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Meijers TA, Nap A, Aminian A, Schmitz T, Dens J, Teeuwen K, van Kuijk JP, van Wely M, Bataille Y, Kraaijeveld AO, Roolvink V, Dambrink JHE, Gosselink ATM, Hermanides RS, Ottervanger JP, Tsilingiris I, van den Buijs DMF, van Royen N, van Leeuwen MAH. Ultrasound-guided versus fluoroscopy-guided large-bore femoral access in PCI of complex coronary lesions: the international, multicentre, randomised ULTRACOLOR Trial. EUROINTERVENTION 2024; 20:e876-e886. [PMID: 38742577 PMCID: PMC11228538 DOI: 10.4244/eij-d-24-00089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 04/10/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Transfemoral access is often used when large-bore guide catheters are required for percutaneous coronary intervention (PCI) of complex coronary lesions, especially when large-bore transradial access is contraindicated. Whether the risk of access site complications for these procedures may be reduced by ultrasound-guided puncture is unclear. AIMS We aimed to show the superiority of ultrasound-guided femoral puncture compared to fluoroscopy-guided access in large-bore complex PCI with regard to access site-related Bleeding Academic Research Consortium 2, 3 or 5 bleeding and/or vascular complications requiring intervention during hospitalisation. METHODS The ULTRACOLOR Trial is an international, multicentre, randomised controlled trial investigating whether ultrasound-guided large-bore femoral access reduces clinically relevant access site complications compared to fluoroscopy-guided large-bore femoral access in PCI of complex coronary lesions. RESULTS A total of 544 patients undergoing complex PCI mandating large-bore (≥7 Fr) transfemoral access were randomised at 10 European centres (median age 71; 76% male). Of these patients, 68% required PCI of a chronic total occlusion. The primary endpoint was met in 18.9% of PCI with fluoroscopy-guided access and 15.7% of PCI with ultrasound-guided access (p=0.32). First-pass puncture success was 92% for ultrasound-guided access versus 85% for fluoroscopy-guided access (p=0.02). The median time in the catheterisation laboratory was 102 minutes versus 105 minutes (p=0.43), and the major adverse cardiovascular event rate at 1 month was 4.1% for fluoroscopy-guided access and 2.6% for ultrasound-guided access (p=0.32). CONCLUSIONS As compared to fluoroscopy-guided access, the routine use of ultrasound-guided access for large-bore transfemoral complex PCI did not significantly reduce clinically relevant bleeding or vascular access site complications. A significantly higher first-pass puncture success rate was demonstrated for ultrasound-guided access. CLINICALTRIALS gov identifier: NCT04837404.
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Affiliation(s)
- Tom A Meijers
- Department of Cardiology, Isala Heart Center, Zwolle, the Netherlands
| | - Alexander Nap
- Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Adel Aminian
- Department of Cardiology, Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium
| | - Thomas Schmitz
- Department of Cardiology, Elisabeth Krankenhaus, Essen, Germany
| | - Joseph Dens
- Department of Cardiology, Hospital Oost-Limburg, Genk, Belgium
| | - Koen Teeuwen
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands
| | - Jan-Peter van Kuijk
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Marleen van Wely
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Yoann Bataille
- Department of Cardiology, Jessa Hospital, Hasselt, Belgium
| | - Adriaan O Kraaijeveld
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Vincent Roolvink
- Department of Cardiology, Isala Heart Center, Zwolle, the Netherlands
| | | | | | | | | | | | | | - Niels van Royen
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
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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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Gorgulu S, Kalay N, Norgaz T, Kocas C, Goktekin O, Brilakis ES. Femoral or Radial Approach in Treatment of Coronary Chronic Total Occlusion: A Randomized Clinical Trial. JACC Cardiovasc Interv 2022; 15:823-830. [PMID: 35450683 DOI: 10.1016/j.jcin.2022.02.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 02/04/2022] [Accepted: 02/08/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVES The aim of this study was to compare transradial access (TRA) with transfemoral access (TFA) for chronic total occlusion (CTO) percutaneous coronary intervention (PCI). BACKGROUND TRA reduces the risk for vascular access complications but may make complex PCI, such as CTO PCI, more challenging. METHODS FORT CTO (Femoral or Radial Approach in the Treatment of Coronary Chronic Total Occlusion) (NCT03265769) was a prospective, noninferiority, randomized controlled study of TRA vs TFA for CTO PCI. The primary study endpoint was procedural success, defined as technical success without any in-hospital major adverse cardiovascular events. The secondary study endpoint was major access-site complications. RESULTS Between 2017 and 2021, 610 of 800 patients referred for CTO PCI at 4 centers were randomized to TRA (n = 305) or TFA (n = 305). Mean J-CTO (Multicenter CTO Registry in Japan) (2.1 ± 0.1 vs 2.2 ± 0.1; P = 0.279), PROGRESS CTO (Prospective Global Registry for the Study of Chronic Total Occlusion Intervention) (1.3 ± 0.9 vs 1.1 ± 1.0; P = 0.058) and PROGRESS CTO complication (2.4 ± 1.8 vs 2.3 ± 1.8; P = 0.561) scores and use of the retrograde approach (11% vs 14%; P = 0.342) were similar in the TRA and TFA groups. TRA was noninferior to TFA for procedural success (84% vs 86%; P = 0.563) but had fewer access-site complications (2.0% vs 5.6%; P = 0.019). There was no difference between TFA and TRA in procedural duration, contrast volume, or radiation dose. CONCLUSIONS TRA was noninferior to TFA for CTO PCI but had fewer access-site complications.
