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Ok T, Seo KD, Lee IH. Fatal Femoral Pseudoaneurysm Rupture after Endovascular Intervention: A Case Report and Literature Review. Neurointervention 2024; 19:52-56. [PMID: 38303611 PMCID: PMC10910178 DOI: 10.5469/neuroint.2024.00017] [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: 01/13/2024] [Revised: 01/26/2024] [Accepted: 01/27/2024] [Indexed: 02/03/2024] Open
Abstract
A rupture of a femoral pseudoaneurysm is an extremely rare complication of endovascular procedures, but its outcome can be life-threatening. In this report, we present a case of a femoral pseudoaneursym rupture in a patient in their early 90s following intra-arterial mechanical thrombectomy for acute ischemic stroke. Despite receiving medical and surgical interventions, the patient subsequently developed multiple organ failure, ultimately resulting in death. This case emphasizes the critical role of appropriate selection of vascular closure technique and careful post-procedural monitoring, particularly in high-risk patients.
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Affiliation(s)
- Taedong Ok
- Department of Neurology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Kwon-Duk Seo
- Department of Neurology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Il Hyung Lee
- Department of Neurology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
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2
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Leesar MA, Waheed S, Al Solaiman F, Chatterjee A, Daya HA, Hage FG, Brott BC. Randomized trial of an oblique versus standard fluoroscopic-guided micropuncture technique for femoral arterial access: The Micropuncture-CFA trial. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2023; 57:43-50. [PMID: 37414613 DOI: 10.1016/j.carrev.2023.06.029] [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: 04/01/2023] [Revised: 06/26/2023] [Accepted: 06/27/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND The anterior-posterior fluoroscopic guidance (the AP technique) is a standard method for common femoral artery (CFA) access, but the rate of CFA access with ultrasound vs. the AP technique was not significantly different. We have shown an oblique fluoroscopic guidance (the oblique technique) with a micropuncture needle (MPN) resulted in CFA access in 100 % of patients. The outcome of the oblique vs. AP technique is unknown. We compared the utilities of the oblique vs. AP technique for CFA access with a MPN in patients undergoing coronary procedures. METHODS A total of 200 patients were randomized to the oblique vs. AP technique. Using the oblique technique, a MPN was advanced to the mid pubis in the 20° ipsilateral right-or left anterior oblique view with fluoroscopic guidance and the CFA was punctured. In the AP technique, a MPN was advanced to the mid femoral head in the AP view with fluoroscopic guidance and the CFA was punctured. The primary endpoint was the rate of successful access to the CFA. RESULTS The rates of first pass and CFA access were higher with the oblique vs. AP technique (82 % vs. 61 %, and 94 % vs. 81 %, respectively; P < 0.01). The number of needle punctures was lower with the oblique vs. AP technique (1.1 ± 0.39 vs. 1.4 ± 0.78, respectively; P < 0.01). In high CFA bifurcations, the rate of CFA access was higher with the oblique vs. AP technique (76 % vs. 52 %, respectively; P < 0.01). Vascular complications were lower with the oblique vs. AP technique (1 % vs. 7 %, respectively; P < 0.05). CONCLUSIONS Our data suggest that the oblique technique, compared with the AP technique, significantly increased the rates of first pass and access to the CFA, and decreased the number of punctures and vascular complication. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03955653.
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Affiliation(s)
- Massoud A Leesar
- Division of Cardiovascular Disease, University of Alabama, Birmingham, Birmingham Veterans Affairs Medical Center, United States of America.
| | - Salman Waheed
- Division of Cardiovascular Disease, University of Alabama, Birmingham, Birmingham Veterans Affairs Medical Center, United States of America; Division of Cardiology, University of Illinois, Chicago, IL, United States of America
| | - Firas Al Solaiman
- Division of Cardiovascular Disease, University of Alabama, Birmingham, Birmingham Veterans Affairs Medical Center, United States of America
| | - Arka Chatterjee
- Division of Cardiovascular Disease, University of Alabama, Birmingham, Birmingham Veterans Affairs Medical Center, United States of America; Division of Cardiology, Banner-University Medical Center in Tucson, AZ, United States of America
| | - Hussein Abu Daya
- Division of Cardiovascular Disease, University of Alabama, Birmingham, Birmingham Veterans Affairs Medical Center, United States of America
| | - Fadi G Hage
- Division of Cardiovascular Disease, University of Alabama, Birmingham, Birmingham Veterans Affairs Medical Center, United States of America
| | - Brigitta C Brott
- Division of Cardiovascular Disease, University of Alabama, Birmingham, Birmingham Veterans Affairs Medical Center, United States of America
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Kumar AP, Valakkada J, Ayappan A, Kannath S. Management of Acute Complications during Endovascular Procedures in Peripheral Arterial Disease: A Review. JOURNAL OF CLINICAL INTERVENTIONAL RADIOLOGY ISVIR 2022. [DOI: 10.1055/s-0042-1760246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
AbstractEndovascular therapy, as opposed to surgical bypass, has become the mainstay for peripheral arterial disease even in long segment occlusions. Complications can occur during the arterial access, catheter manipulation, balloon dilation, and/or stent placement. Given the high prevalence of comorbidities such as diabetes, hypertension, renal dysfunction, and coronary artery disease in these patients, early identification of procedural complications and initiation of treatment are of paramount importance. This review aims to provide comprehensive data on the identification and management of commonly encountered endovascular complications during endovascular interventions in peripheral arterial disease.
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Affiliation(s)
- Ajay Pawan Kumar
- Department of Imaging Sciences and Interventional Radiology, Sreechitra Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Jineesh Valakkada
- Department of Imaging Sciences and Interventional Radiology, Sreechitra Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Anoop Ayappan
- Department of Imaging Sciences and Interventional Radiology, Sreechitra Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Santhosh Kannath
- Department of Imaging Sciences and Interventional Radiology, Sreechitra Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
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Sinning JM, Ibrahim K, Schröder J, Sef D, Burzotta F. Optimal bail-out and complication management strategies in protected high-risk percutaneous coronary intervention with the Impella. Eur Heart J Suppl 2022; 24:J37-J42. [PMID: 36518892 PMCID: PMC9730790 DOI: 10.1093/eurheartjsupp/suac064] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Despite the routine use of percutaneous mechanical circulatory support (pMCS) with the Impella heart pump, vascular and bleeding complications may occur during removal with or without pre-closure. To safely close the large-bore access (LBA), post-hoc selection of the appropriate treatment of vascular complications is critical to patient recovery and survival. Femoral artery access is typically utilized for LBA, and percutaneous axillary artery access is a common alternative, especially in the instance of severe peripheral artery disease. Optimization of patient outcomes and efficiency of pMCS can be achieved with adequate arterial access using state-of-the-art techniques. Impella removal techniques with or without pre-closure will be addressed as well as the management of large-bore femoral access complications. In addition, treatment strategies to manage patient deterioration during a protected high-risk percutaneous coronary intervention will be provided.
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Affiliation(s)
- Jan-Malte Sinning
- Department of Cardiology, St Vinzenz Hospital Cologne, Cologne, Germany
| | - Karim Ibrahim
- Department of Cardiology, Technische Universität Dresden (Campus Chemnitz), Klinikum Chemnitz, Chemnitz, Germany
| | - Jörg Schröder
- Department of Cardiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Davorin Sef
- Department of Cardiac Surgery and Transplant Unit, Royal Brompton & Harefield NHS Foundation Trust Harefield Hospital, Harefield, UK
| | - Francesco Burzotta
- UOC Interventistica Cardiologica e Diagnostica Invasiva, Fondazione Policlinico Gemelli IRCCS and Università Cattolica del Sacro Cuore, Rome, Italy
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Zhao X, Liu C, Zhou P, Sheng Z, Li J, Zhou J, Chen R, Wang Y, Chen Y, Song L, Zhao H, Yan H. Development and Validation of a Prediction Rule for Major Adverse Cardiac and Cerebrovascular Events in High-Risk Myocardial Infarction Patients After Primary Percutaneous Coronary Intervention. Clin Interv Aging 2022; 17:1099-1111. [PMID: 35880211 PMCID: PMC9307870 DOI: 10.2147/cia.s358761] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 06/06/2022] [Indexed: 11/23/2022] Open
Abstract
Background and Aims We aimed to develop a clinical prediction tool to improve the prognosis of major adverse cardiac and cerebrovascular events (MACCE) among high-risk myocardial infarction (MI) patients undergoing primary percutaneous coronary intervention (PCI). Methods The present study was a prospective and observational study. A total of 4151 consecutive MI patients who underwent primary PCI at Fuwai Hospital in Beijing, China (January 2010 and June 2017) were enrolled. Forty-eight patients without follow-up data were excluded from the study. The pre-specified criteria (Supplementary Information 1) were chosen to enroll MI patients at high risk for MACCE complications after PCI. Results The full model included seven variables, with a risk score of 160 points. Derivation and validation cohort models predicting MACCE had C-statistics of 0.695 and 0.673. The area under the curve (AUC) of the survival receiver operating characteristic curve (ROC) for predicting MACCE was 0.991 and 0.883 in the derivation and validation cohorts, respectively. Conclusion The predicted model was internally validated and calibrated in large cohorts of patients with high-risk MI receiving primary PCI to predict MACCE and showed modest accuracy in the derivation and validation cohorts.
