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Sethi S, Michalski J, Moh'd Elayyan Al-Shboul R, Carey F, Tan K, Ali T. Procedure-Related Complication Rates With the Use of Vascular Closure Devices; Does Size Only Matter? A Large Single Centre Retrospective Study. Vasc Endovascular Surg 2024; 58:847-853. [PMID: 39172918 DOI: 10.1177/15385744241276688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2024]
Abstract
INTRODUCTION Our retrospective study aimed at assessing safety of vascular closure devices (VCDs) used in a large single-centre Interventional Radiology (IR) department. Complication and deployment failure rates using collagen-based (Angio-seal) and suture-based (ProGlide) devices for common femoral artery haemostasis were compared. MATERIALS AND METHODS Data from VCDs deployed over a 6-year period were retrospectively analysed for patient age, procedure indication, puncture mode (antegrade/retrograde), sheath size, deployment failure and complications (haematoma, pseudoaneurysm formation, limb occlusion). Numerical and statistical analysis was undertaken. RESULTS Overall, 1321 common femoral artery punctures in 1217 patients were closed using VCDs. Failure rate using ProGlide was significantly higher when compared with Angio-seal (P=<0.001) in sheath sizes ≤8 Fr. Heparin was not administered in embolisation procedures compared with angioplasty with or without stenting. Therefore, haematoma tended to occur more frequently following angioplasty without stenting (P = 0.003) and angioplasty with stenting (P = 0.001), when compared with embolisation. Deployment failure occurred more frequently when heparin was used during the procedure (P = 0.005). CONCLUSION Although complications relating to sheath size are well established in the literature, there remains a paucity of data assessing the impact of procedure specific factors when comparing VCDs. Our study challenges that size is the sole determinant of VCD success and invites a more holistic view of VCD deployment strategies. This study advocates continued research into the nuances of other potential confounding variables to optimise patient outcomes.
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Affiliation(s)
- Sifut Sethi
- Interventional Radiology Unit, Norfolk and Norwich University Hospitals, Norwich, UK
| | - Jakub Michalski
- Interventional Radiology Unit, Norfolk and Norwich University Hospitals, Norwich, UK
| | | | - Frank Carey
- Interventional Radiology Unit, Norfolk and Norwich University Hospitals, Norwich, UK
| | - Kelvin Tan
- Interventional Radiology Unit, Norfolk and Norwich University Hospitals, Norwich, UK
| | - Tariq Ali
- Interventional Radiology Unit, Norfolk and Norwich University Hospitals, Norwich, UK
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Vascular Closure Devices versus Manual Compression in Cardiac Interventional Procedures: Systematic Review and Meta-Analysis. Cardiovasc Ther 2022; 2022:8569188. [PMID: 36134143 PMCID: PMC9482152 DOI: 10.1155/2022/8569188] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 08/20/2022] [Accepted: 08/22/2022] [Indexed: 11/18/2022] Open
Abstract
Backgrounds Manual compression (MC) and vascular closure device (VCD) are two methods of vascular access site hemostasis after cardiac interventional procedures. However, there is still controversial over the use of them and a lack of comprehensive and systematic meta-analysis on this issue. Methods Original articles comparing VCD and MC in cardiac interventional procedures were searched in PubMed, EMbase, Cochrane Library, and Web of Science through April 2022. Efficacy, safety, patient satisfaction, and other parameters were assessed between two groups. Heterogeneity among studies was evaluated by I2 index and the Cochran Q test, respectively. Publication bias was assessed using the funnel plot and Egger's test. Results A total of 32 studies were included after screening with inclusion and exclusion criteria (33481 patients). This meta-analysis found that VCD resulted in shorter time to hemostasis, ambulation, and discharge (p < 0.00001). In terms of vascular complication risks, VCD group might be associated with a lower risk of major complications (p = 0.0001), but the analysis limited to randomized controlled trials did not support this result (p = 0.68). There was no significant difference in total complication rates (p = 0.08) and bleeding-related complication rates (p = 0.05) between the two groups. Patient satisfaction was higher in VCD group (p = 0.002). Meta-regression analysis revealed no specific covariate as an influencing factor for above results (p > 0.05). Conclusions Compared with MC, the use of VCDs significantly shortens the time of hemostasis and allows earlier ambulation and discharge, meanwhile without increase in vascular complications. In addition, use of VCDs achieves higher patient satisfaction and leads cost savings for patients and institutions.
