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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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Meijers TA, Aminian A, Valgimigli M, Dens J, Agostoni P, Iglesias JF, Gasparini GL, Seto AH, Saito S, Rao SV, van Royen N, Brilakis ES, van Leeuwen MAH. Vascular Access in Percutaneous Coronary Intervention of Chronic Total Occlusions: A State-of-the-Art Review. Circ Cardiovasc Interv 2023; 16:e013009. [PMID: 37458110 DOI: 10.1161/circinterventions.123.013009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
The outcomes of chronic total occlusion percutaneous coronary intervention have considerably improved during the last decade with continued emphasis on improving procedural safety. Vascular access site bleeding remains one of the most frequent complications. Several procedural strategies have been implemented to reduce the rate of vascular access site complications. This state-of-the-art review summarizes and describes the current evidence on optimal vascular access strategies for chronic total occlusion percutaneous coronary intervention.
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Affiliation(s)
- Thomas A Meijers
- Department of Cardiology, Isala Heart Center, Zwolle, the Netherlands (T.A.M., M.A.H.v.L.)
| | - Adel Aminian
- Department of Cardiology, Centre Hospitalier Universitaire de Charleroi, Belgium (A.A.)
| | - Marco Valgimigli
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Università della Svizzera Italiana, Lugano, Switzerland (M.V.)
| | - Joseph Dens
- Department of Cardiology, Hospital Oost-Limburg, Genk, Belgium (J.D.)
| | | | - Juan F Iglesias
- Department of Cardiology, Geneva University Hospital, Switzerland (J.F.I.)
| | - Gabriele L Gasparini
- Department of Cardiology, Humanitas Clinical and Research Center, Milan, Italy (G.L.G.)
| | - Arnold H Seto
- Department of Cardiology, Veterans Affairs, Washington, DC (A.H.S.)
| | - Shigeru Saito
- Department of Cardiology, Shonan Kamakura General Hospital, Kanagawa, Japan (S.S.)
| | - Sunil V Rao
- Department of Cardiology, New York University Langone Health System (S.V.R.)
| | - Niels van Royen
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands (N.v.R.)
| | - Emmanouil S Brilakis
- Allina Health Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, MN (E.S.B.)
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Villela MA, Sanina C, Pyo R. Vascular Access Site Complications. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Lee MO, Jeong KU, Kim KM, Song YG. Risk Factors Affecting Complications of Access Site in Vascular Intervention through Common Femoral Artery. Niger J Clin Pract 2022; 25:85-89. [PMID: 35046200 DOI: 10.4103/njcp.njcp_37_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Backgrounds Traditionally, vascular interventions have been performed through the femoral artery. Aims The purpose of this study was to evaluate risk factors affecting access-site complications in patients with hepatocellular carcinoma or peripheral arterial disease in lower extremity who underwent vascular intervention by accessing the common femoral artery (CFA). Patients and Methods From December 2015 to November 2018, 287 patients underwent transarterial chemoembolization (TACE) or peripheral vascular intervention with ultrasound (US)-guided CFA access. Standard 18-gauge (G) access was used in 127 patients and Micropuncture® 21-G needles in 160 patients. Most access sites were managed with vascular closure devices and several were managed with manual compression. Within 24 hours after the procedure, all patients underwent US to evaluate the puncture site. Results Access-site complications occurred in 55 of 287 patients: 34 hematomas (11.9%), 20 pseudoaneurysms (7.0%), and 1 dissection (0.4%). In the crude model, risk factors related to access-site complications were the usage of 18-G needles (OR, 2.18; 95% CI, 1.17-4.07; P = 0.014), smoking (OR, 2.23; 95% CI, 1.16-4.27; P = 0.016), and approach route (OR, 3.23; 95% CI, 1.33-7.82; P = 0.009). Needle size (OR, 2.13; 95% CI, 1.10-4.12; P = 0.025) was the only factor associated with access-site complications in the adjusted model. Conclusion Needle profile was the only factor associated with access-site complications in this study. Therefore, a needle with a smaller profile than an 18-G needle will reduce the incidence of complications at the access site.
