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Brahmandam A, Huttler J, Bellamkonda K, Setia O, Cardella JA, Stewart W, Guzman RJ, Ochoa Chaar CI. The radiographic relationship of the femoral head, inguinal ligament, and common femoral artery bifurcation for optimal vascular access. JVS Vasc Sci 2024; 5:100196. [PMID: 38633882 PMCID: PMC11022081 DOI: 10.1016/j.jvssci.2024.100196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 02/15/2024] [Indexed: 04/19/2024] Open
Abstract
Objective Common femoral artery (CFA) access is commonly used for endovascular interventions. Access site complications contribute to significant morbidity and mortality. This study characterizes the radiographic variability in the relationship of the femoral head, the inguinal ligament, and the CFA bifurcation, to identify the zone of optimal CFA access. Methods Human cadaver dissection of the inguinal ligament and CFA bifurcation was performed. The inguinal ligament and CFA bifurcation were marked with radiopaque pins and plain anteroposterior radiographs were obtained. Radiographic measurements of the femoral head length, the distance of the top of the femoral head to the inguinal ligament, and to the CFA bifurcation were obtained. Results were reported as percentage of femoral head covered by the inguinal ligament or the CFA bifurcation relative to the top of the femoral head. A heatmap was derived to determine a safe access zone between the inguinal ligament and CFA bifurcation. Results Forty-five groin dissections (male, n = 20; female, n = 25) were performed in 26 cadavers. The mean overlap of the inguinal ligament with the femoral head was 11.2 mm (range, -19.4 to 27.4 mm). There were no age (<85 vs ≥85 years) or sex-related differences. In 82.6% of cadaveric CFA exposures, there was overlap between the inguinal ligament and femoral head (mean, 27.7%; range, -85.7% to 70.1%), with 55.6% having a >25% overlap. In 11.1%, there was an overlap between the lower one-third of the femoral head and the CFA bifurcation. Cumulatively, heatmap analysis depicted a >80% likelihood of avoiding the inguinal ligament and CFA bifurcation below the midpoint of the femoral head. Conclusions Significant variability exists in the relationship between the inguinal ligament, CFA bifurcation, and the femoral head, suggesting the lack of a consistently safe access zone. The safest access zone in >80% of patients lies below the radiographic midpoint of the femoral head and the inferior aspect of the femoral head.
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Affiliation(s)
- Anand Brahmandam
- Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Kirthi Bellamkonda
- Division of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Ocean Setia
- Division of Vascular Surgery and Endovascular Therapy, Yale University School of Medicine, New Haven, CT
| | - Jonathan A. Cardella
- Division of Vascular Surgery and Endovascular Therapy, Yale University School of Medicine, New Haven, CT
| | - William Stewart
- Section of Anatomy, Department of Surgery, Yale University School of Medicine, New Haven, CT
| | - Raul J. Guzman
- Division of Vascular Surgery and Endovascular Therapy, Yale University School of Medicine, New Haven, CT
| | - Cassius Iyad Ochoa Chaar
- Division of Vascular Surgery and Endovascular Therapy, Yale University School of Medicine, New Haven, CT
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Clinical application of Shenton's line to determine the femoral artery bifurcation using the antegrade common femoral artery approach. Chin Med J (Engl) 2022; 135:2107-2109. [PMID: 34985020 PMCID: PMC9746745 DOI: 10.1097/cm9.0000000000001873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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Fujiwara T, Ikeda H, Kuriyama A, Ono T, Takada K, Handa A, Uezato M, Kinosada M, Kurosaki Y, Chin M. Inferior Epigastric Artery Injury due to Femoral Venipuncture for Neuroendovascular Intervention: Two Cases Requiring Transcatheter Arterial Embolization. JOURNAL OF NEUROENDOVASCULAR THERAPY 2022; 16:467-473. [PMID: 37502792 PMCID: PMC10370989 DOI: 10.5797/jnet.cr.2022-0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 04/01/2022] [Indexed: 07/29/2023]
Abstract
Objective Injury to the inferior epigastric artery (IEA) caused by femoral puncture may lead to retroperitoneal hematoma. We report on two cases of IEA injury due to femoral venipuncture for neuroendovascular intervention that resulted in hemorrhagic shock and required transcatheter arterial embolization. Case Presentations A 67-year-old woman and a 71-year-old man receiving dual antiplatelet therapy sustained injury to a branch of the IEA in the process of right femoral venipuncture for neuroendovascular intervention. In both cases, stent placement in the intracranial artery was accomplished as intended with systemic heparinization throughout the procedure; however, the patients became hypotensive during the procedure, and contrast-enhanced CT scans taken after the stenting revealed extravasation of contrast from the IEA and retroperitoneal hematoma. Transcatheter arterial embolization of the bleeding branch of the IEA was performed with the left femoral approach, and subsequent angiography confirmed the disappearance of the extravasation of contrast. Conclusion Femoral venipuncture for neuroendovascular intervention in patients receiving antithrombotic agents may cause IEA injury requiring transcatheter arterial embolization. The risk of IEA injury may be reduced by using the femoral head as a reference, performing ultrasound-guided puncture, and confirming the course of the IEA by femoral angiography before venipuncture.