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Affiliation(s)
- Sevket Gorgulu
- Cardiology Department, Acıbadem University Medical Faculty, Istanbul, Turkey.
| | - Nihat Kalay
- Cardiology Department, Acıbadem University Medical Faculty, Istanbul, Turkey
| | - Tugrul Norgaz
- Cardiology Department, Acıbadem University Medical Faculty, Istanbul, Turkey
| | - Cuneyt Kocas
- Cardiology Department, Biruni University Medical Faculty, Istanbul, Turkey
| | - Omer Goktekin
- Cardiology Department, Memorial Bahçelievler Hospital, Istanbul, Turkey
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
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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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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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Temporal trends in the practice of the transradial approach for percutaneous coronary intervention in a large tertiary center. Coron Artery Dis 2019; 31:40-48. [PMID: 31205054 DOI: 10.1097/mca.0000000000000764] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The transradial approach (TRA) has increasingly been adopted for the use of percutaneous coronary interventions (PCI), with reported clinical benefits. Little is known regarding the change in outcomes over time. PATIENTS AND METHODS From our large single-center PCI registry, we have analyzed 15 429 patients in two periods - 2008-2012 (period 1) and 2013-2017 (period 2). We examined the proportions of use of TRA, the influence on in-hospital outcomes, and adjusted long-term effects. RESULTS The rate of TRA rose from 15.9% in period 1 to 69.1% in period 2, including in specific situations such as acute coronary syndrome, chronic total occlusion, bifurcation, calcified lesions, and unprotected left main PCI. In-hospital rates of bleeding were lower for TRA versus transfemoral artery (1.8 vs. 5.1%, overall, P < 0.001), as were rates of additional bleeding events in the following 12 months (1.3 vs. 2.4%, P < 0.001). Following multivariate analysis, use of TRA was associated with a lower 30-day and 4-year rate of the composite outcomes of death, myocardial infarction, target vessel revascularization, or coronary artery bypass surgery [at 4 years, hazard ratio (HR) = 0.86; 95% confidence interval (CI): 0.77-0.96; P = 0.007, during period 1 and HR = 0.62; 95% CI 0.55-0.7; P < 0.0001 during period 2]. Interaction analysis showed a stronger effect at the latter period (HR = 0.69, 95% CI: 0.59-0.81, P < 0.001). CONCLUSION Over a decade of follow-up, TRA has gained acceptance for different PCI scenarios, including complex patients - a course which is associated with consistent short and long-term clinical benefits.
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Sorenson TJ, Nicholson PJ, Hilditch CA, Murad MH, Brinjikji W. A Lesson from Cardiology: The Argument for Ultrasound-Guided Femoral Artery Access in Interventional Neuroradiology. World Neurosurg 2019; 126:124-128. [DOI: 10.1016/j.wneu.2019.02.171] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 02/16/2019] [Accepted: 02/18/2019] [Indexed: 11/28/2022]
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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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Kaki A, Blank N, Alraies MC, Kajy M, Grines CL, Hasan R, Htun WW, Glazier J, Mohamad T, Elder M, Schreiber T. Access and closure management of large bore femoral arterial access. J Interv Cardiol 2018; 31:969-977. [PMID: 30456854 DOI: 10.1111/joic.12571] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 09/30/2018] [Accepted: 10/01/2018] [Indexed: 11/29/2022] Open
Abstract
Femoral and radial artery access continue to be the standard of care for percutaneous coronary interventions. Cardiac catheterization has progressed to encompass a wide range of diagnostic and interventional procedures including coronary, peripheral, endovascular, and structural heart disease interventions. Despite advanced technology to make these procedures safe, bleeding, and vascular complications continue to be a substantial source of morbidity, especially in patients undergoing large-bore access procedures. New variations of percutaneous devices have reduced complications associated with these procedures. However, safe vascular access with effective hemostasis requires special techniques which have not been well described in the literature. Large-bore femoral artery access is feasible, safe, and associated with low complication rates when a protocol is implemented. Wayne State University, Detroit Medical Center Heart Hospital is a tertiary care, high-volume center for endovascular, structural heart and complex high risk indicated procedures with more 150 procedures involving mechanical circulatory support (MCS) devices per year. In this manuscript, we describe our approach to femoral artery large-bore sheath insertion and management. Our protocol includes proper identification of the puncture site, device selection, insertion, assessment of limb perfusion while on prolong MCS support, and hemostasis techniques after sheath removal.
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Affiliation(s)
- Amir Kaki
- Wayne State University, School of Medicine, Detroit Medical Center, Detroit Heart Hospital, Detroit, Michigan
| | - Nimrod Blank
- Wayne State University, School of Medicine, Detroit Medical Center, Detroit Heart Hospital, Detroit, Michigan
| | - M Chadi Alraies
- Wayne State University, School of Medicine, Detroit Medical Center, Detroit Heart Hospital, Detroit, Michigan
| | - Marvin Kajy
- Wayne State University, School of Medicine, Detroit Medical Center, Detroit Heart Hospital, Detroit, Michigan
| | - Cindy L Grines
- Zucker School of Medicine at Hofstra Northwell Health, Northshore University Hospital, Manhasset, New York
| | | | - Wah Wah Htun
- Northwell Health, Lenox Hill Hospital, New York, New York
| | - James Glazier
- Wayne State University, School of Medicine, Detroit Medical Center, Detroit Heart Hospital, Detroit, Michigan
| | - Tamam Mohamad
- Wayne State University, School of Medicine, Detroit Medical Center, Detroit Heart Hospital, Detroit, Michigan
| | - Mahir Elder
- Wayne State University, School of Medicine, Detroit Medical Center, Detroit Heart Hospital, Detroit, Michigan
| | - Theodore Schreiber
- Wayne State University, School of Medicine, Detroit Medical Center, Detroit Heart Hospital, Detroit, Michigan
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Inagaki E, Farber A, Siracuse JJ, Mell MW, Rybin DV, Doros G, Kalish J. Routine Use of Ultrasound Guidance in Femoral Arterial Access for Peripheral Vascular Intervention Decreases Groin Hematoma Rates in High-Volume Surgeons. Ann Vasc Surg 2018; 51:1-7. [DOI: 10.1016/j.avsg.2018.02.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 02/19/2018] [Accepted: 02/19/2018] [Indexed: 11/17/2022]