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Affiliation(s)
- Xiaoxiao Zhao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, BeiJing, People's Republic of China
| | - Chen Liu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, BeiJing, People's Republic of China
| | - Peng Zhou
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, BeiJing, People's Republic of China
| | - Zhaoxue Sheng
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, BeiJing, People's Republic of China
| | - Jiannan Li
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, BeiJing, People's Republic of China
| | - Jinying Zhou
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, BeiJing, People's Republic of China
| | - Runzhen Chen
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, BeiJing, People's Republic of China
| | - Ying Wang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, BeiJing, People's Republic of China
| | - Yi Chen
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, BeiJing, People's Republic of China
| | - Li Song
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, BeiJing, People's Republic of China
| | - Hanjun Zhao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College & Chinese Academy of Medical Sciences, BeiJing, People's Republic of China
| | - Hongbing Yan
- Fuwai Hospital, Chinese Academy of Medical Sciences, Shenzhen, People's Republic of China
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Fujiwara T, Ikeda H, Kuriyama A, Ono T, Takada K, Handa A, Uezato M, Kinosada M, Kurosaki Y, Chin M. Inferior Epigastric Artery Injury due to Femoral Venipuncture for Neuroendovascular Intervention: Two Cases Requiring Transcatheter Arterial Embolization. JOURNAL OF NEUROENDOVASCULAR THERAPY 2022; 16:467-473. [PMID: 37502792 PMCID: PMC10370989 DOI: 10.5797/jnet.cr.2022-0010] [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: 03/01/2022] [Accepted: 04/01/2022] [Indexed: 07/29/2023]
Abstract
Objective Injury to the inferior epigastric artery (IEA) caused by femoral puncture may lead to retroperitoneal hematoma. We report on two cases of IEA injury due to femoral venipuncture for neuroendovascular intervention that resulted in hemorrhagic shock and required transcatheter arterial embolization. Case Presentations A 67-year-old woman and a 71-year-old man receiving dual antiplatelet therapy sustained injury to a branch of the IEA in the process of right femoral venipuncture for neuroendovascular intervention. In both cases, stent placement in the intracranial artery was accomplished as intended with systemic heparinization throughout the procedure; however, the patients became hypotensive during the procedure, and contrast-enhanced CT scans taken after the stenting revealed extravasation of contrast from the IEA and retroperitoneal hematoma. Transcatheter arterial embolization of the bleeding branch of the IEA was performed with the left femoral approach, and subsequent angiography confirmed the disappearance of the extravasation of contrast. Conclusion Femoral venipuncture for neuroendovascular intervention in patients receiving antithrombotic agents may cause IEA injury requiring transcatheter arterial embolization. The risk of IEA injury may be reduced by using the femoral head as a reference, performing ultrasound-guided puncture, and confirming the course of the IEA by femoral angiography before venipuncture.
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Affiliation(s)
- Toshio Fujiwara
- Department of Neurosurgery and Stroke, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Hiroyuki Ikeda
- Department of Neurosurgery and Stroke, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Akira Kuriyama
- Emergency and Critical Care Center, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Takafumi Ono
- Department of Diagnostic Radiology, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Kensuke Takada
- Department of Neurosurgery and Stroke, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Akira Handa
- Department of Neurosurgery and Stroke, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Minami Uezato
- Department of Neurosurgery and Stroke, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Masanori Kinosada
- Department of Neurosurgery and Stroke, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Yoshitaka Kurosaki
- Department of Neurosurgery and Stroke, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Masaki Chin
- Department of Neurosurgery and Stroke, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
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7
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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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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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9
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Triantafyllou K, Karkos CD, Fragakis N, Antoniadis AP, Meletidou M, Vassilikos V. Ultrasound-guided versus anatomic landmark-guided vascular access in cardiac electrophysiology procedures: A systematic review and meta-analysis. Indian Pacing Electrophysiol J 2022; 22:145-153. [PMID: 35143989 PMCID: PMC9091764 DOI: 10.1016/j.ipej.2022.01.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 12/21/2021] [Accepted: 01/25/2022] [Indexed: 10/31/2022] Open
Abstract
Introduction Methods Results Conclusion
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10
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Preoperative Risk Factors for Access Site Failure in Ultrasound-Guided Percutaneous Treatment of TASC C and D Aorto-Iliac Occlusive Disease. Ann Vasc Surg 2021; 79:130-138. [PMID: 34644647 DOI: 10.1016/j.avsg.2021.06.048] [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: 06/08/2021] [Revised: 06/30/2021] [Accepted: 06/30/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND At our institution, we adopted routinely ultrasound guided approach for all percutaneous procedures. The objective of this study was to describe the predictors of access site failures (ASFs) in patients undergoing percutaneous aorto iliac revascularization and to also evaluate whether other factors such as time period or different vascular devices may influence outcomes in terms of ASFs. METHODS We reviewed all consecutive percutaneous revascularizations performed for aortoiliac occlusion or stenosis at our institution from 2011 to 2020. All procedure were performed using an ultrasound (US) guided common femoral access. The primary outcome was ASFs, defined as bleeding or groin hematomas that required transfusions; pseduoaneurysm (diagnosed by US); retroperitoneal hematoma; artery laceration or ruptured (diagnosed intraoperatively); and thrombosis. Multivariable logistic regression was used to determine predictors of ASFs. RESULTS A total of 502 femoral arteries were accessed under DUS guidance with no failure in sheath placement. Technical success was achieved in 498 of 502 procedures (99.2%). ASFs occurred in 21 patients (7%); but year of procedure appear to be associated with an excess of ASFs as rates were different between the first and second period of the study (10.9% vs. 4.8%, P = 0.04). Results of multivariable logistic regression model indicated that independent predictors of ASFs were common femoral artery (CFA) calcification peripheral artery calcium scoring system (PACCS) grade (odds ratio [OR], 8.7; 95% confidence interval [CI], 5.5-13.7), and CFA diameter (OR, 0.46; 95% CI, 0.25-0.85). Compared to patients with successful percutaneous access, ASFs resulted in longer post-op lengths of stay (P = < 0.001). CONCLUSION Percutaneous US guided access can be safely performed in patients undergoing endovascular procedures for aorto iliac revascularization with TASC C and D lesions. CFA calcification PACCS grade greater than 3 and smaller femoral vessel diameter are independent risk factors for ASFs.
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11
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Manning JE, Moore EE, Morrison JJ, Lyon RF, DuBose JJ, Ross JD. Femoral vascular access for endovascular resuscitation. J Trauma Acute Care Surg 2021; 91:e104-e113. [PMID: 34238862 DOI: 10.1097/ta.0000000000003339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Endovascular resuscitation is an emerging area in the resuscitation of both severe traumatic hemorrhage and nontraumatic cardiac arrest. Vascular access is the critical first procedural step that must be accomplished to initiate endovascular resuscitation. The endovascular interventions presently available and emerging are routinely or potentially performed via the femoral vessels. This may require either femoral arterial access alone or access to both the femoral artery and vein. The time-critical nature of resuscitation necessitates that medical specialists performing endovascular resuscitation be well-trained in vascular access techniques. Keen knowledge of femoral vascular anatomy and skill with vascular access techniques are required to meet the needs of critically ill patients for whom endovascular resuscitation can prove lifesaving. This review article addresses the critical importance of femoral vascular access in endovascular resuscitation, focusing on the pertinent femoral vascular anatomy and technical aspects of ultrasound-guided percutaneous vascular access and femoral vessel cutdown that may prove helpful for successful endovascular resuscitation.
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Affiliation(s)
- James E Manning
- From the Department of Emergency Medicine (J.E.M.), University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Division of Trauma Surgery (J.E.M.), Oregon Health & Sciences University, Portland, Oregon; Ernest E Moore Shock Trauma Center at Denver Health (E.E.M.), Denver; Department of Surgery (E.E.M.), University of Colorado, Denver, Colorado; R. Adams Cowley Shock Trauma Center (J.J.M., J.J.D.); Department of Surgery (J.J.M., J.J.D.), University of Maryland School of Medicine, Baltimore, Maryland; Naval Postgraduate School Department of Defense Analysis (R.F.L.) Monterey, California; Charles T. Dotter Department of Interventional Radiology (J.D.R.), Oregon Health & Sciences University, Portland, Oregon; and Military & Health Research Foundation (J.D.R.), Laurel, Maryland
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12
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Strauss SA, Siracuse JJ, Madassery S, Truesdell AG, Pereira K, Korngold EC, Kayssi A. Ultrasound-guided versus anatomic landmark-guided percutaneous femoral artery access. Hippokratia 2021. [DOI: 10.1002/14651858.cd014594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Shira A Strauss
- Division of Vascular Surgery; The Ottawa Hospital, University of Ottawa; Ottawa Canada
| | | | - Sreekumar Madassery
- Vascular and Interventional Radiology Section; Rush University Medical Center; Chicago Illinois USA
| | | | - Keith Pereira
- Division of Vascular and Interventional Radiology; Saint Louis University; St. Louis Missouri USA
| | | | - Ahmed Kayssi
- Division of Vascular Surgery; Sunnybrook Health Sciences Centre, University of Toronto; Toronto Canada
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13
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Karatolios K, Hunziker P, Schibilsky D. Managing vascular access and closure for percutaneous mechanical circulatory support. Eur Heart J Suppl 2021; 23:A10-A14. [PMID: 33815009 PMCID: PMC8005891 DOI: 10.1093/eurheartj/suab002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Even with current generation mechanical circulatory support (MCS) devices, vascular complications are still considerable risks in MCS that influence patients’ recovery and survival. Hence, efforts are made to reduce vascular trauma and obtaining safe and adequate arterial access using state-of-the-art techniques is one of the most critical aspects for optimizing the outcomes and efficiency of percutaneous MCS. Femoral arterial access remains necessary for numerous large-bore access procedures and is most commonly used for MCS, whereas percutaneous axillary artery access is typically considered an alternative for the delivery of MCS, especially in patients with severe peripheral artery disease. This article will address the access, maintenance, closure and complication management of large-bore femoral access and concisely describe alternative access routes.
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Affiliation(s)
| | - Patrick Hunziker
- Department of Intensive Care, University Hospital Basel, Petersgraben 5, 4031 Basel, Switzerland
| | - David Schibilsky
- Klinik für Herz- und Gefäßchirurgie, University Heartcenter Freiburg-Bad Krozingen, Hugstetter Straβe 55, 79106, Freiburg, Germany.,Faculty of Medicine, University Freiburg, Breisacher Str. 153, 79110 Freiburg, Germany
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14
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McHugh S, Noory A, Mishra S, Vanchiere C, Lakhter V. Vascular Access for Large Bore Access. Interv Cardiol Clin 2021; 10:157-167. [PMID: 33745666 DOI: 10.1016/j.iccl.2020.12.004] [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: 11/24/2022]
Abstract
Recent advances in the field of interventional cardiology have allowed for more complex procedures to be performed percutaneously. Ability to obtain safe large bore vascular access is frequently the key factor to procedural success. Meticulous technique for successful vascular access incorporates the understanding of anatomic landmarks, ultrasound, fluoroscopy, and micropuncture. Adequate hemostasis at the end of the case can be achieved through careful use of commercially available vascular closure devices. Although access-related vascular complications are uncommon, early recognition is key to successful management. Arterial tortuosity and calcification can present a significant challenge to successful common femoral artery access.