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Affiliation(s)
- M O Lee
- Department of Anesthesia and Pain Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - K U Jeong
- Department of Anesthesia and Pain Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - K M Kim
- Division of Gastroenterology, Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Y G Song
- Department of Radiology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
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Mathisen SR, Nilsson KF, Larzon T. A Single Center Study of ProGlide Used for Closure of Large-Bore Puncture Holes After EVAR for AAA. Vasc Endovascular Surg 2021; 55:798-803. [PMID: 34105422 DOI: 10.1177/15385744211022654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE The objective of this study was to evaluate the primary and assisted secondary percutaneous and non-invasive technical success of the ProGlide device on all-comers in a consecutive case series of percutaneous endovascular aortic aneurysm repair (P-EVAR). METHOD A single-center consecutive case series where 434 elective and acute P-EVAR procedures were registered prospectively between May 2011 and July 2017. The mean age was 74.5 years ± SD 11.4 years. 82.3% of the patients were male. All patients were pre-planned from CT angiography. Percutaneous access punctures, performed in local anesthesia in the common femoral artery, with a final introducer size between 12-22 Fr OD were included and stratified in 2 groups, 12-16 Fr and 17-22 Fr. RESULTS By screening 868 access groins 22 groins were excluded. Of the remaining 846 groins, intended to be treated with ProGlide, 9 groins were excluded peri-procedurally and treated with the Fascia Suture Technique or surgical cutdown. The remaining 837 groins had access closure with ProGlide, with a mean value of 2.15 devices per groin with a slight significant difference between the 2 stratification groups. Primary ProGlide technical success was achieved in 68.1% of the groins. Secondary percutaneous or non-invasive technical success was achieved in 96.9%. Here there was no statistically significant difference between the 2 stratification groups. Thirty-one (3.7%) groin complications were registered during 30-day follow-up and 17 required additional treatment. Total mortality was 2.8%. None of these deaths were related to the access site. CONCLUSION ProGlide by itself has a significant failure rate in the closure of large-bore access holes on an unselected cohort of patients eligible for P-EVAR. However, together with adjunct percutaneous or non-invasive methods a success rate of 97% can be achieved. The access complication rate was lower than 4% at 30-day follow-up.
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Affiliation(s)
| | - Kristofer F Nilsson
- Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Thomas Larzon
- Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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McHugh S, Noory A, Mishra S, Vanchiere C, Lakhter V. Vascular Access for Large Bore Access. Interv Cardiol Clin 2021; 10:157-167. [PMID: 33745666 DOI: 10.1016/j.iccl.2020.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Recent advances in the field of interventional cardiology have allowed for more complex procedures to be performed percutaneously. Ability to obtain safe large bore vascular access is frequently the key factor to procedural success. Meticulous technique for successful vascular access incorporates the understanding of anatomic landmarks, ultrasound, fluoroscopy, and micropuncture. Adequate hemostasis at the end of the case can be achieved through careful use of commercially available vascular closure devices. Although access-related vascular complications are uncommon, early recognition is key to successful management. Arterial tortuosity and calcification can present a significant challenge to successful common femoral artery access.
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Affiliation(s)
- Stephen McHugh
- Department of Medicine, Temple University Hospital, Lewis Katz School of Medicine, 3401 North Broad Street, Philadelphia, PA 19140, USA
| | - Ali Noory
- Department of Medicine, Temple University Hospital, Lewis Katz School of Medicine, 3401 North Broad Street, Philadelphia, PA 19140, USA
| | - Suraj Mishra
- Department of Medicine, Temple University Hospital, Lewis Katz School of Medicine, 3401 North Broad Street, Philadelphia, PA 19140, USA
| | - Catherine Vanchiere
- Department of Medicine, Temple University Hospital, Lewis Katz School of Medicine, 3401 North Broad Street, Philadelphia, PA 19140, USA
| | - Vladimir Lakhter
- Division of Cardiovascular Diseases, Department of Medicine, Temple University Hospital, Lewis Katz School of Medicine, 3401 North Broad Street (9PP), Philadelphia, PA 19140, USA.
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Routine Ultrasound or Fluoroscopy Use and Risk of Vascular/Bleeding Complications After Transfemoral TAVR. JACC Cardiovasc Interv 2020; 13:1460-1468. [PMID: 32553335 DOI: 10.1016/j.jcin.2020.03.047] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 02/25/2020] [Accepted: 03/31/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVES This study aimed to examine the benefits of routine use of 2D-US in patients undergoing transfemoral transcatheter aortic valve replacement (TAVR). BACKGROUND Two-dimensional ultrasound (2D-US) reduces access-related vascular complications (VCs) and bleeding in patients undergoing percutaneous coronary intervention via transfemoral approach. Potential similar benefits in patients undergoing transfemoral TAVR have not been systemically investigated. METHODS Rates of access-related VCs or bleeding were compared using 5-year retrospective observational data from 2 neighboring high-volume UK TAVR centers systemically using 2 different techniques (center 1: fluoroscopy and contralateral angiography [FCA], center 2: 2D-US) for femoral puncture at the time of transfemoral TAVR. RESULTS Overall, 1,171 patients were included in the study (FCA, n = 624; 2D-US, n = 529). Baseline clinical and procedural characteristics were similar between the 2 groups. There was no difference in the risk of VCs, bleeding, or their composite according to femoral puncture technique (FCA vs. 2D-US: 6.7% [95% confidence interval (CI): 4.9% to 8.9%] vs. 6.8% [95% CI: 4.8% to 9.3%]; p = 0.63; 6.1% [95% CI: 4.4% to 8.2%] vs. 6.4% [95% CI: 4.8% to 9.3%]; p = 0.70; and 9.8% [95% CI: 7.6% to 12.4%] vs. 9.8% [95% CI: 7.4% to 12.7%]; p = 0.76, respectively) and no difference when analysis was restricted to a composite of major VCs or major and life-threatening bleeding. CONCLUSIONS Vascular and bleeding complications can be achieved using either FCA or 2D-US guidance. Further studies are required to identify and assess alternative strategies to reduce periprocedural VCs and bleeding in this patient population.