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Sun LX, Yang XS, Zhang DW, Zhao B, Li LL, Zhang Q, Hao QZ. Flip-over of blood vessel intima caused by vascular closure device: A case report. World J Clin Cases 2022; 10:2247-2252. [PMID: 35321181 PMCID: PMC8895181 DOI: 10.12998/wjcc.v10.i7.2247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 11/03/2021] [Accepted: 01/22/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Complications of vascular closure devices mainly include bleeding, vascular injury, and trapped device that cannot be removed percutaneously. However, arterial stenosis or occlusion induced by vascular injury is rare. This article introduces a rare case with severe acute limb ischemia after using the vascular closure device (StarClose).
CASE SUMMARY A 54-year-old man was admitted because of necrosis of the second toe of the left foot for 2 mo. Ultrasound showed left femoral artery stenosis, and occlusion of the left popliteal, posterior tibial, peroneal, anterior tibial and dorsalis pedis arteries, suggesting arteriosclerosis obliterans of low extremities, gangrene and type 2 diabetes. He underwent an interventional procedure of drug-eluting balloon in the left lower limb via antegrade puncture of the left common femoral artery. He developed acute limb ischemia after 1 h, and severe pain, numbness, pale skin, low skin temperature and weakened sensation in the left foot. Injury of the common femoral artery intima was considered. Exploratory surgery showed occlusion at the puncture point accompanied with bulged vascular lumen and flipped vascular intima caused by StarClose. The flipped intima was removed. The limb blood supply was restored and the limb was saved post-surgery. He recovered well at final follow-up.
CONCLUSION Incorrect use of the vascular closure device was the main cause of severe acute limb ischemia in this case.
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Affiliation(s)
- Li-Xia Sun
- The First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan 250000, Shandong Province, China
| | - Xue-Song Yang
- Department of Peripheral Vascular Diseases, the Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan 250000, Shandong Province, China
| | - Da-Wei Zhang
- Department of Peripheral Vascular Diseases, the Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan 250000, Shandong Province, China
| | - Bo Zhao
- Department of Peripheral Vascular Diseases, the Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan 250000, Shandong Province, China
| | - Lian-Lian Li
- The First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan 250000, Shandong Province, China
| | - Qi Zhang
- The First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan 250000, Shandong Province, China
| | - Qing-Zhi Hao
- Department of Peripheral Vascular Diseases, the Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan 250000, Shandong Province, China
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Tonetti DA, Ferari C, Perez J, Ozpinar A, Jadhav AP, Jovin TG, Gross BA, Jankowitz BT. Validation of an extrinsic compression and early ambulation protocol after diagnostic transfemoral cerebral angiography: a 5-year prospective series. J Neurointerv Surg 2019; 11:837-840. [DOI: 10.1136/neurintsurg-2018-014572] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 12/12/2018] [Accepted: 12/17/2018] [Indexed: 11/04/2022]
Abstract
Background and purposeAccess-site complications constitute a substantial portion of the morbidity associated with transfemoral cerebral angiography, yet no standardized protocol exists for femoral closure and practice patterns vary widely. The objective of this single-arm prospective cohort study was to validate the efficacy and safety of a standardized femoral closure strategy for all diagnostic angiography, regardless of antiplatelet regimen.MethodsA single-arm, prospective study was designed enrolling consecutive patients undergoing diagnostic transfemoral cerebral angiography by a single neurointerventional surgeon from March 2013 – March 2018. The closure protocol consisted of 20 minutes of manual compression to the site of arterial access and 2 hours of bedrest. The primary outcome was hematoma or oozing after manual compression. Demographic, clinic, and laboratory data were collected and analyzed, and patients were stratified by antiplatelet use.ResultsOf 525 angiograms, 263 (50.1%) were on patients taking antiplatelet medication, with 66 (12.6%) on dual antiplatelet regimens. Five patients (0.95% of all patients) met the primary outcome: in all five cases, there was no further oozing or enlarging hematoma after the additional compression period. There were not significant differences in primary outcome in groups stratified by antiplatelet use, and there were no instances of delayed hematoma, pseudoaneurysm, or arteriovenous fistula.ConclusionIn this single-arm cohort study of 525 consecutive transfemoral angiograms with a standardized extrinsic compression protocol, hemostasis was achieved without complication in >99% regardless of antiplatelet strategy. This protocol is effective and safe for diagnostic transfemoral angiography regardless of a patient’s antiplatelet use.