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Affiliation(s)
- Toshio Fujiwara
- Department of Neurosurgery and Stroke, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Hiroyuki Ikeda
- Department of Neurosurgery and Stroke, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Akira Kuriyama
- Emergency and Critical Care Center, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Takafumi Ono
- Department of Diagnostic Radiology, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Kensuke Takada
- Department of Neurosurgery and Stroke, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Akira Handa
- Department of Neurosurgery and Stroke, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Minami Uezato
- Department of Neurosurgery and Stroke, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Masanori Kinosada
- Department of Neurosurgery and Stroke, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Yoshitaka Kurosaki
- Department of Neurosurgery and Stroke, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Masaki Chin
- Department of Neurosurgery and Stroke, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
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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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Morita S, Yamamoto T, Kamoshida K, Yamazaki H, Yatabe M, Ichihara A, Sakai S. High Deep Femoral Artery Bifurcation Can Disturb Safe Femoral Venous Access: CT Assessment in Patients Who Underwent Femoral Venous Access Under Doppler Ultrasound Guidance. INTERVENTIONAL RADIOLOGY (HIGASHIMATSUYAMA-SHI (JAPAN) 2021; 6:29-36. [PMID: 35909911 PMCID: PMC9327428 DOI: 10.22575/interventionalradiology.2021-0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 03/28/2021] [Indexed: 06/15/2023]
Abstract
PURPOSE To retrospectively evaluate the variations of deep femoral artery (DFA) bifurcation on computed tomography (CT) and technical success in femoral venous access. MATERIALS AND METHODS CT images of 353 patients who underwent adrenal venous sampling were evaluated. Height with relation to the inferior border of the femoral head and direction of DFA bifurcations were classified as follows: type L, low bifurcation; type H1, high lateral bifurcation; type H2, high posterior to posterolateral bifurcation; type H3, high posteromedial bifurcation; and type H4, high medial bifurcation crossing in front of the femoral vein. Technical success and complications during femoral venous access were also evaluated. RESULTS The frequencies of types L, H1, H2, H3, and H4 were 82.7%, 9.1%, 6.9%, 0.4%, and 0.9%, respectively. In 92.2% of type H1 and 69.4% of type H2, the superior femoral artery displaced medially by the high DFA partially overlapped the femoral vein. Upon the inclusions of H3 and H4, in 14.4% of cases, the high DFAs could obstruct the access route to the femoral vein. Using Doppler ultrasound guidance, no significant differences were observed in the rates of success for puncture in the first attempt (84.5% vs. 75.4%, p = 0.122) and accidental arterial puncture (1.0% vs. 0%, p = 1.00) between low and high DFA bifurcations, respectively. CONCLUSIONS High DFA bifurcation is observed in 17.3% of patients and could obstruct the access route to the femoral vein. This can be evaluated using Doppler ultrasound guidance to avoid accidental arterial puncture during femoral venous access.