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Ybarra LF, Rinfret S. Access Selection for Chronic Total Occlusion Percutaneous Coronary Intervention and Complication Management. Interv Cardiol Clin 2020; 10:109-120. [PMID: 33223100 DOI: 10.1016/j.iccl.2020.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Dual access for chronic total occlusion percutaneous coronary intervention is considered best practice by many experts. There are 2 access sites: radial and femoral. Both accesses have important advantages and disadvantages. Determining the ratio risk/benefit-efficacy/safety of each access for each patient in a specific procedure should be based on procedural and clinical variables. Given the safety benefit and the minimal procedural disadvantages, radial access should be the standard approach, especially in procedures of low complexity and in patients at high risk of vascular complications. Nonetheless, mastering both approaches is important because they are needed in multiple occasions.
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Affiliation(s)
- Luiz F Ybarra
- London Health Sciences Centre, Schulich School of Medicine & Dentistry, Western University, 339 Windermere Road, Room B6-127, London, Ontario N6A 5A5, Canada. https://twitter.com/YbarraLuiz
| | - Stéphane Rinfret
- Division of Cardiology, Department of Medicine, McGill University, McGill University Health Centre, Glen Site, 1001 Boulevard Décarie, Montreal, Quebec H4A 3J1, Canada.
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Ben-Dor I, Sharma A, Rogers T, Yerasi C, Case BC, Chezar-Azerrad C, Musallam A, Forrestal BJ, Zhang C, Hashim H, Bernardo N, Satler LF, Waksman R. Micropuncture technique for femoral access is associated with lower vascular complications compared to standard needle. Catheter Cardiovasc Interv 2020; 97:1379-1385. [PMID: 33063926 DOI: 10.1002/ccd.29330] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/30/2020] [Accepted: 10/02/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVES We compared access-site complications with a Micropuncture 21-gauge (G) needle to a standard 18G needle in patients undergoing femoral-access percutaneous coronary intervention (PCI). BACKGROUND Vascular access-site complications are the most common complication after cardiac catheterization. These complications increase patient morbidity and mortality, along with healthcare costs. METHODS We retrospectively analyzed a cohort of 17,844 consecutive patients undergoing PCI. Micropuncture access was used in 2344 patients and a standard 18G needle in 15,500 patients. Primary endpoints included vascular perforation or limb ischemia requiring repair, retroperitoneal bleeding, pseudoaneurysm, arteriovenous fistula, groin hematoma (>4 cm). RESULTS Patients undergoing PCI with Micropuncture were at higher risk: they were on anticoagulation (557 [23.7%] vs. 1,590 [10.2%], p < .001), used steroids more frequently (131 [5.6%] vs. 638 [4.1%], p < .001) and required the use of an intra-aortic balloon pump more often (191 [(8.1%] vs. 896 [5.7%], p < .001). Overall, the access-site complications rate was lower using Micropuncture (58 [2.5%]) versus standard needle (558 [3.6%], p = .005). The Micropuncture group had a significantly lower rate of hematoma than standard needle (32 [1.4%] vs. 309 [1.9%], p = .03). There was no significant difference in the rate of limb ischemia (1 [0.04%] vs. 12 [0.07%], p = .56), perforation (2 [0.08%] vs. 14 [0.09%], p = .93), retroperitoneal bleeding (3 [0.12%] vs. 18 [0.11%], p = .87), pseudoaneurysm (18 [0.76%] vs. 170 [1.09%], p = .14), and arteriovenous fistula (2 [0.08%] vs. 35 [0.22%], p = .16), comparing the Micropuncture group to a standard needle, respectively. CONCLUSIONS Femoral access using a Micropuncture reduced the rate of vascular complications with significant reduction in the rate of groin hematomas.
