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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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Khan MA, Dodo-Williams TS, Janssen C, Patel RJ, Mahmud E, Malas MB. Comparing Outcomes of Transfemoral Versus Transbrachial or Transradial Approach in Carotid Artery Stenting (CAS). Ann Vasc Surg 2023:S0890-5096(23)00053-5. [PMID: 36758939 DOI: 10.1016/j.avsg.2023.01.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/18/2023] [Accepted: 01/19/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND While Transfemoral Carotid Artery Stenting (TFCAS) is a valid minimally invasive option for patients who also might be suitable for carotid endarterectomy (CEA) or transcarotid artery revascularization (TCAR), alternative access sites such as transbrachial (TB) or transradial (TR) are only utilized when anatomic factors preclude direct carotid or transfemoral access. In this study, we aimed to evaluate the outcomes of TR/TB access in comparison to TF for percutaneous carotid artery revascularization. METHODS All patients undergoing non-TCAR carotid artery stenting (CAS) from January 2012 to June 2021 in the Vascular Quality Initiative (VQI) Database were included. Patients were divided into 2 groups based on the access site for CAS: TF or TR/TB. Primary outcomes included stroke/death, technical failure and access site complications (hematoma, stenosis, infection, pseudoaneurysm and AV fistula). Secondary outcomes included stroke, TIA, MI, death, non-home discharge, extended length of postoperative stay (LOS) (>1 day), and composite endpoints of stroke/MI and stroke/death/MI. Univariable and multivariable logistic regression models were used to assess postoperative outcomes, and results were adjusted for relevant potential confounders including age, gender, race, degree of stenosis, symptomatic status, anesthesia, comorbidities, and preoperative medications. RESULTS Out of the 23,965 patients, TR/TB approach was employed in 819 (3.4%) while TF was used in 23,146 (96.6%). Baseline characteristics found men were more likely to undergo revascularization using TR/TB approach (69.4% vs. 64.9%, P = 0.009). Patients undergoing TR/TB approach were also more likely to be symptomatic (49.9% vs. 28.6%, P < 0.001). Guideline directed medications were more frequently used with TR/TB including P2Y12 inhibitor (80.3% vs. 74.7%, P < 0.01), statin (83.8% vs. 80.6%), and aspirin (88.3% vs. 84.5%, P = 0.003) preoperatively. On univariate analysis, patients with TB/TR approach experienced higher rates of adverse outcomes. After adjusting for potential confounders, TR/TB patients had no significant increase in the risk of stroke/death [aOR 1.10 (0.69-1.76), P = 0.675]; however, the use of TR/TB access was associated with a more than 2-fold increase in risk for in-hospital MI [aOR 2.39 (1.32-4.30), P = 0.004] and 2-fold increase in risk of technical failure [aOR 2.21 (1.31-3.73) P = 0.003]. The use of TR/TB access was also associated with a 50% reduction in the risk of access site complications [aOR 0.53 (0.32-0.85), P = 0.009]. CONCLUSIONS This study confirms that although technically more challenging, TR or TB approach serves as a reasonable alternative with lower access site complications for CAS particularly in patients where anatomic factors preclude revascularization by TFCAS or TCAR. However, TR/TB is associated with an increased risk of technical failure and myocardial infarction, which requires further study.
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Affiliation(s)
- Maryam Ali Khan
- Division of Vascular and Endovascular Surgery, University of California San Diego Health, La Jolla, CA
| | - Taiwo S Dodo-Williams
- Division of Vascular and Endovascular Surgery, University of California San Diego Health, La Jolla, CA
| | - Claire Janssen
- Division of Vascular and Endovascular Surgery, University of California San Diego Health, La Jolla, CA
| | - Rohini J Patel
- Division of Vascular and Endovascular Surgery, University of California San Diego Health, La Jolla, CA
| | - Ehtisham Mahmud
- Division of Cardiovascular Medicine, University of California San Diego Health, La Jolla, CA
| | - Mahmoud B Malas
- Division of Vascular and Endovascular Surgery, University of California San Diego Health, La Jolla, CA.