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Wrist or Groin? Learning From the Wisdom of the Crowd. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 19:142-143. [DOI: 10.1016/j.carrev.2018.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Saab F, Jaff MR, Diaz-Sandoval LJ, Engen GD, McGoff TN, Adams G, Al-Dadah A, Goodney PP, Khawaja F, Mustapha JA. Chronic Total Occlusion Crossing Approach Based on Plaque Cap Morphology: The CTOP Classification. J Endovasc Ther 2018; 25:284-291. [DOI: 10.1177/1526602818759333] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Purpose: To present the chronic total occlusion (CTO) crossing approach based on plaque cap morphology (CTOP) classification system and assess its ability to predict successful lesion crossing. Methods: A retrospective analysis was conducted of imaging and procedure data from 114 consecutive symptomatic patients (mean age 69±11 years; 84 men) with claudication (Rutherford category 3) or critical limb ischemia (Rutherford category 4–6) who underwent endovascular interventions for 142 CTOs. CTO cap morphology was determined from a review of angiography and duplex ultrasonography and classified into 4 types (I, II, III, or IV) based on the concave or convex shape of the proximal and distal caps. Results: Statistically significant differences among groups were found in patients with rest pain, lesion length, and severe calcification. CTOP type II CTOs were most common and type III lesions the least common. Type I CTOs were most likely to be crossed antegrade and had a lower incidence of severe calcification. Type IV lesions were more likely to be crossed retrograde from a tibiopedal approach. CTOP type IV was least likely to be crossed in an antegrade fashion. Access conversion, or need for an alternate access, was commonly seen in types II, III, and IV lesions. Distinctive predictors of access conversion were CTO types II and III, lesion length, and severe calcification. Conclusion: CTOP type I lesions were easiest to cross in antegrade fashion and type IV the most difficult. Lesion length >10 cm, severe calcification, and CTO types II, III, and IV benefited from the addition of retrograde tibiopedal access.
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Affiliation(s)
- Fadi Saab
- Metro Health–University of Michigan Health, Wyoming, MI, USA
| | | | | | | | | | - George Adams
- University of North Carolina–Rex Healthcare, Raleigh, NC, USA
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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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Moschovas A, Amorim PA, Nold M, Faerber G, Diab M, Buenger T, Doenst T. Percutaneous cannulation for cardiopulmonary bypass in minimally invasive surgery is associated with reduced groin complications. Interact Cardiovasc Thorac Surg 2017; 25:377-383. [PMID: 28541427 DOI: 10.1093/icvts/ivx140] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 04/03/2017] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Femoral cutdown is standard in most centres if groin cannulation is used for cardiopulmonary bypass in minimally invasive cardiac surgery (MICS). Arterial closure devices (ACDs) allow placement of larger cannulas percutaneously, but its benefit in MICS is unclear. We assessed our results with percutaneous groin cannulation using ACDs in comparison with conventional surgical access in patients undergoing MICS. METHODS We reviewed 445 consecutive patients having undergone MICS between October 2010 and March 2015. Of those, 92 (21%) were performed with conventional surgical access to the groin vessels and 353 (79%) with the use of ACDs. RESULTS Operative risk was higher in the ACD group [logistic EuroSCORE 7.9% (SD: 8.1) vs 10.6% (SD: 12.3); P = 0.010]. The use of ACDs significantly reduced operation time [193 min (SD: 43.8) vs 173 min (SD: 47.1); P < 0.001] and hospital stay [Cutdown: median 9 days (8, 14); ACD: median 9 days (7, 12), P = 0.040] without affecting the time to full mobilization. The incidence of any complication was significantly lower in the ACD group (2.3% vs 8.7%; P = 0.007). Complications with conventional cannulation consisted of lymphatic fistulae (n = 4), wound infections (n = 2), stenosis (n = 1) and haematoma (n = 1). In the ACD group, there were local dissections (n = 2) and stenoses (n = 3). There was 1 haematoma in both groups. There were 2 vascular injuries in the ACD group (n = 2), leading to conversion to surgical access. CONCLUSIONS Percutaneous groin cannulation using ACDs for establishing cardiopulmonary bypass in minimally invasive valve surgery significantly reduces groin complications, operation time and hospital stay. However, the remaining complications are mainly of vascular nature versus wound infection and lymph fistulae with cutdown.
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Affiliation(s)
- Alexandros Moschovas
- Department of Cardiothoracic Surgery, University Hospital Jena, Friedrich Schiller University Jena, Jena, Germany
| | - Paulo A Amorim
- Department of Cardiothoracic Surgery, University Hospital Jena, Friedrich Schiller University Jena, Jena, Germany
| | - Mariana Nold
- Department of Medical Statistics, University Hospital Jena, Friedrich Schiller University Jena, Jena, Germany
| | - Gloria Faerber
- Department of Cardiothoracic Surgery, University Hospital Jena, Friedrich Schiller University Jena, Jena, Germany
| | - Mahmoud Diab
- Department of Cardiothoracic Surgery, University Hospital Jena, Friedrich Schiller University Jena, Jena, Germany
| | - Tobias Buenger
- Department of Cardiothoracic Surgery, University Hospital Jena, Friedrich Schiller University Jena, Jena, Germany
| | - Torsten Doenst
- Department of Cardiothoracic Surgery, University Hospital Jena, Friedrich Schiller University Jena, Jena, Germany
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Expanding the field of acute care surgery: a systematic review of the use of resuscitative endovascular balloon occlusion of the aorta (REBOA) in cases of morbidly adherent placenta. Eur J Trauma Emerg Surg 2017; 44:519-526. [DOI: 10.1007/s00068-017-0840-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 09/14/2017] [Indexed: 01/20/2023]
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16
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Turi ZG. Ending "poke until you get a gusher": Part II-the evidence based approach to vascular access revisited. Catheter Cardiovasc Interv 2017; 89:1193-1194. [PMID: 28612412 DOI: 10.1002/ccd.27133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 05/03/2017] [Indexed: 11/08/2022]
Abstract
Puncture above the common femoral bifurcation and below the inguinal ligament is optimal A vast majority of femoral bifurcations occur below the middle third of the femoral head while the inferior epigastric artery rarely descends below the middle third Fluoroscopy or if possible, ultrasound, should be used for femoral access to optimize safe puncture.