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Affiliation(s)
- Itsik Ben-Dor
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Colombia, USA
| | - Avinash Sharma
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Colombia, USA
| | - Toby Rogers
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Colombia, USA.,Cardiovascular Branch, Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Charan Yerasi
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Colombia, USA
| | - Brian C Case
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Colombia, USA
| | - Chava Chezar-Azerrad
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Colombia, USA
| | - Anees Musallam
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Colombia, USA
| | - Brian J Forrestal
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Colombia, USA
| | - Cheng Zhang
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Colombia, USA
| | - Hayder Hashim
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Colombia, USA
| | - Nelson Bernardo
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Colombia, USA
| | - Lowell F Satler
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Colombia, USA
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Colombia, USA
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Goldsweig AM, Secemsky EA. Vascular Access and Closure for Peripheral Arterial Intervention. Interv Cardiol Clin 2020; 9:117-124. [PMID: 32147114 DOI: 10.1016/j.iccl.2019.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Peripheral arterial interventions require safe and effective vascular access and closure. The sites, techniques, and equipment used may vary depending on patient and procedural factors. To minimize the risk of procedural complications, arterial access should use micropuncture technique, ultrasound and fluoroscopic guidance, a compressible arterial access site, and the smallest diameter sheath necessary. Hemostasis at an arteriotomy site may be achieved by manual compression, device-mediated compression, an intravascular closure device, or an extravascular closure device. Although closure devices improve patient comfort and expedite hemostasis, they have not been shown to reduce complications in comparison with compression.
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Affiliation(s)
- Andrew M Goldsweig
- Division of Cardiovascular Medicine, University of Nebraska Medical Center, 982265 Nebraska Medical Center, Omaha, NE 68198, USA.
| | - Eric A Secemsky
- Division of Cardiovascular Medicine, Harvard Medical School, Boston, MA, 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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Bogabathina H, Singireddy S, Shi R, Morris L, Abdulbaki A, Zabher H, Katikaneni P, Modi K. Does micropuncture technique really help reduce vascular complications? CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 19:762-765. [DOI: 10.1016/j.carrev.2018.03.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 03/22/2018] [Accepted: 03/22/2018] [Indexed: 11/17/2022]
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Sandoval Y, Burke MN, Lobo AS, Lips DL, Seto AH, Chavez I, Sorajja P, Abu-Fadel MS, Wang Y, Poulouse A, Gössl M, Mooney M, Traverse J, Tierney D, Brilakis ES. Contemporary Arterial Access in the Cardiac Catheterization Laboratory. JACC Cardiovasc Interv 2018; 10:2233-2241. [PMID: 29169493 DOI: 10.1016/j.jcin.2017.08.058] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 07/03/2017] [Accepted: 08/02/2017] [Indexed: 11/18/2022]
Abstract
Obtaining femoral and radial arterial access in the cardiac catheterization laboratory using state-of-the-art techniques is essential to optimize outcomes, patient satisfaction, and procedural efficiency. Although transradial access is increasingly used for coronary angiography and percutaneous coronary intervention, femoral access remains necessary for numerous procedures, many requiring large-bore access, including complex high-risk coronary interventions, structural procedures, and procedures involving mechanical circulatory support. For femoral access, contemporary access techniques should combine the use of fluoroscopy, ultrasound, micropuncture needle, femoral angiography, and vascular closure devices, when feasible. For radial access, ultrasound may reveal important anatomic features and expedite access. Despite randomized controlled trials supporting use of routine ultrasound guidance for femoral and/or radial arterial access, ultrasound remains underused in cardiac catheterization laboratories. This article reviews contemporary techniques to achieve optimal arterial access in the cardiac catheterization laboratory.
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Affiliation(s)
- Yader Sandoval
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota; Division of Cardiology, Hennepin County Medical Center, Minneapolis, Minnesota
| | - M Nicholas Burke
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Angie S Lobo
- Department of Medical Education, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Daniel L Lips
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Arnold H Seto
- Division of Cardiology, Department of Medicine, Veterans Affairs Long Beach Healthcare System and University of California, Irvine Medical Center, Long Beach, California
| | - Ivan Chavez
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Paul Sorajja
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Mazen S Abu-Fadel
- Department of Medicine, Cardiovascular Section, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Yale Wang
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Anil Poulouse
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Mario Gössl
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Michael Mooney
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Jay Traverse
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - David Tierney
- Division of Cardiology, Hennepin County Medical Center, Minneapolis, Minnesota
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota.