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Affiliation(s)
- Stephen McHugh
- Department of Medicine, Temple University Hospital, Lewis Katz School of Medicine, 3401 North Broad Street, Philadelphia, PA 19140, USA
| | - Ali Noory
- Department of Medicine, Temple University Hospital, Lewis Katz School of Medicine, 3401 North Broad Street, Philadelphia, PA 19140, USA
| | - Suraj Mishra
- Department of Medicine, Temple University Hospital, Lewis Katz School of Medicine, 3401 North Broad Street, Philadelphia, PA 19140, USA
| | - Catherine Vanchiere
- Department of Medicine, Temple University Hospital, Lewis Katz School of Medicine, 3401 North Broad Street, Philadelphia, PA 19140, USA
| | - Vladimir Lakhter
- Division of Cardiovascular Diseases, Department of Medicine, Temple University Hospital, Lewis Katz School of Medicine, 3401 North Broad Street (9PP), Philadelphia, PA 19140, USA.
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15
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Fukuda K, Okazaki S, Shiozaki M, Okai I, Nishino A, Tamura H, Inoue K, Sumiyoshi M, Daida H, Minamino T. Ultrasound-guided puncture reduces bleeding-associated complications, regardless of calcified plaque, after endovascular treatment of femoropopliteal lesions, especially using the antegrade procedure: A single-center study. PLoS One 2021; 16:e0248416. [PMID: 33711058 PMCID: PMC7954350 DOI: 10.1371/journal.pone.0248416] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 02/26/2021] [Indexed: 12/24/2022] Open
Abstract
Background A common complication of endovascular treatment for femoropopliteal lesions is bleeding at the vascular access site. Although risk factors of bleeding-associated complications at the approach site have been reported, the results have been inconclusive. Hence, this study aimed to assess the predictors of bleeding-associated complications at the approach site in patients undergoing endovascular treatment for femoropopliteal lesions. Methods This retrospective, single-center, observational study included consecutive patients who underwent endovascular treatment (n = 366, 75% male, 72.4±9.9 year) for peripheral arterial disease with claudication and critical limb ischemia in our hospital from January 2010 to December 2017. We divided the patients into bleeding and non-bleeding groups, depending on whether bleeding-associated complications occurred at the approach site. Bleeding-associated complications were defined according to the Bleeding Academic Research Consortium criteria types 2, 3, and 5. Results Altogether, 366 endovascular treatment procedures and 404 arterial accesses were performed for femoropopliteal lesions in 335 peripheral arterial disease patients with claudication and 69 critical limb ischemia patients. We recorded 35 postprocedural bleeding-associated complications at the approach site (9%), all of which were hematomas. The predictors of increased bleeding-associated complications were age ≥ 80 years (bleeding vs. non-bleeding group, 43% vs. 25%, p<0.05) and antegrade cannulation of the common femoral artery (48% vs. 69%, p<0.05). Ultrasound-guided puncture reduced bleeding-associated complications (odds ratio, 0.28; 95% confidence interval, 0.004–0.21; p<0.05). In contrast, there was no significant difference in puncture site calcification between the groups (bleeding vs. non-bleeding groups, 29% vs. 21%, p = 0.29). Conclusion Ultrasound-guided puncture is associated with a decrease in bleeding-associated complications at the approach site, regardless of the presence of calcified plaque. It is particularly effective and should be more actively used in patients aged ≥80 years and for antegrade cannulation of the common femoral artery.
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Affiliation(s)
- Kentaro Fukuda
- Department of Cardiology, Juntendo University Nerima Hospital, Nerimaku, Tokyo, Japan
| | - Shinya Okazaki
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
- * E-mail:
| | - Masayuki Shiozaki
- Department of Cardiology, Juntendo University Nerima Hospital, Nerimaku, Tokyo, Japan
| | - Iwao Okai
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Akihisa Nishino
- Department of Cardiology, Nishino Naika Clinic, Yamanashi, Japan
| | - Hiroshi Tamura
- Department of Cardiology, Juntendo University Nerima Hospital, Nerimaku, Tokyo, Japan
| | - Kenji Inoue
- Department of Cardiology, Juntendo University Nerima Hospital, Nerimaku, Tokyo, Japan
| | - Masataka Sumiyoshi
- Department of Cardiology, Juntendo University Nerima Hospital, Nerimaku, Tokyo, Japan
| | - Hiroyuki Daida
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
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16
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Femoral artery access site closure with perclose suture mediated device in coronary interventions. Indian Heart J 2020; 73:180-184. [PMID: 33865515 PMCID: PMC8065371 DOI: 10.1016/j.ihj.2020.12.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 11/11/2020] [Accepted: 12/23/2020] [Indexed: 02/06/2023] Open
Abstract
Objective To compare the outcome of suture mediated vascular closure device Perclose Proglide (PP) with manual compression (MC) following transfemoral access for coronary interventions (CI). Methods It is a retrospective, observational, single centre study from January 2018 to September 2019. Consecutive patients undergoing interventions through transfemoral access were divided into PP and MC groups. Those with less than 3 months follow up were excluded. Two groups were compared for baseline characteristics and various complications at 24 h and at 30 days. Results Out of 1743 patients studied, PP group included 1343 and MC group, 400 patients. Both groups were comparable in baseline characteristics, sheath size and use of antiplatelets and anticoagulation. PP group had significantly less minor bleeding (P = .01, CI 0.34–4.03) and hematoma (P = .0007, CI 0.95–5.10) at 24 h. At 30 days, minor bleeding (P < .0001, CI 0.97–4.25), hematoma (P = .0002, CI 1.05–4.93) and pseudo-aneurysm (P = .0095, CI 0.03–1.18) were also significantly less in PP group. Obesity (OR 3.5, CI 1.29–9.49) and hypertension (OR 2.41, CI 1.12–5.19) were associated with increased minor bleeding at 24 h. Device failure rate was 2.38%. Conclusions PP device is safe, effective and is associated with fewer complications than MC in CI. Device failure rate is low. Obesity and hypertension are associated with increased minor bleeding in both groups.
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17
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Khayrutdinov E, Vorontsov I, Arablinskiy A, Shcherbakov D, Gromov D. A randomized comparison of transradial and transfemoral access in uterine artery embolization. Diagn Interv Radiol 2020; 27:59-64. [PMID: 33290238 DOI: 10.5152/dir.2020.19574] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PURPOSE We aimed to compare duration of uterine artery embolization, radiation exposure, safety and quality of life associated with the procedure in patients undergoing uterine artery embolization using transradial and transfemoral access. METHODS This randomized controlled trial was conducted from February 2013 to March 2017 in three hospitals. Transradial access was used in 78 patients and transfemoral access in 75 patients. Clinical characteristics of the patients were comparable between the two groups. Patients were evaluated for the success and duration of the procedure, radiation exposure, major and minor complications. Quality of life associated with the procedure was assessed among patients with uterine fibroids. RESULTS Embolization procedures were successfully performed in all patients in both groups. The duration of uterine artery embolization (32.27±7.99 vs. 39.24±9.72 minutes, P < 0.001), uterine artery catheterization time (12.36±5.73 vs. 19.08±6.06 minutes, P < 0.001) and radiation exposure (0.28±0.14 vs. 0.5±0.21 mZv, P < 0.001) were significantly lower in the transradial access group. The rate of major (0% vs. 2.7%, P = 0.37) and minor (11.53% vs. 17.3%, P = 0.42) complications was comparable between the two groups. Transradial access was associated with a statistically significant improvement in the quality of life associated with the procedure among patients with uterine fibroids. CONCLUSION Transradial access in uterine artery embolization has the same efficacy and safety compared to transfemoral access. This access reduces radiation exposure and duration of the procedure.
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Affiliation(s)
- Evgeny Khayrutdinov
- Department of Interventional Cardiology and Radiology, Botkin Hospital, Moscow, Russia;Department of Interventional Cardiology and Radiology, Emergency Hospital, Omsk, Russia;Department of Roentgen-Endovascular Methods of Diagnosis and Treatment PHDPO, PHGBOU VO Pirogov RNRMU, Moscow, Russia
| | - Ivan Vorontsov
- Department of Interventional Cardiology and Radiology, Emergency Hospital, Omsk, Russia
| | - Alexander Arablinskiy
- Department of Interventional Cardiology and Radiology, Botkin Hospital, Moscow, Russia
| | | | - Dmitry Gromov
- Department of Roentgen-Endovascular Methods of Diagnosis and Treatment PHDPO, PHGBOU VO Pirogov RNRMU, Moscow, Russia;Department of Roentgen-Endovascular Diagnosis and Treatment, Inozemtsev Hospital, Moscow, Russia
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18
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Corones-Watkins K, Cooke M, Theobald K, White K, Thompson DR, Ski CF, King-Shier K, Conway A, Ramis MA. Effectiveness of nurse-led clinics in the early discharge period after percutaneous coronary intervention: A systematic review. Aust Crit Care 2020; 34:510-517. [PMID: 33272768 DOI: 10.1016/j.aucc.2020.10.012] [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: 02/27/2020] [Revised: 10/21/2020] [Accepted: 10/21/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Readmission after percutaneous coronary intervention is common in the early postdischarge period, often linked to limited opportunity for education and preparation for self-care. Attending a nurse-led clinic within 30 d after discharge has the potential to enhance health outcomes. OBJECTIVE The aim of the study was to synthesise the available literature on the effectiveness of nurse-led clinics, during early discharge (up to 30 d), for patients who have undergone percutaneous coronary intervention. REVIEW METHOD USED A systematic review of randomised and quasi-randomised controlled trials was undertaken. DATA SOURCES The databases included PubMed, OVID, CINAHL, EMBASE, the Cochrane Library, SCOPUS, and ProQuest. REVIEW METHODS Databases were searched up to November 2018. Two independent reviewers assessed studies using the Cochrane risk-of-bias tool. RESULTS Of 2970 articles screened, only four studies, representing 244 participants, met the review inclusion criteria. Three of these studies had low to moderate risk of bias, with the other study unclear. Interventions comprised physical assessments and individualised education. Reported outcomes included quality of life, medication adherence, cardiac rehabilitation attendance, and psychological symptoms. Statistical pooling was not feasible owing to heterogeneity across interventions, outcome measures, and study reporting. Small improvements in quality of life and some self-management behaviours were reported, but these changes were not sustained over time. CONCLUSIONS This review has identified an important gap in the research examining the effectiveness of early postdischarge nurse-led support after percutaneous coronary intervention on outcomes for patients and health services. More robust research with sufficiently powered sample sizes and clearly defined interventions, comparison groups, and outcomes is recommended to determine effectiveness of nurse-led clinics in the early discharge period.