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Saraf S, Cockburn J, Alsanjari O, Hildick-Smith D. Transcatheter aortic valve implantation via the superficial femoral artery: An underused access route? Catheter Cardiovasc Interv 2018; 92:808-812. [PMID: 29481731 DOI: 10.1002/ccd.27544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 01/09/2018] [Accepted: 01/27/2018] [Indexed: 11/08/2022]
Abstract
Common femoral arterial (CFA) access is the most commonly used access route for transcatheter aortic valve implantation (TAVI). In majority of cases, it is easily accessible percutaneously without requiring surgical cut down. However, in patients with high body mass index (BMI) or central obesity, it can be more than 8-10 cm below the skin making the procedure more technically demanding and satisfactory hemostasis more difficult to achieve. The superficial femoral artery (SFA) lies only a few centimeters distal to the CFA with little compromise on vessel caliber, yet can allow more suitable access in certain patients with a high BMI. We describe three cases in which SFA access was successfully used as the primary delivery route for TAVI.
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Affiliation(s)
- Smriti Saraf
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, United Kingdom
| | - James Cockburn
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, United Kingdom
| | - Osama Alsanjari
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, United Kingdom
| | - David Hildick-Smith
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, United Kingdom
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A systematic review of vascular closure devices for femoral artery puncture sites. J Vasc Surg 2018; 68:887-899. [DOI: 10.1016/j.jvs.2018.05.019] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 05/15/2018] [Indexed: 12/17/2022]
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Zuckerman SL, Bhatia R, Tsujiara C, Baker CB, Szafran A, Cushing D, Aiken J, Tracy M, Mocco J, Ecker RD. Prospective series of two hours supine rest after 4fr sheath-based diagnostic cerebral angiography: Outcomes, productivity and cost. Interv Neuroradiol 2018; 21:114-9. [PMID: 25934785 DOI: 10.15274/inr-2014-10102] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
There is no standard of care for catheter size or post-procedure supine time in cerebral angiography. Catheter sizes range from 4-Fr to 6-Fr with supine times ranging from two to over six hours. The objective of our study was to establish the efficacy, safety, and cost savings of two-hour supine time after 4-Fr elective cerebral angiography. A prospective, single arm study was performed on 107 patients undergoing elective cerebral angiography. All cerebral angiograms were performed with a 4-Fr sheath-based system without closure devices. Ten minutes of manual compression was applied to the femoral access site, with further compression held as clinically indicated. Patients were then monitored in a nursing unit for two hours supine and subsequently mobilized. Nursing discretion was allowed for earlier mobilization. Patients were called the next day to assess delayed hematoma and bleeding. Estimates of cost savings and productivity increases are provided. All patients ambulated in two hours or less. There were no strokes or vessel dissections. Five patients (4.7%) experienced a palpable hematoma, three patients (2.8%) experienced bleeding immediately following the procedure requiring further compression, and one patient (0.9%) experienced minor groin oozing at home. No patient required transfusion, thrombin injection, or endovascular/surgical management of a groin complication. A two-hour post-procedure supine time resulted in cost savings of $952 per angiogram and a total of $101,864. 4-Fr sheath based cerebral angiography with two-hour post-procedure supine time is safe and effective, and allows for a considerable increase in patient satisfaction, cost savings and productivity.