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Kumar AP, Valakkada J, Ayappan A, Kannath S. Management of Acute Complications during Endovascular Procedures in Peripheral Arterial Disease: A Review. JOURNAL OF CLINICAL INTERVENTIONAL RADIOLOGY ISVIR 2022. [DOI: 10.1055/s-0042-1760246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
AbstractEndovascular therapy, as opposed to surgical bypass, has become the mainstay for peripheral arterial disease even in long segment occlusions. Complications can occur during the arterial access, catheter manipulation, balloon dilation, and/or stent placement. Given the high prevalence of comorbidities such as diabetes, hypertension, renal dysfunction, and coronary artery disease in these patients, early identification of procedural complications and initiation of treatment are of paramount importance. This review aims to provide comprehensive data on the identification and management of commonly encountered endovascular complications during endovascular interventions in peripheral arterial disease.
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Affiliation(s)
- Ajay Pawan Kumar
- Department of Imaging Sciences and Interventional Radiology, Sreechitra Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Jineesh Valakkada
- Department of Imaging Sciences and Interventional Radiology, Sreechitra Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Anoop Ayappan
- Department of Imaging Sciences and Interventional Radiology, Sreechitra Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Santhosh Kannath
- Department of Imaging Sciences and Interventional Radiology, Sreechitra Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
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Manning JE, Moore EE, Morrison JJ, Lyon RF, DuBose JJ, Ross JD. Femoral vascular access for endovascular resuscitation. J Trauma Acute Care Surg 2021; 91:e104-e113. [PMID: 34238862 DOI: 10.1097/ta.0000000000003339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Endovascular resuscitation is an emerging area in the resuscitation of both severe traumatic hemorrhage and nontraumatic cardiac arrest. Vascular access is the critical first procedural step that must be accomplished to initiate endovascular resuscitation. The endovascular interventions presently available and emerging are routinely or potentially performed via the femoral vessels. This may require either femoral arterial access alone or access to both the femoral artery and vein. The time-critical nature of resuscitation necessitates that medical specialists performing endovascular resuscitation be well-trained in vascular access techniques. Keen knowledge of femoral vascular anatomy and skill with vascular access techniques are required to meet the needs of critically ill patients for whom endovascular resuscitation can prove lifesaving. This review article addresses the critical importance of femoral vascular access in endovascular resuscitation, focusing on the pertinent femoral vascular anatomy and technical aspects of ultrasound-guided percutaneous vascular access and femoral vessel cutdown that may prove helpful for successful endovascular resuscitation.
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Affiliation(s)
- James E Manning
- From the Department of Emergency Medicine (J.E.M.), University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Division of Trauma Surgery (J.E.M.), Oregon Health & Sciences University, Portland, Oregon; Ernest E Moore Shock Trauma Center at Denver Health (E.E.M.), Denver; Department of Surgery (E.E.M.), University of Colorado, Denver, Colorado; R. Adams Cowley Shock Trauma Center (J.J.M., J.J.D.); Department of Surgery (J.J.M., J.J.D.), University of Maryland School of Medicine, Baltimore, Maryland; Naval Postgraduate School Department of Defense Analysis (R.F.L.) Monterey, California; Charles T. Dotter Department of Interventional Radiology (J.D.R.), Oregon Health & Sciences University, Portland, Oregon; and Military & Health Research Foundation (J.D.R.), Laurel, Maryland
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Heiliger C, Piecuch J, Frank A, Andrade D, von Ehrlich-Treuenstätt V, Evtimova D, Kühn F, Werner J, Karcz K. Laparoscopic intraarterial catheterization with selective ICG fluorescence imaging in colorectal surgery. Sci Rep 2021; 11:14753. [PMID: 34285284 PMCID: PMC8292501 DOI: 10.1038/s41598-021-94244-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 07/07/2021] [Indexed: 11/29/2022] Open
Abstract
The quality of mesorectal resection is crucial for resection in rectal cancer, which should be performed by laparoscopy for better outcome. The use of indocyanine green (ICG) fluorescence is now routinely used in some centers to evaluate bowel perfusion. Previous studies have demonstrated in animal models that selective intra-arterial ICG staining can be used to define and visualize resection margins in rectal cancer. In this animal study, we investigate if laparoscopic intra-arterial catheterization is feasible and the staining of resection margins when performing total mesorectal excision with a laparoscopic medial to lateral approach is possible. In 4 pigs, laparoscopic catheterization of the inferior mesenteric artery (IMA) is performed using a seldinger technique. After a bolus injection of 10 ml ICG with a concentration of 0.25 mg/ml, a continuous intra-arterial perfusion was established at a rate of 2 ml/min. The quality of the staining was evaluated qualitatively. Laparoscopic catheterization was possible in all cases, and the average time for this was 30.25 ± 3.54 min. We observed a significant fluorescent signal in all areas of the IMA supplied, but not in other parts of the abdominal cavity or organs. In addition, the mesorectum showed a sharp border between stained and unstained tissue. Intraoperative isolated fluorescence augmentation of the rectum, including the mesorectum by laparoscopic catheterization, is feasible. Inferior mesenteric artery catheterization and ICG perfusion can provide a fluorescence-guided roadmap to identify the correct plane in total mesorectal excision, which should be investigated in further studies.