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Affiliation(s)
| | - Marie Cooke
- School of Nursing and Midwifery, Griffith University, Brisbane, Australia
| | - Karen Theobald
- School of Nursing, Queensland University of Technology, Brisbane, Australia
| | - Katherine White
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, Australia
| | - David R Thompson
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Chantal F Ski
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK; Integrated Care Academy, University of Suffolk, Ipswich, UK.
| | | | - Aaron Conway
- Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Mary-Anne Ramis
- School of Nursing, Queensland University of Technology, Brisbane, Australia
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19
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Pezold M, Blumberg S, Sadek M, Maldonado T, Cayne N, Jacobowitz G, James H, Berland T. Antegrade Superficial Femoral Artery Access for Lower Extremity Arterial Disease Is Safe and Effective in the Outpatient Setting. Ann Vasc Surg 2020; 72:175-181. [PMID: 33271278 DOI: 10.1016/j.avsg.2020.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 09/17/2020] [Accepted: 10/04/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Antegrade superficial femoral artery (SFA) access for peripheral artery disease reduces the time, radiation, and contrast required with contralateral common femoral access (CFA). Yet, this technique remains underutilized in the treatment of SFA, popliteal and tibial disease, and there remains limited data on the safety and effectiveness of antegrade SFA access in the outpatient setting. METHODS A retrospective review of lower extremity peripheral arterial interventions in our office-based endovascular suite was conducted from 2013 to 2018. Interventions necessitating CFA access such as iliac, common femoral, or deep femoral artery revascularization were excluded (n = 206). In addition, interventions potentially requiring large sheaths not amenable to SFA access (e.g., popliteal aneurysm) were excluded. Relevant demographic and treatment variables including postoperative complications were abstracted. RESULTS We identified 718 patients, who underwent revascularization of the SFA, popliteal and tibial arteries. Antegrade SFA access was chosen in 448 patients (62.4%) with the remaining 270 patients having retrograde CFA access. Antegrade SFA access was achieved primarily with a 4-French sheath, while a majority of retrograde CFA interventions utilized a 6-French sheath for access (87.7% vs 69.5%, P < 0.001). Significantly less fluoroscopy (9.5 vs 16.4 min, P < 0.001) and contrast (25.4 vs 38.5 mL, P < 0.001) were used during SFA access compared with retrograde access. Technical success was achieved in 93.2% with antegrade SFA vs 94.8% retrograde CFA access (P = 0.42). The overall rate of complications was low for both cohorts (2.7% vs 3.7%, P = 0.78) and there were no statistical differences in access site complications (1.1% vs 1.5%, P = 0.94), hematoma (0.7% vs 1.1%, P = 0.84), and pseudoaneurysm (0.4% vs 0%, P = 0.98) between techniques. CONCLUSIONS Percutaneous antegrade SFA access can be performed safely in the outpatient setting and remains an effective alternative to retrograde CFA access with significantly less utilization of fluoroscopy and contrast.
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Affiliation(s)
- Michael Pezold
- Division of Vascular Surgery, New York University Langone Health, New York, NY
| | - Sheila Blumberg
- Division of Vascular Surgery, New York University Langone Health, New York, NY
| | - Mikel Sadek
- Division of Vascular Surgery, New York University Langone Health, New York, NY
| | - Thomas Maldonado
- Division of Vascular Surgery, New York University Langone Health, New York, NY
| | - Neal Cayne
- Division of Vascular Surgery, New York University Langone Health, New York, NY
| | - Glenn Jacobowitz
- Division of Vascular Surgery, New York University Langone Health, New York, NY
| | - Herbert James
- New York University School of Medicine, New York, NY
| | - Todd Berland
- Division of Vascular Surgery, New York University Langone Health, New York, NY.
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20
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Ybarra LF, Rinfret S. Access Selection for Chronic Total Occlusion Percutaneous Coronary Intervention and Complication Management. Interv Cardiol Clin 2020; 10:109-120. [PMID: 33223100 DOI: 10.1016/j.iccl.2020.09.009] [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: 11/16/2022]
Abstract
Dual access for chronic total occlusion percutaneous coronary intervention is considered best practice by many experts. There are 2 access sites: radial and femoral. Both accesses have important advantages and disadvantages. Determining the ratio risk/benefit-efficacy/safety of each access for each patient in a specific procedure should be based on procedural and clinical variables. Given the safety benefit and the minimal procedural disadvantages, radial access should be the standard approach, especially in procedures of low complexity and in patients at high risk of vascular complications. Nonetheless, mastering both approaches is important because they are needed in multiple occasions.
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Affiliation(s)
- Luiz F Ybarra
- London Health Sciences Centre, Schulich School of Medicine & Dentistry, Western University, 339 Windermere Road, Room B6-127, London, Ontario N6A 5A5, Canada. https://twitter.com/YbarraLuiz
| | - Stéphane Rinfret
- Division of Cardiology, Department of Medicine, McGill University, McGill University Health Centre, Glen Site, 1001 Boulevard Décarie, Montreal, Quebec H4A 3J1, Canada.
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21
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Dowlati E, Armonda RA, Liu AH, Felbaum DR. Letter: Access-Site Complications in Transfemoral Neuroendovascular Procedures: A Systematic Review of Incidence Rates and Management Strategies. Oper Neurosurg (Hagerstown) 2020; 19:E616-E619. [PMID: 32895695 DOI: 10.1093/ons/opaa279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 07/06/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ehsan Dowlati
- Department of Neurosurgery MedStar Georgetown University Hospital Washington, District of Columbia
| | - Rocco A Armonda
- Department of Neurosurgery MedStar Georgetown University Hospital Washington, District of Columbia.,Department of Neurosurgery MedStar Washington Hospital Center Washington, District of Columbia
| | - Ai-Hsi Liu
- Department of Neurosurgery MedStar Washington Hospital Center Washington, District of Columbia.,Department of Radiology MedStar Washington Hospital Center Washington, District of Columbia
| | - Daniel R Felbaum
- Department of Neurosurgery MedStar Georgetown University Hospital Washington, District of Columbia.,Department of Neurosurgery MedStar Washington Hospital Center Washington, District of Columbia
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22
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Daou BJ, Pandey AS. Commentary: Access-Site Complications in Transfemoral Neuroendovascular Procedures: A Systematic Review of Incidence Rates and Management Strategies. Oper Neurosurg (Hagerstown) 2020; 19:E335-E336. [PMID: 32392292 DOI: 10.1093/ons/opaa127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 03/17/2020] [Indexed: 12/17/2022] Open
Affiliation(s)
- Badih J Daou
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Aditya S Pandey
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
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23
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Del Prete A, Della Rocca DG, Calcagno S, Di Pietro R, Del Prete G, Biondi-Zoccai G, Raponi M, Scappaticci M, Di Matteo A, Natale A, Versaci F. Perclose Proglide™ for vascular closure. Future Cardiol 2020; 17:269-282. [PMID: 32915065 DOI: 10.2217/fca-2020-0065] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
In the past 20 years, numerous percutaneous vascular closure devices have been tested and compared with manual compression and to surgical cut-down. The suture-mediated closure device Perclose ProGlide™ system (Abbott Vascular, CA, USA) emerged as a safe and effective alternative for many procedures requiring either small or large bore vascular accesses. In this review, we will discuss the characteristics of this vascular closure device and the main studies that proved its potential to reduce vascular complications, time to deambulation, time to discharge and patient discomfort.
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Affiliation(s)
| | | | - Simone Calcagno
- Division of Cardiology, S. Maria Goretti Hospital, Latina, Italy
| | | | | | - Giuseppe Biondi-Zoccai
- Department of Medico-Surgical Sciences & Biotechnologies, Sapienza University of Rome, Latina, Italy.,Mediterranea Cardiocentro, Napoli, Italy
| | - Massimo Raponi
- Division of Cardiology, S. Maria Goretti Hospital, Latina, Italy
| | | | | | - Andrea Natale
- Texas Cardiac Arrythmia Institute, St David's Medical Center, Austin, TX 78705, USA
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24
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Park SE, Cho SB, Baek HJ, Moon JI, Ryu KH, Ha JY, Lee S, Won J, Ahn JH, Kim R, Choi SY. Clinical experience with distal transradial access for endovascular treatment of various noncoronary interventions in a multicenter study. PLoS One 2020; 15:e0237798. [PMID: 32822396 PMCID: PMC7444561 DOI: 10.1371/journal.pone.0237798] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 08/02/2020] [Indexed: 11/18/2022] Open
Abstract
Background Transradial access is a well-known alternative to conventional transfemoral access for interventional procedures. Recently, transradial access through the “snuffbox”, which lies in the radial dorsal aspect of the hand, has been introduced as a new technique with positional versatility. In this study, we aimed to evaluate the clinical feasibility and safety of distal transradial access for interventional procedures in a retrospective, multicenter study. Material & methods Distal transradial access was attempted in 46 patients (36 men and 10 women; mean age, 64 years) who underwent 47 consecutive procedures from January 2018 to December 2019. Procedures included chemoembolization (19/47, 40.4%), bronchial artery embolization (7/47, 14.9%), renal intervention (3/47, 6.4%), arteriovenous fistula angioplasty (7/47, 14.9%), subclavian artery stenting (5/47, 10.6%), other embolization (5/47, 10.6%), and uterine artery embolization (1/47, 2.1%). We recorded the success rate of the procedures, complications, and postprocedural hemostasis time during the follow-up period. Results The technical success of distal transradial access without major complications was 97.9% (46/47). Of the 46 patients, one patient (2.2%) had a minor complication, which was a thrombotic segmental occlusion of the distal radial artery. Of the enrolled patients, only one patient did not complete the transradial access procedure via the snuffbox because the left proximal subclavian artery was occluded and a crossover to conventional transfemoral access was performed. The mean postprocedural hemostasis time was 131.7 minutes (range, 120–360 minutes). Conclusion Distal transradial access can be a valid option for the endovascular treatment of various noncoronary interventions with technical feasibility and safety.
