versus 8 (2.9%), p = 0.134). A post-interventional duplex sonography showed stenosis at the puncture site in one patient after use of the MYNX system. For the entire cohort, oral anticoagulation was the only predictor for the failure of the closure device (p = 0.036). Conclusions: Device failure was more common after using the extravascular MYNX CONTROL system than after using the intravascular FemoSeal system. However, the need for surgical or interventional therapy due to device failure was low.
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Affiliation(s)
- Elias Noory
- Department of Cardiology and Angiology, Medical Center—University of Freiburg, 79189 Bad Krozingen, Germany
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17
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Disler L, Disler M, Biddle DD, Friedman C, Couper-Smith J. Femoral Vein Thrombosis Following Femoral Access Cardiac Catheterisation - A Rare Complication. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 53S:S224-S226. [PMID: 35811242 DOI: 10.1016/j.carrev.2022.06.263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 06/15/2022] [Accepted: 06/27/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Laurence Disler
- Netcare Linksfield Hospital, 24 12th Avenue, Linksfield West, Johannesburg, South Africa.
| | - Mathew Disler
- Netcare Linksfield Hospital, 24 12th Avenue, Linksfield West, Johannesburg, South Africa
| | - Dayle Disler Biddle
- Netcare Linksfield Hospital, 24 12th Avenue, Linksfield West, Johannesburg, South Africa
| | - Camilla Friedman
- Netcare Linksfield Hospital, 24 12th Avenue, Linksfield West, Johannesburg, South Africa
| | - Janet Couper-Smith
- Netcare Linksfield Hospital, 24 12th Avenue, Linksfield West, Johannesburg, South Africa
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18
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Krishnaswamy A, Isogai T, Brilakis ES, Nanjundappa A, Ziada KM, Parikh SA, Rodés-Cabau J, Windecker S, Kapadia SR. Same-Day Discharge After Elective Percutaneous Transcatheter Cardiovascular Interventions. JACC Cardiovasc Interv 2023; 16:1561-1578. [PMID: 37438024 DOI: 10.1016/j.jcin.2023.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 04/23/2023] [Accepted: 05/08/2023] [Indexed: 07/14/2023]
Abstract
Percutaneous transcatheter interventions have evolved as standard therapies for a variety of cardiovascular diseases, from revascularization for atherosclerotic vascular lesions to the treatment of structural cardiac diseases. Concomitant technological innovations, procedural advancements, and operator experience have contributed to effective therapies with low complication rates, making early hospital discharge safe and common. Same-day discharge presents numerous potential benefits for patients, providers, and health care systems. There are several key elements that are shared across the spectrum of interventional cardiology procedures to create a successful same-day discharge pathway. These include appropriate patient and procedure selection, close postprocedural observation, predischarge assessments specific for each type of procedure, and the existence of a patient support system beyond hospital discharge. This review provides the rationale, available data, and a framework for same-day discharge across the spectrum of coronary, peripheral, and structural cardiovascular interventions.
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Affiliation(s)
- Amar Krishnaswamy
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Toshiaki Isogai
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Aravinda Nanjundappa
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Khaled M Ziada
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Sahil A Parikh
- Division of Cardiology and Center for Interventional Vascular Therapy, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Josep Rodés-Cabau
- Quebec Heart & Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Stephan Windecker
- Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Samir R Kapadia
- Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA.
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19
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Ierardi AM, Coppola A, Renzulli M, Piacentino F, Fontana F, Paladini A, Guzzardi G, Semeraro V, Di Stasi C, Giurazza F, Niola R, Stefanini M, Contegiacomo A, Carrubba C, Discalzi A, Ciferri F, Carriero S, Lanza C, Biondetti P, Coniglio G, Fonio P, Venturini M, Carrafiello G, Del Giudice C. Effectiveness and Safety of Different Vascular Closure Devices: Multicentre Prospective Observational study. Cardiovasc Intervent Radiol 2023; 46:827-834. [PMID: 37225968 PMCID: PMC10208551 DOI: 10.1007/s00270-023-03463-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 04/29/2023] [Indexed: 05/26/2023]
Abstract
AIM The aim of this prospective, multicentre, observational study was to compare the efficacy and safety of balloon-based and non-balloon-based vascular closure devices (VCDs). MATERIALS AND METHODS From March 2021 to May 2022, 2373 participants from 10 different centres were enrolled. Among them, 1672 patients with 5-7 Fr accesses were selected. Successful haemostasis, failure and safety were evaluated. Successful haemostasis was defined as the possibility to obtain complete haemostasis with the use of VCDs, without any complication. Failure management was defined as the need of manual compression. Safety was defined as the rate of complications. Cases of haematomas/pseudoaneurysms (PSA) and artero-venous fistula (AVF) were collected. RESULTS VCDs mechanism of action is statistically significant associated with the outcome. Non-balloon-based VCDs demonstrated a statistically significant better outcome: successful haemostasis was obtained in 96.5% vs. 85.9%, of cases when compared to balloon occluders (p < 0.001). The incidence of AVF was statistically more frequent using non-balloon occluders devices (1.57% vs 0%, p: 0.007). No significant statistical difference was found in comparing haematoma and PSA occurrence. Thrombocytopenia, coagulation deficit, BMI, diabetes mellitus and anti-coagulation were demonstrated to be independent predictors of failure management. CONCLUSION Our study suggests a better outcome with the same complication rate, except that for AVF incidence for non-balloon collagen plug device if compared to balloon occluders vascular closure devices.
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Affiliation(s)
- Anna Maria Ierardi
- UOC Radiologia, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy.
| | - Andrea Coppola
- UOC Radiologia Diagnostica ed Interventistica, ASST Settelaghi, Insubria University, Varese, Italy
| | - Matteo Renzulli
- Department of Radiology, IRCSS Azienda Ospedaliero-Universitaria di Bologna, 40138, Bologna, Italy
| | - Filippo Piacentino
- UOC Radiologia Diagnostica ed Interventistica, ASST Settelaghi, Insubria University, Varese, Italy
| | - Federico Fontana
- UOC Radiologia Diagnostica ed Interventistica, ASST Settelaghi, Insubria University, Varese, Italy
| | - Andrea Paladini
- U.O. Radiologia Interventistica-AOU "Maggiore della Carità", Università del Piemonte Orientale, Vercelli, Italy
| | - Giuseppe Guzzardi
- U.O. Radiologia Interventistica-AOU "Maggiore della Carità", Università del Piemonte Orientale, Vercelli, Italy
| | - Vittorio Semeraro
- SSD Radiologia Interventistica, POC SS Annunziata, ASL Taranto, Taranto, Italy
| | - Carmine Di Stasi
- SSD Radiologia Interventistica, POC SS Annunziata, ASL Taranto, Taranto, Italy
| | - Francesco Giurazza
- Vascular and Interventional Radiology Department, Cardarelli Hospital, Via Antonio Cardarelli 9, 80131, Naples, Italy
| | - Raffaella Niola
- Vascular and Interventional Radiology Department, Cardarelli Hospital, Via Antonio Cardarelli 9, 80131, Naples, Italy
| | - Matteo Stefanini
- UO Diagnostica per Immagini e Radiologia Interventistica, Policlinico Casilino, Rome, Italy
| | - Andrea Contegiacomo
- UOSA Radiologia d'Urgenza, Fondazione Policlinico Universitario "A Gemelli", IRCCS, Rome, Italy
| | - Claudio Carrubba
- UOSA Radiologia d'Urgenza, Fondazione Policlinico Universitario "A Gemelli", IRCCS, Rome, Italy
| | - Andrea Discalzi
- Department of Surgical Sciences; Radiology Unit, University of Torino, Via Genova 3, 10126, Turin, Italy
| | - Fernanda Ciferri
- Department of Surgical Sciences; Radiology Unit, University of Torino, Via Genova 3, 10126, Turin, Italy
| | - Serena Carriero
- Post-graduate School of Radiology, Università degli Studi di Milano, Milan, Italy
| | - Carolina Lanza
- Post-graduate School of Radiology, Università degli Studi di Milano, Milan, Italy
| | - Pierpaolo Biondetti
- UOC Radiologia, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy
| | - Giovanni Coniglio
- Radiologia diagnostica ed Interventistica, Azienda Ospedaliera per l'emergenza Cannizzaro-Catania, Catania, Italy
| | - Paolo Fonio
- Department of Surgical Sciences; Radiology Unit, University of Torino, Via Genova 3, 10126, Turin, Italy
| | - Massimo Venturini
- UOC Radiologia Diagnostica ed Interventistica, ASST Settelaghi, Insubria University, Varese, Italy
| | - Gianpaolo Carrafiello
- UOC Radiologia, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy
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20
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d'Entremont MA, Alrashidi S, Alansari O, Brochu B, Heenan L, Skuriat E, Tyrwhitt J, Raco M, Tsang M, Valettas N, Velianou JL, Sheth TN, Sibbald M, Mehta SR, Pinilla-Echeverri N, Schwalm JD, Natarajan MK, Kelly A, Akl E, Tawadros S, Camargo M, Faidi W, Bauer J, Moxham R, Nkurunziza J, Dutra G, Winter J, Jolly SS. Ultrasound-guided femoral access in patients with vascular closure devices: a prespecified analysis of the randomised UNIVERSAL trial. EUROINTERVENTION 2023; 19:73-79. [PMID: 36876864 PMCID: PMC10174184 DOI: 10.4244/eij-d-22-01130] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 02/08/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND Whether ultrasound (US)-guided femoral access compared to femoral access without US guidance decreases access site complications in patients receiving a vascular closure device (VCD) is unclear. AIMS We aimed to compare the safety of VCD in patients undergoing US-guided versus non-US-guided femoral arterial access for coronary procedures. METHODS We performed a prespecified subgroup analysis of the UNIVERSAL trial, a multicentre randomised controlled trial of 1:1 US-guided femoral access versus non-US-guided femoral access, stratified for planned VCD use, for coronary procedures on a background of fluoroscopic landmarking. The primary endpoint was a composite of major Bleeding Academic Research Consortium 2, 3 or 5 bleeding and vascular complications at 30 days. RESULTS Of 621 patients, 328 (52.8%) received a VCD (86% ANGIO-SEAL, 14% ProGlide). In patients who received a VCD, those randomised to US-guided femoral access compared to non-US-guided femoral access experienced a reduction in major bleeding or vascular complications (20/170 [11.8%] vs 37/158 [23.4%], odds ratio [OR] 0.44, 95% confidence interval [CI]: 0.23-0.82). In patients who did not receive a VCD, there was no difference between the US- and non-US-guided femoral access groups, respectively (20/141 [14.2%] vs 13/152 [8.6%], OR 1.76, 95% CI: 0.80-4.03; interaction p=0.004). CONCLUSIONS In patients receiving a VCD after coronary procedures, US-guided femoral access was associated with fewer bleeding and vascular complications compared to femoral access without US guidance. US guidance for femoral access may be particularly beneficial when VCD are used.