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Affiliation(s)
- Satoru Morita
- Department of Diagnostic Imaging and Nuclear Medicine, Tokyo Women's Medical University Hospital, Japan
| | - Takahiro Yamamoto
- Department of Diagnostic Imaging and Nuclear Medicine, Tokyo Women's Medical University Hospital, Japan
| | - Kumi Kamoshida
- Department of Diagnostic Imaging and Nuclear Medicine, Tokyo Women's Medical University Hospital, Japan
| | - Hiroshi Yamazaki
- Department of Diagnostic Imaging and Nuclear Medicine, Tokyo Women's Medical University Hospital, Japan
| | - Midori Yatabe
- Department of Medicine II, Endocrinology and Hypertension, Tokyo Women's Medical University Hospital, Japan
| | - Atsuhiro Ichihara
- Department of Medicine II, Endocrinology and Hypertension, Tokyo Women's Medical University Hospital, Japan
| | - Shuji Sakai
- Department of Diagnostic Imaging and Nuclear Medicine, Tokyo Women's Medical University Hospital, Japan
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Hwang JH, Park SW, Kwon YW, Min J, Chee HK, Shin JK. Ultrasonography-guided antegrade common femoral artery approach: Factors associated with access time. J Vasc Access 2020; 22:364-369. [PMID: 32669031 DOI: 10.1177/1129729820942053] [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: 11/15/2022] Open
Abstract
INTRODUCTION The aim of this study was to evaluate the feasibility and safety of ultrasonography-guided antegrade common femoral artery puncture and subsequent superficial femoral artery access without the aid of fluoroscopy. Factors that could affect access time were also assessed. METHODS A total of 294 cases from 218 consecutive patients (163 men, 55 women; mean age: 66.9 ± 12.7 years) who underwent lower extremity endovascular procedures were retrospectively evaluated. The time between the injection of local anesthetic and the insertion of the microsheath into the superficial femoral artery was measured. The common femoral artery diameter, cutis thickness, distance between arterial puncture site and common femoral artery bifurcation, degree of common femoral artery calcification, body mass index, and history of previous access were investigated to assess their relationship with access time. Furthermore, all cases were assessed with ultrasonography for access-site complications before discharge. RESULTS Technical success was achieved in 293 of 294 procedures (99.7%). The mean time for superficial femoral artery access was 1.9 ± 0.8 min (range, 0.7-3.7 min). Additional fluoroscopic guidance was needed in one case. There were moderately positive correlations of body mass index (r = 0.75; p < 0.001) and cutis thickness (r = 0.58; p < 0.001) with access time. The other variables failed to reveal significant correlations with access time. Five groin hematomas occurred after percutaneous transluminal angioplasty. Complications such as pseudoaneurysm, arteriovenous fistula, or retroperitoneal hematoma were not observed. CONCLUSION Antegrade common femoral artery puncture with subsequent superficial femoral artery access conducted solely under ultrasonography guidance was feasible and safe. In addition, the antegrade access time showed positive correlations with body mass index and cutis thickness.