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Affiliation(s)
- Sung Eun Park
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Soo Buem Cho
- Department of Radiology, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
- * E-mail:
| | - Hye Jin Baek
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Jin Il Moon
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Kyeong Hwa Ryu
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Ji Young Ha
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Sangmin Lee
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Jungho Won
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Jong-Hwa Ahn
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Ran Kim
- Department of Radiology, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Sun Young Choi
- Department of Radiology, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
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Galvan Fernandez J, Martínez-Galdámez M, Schüller Arteaga M, Ortega-Quintanilla J, Hermosín A, Crespo-Vallejo E, Rodriguez-Arias CA. Arm-only access for combined transarterial and transvenous neurointerventional procedures. J Neurointerv Surg 2020; 13:39-41. [PMID: 32759328 DOI: 10.1136/neurintsurg-2020-016540] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 07/16/2020] [Accepted: 07/28/2020] [Indexed: 11/04/2022]
Abstract
A simultaneous arterial and venous approach has been widely described for the endovascular treatment of dural arteriovenous fistula (DAVFs) and recently for arteriovenous malformation (AVMs). Conventional venous approaches are performed by direct internal jugular puncture or by femoral access. Although complication rates are low, there are potential life-threatening complications that should be avoided. The advantages of radial artery access have been widely proven, nevertheless the use of upper limb veins in neurointervention are rarely reported. We present five cases of the simultaneous arteriovenous approach through the radial artery and superficial veins of the forearm for the treatment of intracranial neurovascular diseases.
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Affiliation(s)
- Jorge Galvan Fernandez
- Interventional Neuroradiology/Endovascular Neurosurgery, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Mario Martínez-Galdámez
- Interventional Neuroradiology/Endovascular Neurosurgery, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Miguel Schüller Arteaga
- Interventional Neuroradiology/Endovascular Neurosurgery, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | | | - Antonio Hermosín
- Interventional Radiology Unit, Hospital Universitario Fundacion Jimenez Diaz, Madrid, Madrid, Spain
| | - Eduardo Crespo-Vallejo
- Interventional Radiology Unit, Hospital Universitario Fundacion Jimenez Diaz, Madrid, Madrid, Spain
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26
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Stone P, Campbell J, Thompson S, Walker J. A prospective, randomized study comparing ultrasound versus fluoroscopic guided femoral arterial access in noncardiac vascular patients. J Vasc Surg 2020; 72:259-267. [DOI: 10.1016/j.jvs.2019.09.051] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Accepted: 09/23/2019] [Indexed: 12/15/2022]
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27
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Nanjundappa A, Dieter R. Editorial: Revisiting Fluoroscopic-Guided Femoral Access. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:675. [PMID: 32600796 DOI: 10.1016/j.carrev.2020.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Aravinda Nanjundappa
- Robert C. Byrd Clinical Training Center, Vascular Center of Excellence, West Virginia University, Charleston, WV.
| | - Robert Dieter
- Department of Cardiology, Loyola University Medical Center, Maywood, IL
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28
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Petrov I, Stankov Z, Tasheva I, Stanilov P. Safety and Efficacy of Transbrachial Access for Endovascular Procedures: A Single-Center Retrospective Analysis. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:1269-1273. [PMID: 32253168 DOI: 10.1016/j.carrev.2020.02.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 02/18/2020] [Accepted: 02/26/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Endovascular procedures nowadays are generally performed via the femoral and radial artery. Although not routinely used by many, there is still an essential role for vascular interventions via brachial access. The technological advancement of endovascular devices leads to a significant increase of the variety of percutaneously treatable vascular pathology. The brachial artery approach nowadays is becoming crucial for complex procedures either as single access or in the context of mandatory double vascular approach for many complex interventions. OBJECTIVE To evaluate the safety and efficacy of brachial artery access for diagnostic arteriography and endovascular interventions in different vascular territories in a single-center setting on the basis of a retrospective analysis of prospectively collected data in a large patient cohort. METHODS Between 01/2013 and 09/2016, 11,274 endovascular procedures were performed in our hospital, 847 (7.5%) of them via brachial access, presenting the database for this study. All demographic, clinical, and periprocedural data were obtained prospectively and included in the computerized hospital records, and on this basis, a retrospective analysis was performed. RESULTS While the radial access was the most used and constant for coronary and noncoronary interventions in our center (71%) in this period, the use of brachial access increased (from 4% to 12%) causing the femoral to decrease (from 27% to 16%). We used the brachial approach for diagnostic purposes in 162 patients (19%) and for head to toe endovascular interventions (including angioplasty, stenting, thrombolysis, or as adjunctive access) in 685 patients (81%). For 53 patients (6.2%), this was the only possible access for endovascular intervention. Overall access site-related complications occurred in 25 patients (2.9%), in 19 of them (2.2%) required surgical correction, for brachial artery thrombosis or pseudoaneurysm. The other six were managed conservatively. No permanent neurological deficits of the arm or severe bleeding were observed. Minor complications, mostly hematomas, occurred in 62 patients (7.3%), but they required no further treatment. CONCLUSION Brachial artery access expands our capability to perform complex procedures by allowing us to reach arterial targets in all territories. Complications of brachial vascular access are gradually decreasing together with the decrease of the crossing profile of the devices used in practice. However, when they occur, they often require surgical treatment. The growing experience of the team not only while obtaining the access but also while achieving adequate hemostasis ("patent hemostasis") is of great importance for minimizing the complications.
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Affiliation(s)
- Ivo Petrov
- Acibadem City Clinic Cardiovascular Center, Sofia, Bulgaria.
| | - Zoran Stankov
- Acibadem City Clinic Cardiovascular Center, Sofia, Bulgaria
| | - Iveta Tasheva
- Acibadem City Clinic Cardiovascular Center, Sofia, Bulgaria
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Starke RM, Snelling B, Al-Mufti F, Gandhi CD, Lee SK, Dabus G, Fraser JF. Transarterial and transvenous access for neurointerventional surgery: report of the SNIS Standards and Guidelines Committee. J Neurointerv Surg 2019; 12:733-741. [PMID: 31818970 DOI: 10.1136/neurintsurg-2019-015573] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 11/07/2019] [Accepted: 11/12/2019] [Indexed: 12/11/2022]
Abstract
The purpose of this publication is to provide a comprehensive review on the techniques and tools used for vascular access in neurointerventional procedures. Using published literature, we reviewed data on access methods, sites, tools, and techniques for neurointerventions. Recommendations are provided based on quality of data/levels of evidence and, where appropriate, expert consensus. While tools and techniques continue to be developed, current literature and experience supports certain principles regarding vascular access for neurointerventional procedures.
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Affiliation(s)
- Robert M Starke
- Neurological Surgery, University of Miami MILLER School of Medicine, Miami Beach, Florida, USA.,Neurosurgery, Westchester Medical Center, Valhalla, New York, USA
| | - Brian Snelling
- Neurological Surgery, University of Miami MILLER School of Medicine, Miami Beach, Florida, USA.,Neurosurgery, Westchester Medical Center, Valhalla, New York, USA
| | - Fawaz Al-Mufti
- Neurology and Neurosurgery, Westchester Medical Center, Valhalla, New York, USA
| | - Chirag D Gandhi
- Neurosurgery, Westchester Medical Center, Valhalla, New York, USA
| | - Seon-Kyu Lee
- Radiology, Montefiore Hospital and Medical Center, Bronx, New York, USA
| | - Guilherme Dabus
- Interventional Neuroradiology and Neuroendovascular Surgery, Miami Cardiac and Vascular Institute and Baptist Neuroscience Center, Miami, Florida, USA
| | - Justin F Fraser
- Neurological Surgery, University of Kentucky, Lexington, Kentucky, USA
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Chest X-Ray to Predict Difficult Right Transradial Cardiac Catheterization Due to Vascular Tortuosity: A Retrospective Study. Curr Probl Cardiol 2019; 46:100471. [PMID: 31635841 DOI: 10.1016/j.cpcardiol.2019.100471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 08/25/2019] [Indexed: 11/22/2022]
Abstract
Tortuous brachiocephalic artery may lead to procedural difficulties among patients undergoing right transradial cardiac catheterization. By prospectively identifying patients with this anatomic barrier, operators may choose an alternate catheterization site to avoid complications from switching midway. To assess brachiocephalic artery tortuosity, 23 patients who underwent challenging diagnostic coronary angiography by right transradial access were compared to a control group of 29 patients who lacked brachiocephalic artery tortuosity. Preprocedural, plain chest x-rays were analyzed for measurable anatomic parameters and assessed for statistical significance between groups. The vertebrocarinal distance-the distance in centimeters between the spinous process of the first thoracic vertebra (T1) and the most caudal point of tracheal bifurcation, measured at and parallel to the midline-was the most reliable and statistically significant radiographic predictor of brachiocephalic artery tortuosity. Using this novel concept reduces procedure duration and radiation exposure by decreasing transradial cardiac catheterization failure rates.
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Gopalakrishnan PP, Manoharan P, Shekhar C, Seto A, Sinha R, David M, Shah M, Nagajothi N. Redefining the fluoroscopic landmarks for common femoral arterial puncture during cardiac catheterization: Femoral angiogram and computed tomography angiogram (FACT) study of common femoral artery anatomy. Catheter Cardiovasc Interv 2019; 94:367-375. [PMID: 30537421 DOI: 10.1002/ccd.27991] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 10/03/2018] [Accepted: 10/29/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND The mid-femoral head (F50 ) is a common fluoroscopic target for common femoral artery (CFA) puncture during cardiac catheterization. Punctures above the inguinal ligament (marking the proximal end of CFA) increase the risk of retroperitoneal hemorrhage and are classified as high punctures. METHODS We retrospectively analyzed 114 CT angiograms for the anatomic relationship of the inguinal ligament to the femoral head (FH) and inferior epigastric artery (IEA). We analyzed 114 CT angiograms and 500 femoral angiograms, for the relation of the mid-point of CFA to F50 and F75 (the junction of upper 3/4th and lower 1/4th of FH). RESULTS The proximal third of femoral head (F33 ) (-1.4 mm) and IEA nadir (-2.9 mm) were closer approximations to the inguinal ligament than the IEA origin (-12.8 mm) or cranial end of FH (-15.2 mm). The inguinal ligament correlated better with the IEA nadir than F33 (R2 = 0.49 vs. 0.001). F75 was a closer approximation for the mid-point of the CFA than F50 (0.3 mm vs. -9.2 mm). Using F75 as the target for CFA puncture carried the lowest risk for non-CFA punctures (18.6%), while using F50 had a 41.2% risk for non-CFA punctures. F75 had an increased risk for low punctures (14.2%) but F50 had a far higher risk for high punctures (36.6%). CONCLUSIONS The nadir of IEA is the best landmark for identifying the inguinal ligament (the proximal end of CFA) and defining high punctures. F75 is a more accurate target for successful CFA puncture than F50.