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Affiliation(s)
- Zoltan G Turi
- Center for Structural and Congenital Heart Disease, Hackensack University Medical Center and Seton Hall-Hackensack-Meridian School of Medicine, Hackensack, New Jersey
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17
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Kurisu K, Osanai T, Kazumata K, Nakayama N, Abumiya T, Shichinohe H, Shimoda Y, Houkin K. Ultrasound-guided Femoral Artery Access for Minimally Invasive Neuro-intervention and Risk Factors for Access Site Hematoma. Neurol Med Chir (Tokyo) 2016; 56:745-752. [PMID: 27194178 PMCID: PMC5221772 DOI: 10.2176/nmc.oa.2016-0026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Although ultrasound (US) guidance for venous access is becoming the “standard of care” for preventing access site complications, its feasibility for arterial access has not been fully investigated, especially in the neuro-interventional population. We conducted the first prospective cohort study on US-guided femoral artery access during neuro-interventional procedure. This study included 64 consecutive patients who underwent US-guided femoral artery access through 66 arterial access sites for diagnostic and/or neuro-interventional purposes. The number of attempts required for both the sheath insertion and the success of anterior wall puncture were recorded. In addition, the occurrence of major complications and hematoma formation on the arterial access site examined by US were statistically analyzed. The median number of attempts was 1 (1–2) and first-pass success rate was 63.6%. Anterior wall puncture was achieved in 98.5%. In one case (1.5%), a pseudoaneurysm was observed. In all cases, US clearly depicted a common femoral artery (CFA) and its bifurcation. Post-procedural hematoma was detected in 13 cases (19.7%), most of which were “tiny” or “moderate” in size. Low body mass index and antiplatelet therapy were the independent risk factors for access site hematoma. The US-guided CFA access was feasible even in neuro-interventional procedure. The method was particularly helpful in the patients with un-palpable pulsation of femoral arteries. To prevent arterial access site hematoma, special care should be taken in patients with low body mass index and who are on antiplatelet therapy.
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Affiliation(s)
- Kota Kurisu
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine
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18
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Seto AH, Tyler J, Suh WM, Harrison AT, Vera JA, Zacharias SJ, Daly TS, Sparling JM, Patel PM, Kern MJ, Abu-Fadel M. Defining the common femoral artery: Insights from the femoral arterial access with ultrasound trial. Catheter Cardiovasc Interv 2016; 89:1185-1192. [PMID: 27566991 DOI: 10.1002/ccd.26727] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 05/16/2016] [Accepted: 08/01/2016] [Indexed: 11/06/2022]
Abstract
OBJECTIVE We sought to establish the typical location of the common femoral artery (CFA) bifurcation, the origin and most inferior reflection of the inferior epigastric artery (IEA) relative to the femoral head (FH) and whether patient demographics predicted anatomical variations. BACKGROUND In the absence of ultrasound guidance or prior imaging, the precise location of the CFA bifurcation and IEA can only be determined following access site angiography. Fluoroscopic landmarks are commonly used to estimate the location of the CFA bifurcation, but the position of the IEA is less well characterized. METHODS Prospectively collected data on 989 patients with femoral angiography in the FAUST trial were analyzed. The level of CFA bifurcation and the origin and most inferior reflection of the IEA were classified by angiography. Logistic regression was used to explore whether baseline demographics were associated with anatomic variations. RESULTS The CFA bifurcation occurs below the middle 1/3rd of the femoral head in 95% of patients, and no patient factors are predictive of a high bifurcation. The IEA origin has a more variable anatomically pattern, with high BSA, male gender, and white race associated with a low IEA origin. CONCLUSION Operators should attempt to access the CFA at the level of the middle 1/3rd of the FH to maximize the chance of CFA cannulation. However, this location carries an 11% risk of being at or above the IEA origin. Baseline demographics were of limited utility for predicting anatomic variants of the CFA bifurcation and the course of the IEA. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Arnold H Seto
- Department of Medicine, Veterans Affairs Long Beach Health Care System, Long Beach, California.,Department of Medicine, University of Califonia, Irvine Medical Center, Orange, California
| | - Jeffrey Tyler
- Department of Medicine, University of California, San Francisco Medical Center, San Francisco, California
| | - William M Suh
- Department of Medicine, University of California, Los Angeles Medical Center, Los Angeles, California
| | | | - Jesus A Vera
- Cardiothoracic Department, St Jude Medical Center, Fullerton, California
| | | | - Timothy S Daly
- Department of Cardiology, INTEGRIS Heart Hospital, Oklahoma City, Oklahoma
| | - Jeffrey M Sparling
- Department of Cardiology, INTEGRIS Heart Hospital, Oklahoma City, Oklahoma
| | - Pranav M Patel
- Department of Medicine, University of Califonia, Irvine Medical Center, Orange, California
| | - Morton J Kern
- Department of Medicine, Veterans Affairs Long Beach Health Care System, Long Beach, California.,Department of Medicine, University of Califonia, Irvine Medical Center, Orange, California
| | - Mazen Abu-Fadel
- Department of Medicine, Cardiovascular section, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
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19
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Vascular access in critical limb ischemia. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2016; 17:190-8. [DOI: 10.1016/j.carrev.2016.02.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 02/04/2016] [Indexed: 11/22/2022]
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20
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The choice of arterial access for percutaneous coronary intervention and its impact on outcome: An expert opinion perspective. Am Heart J 2015; 170:13-22. [PMID: 26093860 DOI: 10.1016/j.ahj.2015.04.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 04/23/2015] [Indexed: 11/20/2022]
Abstract
The prevention of major bleeding during percutaneous coronary intervention is one of the most widely discussed and often controversial topics within interventional cardiology. The choice of arterial access should be considered a mechanism for bleeding avoidance, and various strategies have been proposed to prevent or lower major bleeding and vascular complications with varying levels of strength. Herein, we review the current literature on arterial access as a bleeding avoidance strategy during percutaneous coronary intervention and its impact on outcome and provide a consensus opinion based on the strength of the evidence supporting various techniques.