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Affiliation(s)
- Jin Ho Hwang
- Department of Radiology, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Sang Woo Park
- Department of Radiology, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Yong Wonn Kwon
- Department of Radiology, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Jeeyoung Min
- Department of Radiology, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Hyun Keun Chee
- Department of Thoracic and Cardiovascular Surgery, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Je Kyoun Shin
- Department of Thoracic and Cardiovascular Surgery, Konkuk University School of Medicine, Seoul, Republic of Korea
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Gopalakrishnan PP, Manoharan P, Shekhar C, Seto A, Sinha R, David M, Shah M, Nagajothi N. Redefining the fluoroscopic landmarks for common femoral arterial puncture during cardiac catheterization: Femoral angiogram and computed tomography angiogram (FACT) study of common femoral artery anatomy. Catheter Cardiovasc Interv 2019; 94:367-375. [PMID: 30537421 DOI: 10.1002/ccd.27991] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 10/03/2018] [Accepted: 10/29/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND The mid-femoral head (F50 ) is a common fluoroscopic target for common femoral artery (CFA) puncture during cardiac catheterization. Punctures above the inguinal ligament (marking the proximal end of CFA) increase the risk of retroperitoneal hemorrhage and are classified as high punctures. METHODS We retrospectively analyzed 114 CT angiograms for the anatomic relationship of the inguinal ligament to the femoral head (FH) and inferior epigastric artery (IEA). We analyzed 114 CT angiograms and 500 femoral angiograms, for the relation of the mid-point of CFA to F50 and F75 (the junction of upper 3/4th and lower 1/4th of FH). RESULTS The proximal third of femoral head (F33 ) (-1.4 mm) and IEA nadir (-2.9 mm) were closer approximations to the inguinal ligament than the IEA origin (-12.8 mm) or cranial end of FH (-15.2 mm). The inguinal ligament correlated better with the IEA nadir than F33 (R2 = 0.49 vs. 0.001). F75 was a closer approximation for the mid-point of the CFA than F50 (0.3 mm vs. -9.2 mm). Using F75 as the target for CFA puncture carried the lowest risk for non-CFA punctures (18.6%), while using F50 had a 41.2% risk for non-CFA punctures. F75 had an increased risk for low punctures (14.2%) but F50 had a far higher risk for high punctures (36.6%). CONCLUSIONS The nadir of IEA is the best landmark for identifying the inguinal ligament (the proximal end of CFA) and defining high punctures. F75 is a more accurate target for successful CFA puncture than F50.
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Affiliation(s)
| | | | | | - Arnold Seto
- Division of Cardiology, University of California, Irvine Medical Center, Orange, California
| | - Rahul Sinha
- Division of Cardiology, Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Manova David
- Division of Cardiology, Aultman Hospital, Canton, Ohio
| | - Moneal Shah
- Division of Cardiology, Allegheny Health Network, Pittsburgh, Pennsylvania
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El-Maadawy MI, Balboula AM, Zaghloul H. Tunneled Ipsilateral Sheath: A Novel Technique in Endovascular Management of Superficial Femoral Artery Ostial Lesions. Vasc Endovascular Surg 2019; 53:337-340. [PMID: 30606079 DOI: 10.1177/1538574418823593] [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
Ostial lesions of the superficial femoral artery preclude the use of ipsilateral common femoral artery antegrade approach. Access via either the contralateral common femoral or the brachial arteries are the 2 alternative classical approaches. Conversely, using an ipsilateral antegrade approach, through a partially inserted sheath, usually leaves the sheath insecure and frequently hits ostial lesion itself during insertion. Dislodgment from the artery frequently occurs, resulting in loss of access. We describe a technique whereby we insert 2 to 3 cm of the sheath into the common femoral artery and the remaining part of the sheath resides in a fashioned subcutaneous tunnel of the lowermost abdomen. Technical details are provided as well as the results of using this technique on 37 patients. The technique is safe, easy to perform, and reproducible.