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Affiliation(s)
- Scott L Zuckerman
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ritwik Bhatia
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Crystiana Tsujiara
- Department of Radiology, Maine Medical Center, Neuroscience Institute, Portland, Maine, USA
| | | | - Alex Szafran
- Surgery, Maine Medical Center, Neuroscience Institute, Portland, Maine, USA
| | - Deborah Cushing
- Department of Radiology, Maine Medical Center, Neuroscience Institute, Portland, Maine, USA Department of Neurosurgery, Mayo Clinic, Jacksonville, FL, USA
| | - Judy Aiken
- Department of Neurosurgery, Mayo Clinic, Jacksonville, FL, USA
| | - Marilyn Tracy
- Department of Neurosurgery, Mayo Clinic, Jacksonville, FL, USA
| | - J Mocco
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Robert D Ecker
- Department of Radiology, Maine Medical Center, Neuroscience Institute, Portland, Maine, USA Nursing, Maine Medical Center, Neuroscience Institute, Portland, Maine, USA
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Brancheau D, Sarsam S, Assaad M, Zughaib M. Accelerated ambulation after vascular access closure device. Ther Adv Cardiovasc Dis 2018; 12:141-144. [PMID: 29421959 DOI: 10.1177/1753944718756604] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Patients who are candidates to receive an Angioseal® (St. Jude Medical) device for arteriotomy closure are allowed to ambulate 20 min after the deployment of the device. More frequently, however, patients are kept on bed rest for several hours following Angioseal® deployment. The purpose of this study was to prospectively assess patients when ambulating 20 min after Angioseal® deployment instead of prolonged best rest of 2-3 h. METHODS Patients undergoing angiography from the common femoral artery approach were included in the study if they received a 6 Fr Angioseal® closure device. RESULTS Twenty-nine patients were successfully enrolled in the study; 27 (93.1%) patients ambulated at 20 min, 1 (3.45%) patient ambulated at 28 min, and 1 (3.45%) patient ambulated at 27 min due to transport times. There were zero complications with regard to hemorrhage or other groin complications. There is a substantial time difference in ambulation times between the conventional and early ambulation groups. CONCLUSION Our study demonstrates that it is probably safe to ambulate patients who undergo diagnostic cardiac catheterization as early as 20 min after deployment of the 6 Fr Angioseal® closure device. ClinicalTrials.gov identifier: NCT03142126.
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Affiliation(s)
- Daniel Brancheau
- St. John-Providence Hospital and Medical Center, Department of Internal Medicine, Division of Cardiology, 16001 West 9 Mile Road, Southfield, MI 48075-4818, USA
| | - Sinan Sarsam
- St. John-Providence Hospital and Medical Center, Department of Internal Medicine, Division of Cardiology, Southfield, MI, USA
| | - Mahmoud Assaad
- St. John-Providence Hospital and Medical Center, Department of Internal Medicine, Division of Cardiology, Southfield, MI, USA
| | - Marcel Zughaib
- St. John-Providence Hospital and Medical Center, Department of Internal Medicine, Division of Cardiology, Southfield, MI, USA
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Scansen BA, Hokanson CM, Friedenberg SG, Khabiri H. Use of a vascular closure device during percutaneous arterial access in a dog with impaired hemostasis. J Vet Emerg Crit Care (San Antonio) 2017; 27:465-471. [PMID: 28544277 DOI: 10.1111/vec.12614] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 08/31/2015] [Accepted: 09/20/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To report the use of a vascular closure device (VCD) to provide rapid arterial hemostasis following percutaneous femoral arterial catheterization and diagnostic angiography in a thrombocytopenic and coagulopathic dog. CASE SUMMARY A 6-year-old female spayed Kai Ken Tora dog presented after vehicular trauma. The dog was diagnosed with traumatic pneumothorax, degloving wounds of the right antebrachium, subcutaneous hemorrhage within the axillary tissues of the left thoracic limb, and anemia and thrombocytopenia secondary to acute hemorrhage. Treatment included therapeutic thoracocentesis and open wound management of the right thoracic limb as well as packed RBC and fresh frozen plasma transfusions. Diagnostic angiography of the left brachial artery was performed via percutaneous femoral arterial access to investigate the source of a persistent axillary hematoma. The arterial access site was closed using an extraluminal VCD and hemostasis was immediate with normal femoral arterial blood flow documented by Doppler ultrasound. NEW OR UNIQUE INFORMATION PROVIDED This report describes use of a VCD for arterial closure following percutaneous access in a dog with impaired hemostasis; to the authors' knowledge, this is the first clinical report of a VCD used in a veterinary species.