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Affiliation(s)
- Christian Heiliger
- Department of General, Visceral, and Transplantation Surgery, Hospital of the LMU Munich, Ludwig-Maximilians-University (LMU), Marchioninistrasse 15, 81377, Munich, Germany.
| | - Jerzy Piecuch
- Klinika Chirurgii Ogolnej, Metabolicznej i Medycyny Ratunkowej w Zabrzu, Slaski Universytet Medyczny w Katowicach, Katowicach, Poland
| | - Alexander Frank
- Department of General, Visceral, and Transplantation Surgery, Hospital of the LMU Munich, Ludwig-Maximilians-University (LMU), Marchioninistrasse 15, 81377, Munich, Germany
| | - Dorian Andrade
- Department of General, Visceral, and Transplantation Surgery, Hospital of the LMU Munich, Ludwig-Maximilians-University (LMU), Marchioninistrasse 15, 81377, Munich, Germany
| | - Viktor von Ehrlich-Treuenstätt
- Department of General, Visceral, and Transplantation Surgery, Hospital of the LMU Munich, Ludwig-Maximilians-University (LMU), Marchioninistrasse 15, 81377, Munich, Germany
| | - Dobromira Evtimova
- Department of General, Visceral, and Transplantation Surgery, Hospital of the LMU Munich, Ludwig-Maximilians-University (LMU), Marchioninistrasse 15, 81377, Munich, Germany
| | - Florian Kühn
- Department of General, Visceral, and Transplantation Surgery, Hospital of the LMU Munich, Ludwig-Maximilians-University (LMU), Marchioninistrasse 15, 81377, Munich, Germany
| | - Jens Werner
- Department of General, Visceral, and Transplantation Surgery, Hospital of the LMU Munich, Ludwig-Maximilians-University (LMU), Marchioninistrasse 15, 81377, Munich, Germany
| | - Konrad Karcz
- Department of General, Visceral, and Transplantation Surgery, Hospital of the LMU Munich, Ludwig-Maximilians-University (LMU), Marchioninistrasse 15, 81377, Munich, Germany
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Naidu SS, Abbott JD, Bagai J, Blankenship J, Garcia S, Iqbal SN, Kaul P, Khuddus MA, Kirkwood L, Manoukian SV, Patel MR, Skelding K, Slotwiner D, Swaminathan RV, Welt FG, Kolansky DM. SCAI expert consensus update on best practices in the cardiac catheterization laboratory: This statement was endorsed by the American College of Cardiology (ACC), the American Heart Association (AHA), and the Heart Rhythm Society (HRS) in April 2021. Catheter Cardiovasc Interv 2021; 98:255-276. [PMID: 33909349 DOI: 10.1002/ccd.29744] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 04/23/2021] [Indexed: 12/28/2022]
Abstract
The current document commissioned by the Society for Cardiovascular Angiography and Interventions (SCAI) and endorsed by the American College of Cardiology, the American Heart Association, and Heart Rhythm Society represents a comprehensive update to the 2012 and 2016 consensus documents on patient-centered best practices in the cardiac catheterization laboratory. Comprising updates to staffing and credentialing, as well as evidence-based updates to the pre-, intra-, and post-procedural logistics, clinical standards and patient flow, the document also includes an expanded section on CCL governance, administration, and approach to quality metrics. This update also acknowledges the collaboration with various specialties, including discussion of the heart team approach to management, and working with electrophysiology colleagues in particular. It is hoped that this document will be utilized by hospitals, health systems, as well as regulatory bodies involved in assuring and maintaining quality, safety, efficiency, and cost-effectiveness of patient throughput in this high volume area.