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Affiliation(s)
- Mohamed I El-Maadawy
- 1 Vascular Surgery Unit, Department of Surgery, Kasr Alainy School of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed M Balboula
- 1 Vascular Surgery Unit, Department of Surgery, Kasr Alainy School of Medicine, Cairo University, Cairo, Egypt
| | - Hossam Zaghloul
- 1 Vascular Surgery Unit, Department of Surgery, Kasr Alainy School of Medicine, Cairo University, Cairo, Egypt
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Son SY, Cho KC, Cho P, Lee JH, Myoung SU, Choi JH. Prepuncture Ultrasound Examination Facilitates Safe and Accurate Common Femoral Artery Access for Transfemoral Cerebral Angiography. J Cerebrovasc Endovasc Neurosurg 2017; 19:276-283. [PMID: 29387628 PMCID: PMC5788835 DOI: 10.7461/jcen.2017.19.4.276] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Revised: 08/22/2017] [Accepted: 10/25/2017] [Indexed: 11/23/2022] Open
Abstract
Objective We aimed to introduce our method involving prepuncture ultrasound scan for cannulation of the common femoral artery (CFA) during transfemoral cerebral angiography (TFCA), and to assess the clinical and radiological outcomes. Material and Methods Our study included 90 patients who underwent prepuncture ultrasound examination of the inguinal area for TFCA between April 2015 and June 2015. Prior to skin preparation and draping of the inguinal area, we identified the CFA and its bifurcation using ultrasound. Based on the ultrasound findings, we marked cruciate lines in the inguinal area. Thereafter, we inserted a puncture needle at the interface between the horizontal and vertical lines at a 30-45° angle, simultaneously palpating the pulsation of the femoral artery. After TFCA was completed, femoral artery angiography was performed in the anteroposterior and oblique directions. Clinical and radiological parameters, including CFA cannulation, the ultrasound scan time, the first pass success rate, the time required for the passage of the wire, and complications, were evaluated. Results The mean ultrasound scan time of the CFA and its bifurcation was 72.6 seconds, and the mean time between administration of local anesthesia and wire passage was 67.44 seconds. The first pass success rate was 77.8% (70/90 patients), and the CFA puncture rate was 98.8% (89/90 patients). Although minor complications were noted in 7 patients, no patient reported serious complications (a large hematoma [≥ 5 cm], pseudoaneurysms, dissection, and/or a retroperitoneal hematoma.). Conclusion Prepuncture ultrasound examination might be a simple, safe, and accurate technique for cannulation of the CFA during TFCA.
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Affiliation(s)
- Seon Yong Son
- Department of Neurosurgery, Bundang Jesaeng General Hospital, Sungnam, Korea
| | - Kwang-Chun Cho
- Department of Neurosurgery, Bundang Jesaeng General Hospital, Sungnam, Korea
| | - Pyunggoo Cho
- Department of Neurosurgery, Bundang Jesaeng General Hospital, Sungnam, Korea
| | - Ju Hyung Lee
- Department of Neurosurgery, Bundang Jesaeng General Hospital, Sungnam, Korea
| | - Seong Uk Myoung
- Department of Radiology, Bundang Jesaeng General Hospital, Sungnam, Korea
| | - Jai Ho Choi
- Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
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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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Pitcher GS, Newton DH, Amendola MF. Common Femoral Artery Access on YouTube: What Practices are Being Shown and Who is Delivering the Message? JOURNAL OF SURGICAL EDUCATION 2017; 74:455-458. [PMID: 28011261 DOI: 10.1016/j.jsurg.2016.11.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 11/19/2016] [Accepted: 11/24/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES Novice learners are increasingly turning to YouTube as a learning resource for surgical procedures. One example of such a procedure is common femoral artery puncture and sheath placement. Practitioners in several specialties perform this procedure to access the arterial system for angiography and intervention. We set forth to compare the techniques demonstrated on YouTube by the various specialists, as well as compare each specialty׳s prevalence on this website. METHODS YouTube (www.youtube.com) was accessed in December 2015 at multiple time points with a cleared-cache web browser for the keyword search categories: "femoral artery access," "femoral access," and "angiography access." The top 500 videos from each of these keyword searches were analyzed. Videos were categorized by practitioner specialty, technique, duration of video, age of video, and total views. Videos with clear demonstration of femoral artery access were included in the analysis. All industry videos were excluded from the analysis. Categorical variables were compared using Fisher׳s exact test, and continuous variables were compared with the Student׳s t-test. RESULTS A total of 2460, 4680 and 1800 videos were found for each keyword search, respectively. Of these, 33 videos clearly demonstrated femoral artery access technique. Vascular specialists, compared to interventional cardiology and radiology, had fewer videos (n = 4 vs. 14) and older videos (3.5 ± 2.1y vs. 2.25 ± 0.5y, p < 0.05). The vascular specialists demonstrated ultrasound-guided access, while interventional cardiology predominantly demonstrated landmark-guided access (p < 0.05). CONCLUSIONS Although YouTube and other online resources are being used by novice learners, vascular specialists are underrepresented for femoral artery access, a foundational vascular procedure. Other practitioners demonstrate videos with landmark-guided access and rarely demonstrate ultrasound use. As recognized vascular experts, vascular surgeons should improve their visibility in online learning resources.