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Transfemoral Approach for Coronary Angiography and Intervention: A Collaboration of International Cardiovascular Societies. JACC Cardiovasc Interv 2018; 10:2269-2279. [PMID: 29169496 DOI: 10.1016/j.jcin.2017.08.035] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 08/03/2017] [Accepted: 08/22/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The aim of this study was to examine the current practice and use of transfemoral approach (TFA) for coronary angiography and intervention. BACKGROUND Wide variability exists in TFA techniques for coronary procedures. METHODS The authors developed a survey instrument that was distributed via e-mail lists from professional societies to interventional cardiologists from 88 countries between March and December 2016. RESULTS Of 987 operators, 18% were femoralists, 38% radialists, 42% both, and 2% neither. Access using femoral pulse palpation alone was preferred by 60% of operators, fluoroscopy guidance by 11%, and a combination of palpation, fluoroscopy, or ultrasound by 27%. Only 11% used micropuncture in >90% of their cases. Performing femoral angiography immediately after access was preferred by 23% and at the end of the procedure by 47%, and not done at all by 31% of operators. Hemostasis by manual compression was preferred by 50%, collagen plug vascular closure device by 31%, and suture-based vascular closure device by 11% of operators. Judkins left and right catheters were preferred for diagnostic angiography of the left (99%) and right (94%) coronary arteries. Extra backup curves (XB or EBU) were most commonly preferred for percutaneous coronary intervention of the left anterior descending (80%) and left circumflex (80%), whereas the Judkins right catheter was preferred for percutaneous coronary intervention of the right coronary artery (86%). CONCLUSIONS There is significant variability in preferences for femoral access technique. Even though recommended best practices advocate for fluoroscopic and ultrasound guidance, most operators use palpation alone. Femoral angiography is also not consistently used despite guideline recommendations. The lack of adoption of imaging guidance for vascular access deserves further investigation.
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Murray TE, O’Neill DC, Lee MJ. Combining Ultrasound-Guided Vascular Access With Ultrasound-Guided Analgesia for Single Skin and Vessel Puncture. J Endovasc Ther 2018. [DOI: 10.1177/1526602818761380] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: To describe a single skin puncture technique combining subcutaneous injection of anesthetic to the depth of the vessel wall with venipuncture in the same movement. Technique: Using ultrasound guidance, controlled anesthetic instillation along the needle tract and outer vessel wall with a 21-G vascular access needle can be combined with vessel puncture. This technique reduces the number of skin punctures and ensures accurate anesthetic instillation. The maximum inadvertent intravascular dose of commercial local anesthetic preparations that can be delivered with a small syringe is far below toxicity thresholds. Conclusion: A technique for combining anesthetic administration and vascular access with a 21-G needle and ultrasound guidance is feasible.
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Affiliation(s)
| | | | - Michael J. Lee
- Department of Radiology, Beaumont Hospital, Dublin, Ireland
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17
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Nelson DW, Damluji AA, Patel N, Valgimigli M, Windecker S, Byrne R, Nolan J, Patel T, Brilakis E, Banerjee S, Mayol J, Cantor WJ, Alfonso CE, Rao SV, Moscucci M, Cohen MG. Influence of operator experience and PCI volume on transfemoral access techniques: A collaboration of international cardiovascular societies. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 19:143-150. [DOI: 10.1016/j.carrev.2017.12.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 12/21/2017] [Accepted: 12/22/2017] [Indexed: 10/18/2022]
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18
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Feasibility of ultrasound-guided vascular access during cardiac implantable device placement. J Interv Card Electrophysiol 2017; 50:105-109. [DOI: 10.1007/s10840-017-0273-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 07/10/2017] [Indexed: 11/27/2022]
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Mignatti A, Friedmann P, Slovut DP. Targeting the safe zone: A quality improvement project to reduce vascular access complications. Catheter Cardiovasc Interv 2017; 91:27-32. [PMID: 28296143 DOI: 10.1002/ccd.26988] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 12/06/2016] [Accepted: 01/28/2017] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The aim of this study was to assess the effectiveness of a quality improvement (QI) program in reducing vascular complications during cardiac catheterization. BACKGROUND Vascular access complications during cardiac catheterization are associated with higher morbidity and mortality. We implemented a QI program focused on using micropuncture techniques and targeting the "safe zone," an area below the inferior border of the inferior epigastric artery and