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Affiliation(s)
- Marc-André d'Entremont
- Centre Hospitalier Universitaire de Sherbrooke (CHUS), Sherbrooke, QC, Canada
- Population Health Research Institute, Hamilton, ON, Canada
| | - Sulaiman Alrashidi
- McMaster University, Hamilton, ON, Canada
- Hamilton Health Sciences, Hamilton, ON, Canada
- Niagara Health, St. Catharines, ON, Canada
| | - Omar Alansari
- McMaster University, Hamilton, ON, Canada
- Hamilton Health Sciences, Hamilton, ON, Canada
- Niagara Health, St. Catharines, ON, Canada
| | - Bradley Brochu
- CK Hui Heart Centre, Royal Alexandra Hospital, Edmonton, AB, Canada
| | - Laura Heenan
- Population Health Research Institute, Hamilton, ON, Canada
| | | | | | - Micheal Raco
- McMaster University, Hamilton, ON, Canada
- Hamilton Health Sciences, Hamilton, ON, Canada
- Niagara Health, St. Catharines, ON, Canada
| | - Micheal Tsang
- McMaster University, Hamilton, ON, Canada
- Hamilton Health Sciences, Hamilton, ON, Canada
- Niagara Health, St. Catharines, ON, Canada
| | - Nicholas Valettas
- McMaster University, Hamilton, ON, Canada
- Hamilton Health Sciences, Hamilton, ON, Canada
- Niagara Health, St. Catharines, ON, Canada
| | - James L Velianou
- McMaster University, Hamilton, ON, Canada
- Hamilton Health Sciences, Hamilton, ON, Canada
- Niagara Health, St. Catharines, ON, Canada
| | - Tej N Sheth
- Population Health Research Institute, Hamilton, ON, Canada
- McMaster University, Hamilton, ON, Canada
- Hamilton Health Sciences, Hamilton, ON, Canada
- Niagara Health, St. Catharines, ON, Canada
| | - Matthew Sibbald
- McMaster University, Hamilton, ON, Canada
- Hamilton Health Sciences, Hamilton, ON, Canada
- Niagara Health, St. Catharines, ON, Canada
| | - Shamir R Mehta
- Population Health Research Institute, Hamilton, ON, Canada
- McMaster University, Hamilton, ON, Canada
- Hamilton Health Sciences, Hamilton, ON, Canada
- Niagara Health, St. Catharines, ON, Canada
| | - Natalia Pinilla-Echeverri
- Population Health Research Institute, Hamilton, ON, Canada
- McMaster University, Hamilton, ON, Canada
- Hamilton Health Sciences, Hamilton, ON, Canada
- Niagara Health, St. Catharines, ON, Canada
| | - Jon David Schwalm
- Population Health Research Institute, Hamilton, ON, Canada
- McMaster University, Hamilton, ON, Canada
- Hamilton Health Sciences, Hamilton, ON, Canada
- Niagara Health, St. Catharines, ON, Canada
| | - Madhu K Natarajan
- Population Health Research Institute, Hamilton, ON, Canada
- McMaster University, Hamilton, ON, Canada
- Hamilton Health Sciences, Hamilton, ON, Canada
- Niagara Health, St. Catharines, ON, Canada
| | - Andrew Kelly
- McMaster University, Hamilton, ON, Canada
- Hamilton Health Sciences, Hamilton, ON, Canada
- Niagara Health, St. Catharines, ON, Canada
| | - Elie Akl
- McGill University Faculty of Medicine and Health Sciences, Montreal, QC, Canada
| | | | | | - Walaa Faidi
- Hamilton Health Sciences, Hamilton, ON, Canada
| | - John Bauer
- Hamilton Health Sciences, Hamilton, ON, Canada
| | | | - James Nkurunziza
- McMaster University, Hamilton, ON, Canada
- Hamilton Health Sciences, Hamilton, ON, Canada
- Niagara Health, St. Catharines, ON, Canada
| | - Gustavo Dutra
- McMaster University, Hamilton, ON, Canada
- Hamilton Health Sciences, Hamilton, ON, Canada
| | - Jose Winter
- Clinica Alemana De Santiago, Universidad de Desarrollo, Santiago, Chile
| | - Sanjit S Jolly
- Population Health Research Institute, Hamilton, ON, Canada
- McMaster University, Hamilton, ON, Canada
- Hamilton Health Sciences, Hamilton, ON, Canada
- Niagara Health, St. Catharines, ON, Canada
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21
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Minici R, Serra R, Maglia C, Guzzardi G, Spinetta M, Fontana F, Venturini M, Laganà D. Efficacy and Safety of Axiostat ® Hemostatic Dressing in Aiding Manual Compression Closure of the Femoral Arterial Access Site in Patients Undergoing Endovascular Treatments: A Preliminary Clinical Experience in Two Centers. J Pers Med 2023; 13:812. [PMID: 37240982 PMCID: PMC10220903 DOI: 10.3390/jpm13050812] [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: 03/31/2023] [Revised: 05/10/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Hemostasis of the femoral arterial access site by manual compression or a vascular closure device is critical to the safe completion of any endovascular procedure. Previous investigations evaluated the hemostatic efficacy at the radial access site of some chitosan-based hemostatic pads. This study aims to assess the efficacy and safety of a new chitosan-based hemostatic dressing, namely Axiostat®, in aiding manual compression closure of the femoral arterial access site in patients undergoing endovascular treatments. Furthermore, the outcomes were compared with evidence on manual compression alone and vascular closure devices. METHODS This investigation is a two-center retrospective analysis of 120 consecutive patients who had undergone, from July 2022 to February 2023, manual compression closure of the femoral arterial access site aided by the Axiostat® hemostatic dressing. Endovascular procedures performed with introducer sheaths ranging from 4 Fr to 8 Fr were evaluated. RESULTS Primary technical success was achieved in 110 (91.7%) patients, with adequate hemostasis obtained in all cases of prolonged manual compression requirements. The mean time-to-hemostasis and time-to-ambulation were 8.9 (±3.9) and 462 (±199) minutes, respectively. Clinical success was achieved in 113 (94.2%) patients, with bleeding-related complications noted in 7 (5.8%) patients. CONCLUSIONS Manual compression aided by the Axiostat® hemostatic dressing is effective and safe in achieving hemostasis of the femoral arterial access site in patients undergoing endovascular treatment with a 4-8 Fr introducer sheath.
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Affiliation(s)
- Roberto Minici
- Radiology Unit, Dulbecco University Hospital, 88100 Catanzaro, Italy; (R.M.); (C.M.)
| | - Raffaele Serra
- Vascular Surgery Unit, Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Dulbecco University Hospital, 88100 Catanzaro, Italy;
| | - Claudio Maglia
- Radiology Unit, Dulbecco University Hospital, 88100 Catanzaro, Italy; (R.M.); (C.M.)
| | - Giuseppe Guzzardi
- Radiology Unit, Maggiore della Carità University Hospital, 28100 Novara, Italy; (G.G.); (M.S.)
| | - Marco Spinetta
- Radiology Unit, Maggiore della Carità University Hospital, 28100 Novara, Italy; (G.G.); (M.S.)
| | - Federico Fontana
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Insubria University, 21100 Varese, Italy; (F.F.); (M.V.)
| | - Massimo Venturini
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Insubria University, 21100 Varese, Italy; (F.F.); (M.V.)
| | - Domenico Laganà
- Radiology Unit, Dulbecco University Hospital, 88100 Catanzaro, Italy; (R.M.); (C.M.)
- Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy
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22
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Lee SH, Kim DR, Lee JS, Nam IC, Ko SY. [Delayed Bilateral Common Femoral Pseudoaneurysm after Percutaneous Access with Interventional Management: A Case Report]. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2023; 84:705-712. [PMID: 37324985 PMCID: PMC10265233 DOI: 10.3348/jksr.2022.0100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 09/27/2022] [Accepted: 10/08/2022] [Indexed: 06/17/2023]
Abstract
Common femoral artery pseudoaneurysm is a potentially serious complication of peripheral angiography. There have been few prior reports of simultaneous pseudoaneurysm in both common femoral arteries after percutaneous access. Here we report the case of a 58-year-old male patient who presented with phlegmon or abscess a few days after bilateral femoral access, after which newly developed bilateral femoral pseudoaneurysm with wide neck was observed on CT angiography 2 months after infection treatment. Because the patient refused surgery for pseudoaneurysm, a stent-graft was inserted in the left side, and percutaneous thrombin injection under US guidance with balloon occlusion was performed for the right side. Most pseudoaneurysms occur immediately after the causative procedure. However, there have been some cases in which pseudoaneurysms may occur several weeks or months later; it is therefore necessary to check the risk factors and to carefully observe the hemostasis site.
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23
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Safety of short 3-hour recovery and same-day discharge following lower-limb angioplasty in outpatients with intermittent claudication and critical limb ischaemia. Clin Radiol 2023; 78:e182-e189. [PMID: 36462943 DOI: 10.1016/j.crad.2022.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 09/21/2022] [Accepted: 10/13/2022] [Indexed: 12/03/2022]
Abstract
AIM To investigate the safety and efficacy of short recovery day-case pathway following lower-limb angioplasty in both intermittent claudication and critical limb ischaemia patients. MATERIALS AND METHODS A retrospective analysis was undertaken of the medical records of consecutive outpatients treated with lower-limb angioplasty over a 1-year period within an interventional radiology (IR) day-case unit in a high-volume vascular centre. Standard post-angioplasty care at York Teaching Hospital is discharge 3 h after puncture site haemostasis without the routine use of closure devices. The rates of successful same-day discharge, procedure success, complications, and re-admissions were calculated with 30-day follow-up. RESULTS The cohort included 301 patients (57% intermittent claudication and 43% critical limb ischaemia) undergoing 605 angioplasties using access sheath size ranging from 4 to 7 F. Closure devices were used in only 7% of patients. Successful same-day discharge achieved in 98% of patients (294/301), with seven admitted overnight because of complications. Eleven patients (3.6%) were re-admitted within 30 days. Technical success rates were 92%, and 96% when including partially successful interventions, with 4% technical failure. Twelve patients (4%) developed minor complications and four major complications (1%). There were no significant differences in complication rates between small and larger sheath sizes (p>0.05). No procedure-related death was recorded within 30 days. CONCLUSION Lower-limb angioplasty can be performed safely as day-case procedure with a short recovery protocol within IR departments for both patients with intermittent claudication (IC) and critical limb ischaemia (CLI). This may significantly increase patient throughput and alleviate pressure on stretched hospital inpatient resources by safely discharging patients on the day of procedure.