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Affiliation(s)
- Srihari S Naidu
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, New York, USA
| | - J Dawn Abbott
- Cardiovascular Institute of Lifespan, Division of Cardiology, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Jayant Bagai
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - James Blankenship
- Cardiology Division, The University of New Mexico, Albuquerque, New Mexico, USA
| | | | - Sohah N Iqbal
- Mass General Brigham Salem Hospital, Salem, Massachusetts, USA
| | | | - Matheen A Khuddus
- The Cardiac and Vascular Institute and North Florida Regional Medical Center, Gainesville, Florida, USA
| | - Lorrena Kirkwood
- Department of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, New York, USA
| | | | - Manesh R Patel
- Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina, USA
| | | | - David Slotwiner
- Division of Cardiology, New York Presbyterian, Weill Cornell Medicine Population Health Sciences, Queens, New York, USA
| | - Rajesh V Swaminathan
- Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Frederick G Welt
- Division of Cardiovascular Medicine, University of Utah Health, Salt Lake City, Utah, USA
| | - Daniel M Kolansky
- Division of Cardiovascular Medicine, Perelman School of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Comparison of radial versus femoral access using hemostatic devices following percutaneous coronary intervention. Indian Heart J 2021; 73:382-384. [PMID: 34154763 PMCID: PMC8322813 DOI: 10.1016/j.ihj.2021.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 03/10/2021] [Accepted: 04/19/2021] [Indexed: 11/24/2022] Open
Abstract
Arterial access site complications are the important predictor of successful percutaneous coronary interventions (PCI). We prospectively studied 722 consecutive PCI patients for access site complications. A total of 303 trans-femoral access (TFA) patients who had suture based vascular closure devices (VCD) were compared with 419 transradial access (TRA) patients. Incidence of hematoma was more in TFA (2.3% vs 0.23%, p 0.01). Median ambulation time (4 h vs 1 h, p < 0.01) was significantly higher in TFA. In conclusion, TRA had fewer access site complications like haematoma, compared to TFA with VCD. TRA also resulted in earlier ambulation and discharge, compared to TFA with VCD.
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Schwartz B, Jain P, Salama M, Kapur NK. The Rise of Endovascular Mechanical Circulatory Support Use for Cardiogenic Shock and High Risk Coronary Intervention: Considerations and Challenges. Expert Rev Cardiovasc Ther 2020; 19:151-164. [PMID: 33356662 DOI: 10.1080/14779072.2021.1863147] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: Cardiogenic shock due to acute myocardial infarction and decompensated advanced heart failure remains a source of significant morbidity and mortality. Endovascular mechanical circulatory support devices including intra-aortic balloon pump (IABP), percutaneous left ventricular assist devices (Impella and Tandemheart pumps), and veno-arterial extracorporeal oxygenation (VA-ECMO) are utilized for a broadening range of indications.Areas covered: This narrative review explores the specific devices, their distinctive hemodynamic profiles, and practical considerations. Furthermore, reviewed are the trials evaluating device outcomes which have generated significant controversy within the field of heart failure and shock. New applications and future directions are discussed.Expert opinion: Use of endovascular mechanical circulatory support has increased over the last decade, though evidence supporting their use is lacking. Development of large-scale prospective registries and clinical classification systems will facilitate patient enrollment and inform trial design. Furthermore, expansion of indications for these devices is revolutionizing how the field of heart failure and cardiogenic shock thinks about hemodynamic support. The ability to tailor therapy to a patient's specific hemodynamic profile appears to be the future of cardiogenic shock management.