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22
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Kim M, Chu A, Khan Y, Malik S. Predicting and preventing vascular complications following percutaneous coronary intervention in women. Expert Rev Cardiovasc Ther 2015; 13:163-72. [PMID: 25553577 DOI: 10.1586/14779072.2015.995635] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The development of vascular complications is associated with increased morbidity and mortality in patients undergoing percutaneous coronary intervention. While the incidence of percutaneous coronary intervention-related vascular complications has greatly improved over time, female sex still persists as a significant and independent predictor of periprocedural vascular complications, which in turn is associated with a greater risk of short- and long-term mortality. This review provides a contemporary overview of the data on the important issues regarding the risk of percutaneous coronary intervention in women. It examines the intrinsic sex-related factors that may be contributing to women's heightened bleeding risk while also examining the various pharmacologic and procedural bleeding avoidance strategies currently in the literature, with a focus on their potential role and benefit in women specifically.
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Affiliation(s)
- Melvie Kim
- University of California, Irvine, CA, USA
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23
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Barbetta I, van den Berg JC. Access and hemostasis: femoral and popliteal approaches and closure devices-why, what, when, and how? Semin Intervent Radiol 2014; 31:353-60. [PMID: 25435661 DOI: 10.1055/s-0034-1393972] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This article reviews the arterial access sites used in the treatment of peripheral arterial disease, including common femoral, superficial femoral, and popliteal arterial puncture. The optimal approach and techniques for arterial puncture will be described and technical tips and tricks will be discussed. An overview of the currently available vascular closure devices will also be presented. Indications, contraindications, and complications will be discussed. Results of the use of vascular closure devices compared with manual compression will be presented.
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Affiliation(s)
- Iacopo Barbetta
- Service of Interventional Radiology, Ospedale Regionale di Lugano, Lugano, Switzerland
| | - Jos C van den Berg
- Service of Interventional Radiology, Ospedale Regionale di Lugano, Lugano, Switzerland
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24
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Ahn HY, Lee HJ, Lee HJ, Yang JH, Yi JS, Lee IW. Assessment of the optimal site of femoral artery puncture and angiographic anatomical study of the common femoral artery. J Korean Neurosurg Soc 2014; 56:91-7. [PMID: 25328644 PMCID: PMC4200372 DOI: 10.3340/jkns.2014.56.2.91] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 05/05/2014] [Accepted: 08/16/2014] [Indexed: 11/29/2022] Open
Abstract
Objective The purpose of this study was to evaluate demographic and clinical factors affecting the common femoral artery diameter and length, and anatomical relationship between the femoral head and the common femoral artery during angiography. Methods We retrospectively reviewed 109 femoral angiograms. We collected the clinical data of the patients and estimated the common femoral artery diameter and length. We divided the areas in the angiogram from cephalic to caudal direction (zone 0 to 5). The lowest levels of the inferior epigastric artery loop and points of the common femoral artery bifurcation were checked. Results The luminal diameter of the common femoral artery was 6.19±1.20 mm. Height, weight, body surface area, as well as common femoral artery diameter were significantly greater in men than in women (p<0.005). The length of the common femoral artery was 27.59±8.87 mm. Height, weight and body surface area showed strong positive relationships with common femoral artery diameter. All of the inferior epigastric artery loops were located above the center of the femoral head. The point of common femoral artery bifurcation was above the center of the femoral head in 4.59% of femoral angiograms. Conclusions Males and patients with a high body surface area have a larger common femoral artery diameter. The cumulative probability of optimal targeting between the lowest margin of the inferior epigastric artery loop and the common femoral artery bifurcation is the highest in zone 3 puncture.
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Affiliation(s)
- Ho-Young Ahn
- Department of Neurosurgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
| | - Hyung-Jin Lee
- Department of Neurosurgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
| | - Hong-Jae Lee
- Department of Neurosurgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
| | - Ji-Ho Yang
- Department of Neurosurgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
| | - Jin-Seok Yi
- Department of Neurosurgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
| | - Il-Woo Lee
- Department of Neurosurgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
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25
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Lucatelli P, Cannavale A, Cirelli C, d’Adamo A, Salvatori FM, Fanelli F. Use of ultrasound in the insertion of a vascular closure device: a comparative retrospective study with the standard blind technique. Radiol Med 2014; 120:283-8. [DOI: 10.1007/s11547-014-0439-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Accepted: 05/06/2014] [Indexed: 10/24/2022]
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26
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Pradhan A, Abbott JD. Improvements in transfemoral catheterization access techniques. Cardiology 2014; 129:36-8. [PMID: 25012629 DOI: 10.1159/000362924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 04/17/2014] [Indexed: 11/19/2022]
Affiliation(s)
- Anay Pradhan
- Division of Cardiology, Rhode Island Hospital, Brown Medical School, Providence, R.I., USA
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27
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Lee MS, Applegate B, Rao SV, Kirtane AJ, Seto A, Stone GW. Minimizing femoral artery access complications during percutaneous coronary intervention: a comprehensive review. Catheter Cardiovasc Interv 2014; 84:62-9. [PMID: 24677734 DOI: 10.1002/ccd.25435] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 01/11/2014] [Accepted: 02/11/2014] [Indexed: 11/10/2022]
Abstract
Major bleeding complications after percutaneous coronary intervention (PCI) increase patient morbidity, prolong the hospital stay and costs, and are associated with reduced survival. Transfemoral access is still preferred at many centers given its familiarity and ease of use and is necessary in cases where large bore access is needed. Multimodality imaging with fluoroscopy, ultrasonography, and angiography can facilitate proper puncture of the common femoral artery. A proper technique (which includes femoral artery puncture and vascular access site closure) associated with adequate pharmacotherapy (both during PCI and peri-procedural, for the treatment of the underlying coronary artery disease) has been shown to reduce the risk of bleeding and vascular complications associated with femoral artery access. Avoiding the use of arterial sheaths >6 French may further reduce the risk of bleeding. Data with vascular closure devices as a bleeding avoidance strategy are evolving but when used appropriately may further reduce the risk of bleeding and vascular access complications, and in this regard are synergistic with bivalirudin. Randomized trials to confirm these recommendations are needed.