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Affiliation(s)
- Brian A Scansen
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, OH, 43210
| | - Caitlin M Hokanson
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, OH, 43210
| | - Steven G Friedenberg
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, OH, 43210
| | - Hooman Khabiri
- The Wexner Medical Center, The Ohio State University, Columbus, OH, 43210
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Sekhar A, Sutton BS, Raheja P, Mohsen A, Anggelis E, Anggelis CN, Keith MC, Dawn B, Straton S, Flaherty MP. Femoral arterial closure using ProGlide® is more efficacious and cost-effective when ambulating early following cardiac catheterization. IJC HEART & VASCULATURE 2016; 13:6-13. [PMID: 28616553 PMCID: PMC5454184 DOI: 10.1016/j.ijcha.2016.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 09/08/2016] [Accepted: 09/24/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This was a prospective, single-center study evaluating the efficacy and cost-effectiveness of early ambulation (within 30 min) following femoral artery closure with the ProGlide® suture-mediated vascular closure device (PD) in patients undergoing diagnostic cardiac catheterization compared with manual compression. BACKGROUND It is unclear whether early ambulation with ProGlide is safe or is associated with patient satisfaction and cost savings as compared with manual compression (MC). METHODS AND RESULTS Inclusion criteria were met in 170 patients (85 PD and 85 MC patients). Patients ambulated 20 ft. within 30 min (PD) or after the requisite 4 h recumbent time (MC) if feasible. Primary endpoint was time-to-ambulation (TTA) following device closure. We also directly compared the safety of closure, times-to-hemostasis (TTH), -ambulation (TTA) and -discharge (TTD) with MC and, using a fully allocated cost model, performed cost analysis for both strategies. Multivariate analysis was used to determine predictors of patient satisfaction. The primary endpoint of safe, early ambulation was achieved following closure (mean of 27.1 ± 14.9 min; 95% confidence interval [CI] 25.2-30.2). Predictors of patient satisfaction in the PD group were absence of pain during closure, decreased TTA, and drastic reductions in TTD; the latter contributed indirectly to significant cost savings in the PD group (1250.3 ± 146.4 vs. 2248.1 ± 910.2 dollars, respectively; P < 0.001) and incremental cost savings by strategy also favored closure over MC ($84,807). CONCLUSIONS ProGlide is safe and effective for femoral artery closure in patients who ambulate within 30 min after cardiac catheterization; translating into improved patient satisfaction and substantial cost savings.
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Affiliation(s)
- Aravind Sekhar
- Division of Cardiovascular Medicine, University of Louisville, Louisville, KY, United States
- Jewish Hospital Heart and Lung Institute, Louisville, KY, United States
| | - Brad S. Sutton
- Division of Cardiovascular Medicine, University of Louisville, Louisville, KY, United States
- Jewish Hospital Heart and Lung Institute, Louisville, KY, United States
| | - Prafull Raheja
- Division of Cardiovascular Medicine, University of Louisville, Louisville, KY, United States
- Jewish Hospital Heart and Lung Institute, Louisville, KY, United States
| | - Amr Mohsen
- Division of Cardiovascular Medicine, University of Louisville, Louisville, KY, United States
- Jewish Hospital Heart and Lung Institute, Louisville, KY, United States
| | - Emily Anggelis
- Division of Cardiovascular Medicine, University of Louisville, Louisville, KY, United States
- Jewish Hospital Heart and Lung Institute, Louisville, KY, United States
| | - Chris N. Anggelis
- Division of Cardiovascular Medicine, University of Louisville, Louisville, KY, United States
- Jewish Hospital Heart and Lung Institute, Louisville, KY, United States
| | - Matthew C. Keith
- Division of Cardiovascular Medicine, University of Louisville, Louisville, KY, United States
- Jewish Hospital Heart and Lung Institute, Louisville, KY, United States
| | - Buddhadeb Dawn
- Division of Cardiovascular Diseases, Kansas University Medical Center, Kansas City, KS, United States
| | - Samantha Straton
- Division of Cardiovascular Medicine, University of Louisville, Louisville, KY, United States
- Jewish Hospital Heart and Lung Institute, Louisville, KY, United States
| | - Michael P. Flaherty
- Division of Cardiovascular Medicine, University of Louisville, Louisville, KY, United States
- Jewish Hospital Heart and Lung Institute, Louisville, KY, United States