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Affiliation(s)
- Benjamin Schwartz
- Department of Internal Medicine, Tufts Medical Center, Boston, MA, USATurkey
| | - Pankaj Jain
- The Cardiovascular Center, Tufts Medical Center, Boston, MA, USATurkey
| | - Michael Salama
- The Cardiovascular Center, Tufts Medical Center, Boston, MA, USATurkey
| | - Navin K Kapur
- The Cardiovascular Center, Tufts Medical Center, Boston, MA, USATurkey
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Hanaoka Y, Koyama JI, Yamazaki D, Miyaoka Y, Fujii Y, Nakamura T, Ogiwara T, Ito K, Horiuchi T. Transradial Approach as the Primary Vascular Access with a 6-Fr Simmons Guiding Sheath for Anterior Circulation Interventions: A Single-Center Case Series of 130 Consecutive Patients. World Neurosurg 2020; 138:e597-e606. [PMID: 32165342 DOI: 10.1016/j.wneu.2020.03.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 02/29/2020] [Accepted: 03/02/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE In coronary intervention, the transradial approach (TRA) is increasingly used as the primary vascular access because of its numerous advantages over the transfemoral approach. However, in neurointerventions, conventional TRA with a straight-shaped guiding system is used as an alternative vascular access because transradial carotid cannulation can be technically challenging for right common carotid artery (CCA) lesions with steep angulation to the right subclavian artery or left CCA lesions with a nonbovine origin. The purpose of the present study was to evaluate the feasibility and safety of TRA as the primary vascular access with a pre-shaped Simmons guiding sheath for anterior circulation interventions. METHODS Between June 2018 and September 2019, 130 consecutive patients (75 carotid artery stenting and 55 cerebral aneurysm coiling cases) who underwent TRA as the primary vascular access were included in this study. A 6-Fr Simmons guiding sheath was introduced into the target CCA by selecting a cannulation technique based on preprocedural image assessment. We retrospectively analyzed the carotid cannulation success, procedural success, and periprocedural or vascular access site complications. RESULTS Carotid cannulation (69 right CCA, 6 left CCA with a bovine origin, and 55 left CCA with a nonbovine origin) and the subsequent procedure were successfully performed for all 130 patients without periprocedural or vascular access site complications. CONCLUSIONS TRA with a 6-Fr Simmons guiding sheath for anterior circulation interventions is highly successful and safe for all target CCAs and aortic arch types. This method can be utilized as the primary vascular access for anterior circulation interventions.
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Affiliation(s)
- Yoshiki Hanaoka
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Jun-Ichi Koyama
- Neurointervention Center, Shinshu University Hospital, Matsumoto, Nagano, Japan
| | - Daisuke Yamazaki
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Yoshinari Miyaoka
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Yu Fujii
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Takuya Nakamura
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Toshihiro Ogiwara
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Kiyoshi Ito
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Tetsuyoshi Horiuchi
- Department of Neurosurgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan.