above the inferior border of the femoral head, for femoral artery puncture. METHODS Our catheterization laboratory implemented a protocol that required all operators to use micro puncture technique during diagnostic and/or percutaneous coronary interventions and to document arteriotomy in the "safe zone." We also encouraged use of vascular ultrasound, radial artery approach, and increased use of vascular closure devices (VCDS). We analyzed data on 3120 patients (2013, pre-QI cohort) and 3222 patients (2014, QI cohort). Data on vascular complications were prospectively collected and compared with the rate of complications that occurred during the same time one year prior when the QI project was not in effect. RESULTS Baseline characteristics of two cohorts of patients were similar. Compliance with the protocol was excellent. Appropriate documentation of the wire exiting the needle was observed in 95% of cases. VCD use increased from 35% in 2013 to 60% in 2014 (P < 0.001) There were no significant differences in the overall number of complications after implementation of the QI project (1.03% complications before QI implementation and 0.96% after QI implementation. P = 0.79) but there was an absolute reduction in the number of hematomas (0.77 vs. 0.40% in 2013 vs. 2014, respectively, P = 0.06) and of pseudoaneurysms (0.35 vs. 0.19% P = 0.20). Correlates of major vascular complications included), age > 75 years (HR 3.1, P < 0.0001), and PCI (vs. diagnostic cath). CONCLUSIONS Micropuncture technique in association with "safe zone targeting "did not significantly reduce vascular complications in patients undergoing cardiac catheterization, but a trend toward decrease of hematomas and pseudoaneurysms was noted. Factors such as age and type of procedure (PCI vs. diagnostic) play a significant role in the occurrence of vascular complications. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Andrea Mignatti
- Department of Cardiology, Northshore Hospital, Manhassett, New York
| | - Patricia Friedmann
- Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center, Bronx, New York
| | - David Paul Slovut
- Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center, Bronx, New York.,Division of Cardiology, Montefiore Medical Center, Bronx, New York
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20
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Azzalini L, Jolicœur EM. The wise radialist's guide to optimal transfemoral access: Selection, performance, and troubleshooting. Catheter Cardiovasc Interv 2016; 89:399-407. [DOI: 10.1002/ccd.26577] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 04/22/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Lorenzo Azzalini
- Interventional Cardiology; San Raffaele Scientific Institute; Milan Italy
| | - E. Marc Jolicœur
- Dept. of Medicine; Montreal Heart Institute, Université de Montréal; Québec Canada
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Iliescu CA, Grines CL, Herrmann J, Yang EH, Cilingiroglu M, Charitakis K, Hakeem A, Toutouzas KP, Leesar MA, Marmagkiolis K. SCAI Expert consensus statement: Evaluation, management, and special considerations of cardio-oncology patients in the cardiac catheterization laboratory (endorsed by the cardiological society of india, and sociedad Latino Americana de Cardiologıa intervencionista). Catheter Cardiovasc Interv 2016; 87:E202-23. [PMID: 26756277 DOI: 10.1002/ccd.26379] [Citation(s) in RCA: 127] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 11/28/2015] [Indexed: 12/24/2022]
Abstract
In the United States alone, there are currently approximately 14.5 million cancer survivors, and this number is expected to increase to 20 million by 2020. Cancer therapies can cause significant injury to the vasculature, resulting in angina, acute coronary syndromes (ACS), stroke, critical limb ischemia, arrhythmias, and heart failure, independently from the direct myocardial or pericardial damage from the malignancy itself. Consequently, the need for invasive evaluation and management in the cardiac catheterization laboratory (CCL) for such patients has been increasing. In recognition of the need for a document on special considerations for cancer patients in the CCL, the Society for Cardiovascular Angiography and Interventions (SCAI) commissioned a consensus group to provide recommendations based on the published medical literature and on the expertise of operators with accumulated experience in the cardiac catheterization of cancer patients.
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Affiliation(s)
- Cezar A Iliescu
- MD Anderson Cancer Center, University of Texas, Houston, Texas
| | - Cindy L Grines
- Detroit Medical Center, Cardiovascular Institute, Detroit, Michigan
| | - Joerg Herrmann
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Eric H Yang
- Division of Cardiology, University of California at Los Angeles, Los Angeles, California
| | - Mehmet Cilingiroglu
- School of Medicine, Arkansas Heart Hospital, Little Rock, Arkansas.,Department of Cardiology, Koc University, Istanbul, Turkey
| | | | - Abdul Hakeem
- Department of Cardiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | | | - Massoud A Leesar
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama
| | - Konstantinos Marmagkiolis