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24
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Huang YC, Kao CC, Lu YH, Chou YY, Lin YK, Tam KW. Effects of Shared Decision-Making with a Patient Decision Aid for Postangiography Hemostasis Method Selection: A Randomized Controlled Trial. J Vasc Interv Radiol 2023; 34:832-839. [PMID: 36632966 DOI: 10.1016/j.jvir.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 12/20/2022] [Accepted: 01/02/2023] [Indexed: 01/11/2023] Open
Abstract
PURPOSE To evaluate the effects of shared decision-making (SDM) with a patient decision aid (PtDA) on hemostasis device selection and reduction of decisional conflicts in patients undergoing transfemoral angiography. MATERIALS AND METHODS Patients undergoing angiography were randomized to receive either a standard explanation or the process aid of PtDA for choosing hemostasis devices. The decisional conflict was assessed using the 4-item Sure of myself; Understand information; Risk-benefit ratio; Encouragement (SURE) scale. Differences in demographic variables, clinical variables, and final choice of hemostasis devices were compared via univariate and multivariate logistic regression analyses. RESULTS In total, 158 patients were included-80 in the PtDA group and 78 in the standard group. No difference was found between the 2 groups in terms of patient demographic and clinical variables. The PtDA group scored better on all questions of the SURE scale both individually and collaboratively (P <.001). PtDA intervention (P =.031) and reason for angiography (P =.0006) were the main variables that influenced patient hemostasis device choice in the univariate logistic regression analysis. Reason for angiography remained the only deciding factor that affected patient choice in the multivariate logistic regression analysis (P =.015). CONCLUSIONS Step-by-step guidance and pictorial explanation with the assistance of PtDA led to improvements in patient knowledge but showed no significant impact in multivariate analysis for the influence on the choice of hemostasis device.
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Affiliation(s)
- Yi-Chun Huang
- Department of Medical Imaging, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Chao-Chen Kao
- School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yueh-Hsun Lu
- Department of Radiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yun-Yun Chou
- Shared Decision Making Resource Center, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Yen-Kuang Lin
- Graduate Institute of Athletics and Coaching Science, National Taiwan Sport University, Taoyuan, Taiwan
| | - Ka-Wai Tam
- Shared Decision Making Resource Center, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; Division of General Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; Division of General Surgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan.
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25
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Marquis‐Gravel G, Boivin‐Proulx L, Huang Z, Zelenkofske SL, Lincoff AM, Mehran R, Steg PG, Bode C, Alexander JH, Povsic TJ. Femoral Vascular Closure Devices and Bleeding, Hemostasis, and Ambulation Following Percutaneous Coronary Intervention. J Am Heart Assoc 2022; 12:e025666. [PMID: 36583436 PMCID: PMC9973572 DOI: 10.1161/jaha.122.025666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background The effectiveness of vascular closure devices (VCDs) to reduce bleeding after transfemoral percutaneous coronary intervention remains unsettled. Methods and Results Participants in the REGULATE-PCI (Effect of the REG1 anticoagulation system versus bivalirudin on outcomes after percutaneous coronary intervention) trial who underwent transfemoral percutaneous coronary intervention with VCD implantation were compared with those who underwent manual compression. The primary effectiveness end point was type 2, 3, or 5 Bleeding Academic Research Consortium access site bleeding at day 3. Univariate and multivariate analyses were adjusted by the inverse probability weighting method using propensity score. Time to hemostasis and time to ambulation were compared between groups. Of the 1580 patients who underwent transfemoral percutaneous coronary intervention, 1004 (63.5%) underwent VCD implantation and 576 (36.5%) had manual compression. The primary effectiveness end point occurred in 64 (6.4%) participants in the VCD group and in 38 (6.6%) participants in the manual compression group (inverse probability weighting-adjusted odds ratio, 1.02 [95% CI, 0.77-1.36]; P=0.89). There were statistically significant 2-way interactions between VCD use and female sex, chronic kidney disease, and use of high-potency P2Y12 inhibition (ticagrelor or prasugrel) (P<0.05 for all) with less bleeding with VCD use in these high-risk subgroups. Median time to hemostasis and time to ambulation were shorter in the VCD versus the manual compression group (P<0.01 for both). Conclusions Following transfemoral percutaneous coronary intervention, VCD use is associated with a shorter time to hemostasis and time to ambulation but not less bleeding. Further study of patients with high-bleeding risk is required, including women, patients with chronic kidney disease, and those using high-potency P2Y12 inhibitors. Registration URL: https://clinicaltrials.gov/ct2/show/NCT01848106; Unique identifier: NCT01848106.
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Affiliation(s)
- Guillaume Marquis‐Gravel
- Duke HealthDuke Clinical Research Institute and Duke UniversityDurhamNC,Montreal Heart Institute, University of MontrealMontrealQC
| | | | - Zhen Huang
- Duke HealthDuke Clinical Research Institute and Duke UniversityDurhamNC
| | | | - A. Michael Lincoff
- Cleveland Clinic Coordinating Center for Clinical Research (C5Research)ClevelandOH
| | | | | | | | - John H. Alexander
- Duke HealthDuke Clinical Research Institute and Duke UniversityDurhamNC
| | - Thomas J. Povsic
- Duke HealthDuke Clinical Research Institute and Duke UniversityDurhamNC
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26
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Thakker R, Iturrizaga JC, Abu Sharifeh T. Vascular Closure Devices after Femoral Arteriotomy: Insight in High-Risk Patients. J Am Heart Assoc 2022; 12:e028501. [PMID: 36583433 PMCID: PMC9973604 DOI: 10.1161/jaha.122.028501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Ravi Thakker
- Division of Cardiovascular DiseaseUniversity of Texas Medical BranchGalvestonTX
| | - Jose C. Iturrizaga
- Division of Cardiovascular DiseaseUniversity of Texas Medical BranchGalvestonTX
| | - Tareq Abu Sharifeh
- Division of Cardiovascular DiseaseUniversity of Texas Medical BranchGalvestonTX
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27
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Zhang X, Luo Y, Tsauo J, Zhao H, Gong T, Li J, Li Y, Zeng H, Sun W, Li X. Transradial versus transfemoral access without closure device for transarterial chemoembolization in patients with hepatocellular carcinoma: a randomized trial. Eur Radiol 2022; 32:6812-6819. [PMID: 36018356 DOI: 10.1007/s00330-022-09038-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/18/2022] [Accepted: 07/19/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To compare patient satisfaction, procedural variables, and safety with transradial access (TRA) and transfemoral access (TFA) in patients undergoing transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC). MATERIALS AND METHODS From February 2019 to August 2021, 130 patients undergoing TACE for HCC were randomly allocated to the TRA (n = 65) or TFA (n = 65) group. Vascular closure devices were not used after TFA-TACE. All patients completed the post-catheterization questionnaire and 8-item Short-Form Health Survey 1 day after TACE. RESULTS Technical success rate, crossover rate, contrast agent dose, fluoroscopy time, procedure time, air kerma, dose-area product, length of hospital stay, and total cost were similar between the two groups (all p > 0.05). The incidence and severity of adverse events were also similar between the two groups (all p > 0.05). However, overall discomfort, difficulty going to the bathroom, difficulty feeding or self-caring, difficulty walking, general health, physical function, role physical function, social function, mental health, and role emotional function were better in the TRA group than in the TFA group (all p < 0.001). Consequently, more patients preferred the current access for their next procedure in the TRA group than in the TFA group (90.8% vs. 24.6%; p < 0.001). CONCLUSION In patients undergoing TACE for HCC, using TRA instead of TFA can improve patient satisfaction without compromising procedural variables and safety. KEY POINTS • Transradial access (TRA) enabled early ambulation after transarterial chemoembolization (TACE), resulting in significant increase in activities of daily living and health-related quality of life (HRQoL) compared to transfemoral access (TFA) when vascular closure devices were not used. • Procedural variables (contrast agent dose, fluoroscopy time, procedure time, air kerma, dose-area product, length of hospital stay, and total cost) were not significantly different between patients who received TRA-TACE and TFA-TACE. • The incidence and severity of adverse events were similar between patients who received TRA-TACE and TFA-TACE.
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Affiliation(s)
- Xiaowu Zhang
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Yingen Luo
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Jiaywei Tsauo
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - He Zhao
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Tao Gong
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Jingui Li
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Yawei Li
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Huiying Zeng
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Wei Sun
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
| | - Xiao Li
- Department of Interventional Therapy, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
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28
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Di Mario C, Mashayekhi KA, Garbo R, Pyxaras SA, Ciardetti N, Werner GS. Recanalisation of coronary chronic total occlusions. EUROINTERVENTION 2022; 18:535-561. [PMID: 36134683 DOI: 10.4244/eij-d-21-01117] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Percutaneous treatment of coronary chronic total occlusions (CTO) has advanced greatly since its advent in the late 1970s through the development of dedicated wires and microcatheters, the improved skills of highly experienced operators and the adoption of new sophisticated strategies to guide procedural planning. The contemporary procedural success rate is 80-90% with a reduction in complications. Although there has been no improvement in prognosis in randomised trials to date, they, and other controlled registries of thousands of patients, confirm the pivotal role of CTO recanalisation in the treatment of angina and dyspnoea and an improvement in quality of life. Despite this evidence, CTO recanalisation is grossly underutilised. This review reports a detailed overview of the history, indications and treatment strategies for CTO recanalisation and hopes to increase interest among new, and especially young, operators in this demanding, rapidly evolving field of interventional cardiology.