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Affiliation(s)
- Grayson S Pitcher
- Division of Vascular Surgery, VCU School of Medicine, Richmond, Virginia.
| | - Daniel H Newton
- Division of Vascular Surgery, VCU School of Medicine, Richmond, Virginia
| | - Michael F Amendola
- Division of Vascular Surgery, VCU School of Medicine, Richmond, Virginia; Division of Vascular Surgery, VCU Health System, Richmond, Virginia
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12
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Nawaz Y, Barvalia M, Rana G, Khakwani MZ, Azim K, Patel R, Idrees S, Baker G, Cohen M, Wasty N. Poorly recognized age-related downward deviation of the inguinal ligament. SAGE Open Med 2016; 4:2050312116675565. [PMID: 27826446 PMCID: PMC5084609 DOI: 10.1177/2050312116675565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 09/26/2016] [Indexed: 11/17/2022] Open
Abstract
Objective: To determine factors affecting actual inguinal ligament course in live human subjects. Introduction and hypothesis: Although the expected inguinal ligament course is supposedly a straight line extending from anterior superior iliac spine to pubic tubercle, the actual inguinal ligament course is frequently depicted a priori by a downward bowing dotted line. There are no studies in a live subject supporting this assumption. We hypothesized this assumption is indeed valid and is related to among other factors a lifelong effect of gravity and lax abdominal musculature on the inguinal ligament course. Methods: We retrospectively reviewed 54 consecutive computed tomography scans of the abdomen and pelvis randomly distributed across all age groups. Actual inguinal ligament course was visualized by reconstructing images using Terracon software. Vertical distance from the lowest point of actual inguinal ligament course to the expected inguinal ligament course was measured. We used multiple linear regression analysis to study the correlation between degree of inguinal ligament deviation and several variables. Results: Actual inguinal ligament course was below the expected inguinal ligament course in 52 of 54 patients. The mean deviation was 8.2 ± 5.9 mm. Advanced age was significantly associated with greater downward bowing of the inguinal ligament (p = 0.001). Conclusion: Actual inguinal ligament course is often well below the expected inguinal ligament course; this downward bowing of the inguinal ligament is especially pronounced with advancing age. Operators need to be mindful as this downward bowing can lead to supra-inguinal sticks causing vascular complications.
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Affiliation(s)
- Yassir Nawaz
- Cardiac Catheterization Lab, Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ, USA
| | - Mihir Barvalia
- Cardiac Catheterization Lab, Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ, USA
| | - Gurinder Rana
- Cardiac Catheterization Lab, Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ, USA
| | - M Zain Khakwani
- Cardiac Catheterization Lab, Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ, USA
| | - Khizr Azim
- Cardiac Catheterization Lab, Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ, USA
| | - Rahul Patel
- Cardiac Catheterization Lab, Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ, USA
| | - Sohira Idrees
- Cardiac Catheterization Lab, Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ, USA
| | - Gail Baker
- Cardiac Catheterization Lab, Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ, USA
| | - Marc Cohen
- Cardiac Catheterization Lab, Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ, USA
| | - Najam Wasty
- Cardiac Catheterization Lab, Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ, USA
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13
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Seto AH, Tyler J, Suh WM, Harrison AT, Vera JA, Zacharias SJ, Daly TS, Sparling JM, Patel PM, Kern MJ, Abu-Fadel M. Defining the common femoral artery: Insights from the femoral arterial access with ultrasound trial. Catheter Cardiovasc Interv 2016; 89:1185-1192. [PMID: 27566991 DOI: 10.1002/ccd.26727] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 05/16/2016] [Accepted: 08/01/2016] [Indexed: 11/06/2022]
Abstract