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Affiliation(s)
- Michael S Lee
- Division of Cardiology, UCLA Medical Center, Los Angeles, California
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28
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Turi ZG. Ultrasound versus palpation and fluoroscopy for femoral access-sibling rivalry in the face of the radial onslaught. Catheter Cardiovasc Interv 2013; 82:1193-4. [PMID: 24255035 DOI: 10.1002/ccd.25257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 10/10/2013] [Indexed: 11/11/2022]
Affiliation(s)
- Zoltan G Turi
- Division of Cardiology, Cooper University Hospital, Camden, New Jersey
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29
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Nguyen CT, Lee E, Luo H, Siegel RJ. Echocardiographic guidance for diagnostic and therapeutic percutaneous procedures. Cardiovasc Diagn Ther 2013; 1:11-36. [PMID: 24282682 DOI: 10.3978/j.issn.2223-3652.2011.09.02] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Accepted: 09/24/2011] [Indexed: 11/14/2022]
Abstract
Echocardiographic guidance has an important role in percutaneous cardiovascular procedures and vascular access. The advantages include real time imaging, portability, and availability, which make it an effective imaging modality. This article will review the role of echocardiographic guidance for diagnostic and therapeutic percutaneous procedures, specifically, transvenous and transarterial access, pericardiocentesis, endomyocardial biopsy, transcatheter pulmonary valve replacement, pulmonary valve repair, transcatheter aortic valve implantation, and percutaneous mitral valve repair. We will address the ways in which echocardiographic guidance provides these procedures with detailed information on anatomy, adjacent structures, and intraprocedural instrument position, thus resulting in improvement in procedural efficacy, safety and patient outcomes.
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Affiliation(s)
- Cam Tu Nguyen
- Cedars Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, USA
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30
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Gedikoglu M, Oguzkurt L, Gur S, Andic C, Sariturk C, Ozkan U. Comparison of ultrasound guidance with the traditional palpation and fluoroscopy method for the common femoral artery puncture. Catheter Cardiovasc Interv 2013; 82:1187-92. [PMID: 23592533 DOI: 10.1002/ccd.24955] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Revised: 03/16/2013] [Accepted: 04/09/2013] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To compare the success and complication rates of ultrasound-guided or palpation-guided punctures of the common femoral artery in a prospective randomized study. BACKGROUND Percutaneous femoral arterial access is sometimes difficult to perform and is the source of complications. It has not been established whether ultrasound-guided puncture of the common femoral artery is the standard practice for angiography. MATERIALS AND METHODS Two hundred and eight patients were randomized into two groups. One had ultrasound-guided puncture and the other had palpation-guided puncture of the common femoral artery. The technical success, first pass success rate, total number of attempts required for access, time to sheath insertion, pain during puncture, and access-related complication were compared. RESULTS Technical success tended to be higher and the complication rates tended to be lower in the ultrasound-guided group but the difference did not reach statistical significance (P = 0.052 and P = 0.052). The first pass success rate was higher, total number of attempts required for access and time to sheath insertion were lower in the ultrasound-guided group. Atheromatous plaques on the common femoral artery, iliac artery obstructive lesion, previous ipsilateral puncture of the common femoral artery, obesity, and blood pressure during puncture did not change the outcome. CONCLUSIONS Ultrasound guidance improves secondary outcomes of the common femoral artery puncture when compared to palpation-guided puncture. Technical success and complication rates seem lower in the presence of ultrasound guidance but larger study populations are needed to verify the result.
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Affiliation(s)
- Murat Gedikoglu
- Department of Radiology, Baskent University Faculty of Medicine, Adana, Turkey
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Chinikar M, Ahmadi A, Heidarzadeh A, Sadeghipour P. Imaging or trusting on surface anatomy? A comparison between fluoroscopic guidance and anatomic landmarks for femoral artery access in diagnostic cardiac catheterization. A randomized control trial. Cardiovasc Interv Ther 2013; 29:18-23. [PMID: 23959379 DOI: 10.1007/s12928-013-0203-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Accepted: 08/04/2013] [Indexed: 11/26/2022]
Abstract
We performed a randomized controlled trial to test the potential benefits of fluoroscopic-guided femoral artery puncture. Observational studies showed a consistent relationship between common femoral artery (CFA) and the head of femur. Fluoroscopy locating the femoral head may increase the accuracy of femoral puncture and consequently decrease the vascular complication. Despite these theoretical benefits, we have no sufficient evidence to verify its advantages. Patients undergoing diagnostic cardiac catheterization were randomized into fluoroscopic and anatomic method groups. Of total of 609 patients participated in this study, 305 and 304 patients were assigned to fluoroscopic and anatomic method groups, respectively. Fluoroscopy significantly increases the puncture over the femoral head (96.7 vs. 82.3 %, p value 0.001) and also the fluoroscopic method increased CFA puncture significantly (93.8 vs. 87.5 %, p value 0.012). The combined end point of “proper” femoral puncture (CFA puncture over the femoral head) was highly significant in our fluoroscopy-guided method (91.8 vs. 75.7 %, p value <0.0001). Hematoma was the only vascular complication trough the study (2.6 % of patients) but no significant difference was seen between the two groups. In conclusion, our study showed the efficacy of fluoroscopy in increasing the proper femoral artery puncture, and although it did not show significant improvement in vascular complications, the method should be regard as an accurate guide for femoral access.