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Affiliation(s)
| | | | | | - Arnold Seto
- Division of Cardiology, University of California, Irvine Medical Center, Orange, California
| | - Rahul Sinha
- Division of Cardiology, Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Manova David
- Division of Cardiology, Aultman Hospital, Canton, Ohio
| | - Moneal Shah
- Division of Cardiology, Allegheny Health Network, Pittsburgh, Pennsylvania
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Leesar MA, Al Solaiman F, Azarbal A, Marmagkiolis K, Cilingiroglu M. A Novel Fluoroscopic-guided Technique With Micropuncture Needle for the Common Femoral Artery Access. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 21:668-674. [PMID: 31627988 DOI: 10.1016/j.carrev.2019.08.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 08/18/2019] [Accepted: 08/19/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Randomized trials demonstrated that the rate of access to the center of the CFA was low and not different with fluoroscopy vs. anatomic landmarks. We investigated the role a novel fluoroscopic-guided technique with the micropuncture needle (MPN) for the common femoral artery (CFA) access. METHODS A MPN was advanced to the center of pubis in the 20° ipsilateral right- or left anterior oblique view for the CFA access in 150 patients undergoing cardiac catheterization. After the CFA puncture and guidewire advancement, if the MPN tip was within pelvic-femoral line (the line between pelvic brim and inferior border of the femoral head), a sheath was inserted into the CFA and femoral angiography was performed. The acceptable sites of CFA access were defined zone III, as the sheath position in the middle third of the CFA; Zone II, between the pelvic brim and Zone III; and Zone IV, between the femoral bifurcation and Zone III. High or low access sites were zones I and V, respectively. RESULTS The primary-end point, the CFA access to the center of CFA (zone III) was significantly higher than zones II and IV (64% vs. 13% and 23%; P < 0.001, respectively). The MPN tip was high or low in 17 and 11 patients (19%), respectively, which was readvanced to the center of pubis using fluoroscopy; this resulted in CFA access in 100% of patients. There were no bleeding complications; the baseline and next day hemoglobin levels were 13.0 ± 2.0 g/dl vs. 12.4 ± 1.9 g/dl, respectively; P = NS. CONCLUSIONS The use of this novel fluoroscopic-guided technique with the MPN resulted in access to the CFA in all patients and to the center of the CFA in the majority of patients. There was no significant hemoglobin drop or bleeding complications after the procedure.
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Affiliation(s)
- Massoud A Leesar
- Division of Cardiology, University of Alabama at Birmingham, United States of America.
| | - Firas Al Solaiman
- Division of Cardiology, University of Alabama at Birmingham, United States of America
| | - Amir Azarbal
- Division of Cardiology, University of Alabama at Birmingham, United States of America
| | - Kostas Marmagkiolis
- Citizens Memorial and Vascular Institute Bolivar, Mo and the University of Missouri, Columbia, United States of America
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Nguyen P, Makris A, Hennessy A, Jayanti S, Wang A, Park K, Chen V, Nguyen T, Lo S, Xuan W, Leung M, Juergens C. Standard versus ultrasound-guided radial and femoral access in coronary angiography and intervention (SURF): a randomised controlled trial. EUROINTERVENTION 2019; 15:e522-e530. [PMID: 31113763 DOI: 10.4244/eij-d-19-00336] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS This study aimed to compare outcomes in unselected patients undergoing cardiac catheterisation via transradial versus transfemoral access and standard versus ultrasound-guided arterial access. METHODS AND RESULTS This was a prospective, randomised (radial vs. femoral and standard vs. ultrasound), 2x2 factorial trial of 1,388 patients undergoing coronary angiography and percutaneous coronary intervention. The primary outcome was a composite of ACUITY (Acute Catheterization and Urgent Intervention Triage strategY) major bleeding, MACE (death, stroke, myocardial infarction or urgent target lesion revascularisation) and vascular complications at 30 days. Transradial access reduced the primary outcome (RR 0.37, 95% CI: 0.17-0.81; p=0.013), mostly driven by ACUITY major bleeding (RR 0.343, 95% CI: 0.123-0.959; p=0.041) when compared with the transfemoral approach. There was no difference in the primary outcome between standard and ultrasound guidance (p=0.76). Ultrasound guidance, however, reduced mean access time (93 sec vs. 111 sec; p=0.009), attempts (1.47 vs. 1.9; p<0.0001), difficult accesses (4.5% vs. 9.2%; p=0.0007), venepuncture (4.1% vs. 9.2%; p<0.0001) and improved first-pass success (73% vs. 59.7%; p<0.0001). CONCLUSIONS Transradial access significantly reduced the composite outcome compared to transfemoral access. Ultrasound guidance did not reduce the primary outcome compared to the standard technique, but significantly improved the efficiency and overall success rate of arterial access.
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Affiliation(s)
- Phong Nguyen
- Campbelltown Hospital, Campbelltown, NSW, Australia
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Outcomes of a randomised pilot trial of a nurse-led clinic for patients after percutaneous coronary intervention. Aust Crit Care 2019; 32:285-292. [PMID: 31280772 DOI: 10.1016/j.aucc.2018.06.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 04/13/2018] [Accepted: 06/28/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Hospitalisation for percutaneous coronary intervention (PCI) in Australia is reducing. Patients who undergo PCI may be discharged home without a post-discharge health management plan, referral for secondary prevention, or understand their chronic condition. Subsequently, negative psychological symptoms such as anxiety and depression may be experienced in the post-discharge period. OBJECTIVES This study assessed the effectiveness of a nurse-led clinic on patients' cardiac self-efficacy and negative psychological symptoms of anxiety and depression 1-week post-PCI discharge. METHODS One-hundred and eighty-eight potential participants were screened, and 33 participants were block-randomised to study groups. The nurse-led clinic used a person-centred approach and delivered tailored education, health assessment, and post-discharge support. In Phase 1, the Cardiac Self-efficacy Scale and State-Trait Anxiety Inventory measured primary outcomes, while the Cardiac Depression Scale was used to measure secondary outcomes. Phase 2 evaluated participants' experiences and healthcare professionals' perceptions of the intervention through semi-structured interviews. RESULTS In Phase 1, intervention group participants did not show improvements in mental health indicators compared to standard care group participants, except for a moderate reduction in anxiety levels (d = 0.50). Phase 2 qualitative findings; however, highlighted the benefits of the nurse-led clinic. CONCLUSIONS Overall, findings suggest that nurse-led clinics may be valuable to reduce anxiety and act as a supportive measure in the early post-discharge period until commencement of a secondary prevention program. Further research with a more powered sample is needed to determine the significance of the findings.
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Common femoral artery antegrade and retrograde approaches have similar access site complications. J Vasc Surg 2019; 69:1160-1166.e2. [DOI: 10.1016/j.jvs.2018.06.226] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 06/29/2018] [Indexed: 12/22/2022]
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van Wiechen MP, Ligthart JM, Van Mieghem NM. Large-bore Vascular Closure: New Devices and Techniques. ACTA ACUST UNITED AC 2019; 14:17-21. [PMID: 30858887 PMCID: PMC6406132 DOI: 10.15420/icr.2018.36.1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Endovascular aneurysm repair, transcatheter aortic valve implantation and percutaneous mechanical circulatory support systems have become valuable alternatives to conventional surgery and even preferred strategies for a wide array of clinical entities. Their adoption in everyday practice is growing. These procedures require large-bore access into the femoral artery. Their use is thus associated with clinically significant vascular bleeding complications. Meticulous access site management is crucial for safe implementation of large-bore technologies and includes accurate puncture technique and reliable percutaneous closure devices. This article reviews different strategies for obtaining femoral access and contemporary percutaneous closure technologies.
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Affiliation(s)
- Maarten P van Wiechen
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center Rotterdam, the Netherlands
| | - Jurgen M Ligthart
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center Rotterdam, the Netherlands
| | - Nicolas M Van Mieghem
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center Rotterdam, the Netherlands
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Ram P, Horn B, Lo KBU, Pressman G, Rangaswami J. Acute Kidney Injury Post Cardiac Catheterization: Does Vascular Access Route Matter? Curr Cardiol Rev 2019; 15:96-101. [PMID: 30421683 PMCID: PMC6520579 DOI: 10.2174/1573403x14666181113112210] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 10/31/2018] [Accepted: 11/08/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Acute Kidney Injury as a complication of cardiac catheterization is associated with increased length of hospital stay and mortality. In recent years, the use of the radial artery for cardiac catheterization is increasing in frequency. OBJECTIVE The objective of this concise review was to evaluate the method of cardiac access site and its impact on Acute Kidney Injury following cardiac catheterization. METHODS After a thorough search on Medline, Google Scholar and PubMed, we included all the literature relevant to Acute kidney injury following transradial and transfemoral cardiac catheterization. RESULTS While acute kidney injury was caused due to a variety of reasons, it was important to consider each case on an individual basis. We found a trend towards increased use of transradial approach in patients at high risk of developing kidney injury. However, limitations such as operator experience, anatomical challenges and so on do exist with this approach. CONCLUSION Transradial access offers several advantages to a patient at high risk of acute kidney injury undergoing cardiac catheterization. Further large studies are needed to establish this trend in the years ahead.
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Affiliation(s)
- Pradhum Ram
- Address correspondence to this author at the Albert Einstein Medical Center, 5501 Old York Road, Philadelphia, PA 19141, USA; Tel: 215-688-3183; E-mail:
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Mengal MN, Ashraf T, Hassan Rizvi SN, Badini A, Karim M. Assessment of Femoral Artery Bifurcation Level with Conventional Angiography. Cureus 2018; 10:e3479. [PMID: 30648030 PMCID: PMC6318095 DOI: 10.7759/cureus.3479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 10/22/2018] [Indexed: 11/20/2022] Open
Abstract
Introduction The common femoral artery (CFA) is the optimal access point for femoral arterial puncture. A higher or lower puncture can result in various vascular complications and by the proper definition of the femoral arterial bifurcation level and the optimal puncture point such complications can potentially be avoided. In the literature, little data is available about the frequency of femoral artery bifurcation and the relationship between the bifurcation level of one artery and its contralateral counterpart in our part of the world. Methods We performed a prospective study from April 2016 to September 2016 to define the frequency of bifurcation of the CFA in relation to the femoral head and the relationship between bilateral CFA bifurcations, with bilateral femoral angiography on 579 patients undergoing routine coronary angiography. Results The frequency of normal/low, high, and very high femoral bifurcations was 66%, 26%, and 8%, respectively. There was no significant difference in the bifurcation of CFA between the two sides (p = 0.51). A specific bifurcation level on one side significantly increased the likelihood of the same bifurcation level on the contralateral side (odds ratio (OR) = 151.86 (51.39-448.77)). A multivariable logistic regression analysis revealed age, race, gender, height and weight, body surface area (BSA), and body mass index (BMI) were not predictive of any specific bifurcation level on either side. Conclusions The majority (two-thirds) of the individuals in the study population were with normal/low femoral bifurcation with no significant difference in bifurcation level on either side.