- Department of Cardiology, Citizens Memorial Hospital, Bolivar, Missouri.,Department of Medicine, University of Missouri, Columbia, Missouri
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22
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Gunda S, Reddy M, Pillarisetti J, Atoui M, Badhwar N, Swarup V, DiBiase L, Mohanty S, Mohanty P, Nagaraj H, Ellis C, Rasekh A, Cheng J, Bartus K, Lee R, Natale A, Lakkireddy D. Differences in Complication Rates Between Large Bore Needle and a Long Micropuncture Needle During Epicardial Access. Circ Arrhythm Electrophysiol 2015; 8:890-5. [DOI: 10.1161/circep.115.002921] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 06/05/2015] [Indexed: 11/16/2022]
Affiliation(s)
- Sampath Gunda
- From the Department of Cardiology, Mid-America Cardiology and University of Kansas Medical Center, Kansas City (S.G., M.R., J.P., M.A., D.L.); Department of Cardiology, University of California, San Francisco (N.B., R.L.); Department of Cardiology, Arizona Heart Rhythm Center, Phoenix (V.S.); Department of Cardiology, Montefiore Medical Center, Bronx, NY (L.D.); Department of Cardiology, Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin (S.M., P.M., A.N.); Nebraska Heart
| | - Madhu Reddy
- From the Department of Cardiology, Mid-America Cardiology and University of Kansas Medical Center, Kansas City (S.G., M.R., J.P., M.A., D.L.); Department of Cardiology, University of California, San Francisco (N.B., R.L.); Department of Cardiology, Arizona Heart Rhythm Center, Phoenix (V.S.); Department of Cardiology, Montefiore Medical Center, Bronx, NY (L.D.); Department of Cardiology, Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin (S.M., P.M., A.N.); Nebraska Heart
| | - Jayasree Pillarisetti
- From the Department of Cardiology, Mid-America Cardiology and University of Kansas Medical Center, Kansas City (S.G., M.R., J.P., M.A., D.L.); Department of Cardiology, University of California, San Francisco (N.B., R.L.); Department of Cardiology, Arizona Heart Rhythm Center, Phoenix (V.S.); Department of Cardiology, Montefiore Medical Center, Bronx, NY (L.D.); Department of Cardiology, Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin (S.M., P.M., A.N.); Nebraska Heart
| | - Moustapha Atoui
- From the Department of Cardiology, Mid-America Cardiology and University of Kansas Medical Center, Kansas City (S.G., M.R., J.P., M.A., D.L.); Department of Cardiology, University of California, San Francisco (N.B., R.L.); Department of Cardiology, Arizona Heart Rhythm Center, Phoenix (V.S.); Department of Cardiology, Montefiore Medical Center, Bronx, NY (L.D.); Department of Cardiology, Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin (S.M., P.M., A.N.); Nebraska Heart
| | - Nitish Badhwar
- From the Department of Cardiology, Mid-America Cardiology and University of Kansas Medical Center, Kansas City (S.G., M.R., J.P., M.A., D.L.); Department of Cardiology, University of California, San Francisco (N.B., R.L.); Department of Cardiology, Arizona Heart Rhythm Center, Phoenix (V.S.); Department of Cardiology, Montefiore Medical Center, Bronx, NY (L.D.); Department of Cardiology, Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin (S.M., P.M., A.N.); Nebraska Heart
| | - Vijay Swarup
- From the Department of Cardiology, Mid-America Cardiology and University of Kansas Medical Center, Kansas City (S.G., M.R., J.P., M.A., D.L.); Department of Cardiology, University of California, San Francisco (N.B., R.L.); Department of Cardiology, Arizona Heart Rhythm Center, Phoenix (V.S.); Department of Cardiology, Montefiore Medical Center, Bronx, NY (L.D.); Department of Cardiology, Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin (S.M., P.M., A.N.); Nebraska Heart
| | - Luigi DiBiase
- From the Department of Cardiology, Mid-America Cardiology and University of Kansas Medical Center, Kansas City (S.G., M.R., J.P., M.A., D.L.); Department of Cardiology, University of California, San Francisco (N.B., R.L.); Department of Cardiology, Arizona Heart Rhythm Center, Phoenix (V.S.); Department of Cardiology, Montefiore Medical Center, Bronx, NY (L.D.); Department of Cardiology, Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin (S.M., P.M., A.N.); Nebraska Heart
| | - Sanghamitra Mohanty
- From the Department of Cardiology, Mid-America Cardiology and University of Kansas Medical Center, Kansas City (S.G., M.R., J.P., M.A., D.L.); Department of Cardiology, University of California, San Francisco (N.B., R.L.); Department of Cardiology, Arizona Heart Rhythm Center, Phoenix (V.S.); Department of Cardiology, Montefiore Medical Center, Bronx, NY (L.D.); Department of Cardiology, Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin (S.M., P.M., A.N.); Nebraska Heart
| | - Prashanth Mohanty
- From the Department of Cardiology, Mid-America Cardiology and University of Kansas Medical Center, Kansas City (S.G., M.R., J.P., M.A., D.L.); Department of Cardiology, University of California, San Francisco (N.B., R.L.); Department of Cardiology, Arizona Heart Rhythm Center, Phoenix (V.S.); Department of Cardiology, Montefiore Medical Center, Bronx, NY (L.D.); Department of Cardiology, Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin (S.M., P.M., A.N.); Nebraska Heart
| | - Hosakote Nagaraj