OBJECTIVE We sought to establish the typical location of the common femoral artery (CFA) bifurcation, the origin and most inferior reflection of the inferior epigastric artery (IEA) relative to the femoral head (FH) and whether patient demographics predicted anatomical variations. BACKGROUND In the absence of ultrasound guidance or prior imaging, the precise location of the CFA bifurcation and IEA can only be determined following access site angiography. Fluoroscopic landmarks are commonly used to estimate the location of the CFA bifurcation, but the position of the IEA is less well characterized. METHODS Prospectively collected data on 989 patients with femoral angiography in the FAUST trial were analyzed. The level of CFA bifurcation and the origin and most inferior reflection of the IEA were classified by angiography. Logistic regression was used to explore whether baseline demographics were associated with anatomic variations. RESULTS The CFA bifurcation occurs below the middle 1/3rd of the femoral head in 95% of patients, and no patient factors are predictive of a high bifurcation. The IEA origin has a more variable anatomically pattern, with high BSA, male gender, and white race associated with a low IEA origin. CONCLUSION Operators should attempt to access the CFA at the level of the middle 1/3rd of the FH to maximize the chance of CFA cannulation. However, this location carries an 11% risk of being at or above the IEA origin. Baseline demographics were of limited utility for predicting anatomic variants of the CFA bifurcation and the course of the IEA. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Arnold H Seto
- Department of Medicine, Veterans Affairs Long Beach Health Care System, Long Beach, California.,Department of Medicine, University of Califonia, Irvine Medical Center, Orange, California
| | - Jeffrey Tyler
- Department of Medicine, University of California, San Francisco Medical Center, San Francisco, California
| | - William M Suh
- Department of Medicine, University of California, Los Angeles Medical Center, Los Angeles, California
| | | | - Jesus A Vera
- Cardiothoracic Department, St Jude Medical Center, Fullerton, California
| | | | - Timothy S Daly
- Department of Cardiology, INTEGRIS Heart Hospital, Oklahoma City, Oklahoma
| | - Jeffrey M Sparling
- Department of Cardiology, INTEGRIS Heart Hospital, Oklahoma City, Oklahoma
| | - Pranav M Patel
- Department of Medicine, University of Califonia, Irvine Medical Center, Orange, California
| | - Morton J Kern
- Department of Medicine, Veterans Affairs Long Beach Health Care System, Long Beach, California.,Department of Medicine, University of Califonia, Irvine Medical Center, Orange, California
| | - Mazen Abu-Fadel
- Department of Medicine, Cardiovascular section, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
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Yun SJ, Nam DH, Ryu JK. Femoral Artery Access Using the US-Determined Inguinal Ligament and Femoral Head as Reliable Landmarks: Prospective Study of Usefulness and Safety. J Vasc Interv Radiol 2015; 26:552-9. [DOI: 10.1016/j.jvir.2014.12.613] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2014] [Revised: 12/17/2014] [Accepted: 12/22/2014] [Indexed: 10/23/2022] Open
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15
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Canepa M, AlGhatrif M, Pestelli G, Kankaria R, Makrogiannis S, Strait JB, Brunelli C, Lakatta EG, Ferrucci L. Impact of central obesity on the estimation of carotid-femoral pulse wave velocity. Am J Hypertens 2014; 27:1209-17. [PMID: 24637912 DOI: 10.1093/ajh/hpu038] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Studies have found that central obesity is associated with higher carotid-femoral pulse wave velocity (PWV). However, traveled distance (TD) measured over the body surface can be substantially overestimated with wider waist circumference (WC). We sought to investigate whether central obesity biases the estimation of PWV and whether this bias explains the association between PWV and different measures of adiposity. METHODS Seven hundred eleven participants (49.5% men) from the Baltimore Longitudinal Study of Aging with PWV, anthropometrics, and quantification of different fat depots by computed tomography and dual x-ray absorptiometry were included. TD and relative PWV were estimated with a tape measure over the body surface or linear distances taken from radiological images, unaffected by obesity. RESULTS A significant association was found between wider WC and a greater difference between the 2 TD measurements and their respective PWV in both sexes (r ≥ 0.34; P < 0.001). This overestimation bias appeared to be generally higher in women than men (0.27 m/sec for each unit increase in WC; P < 0.0001). When TD estimated over the body surface was used to calculate PWV, greater WC, total body fat, subcutaneous fat, and visceral fat were all associated with higher PWV (P < 0.05 for all). However, when PWV was calculated using TD estimated from radiological images or body height, only the association with visceral fat held significant. CONCLUSIONS When TD is measured over the body surface, the role of obesity on PWV is substantially overestimated. After accounting for this bias, PWV was still independently associated with visceral fat but not with other measures of adiposity, confirming its contribution to arterial stiffening.