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Affiliation(s)
- Muhammad N Mengal
- Cardiology, National Institute of Cardiovascular Diseases (NICVD), Karachi, PAK
| | - Tariq Ashraf
- Cardiology, National Institute of Cardiovascular Diseases (NICVD), Karachi, PAK
| | - Syed N Hassan Rizvi
- Cardiology, National Institute of Cardiovascular Diseases (NICVD), Karachi, PAK
| | - Abida Badini
- Family Medicine, The Aga Khan University, Karachi, PAK
| | - Musa Karim
- Miscellaneous, National Institute of Cardiovascular Diseases (NICVD), Karachi, PAK
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Bogabathina H, Singireddy S, Shi R, Morris L, Abdulbaki A, Zabher H, Katikaneni P, Modi K. Does micropuncture technique really help reduce vascular complications? CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 19:762-765. [DOI: 10.1016/j.carrev.2018.03.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 03/22/2018] [Accepted: 03/22/2018] [Indexed: 11/17/2022]
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Bosiers M, Deloose K, Callaert J. Anterograde or retrograde arterial access for diabetic limb revascularization. Semin Vasc Surg 2018; 31:76-80. [DOI: 10.1053/j.semvascsurg.2018.12.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Hayıroğlu Mİ, Çınar T, Bıçakçı B, Dağaşan İ, Demir K, Keskin M, Öz A, Işılak Z, Keser N, Uzun M. Predictors of femoral hematoma in patients undergoing elective coronary procedure: a trigonometric evaluation. Int J Cardiovasc Imaging 2018; 34:1177-1184. [PMID: 29550904 DOI: 10.1007/s10554-018-1339-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 03/15/2018] [Indexed: 11/25/2022]
Abstract
Vascular complications in the femoral artery puncture site are the most common complications of the coronary angiography. Femoral hematoma is the leading participant of the vascular complications. We investigated the femoral hematoma predictive value of angle of sheath to trochanter major in patients undergoing elective coronary procedures. In this prospective analysis, we evaluated the femoral hematoma predictive value of angle of sheath to trochanter major on 246 patients undergoing elective coronary procedures. In this prospective analysis, we evaluated the femoral hematoma predictive value of angle of sheath to trochanter major on 246 patients undergoing elective coronary procedures. Patients were divided into two as femoral hematoma (n = 23) and control (n = 223) groups according to post-procedure femoral hematoma status. Other independent predictors of femoral hematoma were also evaluated. In-hospital multivariable analysis revealed higher rates of femoral hematoma for patients with chronic renal failure (OR 24.97, 95% CI 3.04-78.88, p = 0.003), with higher diastolic blood pressure after the procedure (OR 1.08 95% CI 1.00-1.16, p = 0.037), with femoral vein puncture during procedure (OR 17.74, 95% CI 2.67-54.74, p = 0.003) and with higher angle of sheath to trochanter major (OR 1.52, 95% CI 1.13-2.05, p = 0.005). The best cut-off value of the angle of sheath to trochanter major to predict femoral hematoma was 15.6° with 74% sensitivity and 70% specificity (AUC: 0.75; 95% CI 0.63-0.86; p < 0.001). The angle of sheath to trochanter major provides an independent predictor of femoral hematoma in patients undergoing elective coronary procedures. Our data suggests the importance of fluoroscopic guidance during femoral artery access with the predictive role of the angle of sheath to trochanter major.
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Affiliation(s)
- Mert İlker Hayıroğlu
- Department of Cardiology, Haydarpasa Sultan Abdulhamid Han Training and Research Hospital, 34668, Istanbul, Turkey.
| | - Tufan Çınar
- Department of Cardiology, Haydarpasa Sultan Abdulhamid Han Training and Research Hospital, 34668, Istanbul, Turkey
| | - Burhan Bıçakçı
- Department of Cardiology, Haydarpasa Sultan Abdulhamid Han Training and Research Hospital, 34668, Istanbul, Turkey
| | - İbrahim Dağaşan
- Department of Cardiology, Haydarpasa Sultan Abdulhamid Han Training and Research Hospital, 34668, Istanbul, Turkey
| | - Koray Demir
- Department of Cardiology, Muş State Hospital, Muş, Turkey
| | - Muhammed Keskin
- Department of Cardiology, Haydarpasa Sultan Abdulhamid Han Training and Research Hospital, 34668, Istanbul, Turkey
| | - Ahmet Öz
- Department of Cardiology, Haydarpasa Sultan Abdulhamid Han Training and Research Hospital, 34668, Istanbul, Turkey
| | - Zafer Işılak
- Department of Cardiology, Haydarpasa Sultan Abdulhamid Han Training and Research Hospital, 34668, Istanbul, Turkey
| | - Nurgül Keser
- Department of Cardiology, Haydarpasa Sultan Abdulhamid Han Training and Research Hospital, 34668, Istanbul, Turkey
| | - Mehmet Uzun
- Department of Cardiology, Haydarpasa Sultan Abdulhamid Han Training and Research Hospital, 34668, Istanbul, Turkey
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Barbanti M, Gulino S, Costa G, Tamburino C. Optimization and simplification of transcatheter aortic valve implantation therapy. Expert Rev Cardiovasc Ther 2018; 16:287-296. [PMID: 29508624 DOI: 10.1080/14779072.2018.1449644] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Transcatheter aortic valve implantation (TAVI) is now a widely adopted therapy for the treatment of elderly patients with severe aortic stenosis. Improved pre-procedural screening, increased operators' experience and technology advancement have made this technique highly reliable and standardized. Areas covered: The purpose of this review article is to provide an overview of the strategies that can be adopted to optimize the TAVI procedure (pre-interventional work-up and procedural simplification and early discharge). Expert commentary: Optimization of TAVI therapy is already a reality and has shown to be safe in most patients, but its penetration has to face with real-world practice. The adoption of a minimalistic and optimized approach requires integration of multidisciplinary competences and an extended, dynamic conception of heart team, which also includes patients' families, referring cardiologist and general practitioners.
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Affiliation(s)
- Marco Barbanti
- a Division of Cardiology , Ferrarotto Hospital, University of Catania , Catania , Italy
| | - Simona Gulino
- a Division of Cardiology , Ferrarotto Hospital, University of Catania , Catania , Italy
| | - Giuliano Costa
- a Division of Cardiology , Ferrarotto Hospital, University of Catania , Catania , Italy
| | - Corrado Tamburino
- a Division of Cardiology , Ferrarotto Hospital, University of Catania , Catania , Italy
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Aida Y, Misaki K, Kamide T, Mohri M, Uchiyama N, Nakada M. Physical Risk Factors of Hemorrhagic Complications Associated with Angio-Seal Closure Device Use in Neurointerventional Procedures. World Neurosurg 2018; 111:e850-e855. [DOI: 10.1016/j.wneu.2017.12.179] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 12/27/2017] [Accepted: 12/30/2017] [Indexed: 10/18/2022]
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Residual rivaroxaban exposure after discontinuation of anticoagulant therapy in patients undergoing cardiac catheterization. Eur J Clin Pharmacol 2018; 74:611-618. [PMID: 29376194 DOI: 10.1007/s00228-018-2421-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 01/18/2018] [Indexed: 10/18/2022]
Abstract
PURPOSE Patients treated with direct oral anticoagulants (DOACs) frequently undergo interventional procedures requiring temporary discontinuation of anticoagulant therapy. Little is known about remaining peri-procedural exposure to rivaroxaban in real-world patients. METHODS Fifty-six patients with rivaroxaban treatment and scheduled cardiac catheterization were included in this prospective, observational, and single-center study. Rivaroxaban concentrations were determined by LC-MS/MS and a chromogenic anti-Xa assay. Population pharmacokinetic modeling was carried out on LC-MS/MS concentration data using NONMEM software, and results were applied to Monte Carlo simulations to predict appropriate rivaroxaban discontinuation intervals. RESULTS Rivaroxaban concentrations ranged from <LLOQ to 300.6 ng/ml at the time of admission to hospital and from <LLOQ to 55.5 ng/ml at the beginning of the procedure. Times since last rivaroxaban intake were (mean ± SD) 51.0 ± 31.7 h (admission) and 85.5 ± 36.8 h (start catheterization). LC-MS/MS and anti-Xa assay results were in good agreement (r = 0.958); however, the anti-Xa assay may underestimate low rivaroxaban concentrations and overestimate rivaroxaban exposure when performed on plasma samples contaminated with heparins. Pharmacokinetics of rivaroxaban were adequately described, and simulations predicted that 95% of patients will have rivaroxaban concentrations ≤ 28.4 ng/ml (15 mg dose group) and ≤ 31.9 ng/ml (20 mg dose group) after 48 h of discontinuation. CONCLUSIONS In the majority of patients, rivaroxaban plasma concentrations dropped below 30 ng/ml after 48 h of treatment discontinuation which is considered hemostatically safe before surgery with high bleeding risk. For accurate determination of low rivaroxaban concentrations, LC-MS/MS is the preferred choice.