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Affiliation(s)
- Carlo Di Mario
- Structural Interventional Cardiology Division, Department of Clinical & Experimental Medicine, Careggi University Hospital, Florence, Italy
| | - Kambis A Mashayekhi
- Division of Cardiology and Angiology II, University Heart Center Freiburg - Bad Krozingen, Bad Krozingen, Germany
| | - Roberto Garbo
- GVM Care & Research, Maria Pia Hospital, Turin, Italy
| | | | - Niccolò Ciardetti
- Structural Interventional Cardiology Division, Department of Clinical & Experimental Medicine, Careggi University Hospital, Florence, Italy
| | - Gerald S Werner
- Department of Cardiology, Klinikum Darmstadt GmbH, Darmstadt, Germany
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29
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Vascular Closure Devices versus Manual Compression in Cardiac Interventional Procedures: Systematic Review and Meta-Analysis. Cardiovasc Ther 2022; 2022:8569188. [PMID: 36134143 PMCID: PMC9482152 DOI: 10.1155/2022/8569188] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 08/20/2022] [Accepted: 08/22/2022] [Indexed: 11/18/2022] Open
Abstract
Backgrounds Manual compression (MC) and vascular closure device (VCD) are two methods of vascular access site hemostasis after cardiac interventional procedures. However, there is still controversial over the use of them and a lack of comprehensive and systematic meta-analysis on this issue. Methods Original articles comparing VCD and MC in cardiac interventional procedures were searched in PubMed, EMbase, Cochrane Library, and Web of Science through April 2022. Efficacy, safety, patient satisfaction, and other parameters were assessed between two groups. Heterogeneity among studies was evaluated by I2 index and the Cochran Q test, respectively. Publication bias was assessed using the funnel plot and Egger's test. Results A total of 32 studies were included after screening with inclusion and exclusion criteria (33481 patients). This meta-analysis found that VCD resulted in shorter time to hemostasis, ambulation, and discharge (p < 0.00001). In terms of vascular complication risks, VCD group might be associated with a lower risk of major complications (p = 0.0001), but the analysis limited to randomized controlled trials did not support this result (p = 0.68). There was no significant difference in total complication rates (p = 0.08) and bleeding-related complication rates (p = 0.05) between the two groups. Patient satisfaction was higher in VCD group (p = 0.002). Meta-regression analysis revealed no specific covariate as an influencing factor for above results (p > 0.05). Conclusions Compared with MC, the use of VCDs significantly shortens the time of hemostasis and allows earlier ambulation and discharge, meanwhile without increase in vascular complications. In addition, use of VCDs achieves higher patient satisfaction and leads cost savings for patients and institutions.
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30
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Hemostasis control after femoral percutaneous approach: A systematic review and meta-analysis. Int J Nurs Stud 2022; 137:104364. [DOI: 10.1016/j.ijnurstu.2022.104364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 08/26/2022] [Accepted: 09/15/2022] [Indexed: 11/19/2022]
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31
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Tsurusaki Y, Sakai S, Morita T, Miki K, Inoue D, Haga S, Arihiro S. A Case of Huge Scrotal Hematoma during Mechanical Thrombectomy. JOURNAL OF NEUROENDOVASCULAR THERAPY 2022; 16:565-569. [PMID: 37501736 PMCID: PMC10370879 DOI: 10.5797/jnet.cr.2022-0049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 07/31/2022] [Indexed: 07/29/2023]
Abstract
Objective We report a case of huge scrotal hematoma during emergency mechanical thrombectomy. Case Presentation An 85-year-old man presented with sudden aphasia and right-sided hemiplegia. He was diagnosed with cerebral infarction due to left M1 occlusion and underwent an emergency mechanical thrombectomy. The treatment was completed with full recanalization, but when replacing the long sheath in the right femoral artery with a short sheath, the patient flexed his leg. The sheath could not be replaced, resulting in a massive scrotal hematoma. Shortly after, the patient went into cardiopulmonary arrest but recovered spontaneous circulation after cardiopulmonary resuscitation. The puncture site was treated hemostatically with manual compression, and the scrotal hematoma was not enlarged. He was transferred to another hospital with a modified Rankin Scale score of 5. Conclusion Scrotal hematoma is a rare but potentially fatal puncture site complication that should be considered during neuro-endovascular treatment.
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Affiliation(s)
- Yuichiro Tsurusaki
- Department of Cerebrovascular Medicine, Kyushu Rosai Hospital, Kitakyushu, Fukuoka, Japan
| | - Shota Sakai
- Department of Cerebrovascular Medicine, Kyushu Rosai Hospital, Kitakyushu, Fukuoka, Japan
| | - Takao Morita
- Department of Cerebrovascular Medicine, Kyushu Rosai Hospital, Kitakyushu, Fukuoka, Japan
| | - Kenji Miki
- Department of Neurosurgery, Kyushu Rosai Hospital, Kitakyushu, Fukuoka, Japan
| | - Daisuke Inoue
- Department of Neurosurgery, Kyushu Rosai Hospital, Kitakyushu, Fukuoka, Japan
| | - Sei Haga
- Department of Neurosurgery, Kyushu Rosai Hospital, Kitakyushu, Fukuoka, Japan
| | - Shoji Arihiro
- Department of Cerebrovascular Medicine, Kyushu Rosai Hospital, Kitakyushu, Fukuoka, Japan
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32
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Yin X, Ren J, Lan W, Chen Y, Ouyang M, Su H, Zhang L, Zhu J, Zhang C. Microfluidics-assisted optimization of highly adhesive haemostatic hydrogel coating for arterial puncture. Bioact Mater 2022; 12:133-142. [PMID: 35310386 PMCID: PMC8897215 DOI: 10.1016/j.bioactmat.2021.10.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/19/2021] [Accepted: 10/04/2021] [Indexed: 01/05/2023] Open
Abstract
Although common in clinical practice, bleeding after tissue puncture may cause serious outcomes, especially in arterial puncture. Herein, gelatin-tannic acid composite hydrogels with varying compositions are prepared, and their adhesive properties are further optimized in microfluidic channel-based simulated vessels for haemostasis in arterial puncture. It is revealed that the composite hydrogels on the syringe needles used for arterial puncture should possess underwater adhesion higher than 4.9 kPa and mechanical strength higher than 86.0 kPa. The needles coated with the gelatin-tannic acid composite hydrogel completely prevent blood loss after both vein and arterial puncture in different animal models. This study holds great significance for the preparation of haemostatic needles for vessel puncture, and gelatin-tannic acid hydrogel coated needles may help to prevent complications associated with arterial puncture. Haemostatic needles were prepared with coating of gelatin-tannic acid hydrogel. Microfluidic system was employed to optimize the underwater adhesion of gelatin-tannic acid hydrogel coating. Needles coated with the gelatin-tannic acid hydrogel exhibited complete haemostasis after arterial puncture.
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Affiliation(s)
- Xingjie Yin
- Department of Nephrology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan, 430022, China
| | - Jingli Ren
- Key Lab of Material Chemistry for Energy Conversion and Storage of Ministry of Education, School of Chemistry and Chemical Engineering, Huazhong University of Science and Technology, Wuhan, 430074, China
| | - Wei Lan
- State Key Laboratory of Coal Combustion and School of Energy and Power Engineering, Huazhong University of Science and Technology, Wuhan, 430074, China
| | - Yu Chen
- Key Lab of Material Chemistry for Energy Conversion and Storage of Ministry of Education, School of Chemistry and Chemical Engineering, Huazhong University of Science and Technology, Wuhan, 430074, China
| | - Mengping Ouyang
- Key Lab of Material Chemistry for Energy Conversion and Storage of Ministry of Education, School of Chemistry and Chemical Engineering, Huazhong University of Science and Technology, Wuhan, 430074, China
| | - Hua Su
- Department of Nephrology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan, 430022, China
| | - Lianbin Zhang
- Key Lab of Material Chemistry for Energy Conversion and Storage of Ministry of Education, School of Chemistry and Chemical Engineering, Huazhong University of Science and Technology, Wuhan, 430074, China
| | - Jintao Zhu
- Key Lab of Material Chemistry for Energy Conversion and Storage of Ministry of Education, School of Chemistry and Chemical Engineering, Huazhong University of Science and Technology, Wuhan, 430074, China
| | - Chun Zhang
- Department of Nephrology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology Wuhan, 430022, China
- Corresponding author.
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Cheng TW, Farber A, King EG, Levin SR, Arinze N, Malas MB, Eslami MH, Garg K, Rybin D, Siracuse JJ. Access Site Complications Are Uncommon with Vascular Closure Devices or Manual Compression after Lower Extremity Revascularization. J Vasc Surg 2022; 76:788-796.e2. [PMID: 35618194 DOI: 10.1016/j.jvs.2022.03.890] [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: 02/02/2022] [Accepted: 03/31/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Vascular closure devices (VCD) and manual compression (MC) are used to achieve hemostasis following peripheral vascular interventions (PVI). We sought to compare perioperative outcomes between MC and four VCDs following PVI in a multicenter setting. METHODS The Vascular Quality Initiative was queried for all lower extremity (LE) PVIs with common femoral artery access performed from 2010-2020. VCDs included were MynxGrip® (Cordis, Santa Clara, CA, USA), StarClose SE™ (Abbott, Redwood City, CA, USA), Angio-Seal® (Terumo, Somerset, NJ, USA), and Perclose ProGlide™ (Abbott, Redwood City, CA, USA). In a blinded fashion, these four VCDs (A, B, C, D) were compared to MC for baseline characteristics, procedural details, and outcomes (access site hematoma and stenosis/occlusion). Sheath size >8 Fr were excluded. Propensity score matching (1:1) was performed. Univariable and multivariable analyses were completed for unmatched and matched data. RESULTS There were 84,172 LE PVIs identified: 32,013 (38%) used MC and 52,159 (62%) used VCDs (A-12,675;B-6,224;C-19,872;D-13,388). Overall, average age was 68.7 years and 60.4% were male; indications for intervention were most commonly claudication (43.8%) and tissue loss (40.1%). When compared to MC, VCDs were utilized more often in patients with obesity, diabetes, and end stage renal disease (all P<.001). VCDs were used less often in patients with hypertension, chronic obstructive pulmonary disease, coronary artery disease, prior percutaneous coronary and extremity interventions, and major amputation (all P<.001). VCD use was more common, compared to MC, during femoral-popliteal (73% vs. 63.8%) and tibial interventions (33.8% vs. 22.3%), but less common with iliac interventions (20.6% vs. 34.7%) (all P<.001). Protamine was used less often after VCDs (19.1% vs. 25.6%, P<.001). Overall, there were 2,003 (2.4%) hematomas of which 278 (13.9%) required thrombin/surgical intervention. When compared to MC, any VCD use had fewer hematomas (1.7% vs. 3.6%, P<.001) and hematomas requiring intervention (.2% vs. .5%, P<.001). When divided by hemostatic technique, any hematoma were MC-3.6%; A-1.4%; B-1.2%; C-2.3%; D-1.1%, P<.001. Hematomas requiring intervention were MC-.5%; A-.2%; B-.2%; C-.3%; D-.1%, P<.001. Access site stenosis/occlusion was similar between MC and any VCDs (.2% vs. .2%, P=.12). Multivariable analysis demonstrated that any VCDs and individual VCDs, vs. MC, were independently associated with fewer hematomas. Access site stenosis/occlusion was similar between any VCDs and MC. Matched analysis revealed similar findings. CONCLUSIONS Although overall rates of hematomas requiring intervention were low regardless of hemostatic technique, VCD use, irrespective of type, compared favorably to MC with significantly fewer access site complications after PVI.