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Affiliation(s)
| | - Majd AlGhatrif
- Longitudinal Studies Section, Translational Gerontology Branch, National Institute of Aging, National Institutes of Health, Baltimore, Maryland; Laboratory of Cardiovascular Sciences, Human Cardiovascular Studies Unit, National Institute of Aging, National Institutes of Health, Baltimore, Maryland; Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland.
| | - Gabriele Pestelli
- Department of Internal Medicine, University of Genova, Genova, Italy
| | - Rohan Kankaria
- Laboratory of Cardiovascular Sciences, Human Cardiovascular Studies Unit, National Institute of Aging, National Institutes of Health, Baltimore, Maryland
| | - Sokratis Makrogiannis
- Longitudinal Studies Section, Translational Gerontology Branch, National Institute of Aging, National Institutes of Health, Baltimore, Maryland
| | - James B Strait
- Longitudinal Studies Section, Translational Gerontology Branch, National Institute of Aging, National Institutes of Health, Baltimore, Maryland; Laboratory of Cardiovascular Sciences, Human Cardiovascular Studies Unit, National Institute of Aging, National Institutes of Health, Baltimore, Maryland
| | - Claudio Brunelli
- Department of Internal Medicine, University of Genova, Genova, Italy
| | - Edward G Lakatta
- Laboratory of Cardiovascular Sciences, Human Cardiovascular Studies Unit, National Institute of Aging, National Institutes of Health, Baltimore, Maryland
| | - Luigi Ferrucci
- Longitudinal Studies Section, Translational Gerontology Branch, National Institute of Aging, National Institutes of Health, Baltimore, Maryland
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16
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Ahn HY, Lee HJ, Lee HJ, Yang JH, Yi JS, Lee IW. Assessment of the optimal site of femoral artery puncture and angiographic anatomical study of the common femoral artery. J Korean Neurosurg Soc 2014; 56:91-7. [PMID: 25328644 PMCID: PMC4200372 DOI: 10.3340/jkns.2014.56.2.91] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 05/05/2014] [Accepted: 08/16/2014] [Indexed: 11/29/2022] Open
Abstract
Objective The purpose of this study was to evaluate demographic and clinical factors affecting the common femoral artery diameter and length, and anatomical relationship between the femoral head and the common femoral artery during angiography. Methods We retrospectively reviewed 109 femoral angiograms. We collected the clinical data of the patients and estimated the common femoral artery diameter and length. We divided the areas in the angiogram from cephalic to caudal direction (zone 0 to 5). The lowest levels of the inferior epigastric artery loop and points of the common femoral artery bifurcation were checked. Results The luminal diameter of the common femoral artery was 6.19±1.20 mm. Height, weight, body surface area, as well as common femoral artery diameter were significantly greater in men than in women (p<0.005). The length of the common femoral artery was 27.59±8.87 mm. Height, weight and body surface area showed strong positive relationships with common femoral artery diameter. All of the inferior epigastric artery loops were located above the center of the femoral head. The point of common femoral artery bifurcation was above the center of the femoral head in 4.59% of femoral angiograms. Conclusions Males and patients with a high body surface area have a larger common femoral artery diameter. The cumulative probability of optimal targeting between the lowest margin of the inferior epigastric artery loop and the common femoral artery bifurcation is the highest in zone 3 puncture.
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Affiliation(s)
- Ho-Young Ahn
- Department of Neurosurgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
| | - Hyung-Jin Lee
- Department of Neurosurgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
| | - Hong-Jae Lee
- Department of Neurosurgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
| | - Ji-Ho Yang
- Department of Neurosurgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
| | - Jin-Seok Yi
- Department of Neurosurgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
| | - Il-Woo Lee
- Department of Neurosurgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
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