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Meier P, Fröhlich GM, Lansky AJ. Bleeding complications in percutaneous coronary interventions. Cardiology 2013; 125:213-6. [PMID: 23797013 DOI: 10.1159/000351581] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Accepted: 04/17/2013] [Indexed: 11/19/2022]
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Butman SM. Feel me, hear me, and see me before you poke me! Catheter Cardiovasc Interv 2013; 81:1212. [PMID: 23704067 DOI: 10.1002/ccd.24965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 04/13/2013] [Indexed: 11/05/2022]
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Stone PA, Campbell JE, Mousa AY, Aburahma AF. Basic data underlying clinical decision making in vascular surgery: arterial access for percutaneous procedures. Ann Vasc Surg 2013; 27:379-88. [PMID: 23498311 DOI: 10.1016/j.avsg.2012.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2012] [Revised: 08/18/2012] [Accepted: 10/08/2012] [Indexed: 12/17/2022]
Abstract
Percutaneous arterial access has become a mainstay in the armamentarium of vascular specialists. Vascular surgeons for decades have managed iatrogenic complications sustained by other specialists and now are more frequently performing catheter-based procedures themselves. A thorough understanding of the basic data underlying complications related to these procedures is imperative and is thoroughly reviewed.
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Affiliation(s)
- Patrick A Stone
- West Virginia University, Department of Surgery, Division of Vascular and Endovascular Surgery, Charleston, WV 25304, USA.
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Mustapha J, Saab F, Diaz L, Karenko B, Richards L, Laeder T, Heaney CM, Das T. Utility and feasibility of ultrasound-guided access in patients with critical limb ischemia. Catheter Cardiovasc Interv 2013; 81:1204-11. [DOI: 10.1002/ccd.24757] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Accepted: 11/07/2012] [Indexed: 12/21/2022]
Affiliation(s)
- J.A. Mustapha
- Department of Internal Medicine, Metro Heart and Vascular; Michigan State University; School of Medicine; Metro Health Hospital; Wyoming; Michigan
| | - Fadi Saab
- Department of Internal Medicine, Metro Heart and Vascular; Michigan State University; School of Medicine; Metro Health Hospital; Wyoming; Michigan
| | - Larry Diaz
- Department of Internal Medicine, Metro Heart and Vascular; Michigan State University; School of Medicine; Metro Health Hospital; Wyoming; Michigan
| | - Barbara Karenko
- Department of Internal Medicine, Metro Heart and Vascular; Michigan State University; School of Medicine; Metro Health Hospital; Wyoming; Michigan
| | - Lance Richards
- Department of Internal Medicine, Metro Heart and Vascular; Michigan State University; School of Medicine; Metro Health Hospital; Wyoming; Michigan
| | - Theresa Laeder
- Department of Internal Medicine, Metro Heart and Vascular; Michigan State University; School of Medicine; Metro Health Hospital; Wyoming; Michigan
| | - Carmen M. Heaney
- Department of Internal Medicine, Metro Heart and Vascular; Michigan State University; School of Medicine; Metro Health Hospital; Wyoming; Michigan
| | - Tony Das
- Department of Internal Medicine, Metro Heart and Vascular; Michigan State University; School of Medicine; Metro Health Hospital; Wyoming; Michigan
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Turi ZG. Pitfalls everywhere: 60 years and still poking blindly. Catheter Cardiovasc Interv 2013; 81:680-1. [PMID: 23436484 DOI: 10.1002/ccd.24831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Accepted: 01/16/2013] [Indexed: 11/10/2022]
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Yaganti V, Mejevoi N, Hasan O, Cohen M, Wasty N. Pitfalls associated with the use of current recommendations for fluoroscopy-guided common femoral artery access. Catheter Cardiovasc Interv 2013; 81:674-9. [PMID: 23292908 DOI: 10.1002/ccd.24335] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2011] [Accepted: 01/03/2012] [Indexed: 11/09/2022]
Abstract
BACKGROUND Vascular access complications remain the leading cause of morbidity after cardiac catheterization procedures. Fluoroscopy-guided vascular access has been recommended to reduce these complications. However, the use of current recommendations still results in arterial access above the inferior epigastric artery (IEA) (high stick) or below the common femoral artery (CFA) bifurcation (low stick). OBJECTIVES The goal of our study was to evaluate the influence of patient characteristics like age, body mass index, and pelvic anatomy on current recommendations. METHODS We prospectively collected clinical, anatomic, and angiographic data on 631 consecutive patients who underwent coronary and noncoronary procedures via CFA access. Anatomic location of IEA loop, CFA bifurcation, public tubercle (PT), and anterior superior iliac spine were identified in relationship to the femoral head Location of IEA loop was used as a surrogate for inguinal ligament (IL). RESULTS Approximately 12% of patients had a low-lying IEA loop (group B). These patients had a significantly higher BMI compared with patients with IEA loop above the centerline of femoral head (group A) (P = 0.018). The anatomic location of PT was below the lower border of femoral head significantly more frequently in group B compared to group A (P < 0.0001). Fifteen percent of patients had a high CFA bifurcation. On clinical follow-up during index hospitalization, there was no significant difference between the two groups, in terms of complications including retroperitoneal hemorrhage, access site hematoma >5 cm, bleeding requiring transfusion or pseudoaneurysm. CONCLUSIONS Anatomic location of PT on fluoroscopy can be used as an additional surrogate to predict the location of IL. Patients with high BMI have a low lying IL, which may predispose them to "high sticks." The location of IEA cannot be used as a surrogate for IL in all patients.