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Affiliation(s)
- Thomas W Cheng
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA
| | - Alik Farber
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA
| | - Elizabeth G King
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA
| | - Scott R Levin
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA
| | - Nkiruka Arinze
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA
| | - Mahmoud B Malas
- Division of Vascular and Endovascular Surgery, University of California San Diego, San Diego, CA
| | - Mohammad H Eslami
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Karan Garg
- Division of Vascular Surgery, NYU Langone Medical Center, New York, NY
| | - Denis Rybin
- Department of Biostatistics, Boston University, School of Public Health, Boston, MA
| | - Jeffrey J Siracuse
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA.
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Meucci F, Stolcova M, Caniato F, Sarraf M, Mattesini A, Di Mario C. The Essentials of Femoral Vascular Access and Closure. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.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
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Villela MA, Sanina C, Pyo R. Vascular Access Site Complications. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Senguttuvan NB, Reddy PMK, Shankar P, Abdulkader RS, Yallanki HP, Kumar A, Majmundar M, Ramalingam V, Rajendran R, Bhoopalan K, Kaliyamoorthy D, T. R. M, Kalra A, Jayaraj R, Ramakrishnan S, Daggubati R, Thanikachalam S, Seth A, Bahl VK. Trans-radial approach versus trans-femoral approach in patients with acute coronary syndrome undergoing percutaneous coronary intervention: An updated meta-analysis of randomized controlled trials. PLoS One 2022; 17:e0266709. [PMID: 35483028 PMCID: PMC9050011 DOI: 10.1371/journal.pone.0266709] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 03/25/2022] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Trans-radial approach (TRA) is recommended over trans-femoral approach (TFA) in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). We intended to study the effect of access on all-cause mortality. METHODS AND RESULTS We searched PubMed and EMBASE for randomized studies on patients with ACS undergoing PCI. The primary outcome was all-cause mortality at 30-days. The secondary outcomes included in-hospital mortality, major adverse cardiac or cerebrovascular event (MACE) as defined by the study, net adverse clinical event (NACE), non-fatal myocardial infarction, non-fatal stroke, stent thrombosis, study-defined major bleeding, and minor bleeding, vascular complications, hematoma, pseudoaneurysm, non-access site bleeding, need for transfusion, access site cross-over, contrast volume, procedure duration, and hospital stay duration. We studied 20,122 ACS patients, including 10,037 and 10,085 patients undergoing trans-radial and trans-femoral approaches, respectively. We found mortality benefit in patients with ACS for the trans-radial approach [(1.7% vs. 2.3%; RR: 0.75; 95% CI: 0.62-0.91; P = 0.004; I2 = 0%). Out of 10,465 patients with STEMI, 5,189 patients had TRA and 5,276 had TFA procedures. A similar benefit was observed in patients with STEMI alone [(2.3% vs. 3.3%; RR: 0.71; 95% CI: 0.56-0.90; P = 0.004; I2 = 0%). We observed reduced MACE, NACE, major bleeding, vascular complications, and pseudoaneurysms. No difference in re-infarction, stroke, and serious bleeding requiring blood transfusions were noted. We noticed a small decrease in contrast volume(ml) {mean difference (95% CI): -4.6 [-8.5 to -0.7]}, small but significantly increase in procedural time {mean difference (95% CI) 1.2 [0.1 to 2.3]}and fluoroscopy time {mean difference (95% CI) 0.8 [0.3 to1.4] min} in the trans-radial group. CONCLUSION TRA has significantly reduced 30-day all-cause mortality among patients undergoing PCI for ACS. TRA should be the preferred vascular access in patients with ACS.
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Affiliation(s)
- Nagendra Boopathy Senguttuvan
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Chennai, Tamil Nadu, India
- Adjunct Faculty, Department of Engineering and design, Indian Institute of Technology-Madras, Chennai, India
| | - Pothireddy M. K. Reddy
- Department of Medicine, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Chennai, Tamil Nadu, India
| | - PunatiHari Shankar
- Department of Medicine, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Chennai, Tamil Nadu, India
| | | | - Hanumath Prasad Yallanki
- Department of Medicine, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Chennai, Tamil Nadu, India
| | - Ashish Kumar
- Section of Cardiovascular Research, Heart, Vascular, and Thoracic Department, Cleveland Clinic Akron General, Akron, Ohio
| | - Monil Majmundar
- Section of Cardiovascular Research, Heart, Vascular, and Thoracic Department, Cleveland Clinic Akron General, Akron, Ohio
- Department of Internal Medicine, New York Medical College, Metropolitan Hospital, New York, New York, United States of America
| | - Vadivelu Ramalingam
- Department of Cardiology, Velammal Medical College and Hospital, Madurai, India
| | | | | | | | - Muralidharan T. R.
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Chennai, Tamil Nadu, India
| | - Ankur Kalra
- Section of Cardiovascular Research, Heart, Vascular, and Thoracic Department, Cleveland Clinic Akron General, Akron, Ohio
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio
| | | | | | - Ramesh Daggubati
- Department of Cardiovascular Medicine, WVU Heart and Vascular Institute, Morgantown, India
| | - Sadagopan Thanikachalam
- Department of Cardiology, Sri Ramachandra Institute of Higher Education and Research (SRIHER), Chennai, Tamil Nadu, India
| | - Ashok Seth
- Department of Cardiology, Fortis Escorts Heart Institute, New Delhi, India
| | - Vinay Kumar Bahl
- Department of Cardiovascular Medicine, WVU Heart and Vascular Institute, Morgantown, India
- Department of Cardiology, Max- Super-speciality Hospitals, New Delhi, India
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Abstract
PURPOSE OF REVIEW Vascular access and closure is a key part of endovascular procedures, and access site-related complications are an independent predictor of adverse procedural outcomes. The purpose of this review is to discuss the methods of vascular closure including manual compression, vascular closure devices (VCDs) for both arterial and venous arteriotomies, their mechanisms, and access site-related complications. RECENT FINDINGS Various VCDs have been approved over the last three decades. These devices have different mechanisms to achieve hemostasis and are generally categorized into active and passive approximators. Studies have largely found that they are non-inferior to manual compression. Uncomplicated vascular closure is pertinent to avoid adverse procedure-related outcomes. The emergence of VCDs has reduced time to hemostasis, facilitating early ambulation and discharge and reducing hospitalization cost with comparable complication rate to manual compression. Nonetheless, they should be used in favorable vascular anatomy and are not intended to reduce complications.
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Affiliation(s)
- Sukhdeep Bhogal
- Section of Interventional Cardiology, MedStar Washington Hospital Center, 110 Irving St.Suite 4B-1, Washington, NWDC, 20010, USA
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, 110 Irving St.Suite 4B-1, Washington, NWDC, 20010, USA.
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Jakobsen L, Holm NR, Maeng M, Thim T, Kristensen SD, Mogensen LH, Christiansen EH. Comparison of MynxGrip vascular closure device and manual compression for closure after femoral access angiography: a randomized controlled trial: the closure devices used in every day practice study, CLOSE-UP III trial. BMC Cardiovasc Disord 2022; 22:68. [PMID: 35196986 PMCID: PMC8864788 DOI: 10.1186/s12872-022-02512-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 02/14/2022] [Indexed: 11/17/2022] Open
Abstract
Background Complications related to femoral artery access for coronary angiography (CAG) is a safety concern. Vascular closure devices (VCDs) have been developed to reduce the rate of complications after femoral artery access. We compared the safety and efficacy of the MynxGrip VCD versus manual compression (MC) after femoral access CAG in a randomized controlled trial. Methods The study was a randomized, single center, non-blinded, two-arm non-inferiority trial. The study was stopped prematurely because of low inclusion rate. Results We randomized 869 patients to closure with the MynxGrip VCD or MC and 865 entered analyses. The incidence of the primary endpoint of major adverse vascular events (MAVE) after 30 days was 1.2% in the MynxGrip group and 0% in the MC group (p = 0.06). The median time to hemostasis was 4 [3:5] minutes and 10 [7:11] minutes in the MynxGrip group and MC group, respectively (p < 0.0001). The corresponding median times to mobilization was 73 [65:87] minutes and 76 [70:88] minutes (p = 0.01). Conclusions MAVE was rare after closure of femoral arterial access by both the MynxGrip VCD and MC. We found a numerical difference in favour of MC but this did not reach statistical significance. Time to hemostasis was shorter in the MynxGrip group when compared to the MC group. Trial registration The study was approved by the local medical ethics committee and registered at clinicaltrials.org (ClinicalTrials identifier: NCT02237430 11/09/2014).