- Corresponding author at: Physiology & Biophysics, Division of Cardiovascular Medicine, University of Louisville School of Medicine, Rudd Heart and Lung Center, 201 Abraham FlexnerWay, Suite 800, Louisville, KY 40202, United States.Physiology & BiophysicsDivision of Cardiovascular MedicineUniversity of Louisville School of MedicineRudd Heart and Lung Center201 Abraham FlexnerWay, Suite 800LouisvilleKY40202United States
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Memon S, Ball TC. Central Pseudo-Aneurysm Formation Following Arterial Closure with a StarClose SE Device: When a StarClose Doesn't Completely Close. AMERICAN JOURNAL OF CASE REPORTS 2016; 17:207-10. [PMID: 27026227 PMCID: PMC4819689 DOI: 10.12659/ajcr.896587] [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] [Indexed: 11/09/2022]
Abstract
BACKGROUND Vascular closure devices (VCDs) are frequently used for hemostasis with endovascular procedures by employing sutures or plug devices (using collagen or hydrogel) or through the use of a metal clip made of nickel and titanium, such as the StarClose SE device. In comparison to manual compression (MC), VCDs are associated with earlier time to discharge and ambulation, improved patient comfort, and better cost-effectiveness. CASE REPORT A 77-year-old man with history of ischemic cardiomyopathy with non-ST segment elevation myocardial infarction (NSTEMI) underwent diagnostic cardiac catheterization with deployment of a StarClose SE vascular closure device for hemostasis. Upon repeat access 4 days later for coronary intervention, retrograde sheath angiography revealed a pseudo-aneurysm emanating from the center of the StarClose clip. CONCLUSIONS A review of the literature shows VCDs to be non-inferior to MC, with an overall high success rate. Major and minor complications rates are comparable to those with MC, and pseudo-aneurysm is an infrequent complication.
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Affiliation(s)
- Sehrish Memon
- Department of Cardiovascular Medicine, Carilion Roanoke Memorial Hospital, Roanoke, VA, USA
| | - Timothy C Ball
- Department of Cardiovascular Medicine , Carilion Roanoke Memorial Hospital, Roanoke, VA, USA
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Zuckerman SL, Bhatia R, Tsujiara C, Baker CB, Szafran A, Cushing D, Aiken J, Tracy M, Mocco J, Ecker RD. Prospective series of two hours supine rest after 4fr sheath-based diagnostic cerebral angiography: Outcomes, productivity and cost. Interv Neuroradiol 2015. [DOI: 10.1177/inr-2014-10102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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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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Chu G, Yang W, Zhang G, Zhang Z, Liu S, Sun B, Wang F. Safety and efficacy of the StarClose vascular closure system following 8-Fr sheath placement for intra-aortic balloon pump: a single-center analysis of 42 consecutive patients. Med Princ Pract 2014; 23:313-7. [PMID: 24776529 PMCID: PMC5586891 DOI: 10.1159/000362127] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 03/10/2014] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To assess the safety and efficacy of the StarClose device following intra-aortic balloon pump (IABP) counterpulsation using 8-Fr femoral sheaths. SUBJECTS AND METHODS From June 2008 to August 2012, 42 consecutive patients who received IABP implantation via common femoral artery (CFA) punctures with an 8-Fr sheath (which were then sealed with the StarClose Vascular Closure System at the bedside) were included in this retrospective single-arm study. All the patients underwent duplex control of the puncture site 24 h after deployment of the device, in order to determine the presence or absence of vascular complications including hematoma, pseudoaneurysm, arteriovenous fistula and arterial/venous thrombosis or stenosis. The safety end points were the vascular complications during the hospital stay, and the efficacy end points included device and procedure success. RESULTS The procedure success rate was 92.9% (39/42) and the device success rate was 88.1% (37/42). Major vascular complications occurred in 3 (7.1%) patients; 1 developed a massive hematoma >10 cm which was managed by blood transfusion and surgical reconstruction, and the other 2 developed pseudoaneurysm which was cured by ultrasound-guided thrombin injection or manual compression. Minor vascular complications occurred in 5 (11.9%) patients, including blood oozing in 2, hematoma <5 cm in 2 and severe pain in the remaining patient. CONCLUSION CFA closure with the StarClose device was safe, feasible and effective in patients undergoing IABP support using 8-Fr sheath sizes.