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Affiliation(s)
- Vamsee Yaganti
- Division of Cardiology, Newark Beth Israel Medical Centre, Newark, New Jersey 07112, USA
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Stone PA, Campbell JE. Complications Related to Femoral Artery Access for Transcatheter Procedures. Vasc Endovascular Surg 2012; 46:617-23. [DOI: 10.1177/1538574412457475] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Percutaneous-based procedures continue to increase as endovascular techniques improve and provide a less morbid approach than the open vascular procedures. The most common complications associated with either cardiac interventions or peripheral interventions involve the access point of the procedure. The retrograde femoral access has and is currently the most frequently used arterial access. Vascular surgeons have been responsible for management of complications following femoral-based procedures and now are a significant contributor to catheter-based diagnostic and interventional procedures. This review provides in-depth review of the literature on specific complications encountered during percutaneous femoral artery puncture. This review includes access complications related to the method of obtaining access (ie, best pulse fluoroscopic guided), direction of access either retrograde or antegrade, risk factors and incidence of complications based on best literature sources, and management strategies for specific complications.
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Affiliation(s)
- Patrick A. Stone
- Division of Vascular & Endovascular Surgery, WVU, Charleston, WV, USA
| | - John E. Campbell
- Division of Vascular & Endovascular Surgery, WVU, Charleston, WV, USA
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Turi ZG. Can't get much higher--one more step to ending the "poke until you get a gusher" method of vascular access. Catheter Cardiovasc Interv 2012; 80:43-4. [PMID: 22736585 DOI: 10.1002/ccd.24489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Ben-Dor I, Maluenda G, Mahmoudi M, Torguson R, Xue Z, Bernardo N, Lindsay J, Satler LF, Pichard AD, Waksman R. A novel, minimally invasive access technique versus standard 18-gauge needle set for femoral access. Catheter Cardiovasc Interv 2012; 79:1180-5. [DOI: 10.1002/ccd.23330] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Accepted: 07/30/2011] [Indexed: 11/10/2022]
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Tam MDBS, Lewis M. The effect of skin entry site, needle angulation and soft tissue compression on simulated antegrade and retrograde femoral arterial punctures: an anatomical study using Cartesian co-ordinates derived from CT angiography. Surg Radiol Anat 2011; 34:751-5. [DOI: 10.1007/s00276-011-0880-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Accepted: 09/20/2011] [Indexed: 10/17/2022]
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Bhatty S, Cooke R, Shetty R, Jovin IS. Femoral vascular access-site complications in the cardiac catheterization laboratory: diagnosis and management. Interv Cardiol 2011. [DOI: 10.2217/ica.11.49] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Seto A, Kern MJ. Optimizing femoral access outcomes: how far can we go? Catheter Cardiovasc Interv 2011; 78:52-3. [PMID: 21681892 DOI: 10.1002/ccd.23254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Pitta SR, Prasad A, Kumar G, Lennon R, Rihal CS, Holmes DR. Location of femoral artery access and correlation with vascular complications. Catheter Cardiovasc Interv 2011; 78:294-9. [DOI: 10.1002/ccd.22827] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2010] [Revised: 09/09/2010] [Accepted: 09/18/2010] [Indexed: 11/10/2022]
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Seto AH, Abu-Fadel MS, Sparling JM, Zacharias SJ, Daly TS, Harrison AT, Suh WM, Vera JA, Aston CE, Winters RJ, Patel PM, Hennebry TA, Kern MJ. Real-time ultrasound guidance facilitates femoral arterial access and reduces vascular complications: FAUST (Femoral Arterial Access With Ultrasound Trial). JACC Cardiovasc Interv 2010; 3:751-8. [PMID: 20650437 DOI: 10.1016/j.jcin.2010.04.015] [Citation(s) in RCA: 306] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2010] [Revised: 03/17/2010] [Accepted: 04/07/2010] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The aim of this study was to compare the procedural and clinical outcomes of femoral arterial access with ultrasound (US) guidance with standard fluoroscopic guidance. BACKGROUND Real-time US guidance reduces time to access, number of attempts, and complications in central venous access but has not been adequately assessed in femoral artery cannulation. METHODS Patients (n = 1,004) undergoing retrograde femoral arterial access were randomized 1:1 to either fluoroscopic or US guidance. The primary end point was successful common femoral artery (CFA) cannulation by femoral angiography. Secondary end points included time to sheath insertion, number of forward needle advancements, first pass success, accidental venipunctures, and vascular access complications at 30 days. RESULTS Compared with fluoroscopic guidance, US guidance produced no difference in CFA cannulation rates (86.4% vs. 83.3%, p = 0.17), except in the subgroup of patients with CFA bifurcations occurring over the femoral head (82.6% vs. 69.8%, p < 0.01). US guidance resulted in an improved first-pass success rate (83% vs. 46%, p < 0.0001), reduced number of attempts (1.3 vs. 3.0, p < 0.0001), reduced risk of venipuncture (2.4% vs. 15.8%, p < 0.0001), and reduced median time to access (136 s vs. 148 s, p = 0.003). Vascular complications occurred in 7 of 503 and 17 of 501 in the US and fluoroscopy groups, respectively (1.4% vs. 3.4% p = 0.04). CONCLUSIONS In this multicenter randomized controlled trial, routine real-time US guidance improved CFA cannulation only in patients with high CFA bifurcations but reduced the number of attempts, time to access, risk of venipunctures, and vascular complications in femoral arterial access. (Femoral Arterial Access With Ultrasound Trial [FAUST]; NCT00667381).
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Affiliation(s)
- Arnold H Seto
- Department of Medicine, Division of Cardiology, University of California, Irvine Medical Center, Orange, California 92868, USA.
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