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Affiliation(s)
- Lars Jakobsen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N., Denmark.
| | - Niels R Holm
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N., Denmark
| | - Michael Maeng
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N., Denmark
| | - Troels Thim
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N., Denmark
| | - Steen D Kristensen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N., Denmark
| | - Lone H Mogensen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N., Denmark
| | - Evald H Christiansen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N., Denmark
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Vascular Accesses in Cardiac Stimulation and Electrophysiology: An Italian Survey Promoted by AIAC (Italian Association of Arrhythmias and Cardiac Pacing). BIOLOGY 2022; 11:biology11020265. [PMID: 35205131 PMCID: PMC8869488 DOI: 10.3390/biology11020265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 01/27/2022] [Accepted: 02/04/2022] [Indexed: 11/17/2022]
Abstract
Simple Summary Both cardiac implantable electronic device (CIED) implantations and electrophysiology procedures require vascular access to reach the heart through vessels. Different types of access carry different rates of complications. Safety and ease of vascular access are the main targets of physicians; in fact, each complication causes morbidity and raises costs. To avoid complications, the use of ultrasound-guided vessel puncture and closure devices is increasing in frequency. We conducted a survey in Italian centers to outline common practice; an uneven pattern of habits emerged. Hopefully, recently published scientific society consensus statements will lead to an improvement in physicians’ practice. The survey highlights that there is an unmet need for dedicated courses, particularly for ultrasound-guided vessel puncture. Abstract Cardiac implantable electronic device (CIED) implants and electrophysiological procedures share a common step: vascular access. On behalf of the AIAC Ricerca Investigators’ Network, we conducted a survey to outline Italian common practice regarding vascular access in EP-lab. All Italian physicians with experience in CIED implantation and electrophysiology were invited to answer an online questionnaire (from May 2020 to November 2020) featuring 20 questions. In total, 103 cardiologists (from 92 Italian hospitals) answered the survey. Vascular access during CIED implants was considered the most complex step following lead placement by 54 (52.4%) respondents and the most complex for 35 (33.9%). In total, 54 (52.4%) and 49 (47.6%) respondents considered the cephalic and subclavian vein the first option, respectively (intrathoracic and extrathoracic subclavian/axillary vein by 22 and 27, respectively). In total, 45 (43.7%) respondents performed close arterial femoral accesses manually; only 12 (11.7%) respondents made extensive use of vascular closure devices. A total of 46 out of 103 respondents had experience in ultrasound-guided vascular accesses, but only 10 (22%) used it for more than 50% of the accesses. In total, 81 (78.6%) respondents wanted to increase their ultrasound-guided vascular access skills. Reducing complications is a goal to reach in cardiac stimulation and electrophysiological procedures. Our survey shows the heterogeneity of the vascular approaches used in Italian centres. Some vascular accesses were proved to be superior to others in terms of complications, with ultrasound-guided puncture as an emerging technique. More effort to produce the standardization of vascular accesses could be made by scientific societies.
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Beshai R. Watchman Device Procedure Complicated by Rare Perclose ProGlide Embolization: Case Report and Literature Review. Cureus 2022; 14:e21173. [PMID: 35165622 PMCID: PMC8831485 DOI: 10.7759/cureus.21173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2022] [Indexed: 11/23/2022] Open
Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia with significant morbidity and mortality. In this case, we present a 69-year-old man with a past medical history of atrial fibrillation on warfarin who came to the hospital for placement of the Watchman device (Boston Scientific Corporation, Marlborough, Massachusetts, United States). His procedure was complicated by Perclose ProGlide™ Suture-Mediated Closure system (Abbott Laboratories Inc., Chicago, Illinois, United States) embolism. The vascular surgery department was consulted STAT in the electrophysiology lab and was unable to fully visualize the vessel. The patient was then brought emergently to a hybrid operating room where venotomy was made. He tolerated the procedure well and was eventually discharged home.
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Nie X, Cui C, Wu T, Wu Y, Bian X, Yang R, Zhang X, Sun Y, Liu Y, Liu W. An anticoagulant/hemostatic indwelling needle for oral glucose tolerance test. Biomater Sci 2022; 10:6570-6582. [DOI: 10.1039/d2bm01133f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Anticoagulant/hemostatic indwelling needles developed by polydopamine co-deposition and underwater hyperbranched polymer adhesive priming monitor changes in blood glucose concentration in diabetic rats.
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Affiliation(s)
- Xiongfeng Nie
- School of Material Science and Engineering, Tianjin Key Laboratory of Composite and Functional Materials, Tianjin University, Tianjin 300350, China
| | - Chunyan Cui
- School of Material Science and Engineering, Tianjin Key Laboratory of Composite and Functional Materials, Tianjin University, Tianjin 300350, China
| | - Tengling Wu
- School of Material Science and Engineering, Tianjin Key Laboratory of Composite and Functional Materials, Tianjin University, Tianjin 300350, China
| | - Yang Wu
- School of Material Science and Engineering, Tianjin Key Laboratory of Composite and Functional Materials, Tianjin University, Tianjin 300350, China
| | - Xinyu Bian
- School of Material Science and Engineering, Tianjin Key Laboratory of Composite and Functional Materials, Tianjin University, Tianjin 300350, China
| | - Rong Yang
- School of Material Science and Engineering, Tianjin Key Laboratory of Composite and Functional Materials, Tianjin University, Tianjin 300350, China
| | - Xiaoping Zhang
- School of Material Science and Engineering, Tianjin Key Laboratory of Composite and Functional Materials, Tianjin University, Tianjin 300350, China
| | - Yage Sun
- School of Material Science and Engineering, Tianjin Key Laboratory of Composite and Functional Materials, Tianjin University, Tianjin 300350, China
| | - Yang Liu
- School of Material Science and Engineering, Tianjin Key Laboratory of Composite and Functional Materials, Tianjin University, Tianjin 300350, China
| | - Wenguang Liu
- School of Material Science and Engineering, Tianjin Key Laboratory of Composite and Functional Materials, Tianjin University, Tianjin 300350, China
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Gouëffic Y, Pin JL, Sabatier J, Coscas R, Ducasse E, Maillos A, Steinmetz E, du Mont LS, Rosset E, Alsac JM, Riche VP, Schirr-Bonnans S, Guyomarc'h B, Nasr B. Outcomes of Same-Day Discharge with Manual Compression and 5F Sheath Compatible Devices for Lower Extremity Arterial Endovascular Treatment. Ann Vasc Surg 2021; 80:87-95. [PMID: 34780966 DOI: 10.1016/j.avsg.2021.10.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 09/30/2021] [Accepted: 10/03/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND For same-day discharge lower extremity arterial disease (LEAD) endovascular procedures, femoral manual compression could be an alternative to arterial closure devices. The aim of this study was to assess the security and efficacy of same-day discharge after manual compression in patients treated for LEAD endovascular revascularization with 5F sheath. METHODS FREEDOM OP was a national multicenter, prospective, single arm study. Patients with symptomatic LEAD (Rutherford 2-5) and eligible for same-day discharge were included. The primary endpoint was the total in-hospital admission rate, which includes overnight surveillance and rehospitalization rate at 1 month. RESULTS Between September 2017 and August 2019, 114 patients were included. The mean age of the patients was 66 ± 10 years and most of them were claudicant (103; 94%). Mainly femoropopliteal lesions were treated (178; 70%) and the technical success was 97%. One hundred forty-two 5F stents and fifty one 5F drug coated balloon were delivered. The mean manual compression duration was 13 ± 4 min. Major access-related complications rate was 4.5%. Total in-hospital admission rate was 11%. Seven patients had overnight surveillance and 5 were rehospitalized (2 for the target lesion). No rehospitalisation was carried out within 24 hr after discharge. No major cardiovascular event, including death, was observed. The patients were significantly improved in term of clinical status (P < 0.0001) and hemodynamic (P < 0.0001) in comparison to baseline. CONCLUSION FREEDOM OP showed that manual compression is feasible and safe for same-day discharge after LEAD revascularization with 5F sheath femoral approach.
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Affiliation(s)
- Yann Gouëffic
- Groupe Hospitalier Paris St Joseph, Service de Chirurgie Vasculaire et Endovasculaire, Paris, France
| | - Jean-Luc Pin
- Clinique de Fontaine-Les-Dijon, Service de Chirurgie Vasculaire, Dijon, France
| | - Jean Sabatier
- Clinique de l'Europe, Service de Chirurgie Vasculaire, Rouen, France
| | - Raphaël Coscas
- AP-HP, Hôpital Ambroise Paré, Service de Chirurgie Vasculaire, Boulogne Billancourt, France
| | - Eric Ducasse
- CHU de Bordeaux, Service de Chirurgie Vasculaire, Bordeaux, France
| | - Alexandros Maillos
- Groupe Hospitalier Paris St Joseph, Service de Chirurgie Vasculaire et Endovasculaire, Paris, France
| | - Eric Steinmetz
- CHU de Dijon, Service de Chirurgie Vasculaire, Dijon, France
| | | | - Eugenio Rosset
- CHU de Clermont Ferrand, Service de Chirurgie Vasculaire, Clermont Ferrand, France
| | - Jean-Marc Alsac
- AP-HP, Hôpital Européen Georges Pompidou, Service de Chirurgie Vasculaire, Paris, France
| | - Valéry-Pierre Riche
- Service Evaluation Economique et Développement des Produits de Santé, Département Partenariats et Innovation, Centre Hospitalier Universitaire de Nantes, Nantes Université, Nantes, France
| | - Solène Schirr-Bonnans
- Service Evaluation Economique et Développement des Produits de Santé, Département Partenariats et Innovation, Centre Hospitalier Universitaire de Nantes, Nantes Université, Nantes, France
| | - Béatrice Guyomarc'h
- CHU de Nantes, Institut du thorax, Service de Chirurgie Vasculaire, Nantes, France
| | - Bahaa Nasr
- CHU de Brest, Service de Chirurgie Vasculaire, Brest, France.