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Affiliation(s)
| | - Wenyi Yang
- *Wenyi Yang, MD, or Fang Wang, PhD, MD, Department of Cardiology, Shanghai Jiaotong University, First People's Hospital, 85 Wu Jin Road, Shanghai 200080 (PR China), E-Mail
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Larsen EN, Hansen CB, Thayssen P, Jensen LO. Immediate mobilization after coronary angiography or percutaneous coronary intervention following hemostasis with the AngioSeal vascular closure device (the MOBS study). Eur J Cardiovasc Nurs 2013; 13:466-72. [PMID: 24336239 DOI: 10.1177/1474515113516702] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND In patients undergoing coronary angiography or percutaneous coronary intervention (PCI), the standard post procedure regime includes immobilization and bed rest despite the use of vascular closure devices. AIM In the Mobilization after Coronary Angiography or Percutaneous Coronary Intervention (MOBS) study we compared bleeding complications after cardiac catheterization with femoral artery access after mobilization immediately off the angiographic table or standard care with1 hour (MOBS I after a diagnostic angiogram) or 2 hours of bed rest before mobilization (MOBS II after PCI). METHODS Bleeding complications were defined as major (requiring surgery of the femoral artery, transfusion or increased hospital stay) and minor (hematoma <5 × 5 cm(2), oozing from the puncture site or minor bleeding that could be compressed manually). RESULTS In the MOBS I cohort (100 patients were mobilized immediately and 100 patients followed standard care) no major bleeding complications were seen. In the immediate mobilization group 2.0% experienced minor bleeding compared to 4.0% in the standard care group (p=0.41). In the MOBS II cohort after PCI (158 patients were mobilized immediately and 161 patients followed standard care), major bleeding complication rates did not differ significantly between the two groups: immediate mobilization group 26.6% vs. standard care group 28.0%, p=0.78. The majority of bleeding complications were due to oozing: immediate mobilization group 22.8% vs. standard care group 20.5%, p=0.62. CONCLUSIONS Immediate mobilization after a coronary angiogram or PCI with the femoral access site closed by the closure device AngioSeal was not associated with increased bleeding risk compared to standard care with bed rest.
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Affiliation(s)
| | | | - Per Thayssen
- Department of Cardiology, Odense University Hospital, Denmark
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Taha A, Walsh EK, Wright KA, Ahmed I, Supakul N, Awwad EE, Tejada JG. Safety and feasibility of a novel vascular closure device in neurointerventional procedures. Interv Neuroradiol 2013; 19:353-8. [PMID: 24070085 DOI: 10.1177/159101991301900313] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 04/14/2013] [Indexed: 11/15/2022] Open
Abstract
This retrospective study evaluated the safety and feasibility of a new arterial femoral access closure device in neurointerventional procedures. The study includes all consecutive adult patients who underwent femoral arteriotomy closure with the MynxGrip™ closure device after Neurointerventional procedures performed between June and December 2012. All patients had a follow-up color Doppler ultrasound (US) within 48 hours after the procedure, which was independently interpreted by two experienced radiologists to evaluate for access site complications. Device success/failure, sheath size, ambulation time, and periprocedural complications were recorded. Fifty-five closure devices were deployed in 53 patients. There were 23 (43%) males and 30 (57%) females; age ranged from 22 to 84 years (mean: 52.1 years). Thirty of the 55 procedures (55%) were therapeutic and 25 were diagnostic interventions (45%). Sheath sizes used were 5F in 35 procedures (64 %) and 6F in 20 procedures (36%). The right femoral artery was accessed in 51 procedures (93 %) and the left in four procedures (7%). There was only one (1.8 %) minor periprocedural complication (small hematoma). Hemostasis was successful in 51 of the 55 procedures (93 %) with subsequent early ambulation. No device-induced complications associated with serious clinical sequelae were reported. In our small series, the MynxGrip™ femoral access closure device provided a safe and feasible way of closing the femoral artery puncture site after neurointerventional procedures with low minor complication rates and no major complications. Further large prospective randomized trials are necessary to evaluate the efficacy of the device.