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Marquis-Gravel G, Tremblay-Gravel M, Lévesque J, Généreux P, Schampaert E, Palisaitis D, Doucet M, Charron T, Terriault P, Tessier P. Ultrasound guidance versus anatomical landmark approach for femoral artery access in coronary angiography: A randomized controlled trial and a meta-analysis. J Interv Cardiol 2018; 31:496-503. [DOI: 10.1111/joic.12492] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Revised: 12/09/2017] [Accepted: 12/12/2017] [Indexed: 11/26/2022] Open
Affiliation(s)
| | | | - Jonathan Lévesque
- Hôpital du Sacré-Coeur de Montréal; Université de Montréal; Montreal Québec
| | - Philippe Généreux
- Hôpital du Sacré-Coeur de Montréal; Université de Montréal; Montreal Québec
- Columbia University Medical Center; New York New York
- Cardiovascular Research Foundation; New York New York
| | - Erick Schampaert
- Hôpital du Sacré-Coeur de Montréal; Université de Montréal; Montreal Québec
| | - Donald Palisaitis
- Hôpital du Sacré-Coeur de Montréal; Université de Montréal; Montreal Québec
| | - Michel Doucet
- Hôpital du Sacré-Coeur de Montréal; Université de Montréal; Montreal Québec
| | - Thierry Charron
- Hôpital du Sacré-Coeur de Montréal; Université de Montréal; Montreal Québec
| | - Paul Terriault
- Hôpital du Sacré-Coeur de Montréal; Université de Montréal; Montreal Québec
| | - Pierre Tessier
- Hôpital du Sacré-Coeur de Montréal; Université de Montréal; Montreal Québec
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Son SY, Cho KC, Cho P, Lee JH, Myoung SU, Choi JH. Prepuncture Ultrasound Examination Facilitates Safe and Accurate Common Femoral Artery Access for Transfemoral Cerebral Angiography. J Cerebrovasc Endovasc Neurosurg 2017; 19:276-283. [PMID: 29387628 PMCID: PMC5788835 DOI: 10.7461/jcen.2017.19.4.276] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Revised: 08/22/2017] [Accepted: 10/25/2017] [Indexed: 11/23/2022] Open
Abstract
Objective We aimed to introduce our method involving prepuncture ultrasound scan for cannulation of the common femoral artery (CFA) during transfemoral cerebral angiography (TFCA), and to assess the clinical and radiological outcomes. Material and Methods Our study included 90 patients who underwent prepuncture ultrasound examination of the inguinal area for TFCA between April 2015 and June 2015. Prior to skin preparation and draping of the inguinal area, we identified the CFA and its bifurcation using ultrasound. Based on the ultrasound findings, we marked cruciate lines in the inguinal area. Thereafter, we inserted a puncture needle at the interface between the horizontal and vertical lines at a 30-45° angle, simultaneously palpating the pulsation of the femoral artery. After TFCA was completed, femoral artery angiography was performed in the anteroposterior and oblique directions. Clinical and radiological parameters, including CFA cannulation, the ultrasound scan time, the first pass success rate, the time required for the passage of the wire, and complications, were evaluated. Results The mean ultrasound scan time of the CFA and its bifurcation was 72.6 seconds, and the mean time between administration of local anesthesia and wire passage was 67.44 seconds. The first pass success rate was 77.8% (70/90 patients), and the CFA puncture rate was 98.8% (89/90 patients). Although minor complications were noted in 7 patients, no patient reported serious complications (a large hematoma [≥ 5 cm], pseudoaneurysms, dissection, and/or a retroperitoneal hematoma.). Conclusion Prepuncture ultrasound examination might be a simple, safe, and accurate technique for cannulation of the CFA during TFCA.
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Affiliation(s)
- Seon Yong Son
- Department of Neurosurgery, Bundang Jesaeng General Hospital, Sungnam, Korea
| | - Kwang-Chun Cho
- Department of Neurosurgery, Bundang Jesaeng General Hospital, Sungnam, Korea
| | - Pyunggoo Cho
- Department of Neurosurgery, Bundang Jesaeng General Hospital, Sungnam, Korea
| | - Ju Hyung Lee
- Department of Neurosurgery, Bundang Jesaeng General Hospital, Sungnam, Korea
| | - Seong Uk Myoung
- Department of Radiology, Bundang Jesaeng General Hospital, Sungnam, Korea
| | - Jai Ho Choi
- Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
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Plehn G, Butz T, Maagh P, Meissner A. Effect of patient’s age on the profitability of inpatient cardiac catheterization: a contribution margin analysis of frequently performed procedures over a 5-year period. BMC Health Serv Res 2017; 17:49. [PMID: 28100220 PMCID: PMC5241940 DOI: 10.1186/s12913-017-1999-4] [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: 05/21/2016] [Accepted: 01/11/2017] [Indexed: 11/10/2022] Open
Abstract
Background Methods Results Conclusions Electronic supplementary material
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Honda Y, Araki M, Yamawaki M, Tokuda T, Tsutumi M, Mori S, Sakamoto Y, Kobayashi N, Hirano K, Ito Y. The novel echo-guided ProGlide technique during percutaneous transfemoral transcatheter aortic valve implantation. J Interv Cardiol 2017; 31:216-222. [DOI: 10.1111/joic.12468] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 10/12/2017] [Accepted: 10/17/2017] [Indexed: 12/14/2022] Open
Affiliation(s)
- Yohsuke Honda
- Saiseikai Yokohama City Eastern Hospital; Division of Cardiology; Yokohama Japan
| | - Motoharu Araki
- Saiseikai Yokohama City Eastern Hospital; Division of Cardiology; Yokohama Japan
| | - Masahiro Yamawaki
- Saiseikai Yokohama City Eastern Hospital; Division of Cardiology; Yokohama Japan
| | - Takahiro Tokuda
- Saiseikai Yokohama City Eastern Hospital; Division of Cardiology; Yokohama Japan
| | - Masakazu Tsutumi
- Saiseikai Yokohama City Eastern Hospital; Division of Cardiology; Yokohama Japan
| | - Shinsuke Mori
- Saiseikai Yokohama City Eastern Hospital; Division of Cardiology; Yokohama Japan
| | - Yasunari Sakamoto
- Saiseikai Yokohama City Eastern Hospital; Division of Cardiology; Yokohama Japan
| | - Norihiro Kobayashi
- Saiseikai Yokohama City Eastern Hospital; Division of Cardiology; Yokohama Japan
| | - Keisuke Hirano
- Saiseikai Yokohama City Eastern Hospital; Division of Cardiology; Yokohama Japan
| | - Yoshiaki Ito
- Saiseikai Yokohama City Eastern Hospital; Division of Cardiology; Yokohama Japan
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Factors affecting treatment, management and mortality in cases of retroperitoneal hematoma after cardiac catheterization: a single-center experience. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2017; 13:218-224. [PMID: 29056994 PMCID: PMC5644040 DOI: 10.5114/aic.2017.70189] [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: 03/03/2017] [Accepted: 04/19/2017] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION There is little information available on the clinical aspects, results, treatment and management of cardiac catheterization-related retroperitoneal hematoma. Data on the subject are rather limited, and current publications are based on a limited number of retrospective cohort studies and case reports. AIM To perform a retrospective analysis of the demographic, clinical, and in-hospital results of patients who developed retroperitoneal hematoma (RPH) after cardiac catheterization (CC). MATERIAL AND METHODS The cases of 124,064 patients who had CCs between January 2010 and October 2016 were retrospectively analyzed. Patients diagnosed with RPH were classified into three groups depending on the method of treatment: conservative (group 1), endovascular stenting (group 2), and surgery (group 3). The independent risk factors, based on RPH-related mortality, were determined by logistic regression analysis. RESULTS Of the 68 (0.054%) patients with RPH, 75% received conservative treatment, 13.2% underwent angiographic stent placement, and 11.7% had surgical treatment. Red blood cell packets (RBCPs) (p = 0.043), duration of hospitalization (p = 0.007), and mortality rates (p = 0.006) were statistically significantly higher in group 3 in comparison to the other groups. Multivariate subgroup analysis was conducted to determine mortality rates, with post-procedural highest creatinine ≥ 2 mg/dl and RBCPs ≥ 10 established as independent risk factors. CONCLUSIONS Hemodynamically stable patients with no active hemorrhaging are shown to have good results with conservative treatment. We believe that endovascular methods should be used initially for hemodynamically unstable patients, while surgical treatment should be employed in cases where endovascular methods fail or abdominal compartment syndrome develops.
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Leslie-Mazwi T, Chen M, Yi J, Starke RM, Hussain MS, Meyers PM, McTaggart RA, Pride GL, Ansari AS, Abruzzo T, Albani B, Arthur AS, Baxter BW, Bulsara KR, Delgado Almandoz JE, Gandhi CD, Heck D, Hetts SW, Klucznik RP, Jayaraman MV, Lee SK, Mack WJ, Mocco J, Prestigiacomo C, Patsalides A, Rasmussen P, Sunenshine P, Frei D, Fraser JF. Post-thrombectomy management of the ELVO patient: Guidelines from the Society of NeuroInterventional Surgery. J Neurointerv Surg 2017; 9:1258-1266. [PMID: 28963364 DOI: 10.1136/neurintsurg-2017-013270] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 07/22/2017] [Accepted: 08/06/2017] [Indexed: 01/01/2023]
Affiliation(s)
- Thabele Leslie-Mazwi
- Neurointerventional Service, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Michael Chen
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Julia Yi
- University Illinois at Chicago, Chicago, Illinois, USA
| | - Robert M Starke
- Department of Neurosurgery and Radiology, University of Miami, Miami, Florida, USA
| | | | | | - Ryan A McTaggart
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - G Lee Pride
- Department of Neuroradiology, University of Texas Southwestern, Dallas, Texas, USA
| | - A Sameer Ansari
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Todd Abruzzo
- Department of Neurosurgery, University of Cincinnati, Cincinnati, Ohio, USA
| | - Barbara Albani
- Department of Neurointerventional Surgery, Christiana Care Health Systems, Newark, Delaware, USA
| | | | - Blaise W Baxter
- Department of Radiology, Erlanger Medical Center, Chattanooga, Tennessee, USA
| | - Ketan R Bulsara
- Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Josser E Delgado Almandoz
- Department of Neurointerventional Radiology, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Chirag D Gandhi
- Department of Neurosurgery, Rutgers-New Jersey Medical School, Newark, New Jersey, USA
| | - Don Heck
- Department of Radiology, Forsyth Medical Center, Winston Salem, North Carolina, USA
| | - Steven W Hetts
- Department of Radiology, University of California in San Francisco, San Francisco, California, USA
| | - Richard P Klucznik
- Houston Methodist Neurological Institute, Houston Methodist Hospital, Houston, Texas, USA
| | - Mahesh V Jayaraman
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Seon-Kyu Lee
- The University of Chicago, Chicago, Illinois, USA
| | - William J Mack
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - J Mocco
- Mount Sinai School of Medicine, Mount Sinai Health System, New York, New York, USA
| | | | - Athos Patsalides
- New York Presbyterian Hospital, Weill Cornell Medical College, New York, New York, USA
| | - Peter Rasmussen
- Cerebrovascular Center, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Donald Frei
- Swedish Medical Center, Denver, Colorado, USA
| | - Justin F Fraser
- Department of Neurological Surgery, University of Kentucky, Lexington, Kentucky, USA
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