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Conversion From an Outpatient to an Inpatient Setting After an Endovascular Treatment for Lower Extremity Artery Disease. Ann Vasc Surg 2021; 80:96-103. [PMID: 34780959 DOI: 10.1016/j.avsg.2021.10.036] [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: 08/08/2021] [Revised: 10/05/2021] [Accepted: 10/05/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Outpatient endovascular treatment (EVT) for lower extremity artery disease (LEAD) is increasing. Some patients will, nonetheless, unexpectedly stay hospitalized for the night after the procedure. The purpose of this study was to identify the factors associated with a conversion from an outpatient setting (OS) to an inpatient setting (IS). METHODS From April 2017 to August 2019, we performed 745 EVT for LEAD. Patients scheduled for a same-day discharge procedure were retrospectively analyzed. The factors potentially associated with a conversion to an IS were assessed. Results are expressed as odds ratio (OR) with 95% confidence intervals. RESULTS Among the 198 (26.6%) patients scheduled for outpatient EVT, mean age was 70.8±14.1 years old, 34.3% had an ASA score≥3 and 38.4% presented a chronic limb-threatening ischemia. Twenty-eight patients (14.1%) were converted from an OS to IS. Univariate analysis found that Rutherford stage≥4 (OR = 5.09 [2.11-12.27], P < 0.001), high blood pressure (OR = 3.19 [1.06-9.63], P = 0.040), ASA score≥3 (OR = 3.61 [1.58-8.24], P = 0.002), duration of procedure ≥90 min (OR = 2.36, [1.03-5.39], P = 0.042), anterograde puncture (OR = 2.94, [1.30-6.66], P = 0.009), arrival in the operating room ≥12:00 (OR = 13.05, [5.29-32.17], P < 0.001) and general anesthesia (OR = 3.89, [1.20-12.62], P = 0.024) were associated with a conversion. The multivariate analysis revealed that an arrival in the operative room ≥12:00 (OR = 11.71, [3.85-35.60], P < 0.001) and general anesthesia (OR = 6.76, [1.28-35.82], P = 0.009) were independent factors associated with a conversion. CONCLUSION Arrival in the operative room after 12:00 and general anesthesia represent two independent correctible factors associated with the risk of OS failure. No factor directly related to comorbidities or the LEAD severity was identified.
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Closure device use for common femoral artery antegrade access is higher risk than retrograde access. Ann Vasc Surg 2021; 76:49-58. [PMID: 33838236 PMCID: PMC9869430 DOI: 10.1016/j.avsg.2021.03.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/20/2021] [Accepted: 03/21/2021] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Although the use of closure devices (CD) for femoral artery antegrade access (AA) is not in the instructions for use (IFU) for many devices, AA has been reported to be associated with a lower incidence of access site complications compared to manual compression alone. We hypothesized that CD use for AA would not be associated with a clinically significant increased odds of access site complications compared to CD use for retrograde access (RA). METHODS This was a retrospective review of the Vascular Quality Initiative from 2010 to 2019 for infrainguinal peripheral vascular interventions with common femoral artery access closed with a CD. Patients who had a cutdown or multiple access sites were excluded. Cases were then stratified into whether access was antegrade or retrograde. Hierarchical multivariable logistic regressions controlling for hospital level variation were used to examine the independent association between AA and access site complications. The primary outcomes were access site hematoma, stenosis, or occlusion as defined in the VQI. The secondary outcome was the development of an access site hematoma requiring an intervention, which was defined as transfusion, thrombin injection, or surgery. Sensitivity analyses after coarsened exact matching were performed to reduce residual bias. RESULTS Overall, 72,463 cases were identified and 6,070 (8.4%) had AA. Patients with AA were less likely to be smokers (27.2% vs 33.0%) or obese (31.5% vs 35.6%; all P<0.05). Patients with AA were more likely to be on dialysis (12.8% vs 10.1%) and have ultrasound-guided access (76.4% vs 66.2%; P<0.05 for all). Compared to RA, patients with AA were more likely to develop any access site hematoma (2.5% vs 1.8%; P<0.01) and a hematoma requiring intervention (0.7% vs 0.5%; P=0.03), but had no difference in access site stenosis or occlusion (0.3% vs 0.2%; P=0.21). On multivariable analyses, AA had increased odds of developing any access site hematoma (OR=1.46; 95% CI=1.22-1.76) and a hematoma requiring intervention (OR=1.48; 95% CI=1.10-1.98). Sensitivity analyses after coarsened exact matching confirmed these findings. CONCLUSION In this nationally representative sample, the use of CDs for femoral access was associated with an overall low rate of access site complications. However, there was an increased odds of access site hematomas with AA. Patient selection for AA remains important and ultrasound guided access should be the standard of care for this approach.
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ULSOSEAL Technique: A Unique Technique to Achieve Hemostasis Using ExoSeal in High-Risk Patients after Common Femoral Artery Puncture. J Interv Cardiol 2021; 2021:2470333. [PMID: 34526872 PMCID: PMC8419493 DOI: 10.1155/2021/2470333] [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: 07/13/2021] [Revised: 08/20/2021] [Accepted: 08/23/2021] [Indexed: 11/17/2022] Open
Abstract
This study aimed to assess the safety and feasibility of the ULtrasound-guided uSe Of exoSEAL technique (ULSOSEAL technique) in patients at a high risk of complications following the use of ExoSeal. ExoSeal is a novel, completely extravascular hemostatic device that can treat punctures of the common femoral artery; however, it is not preferable for use in cases that require hemostasis of complex puncture sites. From November 2019 to August 2020, the ULSOSEAL technique was performed in 35 patients with implanted stents (6 patients, 17%), severe calcification (32 patients, 91%), and plaque (7 patients, 20%) around the puncture site; the presence of these conditions is usually undesirable when using ExoSeal. The antegrade approach was used in 22 patients (71%). The size of the ExoSeal used was 5 Fr (13 patients, 37%), 6 Fr (21 patients, 60%), and 7 Fr (1 patient, 2%). Technical success was achieved in 34 patients (97%), while ExoSeal malfunction occurred in 1 patient. There was no incidence of vessel occlusion, pseudoaneurysm, arteriovenous fistula, infection, and secondary bleeding. One patient developed a hematoma (>5 cm in size); however, it occurred before the use of ExoSeal due to side leakage from the inserted sheath. The ULSOSEAL technique was safe and feasible for hemostasis in patients who were considered unsuitable for the ExoSeal device.
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Ayuso SA, Shipp RC, Aladegbami BG, Farquharson D, Lawson D, Bassett R. AbsorbaSeal™ 5.6.7F vascular closure device: A good laboratory practice chronic study evaluating safety and efficacy in a healthy porcine model. Vascular 2021; 30:934-942. [PMID: 34459306 DOI: 10.1177/17085381211037883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Vascular closure devices (VCDs) are widely used for arteriotomy closure after percutaneous catheter-based procedures. In comparison to manual compression, VCDs have been associated with shorter time to hemostasis, shorter time to ambulation, and also decreased length of stay. Complexity of deployment, lack of immediate hemostasis, and residual deformity of the arterial wall remain as limitations of current VCDs. The aim of this study was to investigate the AbsorbaSeal™ 5.6.7F vascular closure device, a novel, completely bioabsorbable, intuitive, and easy to use VCD which uses a compressive, "sandwich"-type design comprising a low profile intravascular distal seal and gasket and an extravascular floating foot and proximal seal, in an open infrarenal aortic swine model. METHODS Eight fully heparinized swine at a good laboratory practices facility underwent AbsorbaSeal™ 5.6.7F VCD closure of three 6F arteriotomies each in the proximal, mid, and distal infrarenal aorta. Two swine underwent harvest at each of four time cohorts: 30, 60, 90, and 120 days. Acute and chronic procedural safety and efficacy, as well as target site vascular remodeling over time, were the primary outcomes evaluated. Secondary outcome measures included local and systemic inflammatory responses, end-organ tissue analysis, and device-related complications through the follow-up periods. Histopathological evaluation was performed by a blinded pathologist. Standard statistical methods were used. RESULTS In deployment of 24 AbsorbaSeal™ 5.6.7F VCDs, there were no device-related complications or mortalities. All deployments resulted in rapid arteriotomy seal (100% deployment success), with a mean time to hemostasis (cessation of arterial flow) of 21.5 s (median: 6.5 s) across a mean activated clotting time (ACT) of 356 s. Twenty of the 24 implant sites (83%) attained complete hemostasis within 20 s. Immediate post-implant and pre-termination angiographies at all time points were performed of all swine which demonstrated normal aortic appearance and tissue structure and normal downstream vascular beds. At 30 days, each implant's intravascular distal seal and gasket were removed from the circulation and completely covered with a smooth neointimal layer. Minimal inflammation and no intimal or luminal thrombus were observed at any site at every time point. CONCLUSIONS AbsorbaSeal™ 5.6.7F is a safe, effective, and secure VCD that demonstrates rapid hemostasis in a fully heparinized open aortic porcine model. Removal from circulation and complete coverage of the intravascular distal seal and gasket with neointima occurred within 30 days post-implant. Natural transmural vessel healing from the arteriotomy itself with minimal inflammation was noted for each implant at every time point.
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Affiliation(s)
- Sullivan A Ayuso
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, 22442Carolinas Medical Center, Charlotte, NC, USA
| | - R Caroline Shipp
- 171799The University of Tennessee at Chattanooga College of Arts and Sciences, Chattanooga, TN, USA
| | - Bola G Aladegbami
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, 22442Carolinas Medical Center, Charlotte, NC, USA
| | - Delton Farquharson
- General and Vascular Surgery, 58810Princess Margaret Hospital, Nassau, Bahamas
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Singh G, Scalise F, Bianchi P, Cireni L, Sorropago G, Casana R, Tolva V. Sheath Size Up and Down With Single Proglide - A Technique for Achieving Hemostasis With Use of Large Size Delivery System During Endovascular Graft Placement. Ann Vasc Surg 2021; 78:190-196. [PMID: 34464729 DOI: 10.1016/j.avsg.2021.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/25/2021] [Accepted: 06/12/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND A total percutaneous approach for management of aortic pathologies with endovascular grafts requires the use of large size delivery-systems. The diameter of these delivery systems usually exceeds the recommended sizes for most of the currently available percutaneous closure devices. A safe, effective and simple vascular access site closure device is desirable for success for percutaneous procedures for aortic pathologies. Hence, we aim to study safety and effectiveness of the use of a single suture based vascular access closure device (ProGlide) using a technique involving serial up and downsizing of the sheath size to achieve access site hemostasis in patients undergoing endovascular graft placement using femoral artery approach. MATERIALS AND METHODS We studied all consecutive patients who underwent endovascular grafting from January 2018 to December 2019. It is a retrospective observational study comparing procedural and short-term outcomes between single ProGlide use and surgical cut-down for femoral access site closure. We excluded patients with femoral artery minimal luminal diameter less than 5 mm, the presence of an aneurysm of the femoral artery, ≥180 degrees of calcium present at femoral/ external iliac artery and history of any vascular closure device use in the last six months. RESULTS We included 30 patients in single ProGlide group and 30 patients in the surgical cut-down group. One-third of the procedures were urgent procedures in the single Proglide group. Single ProGlide was successful in 93.34% patients and failure (6.66%) was seen due to hematoma and pseudoaneurysm in one patient each detected before discharge. The primary end-point defined by the success of procedure did not differ between the two groups. There were higher complications in the surgical group till 30 days as evidenced by infection, hematoma and neuronal injury. The secondary end-point, defined by the composite of complication events after discharge till 30 days was significantly higher in the surgical group (P-0.005) CONCLUSION: In patients with suitable femoral artery anatomy who undergo endovascular graft placement, effective hemostasis can be achieved safely using up and downsizing of the sheath with a single suture-based technique (Proglide). The results of the study could be considered hypothesis generating and needs to be confirmed in a randomized controlled trial before being adopted in clinical practice.