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Affiliation(s)
- Ammar Taha
- Department of Radiology, Interventional Neuroradiology, Indiana University School of Medicine; Indianapolis, IN, USA - E-mail:
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Treitl M, Eberhardt KM, Maxien D, Behrends B, Reiser MF. [Arterial closure devices. What device for which clinical situation?]. Radiologe 2013; 53:230-45. [PMID: 23456042 DOI: 10.1007/s00117-012-2423-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
CLINICAL/METHODICAL ISSUE Access site complications after endovascular catheterization sometimes require open surgery and negatively impair safety, patient comfort and reimbursement. Increasing numbers of procedures and patients with multiple anticoagulants as well as cost pressure explain the demand for an immediate and stable access site closure. STANDARD RADIOLOGICAL METHODS Manual compression followed by compression bandage and bed rest for 4-24 h is still the gold standard but is unable to prevent access site complications in all cases. METHODICAL INNOVATIONS Arterial vascular closure devices allow immediate and stable closure of the puncture channel either by suture or by implantation of occluding foreign bodies or gluing fluids. PERFORMANCE The safety has been proven in several clinical trials. The main advantage lies in closing large lumen access sites without surgery and in patients treated with multiple anticoagulants as well as in outpatient procedures. ACHIEVEMENTS They have become a valuable supplement to the interventional arsenal. PRACTICAL RECOMMENDATIONS The physician, however, has to decide between different systems and mechanisms with respect to patient constitution, selected access vessel and level of calcification and diameter. Furthermore, all systems require a defined training prior the first use.
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Affiliation(s)
- M Treitl
- Institut für Klinische Radiologie, Klinikum Innenstadt der Ludwig-Maximilians-Universität München, Medizinische Poliklinik, Pettenkoferstrasse 8a, Munich, Germany.
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Gutzeit A, van Schie B, Schoch E, Hergan K, Graf N, Binkert CA. Feasibility and Safety of Vascular Closure Devices in an Antegrade Approach to Either the Common Femoral Artery or the Superficial Femoral Artery. Cardiovasc Intervent Radiol 2012; 35:1036-40. [DOI: 10.1007/s00270-012-0454-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Accepted: 07/12/2012] [Indexed: 10/28/2022]
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Del Corso A, Bargellini I, Cicorelli A, Perrone O, Leo M, Lunardi A, Alberti A, Tomei F, Cioni R, Ferrari M, Bartolozzi C. Efficacy and safety of a novel vascular closure device (Glubran 2 seal) after diagnostic and interventional angiography in patients with peripheral arterial occlusive disease. Cardiovasc Intervent Radiol 2012; 36:371-6. [PMID: 22696010 DOI: 10.1007/s00270-012-0428-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Accepted: 05/24/2012] [Indexed: 11/30/2022]
Abstract
PURPOSE To prospectively evaluate safety and efficacy of a novel vascular closure device (Glubran 2 Seal) after peripheral angiography in patients with peripheral arterial occlusive disease (PAOD). METHODS From December 2010 to June 2011, all consecutive patients with PAOD undergoing peripheral angiography were prospectively enrolled onto the study after percutaneous antegrade or retrograde puncture of the common femoral artery. After angiography, the Glubran 2 Seal device was used to achieve hemostasis. The following data were registered: technical success and manual compression duration, patients' discomfort (scale 0-5), operators' technical difficulty (scale 0-5), and vascular complications. The site of hemostasis was evaluated by clinical inspection and color-coded Duplex ultrasound performed 1 day and 1 month after the procedure. RESULTS One hundred seventy-eight patients were enrolled (112 male, mean age 70.8 years) with a total of 206 puncture sites, including 104 (50.5 %) antegrade accesses. The device was successful in 198(96.1 %) of 206 procedures, with 8 cases of manual compression lasting longer than 5 min (maximum 20 min). No major vascular complications were observed, resulting in 100 % procedural success. Minor complications occurred in seven procedures (3.4 %), including two cases of pseudoaneurysms, successfully treated by ultrasound-guided glue injection. The mean ± standard deviation score for patients' discomfort was 0.9 ± 0.7, whereas the mean score for operators' difficulty was 1.2 ± 0.9. CONCLUSION In patients with PAOD, the Glubran 2 Seal represents a simple, painless, and efficient vascular closure device, able to achieve hemostasis both in antegrade and retrograde accesses.
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Affiliation(s)
- Andrea Del Corso
- Department of Vascular Surgery, University of Pisa, Via Paradisa 2, 56100, Pisa, Italy
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