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Chatzigeorgiadis P, Hellwig K, Almasi-Sperling V, Meyer A, Lang W, Rother U. Major vascular complications after transfemoral arterial closure system implantation: a single-center study. INT ANGIOL 2020; 39:139-144. [DOI: 10.23736/s0392-9590.19.04253-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Hanaoka Y, Koyama JI, Ogiwara T, Miyaoka Y, Fujii Y, Nakamura T, Horiuchi T, Hongo K. Usefulness of a Novel Technique to Make Up for a Deficiency in Transradial Neurointervention with a 6Fr Simmonds Guiding Sheath: Original Experience with the Subclavian Artery Anchoring Technique. World Neurosurg 2019; 131:e362-e370. [DOI: 10.1016/j.wneu.2019.07.162] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 07/20/2019] [Accepted: 07/22/2019] [Indexed: 11/17/2022]
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12
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Gewalt SM, Helde SM, Ibrahim T, Mayer K, Schmidt R, Bott-Flügel L, Hoppe K, Ott I, Hieber J, Morath T, Byrne RA, Kufner S, Cassese S, Hoppmann P, Fusaro M, Schunkert H, Laugwitz KL, Kastrati A, Schüpke S. Comparison of Vascular Closure Devices Versus Manual Compression After Femoral Artery Puncture in Women. Circ Cardiovasc Interv 2019; 11:e006074. [PMID: 30354782 DOI: 10.1161/circinterventions.117.006074] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The value of vascular closure devices (VCD) in women undergoing transfemoral catheterization has not been sufficiently investigated. METHODS AND RESULTS This is a sex-specific analysis of 1395 women enrolled in a large-scale, randomized, multicenter trial, in which patients undergoing transfemoral diagnostic coronary angiography were randomly assigned in a 1:1:1 ratio to arteriotomy closure with an intravascular VCD, extravascular VCD, or manual compression (MC). Primary objective was to assess the safety and efficacy of 2 different VCD compared with MC regarding vascular access-site complications at 30 days. A secondary comparison was between 2 different types of contemporary VCD. Overall, women were at higher risk for vascular access-site complications compared with men (9.0% versus 6.4%; P=0.002). Vascular access-site complications were comparable in women assigned to VCD and MC (8.6% versus 9.8%; P=0.451). There was no interaction of treatment effect and sex ( Pinteraction=0.970). Time to hemostasis was significantly shortened with VCD compared with MC (1 [interquartile range, 0.5-2.0] minutes) versus 11 [interquartile range, 10-15] minutes; P<0.001); however, more women with VCD required repeat MC (2.4% versus 0.6%; P=0.018). The use of the intravascular compared with the extravascular VCD was associated with a numerical reduction in vascular access-site complications (6.6% versus 10.7%; P=0.027) and significant reductions in time to hemostasis and VCD failure. CONCLUSIONS In women undergoing diagnostic coronary angiography via the common femoral artery, VCD and MC provided comparable safety, while time to hemostasis was reduced with VCD. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov . Unique identifier: NCT01389375.
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Affiliation(s)
- Senta M Gewalt
- Deutsches Herzzentrum München, Technische Universität München, Germany (S.M.G., S.M.H., K.M., I.O., J.H., T.M., R.A.B., S.K., S.C., M.F., H.S., A.K., S.S.)
| | - Sandra M Helde
- Deutsches Herzzentrum München, Technische Universität München, Germany (S.M.G., S.M.H., K.M., I.O., J.H., T.M., R.A.B., S.K., S.C., M.F., H.S., A.K., S.S.).,Klinikum Landkreis Erding, Abteilung Kardiologie und Pneumologie, Germany (S.M.H., L.B.-F.)
| | - Tareq Ibrahim
- I. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Germany (T.I., P.H., K.-L.L.)
| | - Katharina Mayer
- Deutsches Herzzentrum München, Technische Universität München, Germany (S.M.G., S.M.H., K.M., I.O., J.H., T.M., R.A.B., S.K., S.C., M.F., H.S., A.K., S.S.)
| | - Roland Schmidt
- Krankenhaus der Barmherzigen Brüder, Innere Medizin II, Munich, Germany (R.S.)
| | - Lorenz Bott-Flügel
- Klinikum Landkreis Erding, Abteilung Kardiologie und Pneumologie, Germany (S.M.H., L.B.-F.)
| | - Katharina Hoppe
- German Center for Cardiovascular Diseases (DZHK), Partner Site Munich Heart Alliance (H.S., K.-L.L., A.K., S.S.)
| | - Ilka Ott
- Deutsches Herzzentrum München, Technische Universität München, Germany (S.M.G., S.M.H., K.M., I.O., J.H., T.M., R.A.B., S.K., S.C., M.F., H.S., A.K., S.S.)
| | - Julia Hieber
- Deutsches Herzzentrum München, Technische Universität München, Germany (S.M.G., S.M.H., K.M., I.O., J.H., T.M., R.A.B., S.K., S.C., M.F., H.S., A.K., S.S.)