- From the Department of Cardiology, Mid-America Cardiology and University of Kansas Medical Center, Kansas City (S.G., M.R., J.P., M.A., D.L.); Department of Cardiology, University of California, San Francisco (N.B., R.L.); Department of Cardiology, Arizona Heart Rhythm Center, Phoenix (V.S.); Department of Cardiology, Montefiore Medical Center, Bronx, NY (L.D.); Department of Cardiology, Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin (S.M., P.M., A.N.); Nebraska Heart
| | - Christopher Ellis
- From the Department of Cardiology, Mid-America Cardiology and University of Kansas Medical Center, Kansas City (S.G., M.R., J.P., M.A., D.L.); Department of Cardiology, University of California, San Francisco (N.B., R.L.); Department of Cardiology, Arizona Heart Rhythm Center, Phoenix (V.S.); Department of Cardiology, Montefiore Medical Center, Bronx, NY (L.D.); Department of Cardiology, Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin (S.M., P.M., A.N.); Nebraska Heart
| | - Abdi Rasekh
- From the Department of Cardiology, Mid-America Cardiology and University of Kansas Medical Center, Kansas City (S.G., M.R., J.P., M.A., D.L.); Department of Cardiology, University of California, San Francisco (N.B., R.L.); Department of Cardiology, Arizona Heart Rhythm Center, Phoenix (V.S.); Department of Cardiology, Montefiore Medical Center, Bronx, NY (L.D.); Department of Cardiology, Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin (S.M., P.M., A.N.); Nebraska Heart
| | - Jie Cheng
- From the Department of Cardiology, Mid-America Cardiology and University of Kansas Medical Center, Kansas City (S.G., M.R., J.P., M.A., D.L.); Department of Cardiology, University of California, San Francisco (N.B., R.L.); Department of Cardiology, Arizona Heart Rhythm Center, Phoenix (V.S.); Department of Cardiology, Montefiore Medical Center, Bronx, NY (L.D.); Department of Cardiology, Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin (S.M., P.M., A.N.); Nebraska Heart
| | - Krzysztof Bartus
- From the Department of Cardiology, Mid-America Cardiology and University of Kansas Medical Center, Kansas City (S.G., M.R., J.P., M.A., D.L.); Department of Cardiology, University of California, San Francisco (N.B., R.L.); Department of Cardiology, Arizona Heart Rhythm Center, Phoenix (V.S.); Department of Cardiology, Montefiore Medical Center, Bronx, NY (L.D.); Department of Cardiology, Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin (S.M., P.M., A.N.); Nebraska Heart
| | - Randall Lee
- From the Department of Cardiology, Mid-America Cardiology and University of Kansas Medical Center, Kansas City (S.G., M.R., J.P., M.A., D.L.); Department of Cardiology, University of California, San Francisco (N.B., R.L.); Department of Cardiology, Arizona Heart Rhythm Center, Phoenix (V.S.); Department of Cardiology, Montefiore Medical Center, Bronx, NY (L.D.); Department of Cardiology, Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin (S.M., P.M., A.N.); Nebraska Heart
| | - Andrea Natale
- From the Department of Cardiology, Mid-America Cardiology and University of Kansas Medical Center, Kansas City (S.G., M.R., J.P., M.A., D.L.); Department of Cardiology, University of California, San Francisco (N.B., R.L.); Department of Cardiology, Arizona Heart Rhythm Center, Phoenix (V.S.); Department of Cardiology, Montefiore Medical Center, Bronx, NY (L.D.); Department of Cardiology, Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin (S.M., P.M., A.N.); Nebraska Heart
| | - Dhanunjaya Lakkireddy
- From the Department of Cardiology, Mid-America Cardiology and University of Kansas Medical Center, Kansas City (S.G., M.R., J.P., M.A., D.L.); Department of Cardiology, University of California, San Francisco (N.B., R.L.); Department of Cardiology, Arizona Heart Rhythm Center, Phoenix (V.S.); Department of Cardiology, Montefiore Medical Center, Bronx, NY (L.D.); Department of Cardiology, Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin (S.M., P.M., A.N.); Nebraska Heart
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24
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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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25
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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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26
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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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27
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Safian RD. Vascular complications during TAVR: The cost of doing business. Catheter Cardiovasc Interv 2014; 83:465-6. [PMID: 24497457 DOI: 10.1002/ccd.25340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 12/04/2013] [Indexed: 11/12/2022]
Affiliation(s)
- Robert D Safian
- Department of Cardiovascular Medicine, Oakland University William Beaumont School of Medicine, Beaumont Health System, Royal Oak, Michigan
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Toggweiler S, Leipsic J, Binder RK, Freeman M, Barbanti M, Heijmen RH, Wood DA, Webb JG. Management of Vascular Access in Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2013; 6:643-53. [DOI: 10.1016/j.jcin.2013.04.003] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Revised: 03/29/2013] [Accepted: 04/11/2013] [Indexed: 12/17/2022]
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