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Affiliation(s)
- Gurbhej Singh
- Department of Interventional Cardiology, Policlinico di Monza, Monza, Italy; Dayanand Medical College and Hospital, Ludhiana, India
| | - Filippo Scalise
- Department of Interventional Cardiology, Policlinico di Monza, Monza, Italy
| | - Paolo Bianchi
- Department of Vascular Surgery, Policlinico di Monza, Monza, Italy
| | - Lea Cireni
- Department of Vascular Surgery, Policlinico di Monza, Monza, Italy
| | - Giovanni Sorropago
- Department of Interventional Cardiology, Policlinico di Monza, Monza, Italy
| | - Renato Casana
- Department of Surgery. Istituto Auxologico Italiano IRCCS, Milano. Italy
| | - Valerio Tolva
- Department of Vascular Surgery, Policlinico di Monza, Monza, Italy; Department of Surgery. Istituto Auxologico Italiano IRCCS, Milano. Italy; Department of Vascular Surgery, Grande Ospedale Metropolitano Niguarda, Milan, Italy.
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Lee HN, Hyun D, Lee WH, Kim SS, Bae SH, Hwang JA, Ko SE. Ultrasound-Guided Deployment of a Plug-Based Vascular Closure Device in Femoral Arteries with Calcified Plaque or Stenosis. J Vasc Interv Radiol 2021; 32:802-806. [PMID: 34051988 DOI: 10.1016/j.jvir.2021.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/15/2021] [Accepted: 02/21/2021] [Indexed: 10/21/2022] Open
Abstract
From January 2019 to January 2020, 106 patients (age, 64.8 ± 14.1 years; male, 63.2%) were included to retrospectively investigate the feasibility and safety of ultrasound-guided deployment of ExoSeal after femoral artery access. Baseline characteristics were not different except for age (P = .022), body mass index (P = .009), and diameter (P < .001) between the calcified plaque or stenosis (CS) group (n = 49) and non-CS group (n = 57). The overall technical and clinical success rates were 96.2% and 100%, respectively. The technical (CS group, 48/49; non-CS group, 54/57) and clinical success rates (100%), time to hemostasis (CS group, 3.21 ± 0.54 min; non-CS group, 3.39 ± 0.71 min), and complication rates (CS group, 1/49; non-CS group, 0/57) were not different between the 2 groups. ExoSeal seems to be safe to use under ultrasound guidance in the femoral arteries with CS.
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Affiliation(s)
- Hyoung Nam Lee
- Department of Radiology, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan-si, Korea
| | - Dongho Hyun
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea3.
| | - Woong Hee Lee
- Department of Radiology, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan-si, Korea
| | - Seung Soo Kim
- Department of Radiology, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan-si, Korea
| | - Suk Hyun Bae
- Department of Radiology, Inje University College of Medicine, Ilsan Paik Hospital, Goyang, Korea
| | - Jeong Ah Hwang
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea3
| | - Seong Eun Ko
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea3
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Gouëffic Y, Picquet J, Schneider F, Kaladji A, Marret O, Muller L, Guyomarc'h B, Riche VP, Chaillou P, Guillou M, Nasr B. A Randomized Trial Comparing Polymer Versus Suture-Based Vascular Closure Devices for Arterial Closure Following Lower-Limb Arterial Endovascular Revascularization. Cardiovasc Intervent Radiol 2021; 44:1883-1892. [PMID: 34386892 DOI: 10.1007/s00270-021-02940-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 07/31/2021] [Indexed: 12/19/2022]
Abstract
PURPOSES The primary objective of this study (STEP trial) was to compare the efficacy of the polymer-based FemoSeal® vascular closure device (VCD) and the suture-based ProGlide® VCD in achieving hemostasis at the femoral access site after lower-limb arterial endovascular revascularization. MATERIALS AND METHODS STEP was a multicenter randomized clinical trial including patients undergoing lower-limb arterial endovascular revascularization. The primary endpoint was technical success 5 h after the VCD intervention, defined as achievement of hemostasis without the need for a follow-up intervention at the access site and without a 2-g/dL drop in hemoglobin. RESULTS Between December 2017 and April 2019, 113 patients were assigned to the FemoSeal® group (FS) and 117 to the ProGlide® group (PG). VCD interventions were technically successful for 90 FS patients (80%) and 58 PG patients (50%) (odds ratio, 3.98; 95% CI, 2.22 to 7.14; p < 0.0001). This difference in success rates between FS and PG is partly explained by more frequent recourse to manual compression (FS: n = 19; PG: n = 45) and an additional VCD (FS: n = 0; PG: n = 23) in the latter group. After 5 h, 87% of FS patients and 69% of PG patients resumed ambulation (odds ratio: 3.07; 95% CI: 1.93 to 6.15; p = 0.0016). CONCLUSIONS In patients undergoing lower-limb arterial endovascular revascularization, FemoSeal® was superior to ProGlide® in terms of technical success. CLINICAL TRIAL REGISTRATION Step trial was registered on http://ClinicalTrials.gov (NCT03192033).
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Affiliation(s)
- Yann Gouëffic
- Department of Vascular and Endovascular Surgery, Paris Saint Joseph Hospital, Paris, France.,Laboratoire de Physiopathologie de La Résorption Osseuse, INSERM-UN UMR 957, Nantes, France
| | - Jean Picquet
- Department of Vascular Surgery, Angers University Hospital, Angers, France
| | - Fabrice Schneider
- Department of Vascular Surgery, Poitiers University Hospital, Poitiers, France
| | - Adrien Kaladji
- Department of Cardiovascular and Thoracic Surgery, Rennes University Hospital, Rennes, France
| | - Olivier Marret
- Department of Vascular Surgery, La Roche-sur-Yon Hospital, La Roche-sur-Yon, France
| | - Laurent Muller
- Department of Vascular Surgery, Cholet Hospital, Cholet, France
| | - Béatrice Guyomarc'h
- Institut du Thorax, Nantes University Hospital/INSERM/CNRS/Nantes University, Nantes, France
| | - Valéry-Pierre Riche
- Division of Health Product Development and Economic Evaluation, Department of Partnerships and Innovation, Nantes University Hospital, Nantes, France
| | - Philippe Chaillou
- Department of Vascular Surgery, Institut du Thorax, Nantes University Hospital, Nantes, France
| | - Marie Guillou
- Department of Vascular Surgery, Institut du Thorax, Nantes University Hospital, Nantes, France
| | - Bahaa Nasr
- Department of Vascular Surgery, Brest University Hospital, Brest, France. .,Service de Chirurgie Vasculaire, CHU Brest, 29200, Brest, France.
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50
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Ciprian Cacuci A, Krankenberg H, Ingwersen M, Gayed M, Stein SD, Kretzschmar D, Schulze PC, Thieme M. Access Site Complications of Peripheral Endovascular Procedures: A Large, Prospective Registry on Predictors and Consequences. J Endovasc Ther 2021; 28:746-754. [PMID: 34137662 DOI: 10.1177/15266028211025044] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE The purpose of this study was to investigate predictors and consequences of acute vascular access site complications (ASCs) related to peripheral endovascular diagnostic or interventional procedures. Despite improvement of puncture techniques, access site-related morbidity and mortality is still considerable. MATERIALS AND METHODS A total of 5263 participants who underwent 5385 endovascular procedures at a single center were consecutively included in this prospective, observational study. Primary outcomes were ASCs defined as composite of puncture site hematoma, pseudoaneurysm, arteriovenous fistula, and overt puncture site bleeding on the first day after procedure. RESULTS ASCs occurred in 16.6% of peripheral endovascular procedures (78.6% hematomas, 18.9% pseudoaneurysms, 1.4% arteriovenous fistulas, 1.1% overt bleedings). Independent predictors were advanced age [odds ratio (OR) per 10 years: 1.12, p=0.004], female sex (OR men, 0.77; p=0.001), lysis (OR 3.56; p<0.001), periprocedural heparin (OR 5000 IU, 1.96; p=0.001; OR >5000 IU, 3.56; p=0.02), time to access (OR per 10 seconds, 1.01; p<0.001), sheath size (OR per French, 1.59; p<0.001), brachial artery access (OR vs retrograde transfemoral, 4.58; p<0.001), and compression only (OR Angio-Seal, 0.57, p=0.02; ProGlide, 0.36, p<0.001; FemoSeal, 0.57, p<0.001). Treatment was required in 20.2% and prolonged hospitalization in 17.7% of ASC. Three participants died from access site-related bleeding. CONCLUSION ASCs after peripheral endovascular procedures are associated with advanced age, female sex, periprocedural antithrombotic medication, brachial artery access, postinterventional bleeding, and nonuse of vascular closure devices.
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Affiliation(s)
- Andrei Ciprian Cacuci
- Department of Angiology, Cardiology, Diabetology, Regiomed-Vascular Center, Sonneberg, Germany
| | - Hans Krankenberg
- Department of Angiology, Cardiology, Diabetology, Regiomed-Vascular Center, Sonneberg, Germany
| | - Maja Ingwersen
- Department of Angiology, Cardiology, Diabetology, Regiomed-Vascular Center, Sonneberg, Germany.,Department of Radiology, Jena University Hospital, Jena, Germany
| | - Mohamed Gayed
- Department of Angiology, Cardiology, Diabetology, Regiomed-Vascular Center, Sonneberg, Germany
| | - Sven Daniel Stein
- Department of Angiology, Cardiology, Diabetology, Regiomed-Vascular Center, Sonneberg, Germany
| | | | | | - Marcus Thieme
- Department of Angiology, Cardiology, Diabetology, Regiomed-Vascular Center, Sonneberg, Germany.,Clinic of Internal Medicine I, Jena University Hospital, Jena, Germany
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