| | - Tanja Morath
- Deutsches Herzzentrum München, Technische Universität München, Germany (S.M.G., S.M.H., K.M., I.O., J.H., T.M., R.A.B., S.K., S.C., M.F., H.S., A.K., S.S.)
| | - Robert A Byrne
- Deutsches Herzzentrum München, Technische Universität München, Germany (S.M.G., S.M.H., K.M., I.O., J.H., T.M., R.A.B., S.K., S.C., M.F., H.S., A.K., S.S.)
| | - Sebastian Kufner
- Deutsches Herzzentrum München, Technische Universität München, Germany (S.M.G., S.M.H., K.M., I.O., J.H., T.M., R.A.B., S.K., S.C., M.F., H.S., A.K., S.S.).,German Center for Cardiovascular Diseases (DZHK), Partner Site Munich Heart Alliance (H.S., K.-L.L., A.K., S.S.)
| | - Salvatore Cassese
- Deutsches Herzzentrum München, Technische Universität München, Germany (S.M.G., S.M.H., K.M., I.O., J.H., T.M., R.A.B., S.K., S.C., M.F., H.S., A.K., S.S.)
| | - Petra Hoppmann
- I. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Germany (T.I., P.H., K.-L.L.)
| | - Massimiliano Fusaro
- Deutsches Herzzentrum München, Technische Universität München, Germany (S.M.G., S.M.H., K.M., I.O., J.H., T.M., R.A.B., S.K., S.C., M.F., H.S., A.K., S.S.)
| | - Heribert Schunkert
- Deutsches Herzzentrum München, Technische Universität München, Germany (S.M.G., S.M.H., K.M., I.O., J.H., T.M., R.A.B., S.K., S.C., M.F., H.S., A.K., S.S.)
| | - Karl-Ludwig Laugwitz
- I. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Germany (T.I., P.H., K.-L.L.).,German Center for Cardiovascular Diseases (DZHK), Partner Site Munich Heart Alliance (H.S., K.-L.L., A.K., S.S.)
| | - Adnan Kastrati
- Deutsches Herzzentrum München, Technische Universität München, Germany (S.M.G., S.M.H., K.M., I.O., J.H., T.M., R.A.B., S.K., S.C., M.F., H.S., A.K., S.S.).,German Center for Cardiovascular Diseases (DZHK), Partner Site Munich Heart Alliance (H.S., K.-L.L., A.K., S.S.)
| | - Stefanie Schüpke
- Deutsches Herzzentrum München, Technische Universität München, Germany (S.M.G., S.M.H., K.M., I.O., J.H., T.M., R.A.B., S.K., S.C., M.F., H.S., A.K., S.S.).,German Center for Cardiovascular Diseases (DZHK), Partner Site Munich Heart Alliance (H.S., K.-L.L., A.K., S.S.)
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13
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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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Romero PS, Costanzi AP, Hirakata VN, Beghetto MG, Sauer JM, Rabelo-Silva ER. Subsample analysis of the Vascular Complications Risk Score at two public referral centers for interventional cardiology. Rev Esc Enferm USP 2019; 53:e03438. [PMID: 31215613 DOI: 10.1590/s1980-220x2018005103438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 08/20/2018] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Evaluate the performance of the Vascular Complications Risk Score in two public referral centers for interventional cardiology. METHOD Subsample analysis of the Vascular Complications Risk Score, which was developed and validated in the catheterization laboratories of three cardiology referral centers (two public, one private) with a cutoff of <3 for no risk of developing vascular complications and ≥3 for risk. In this new analysis, we excluded data from the private facility, and only included participants from the original (validation) cohort of the two public hospitals. RESULTS Among the 629 patients studied, 11.8% had vascular complications; of these, 1.8% were major and 10% minor. Among the patients with a score <3, 310 (94.5%) presented no vascular complications; of those with a score ≥3, 50 (17%) developed complications. Of those who developed vascular complications, 18 scored <3; two of these had major complications. CONCLUSION This subanalysis confirms the ability of the Vascular Complications Risk core to predict low risk of vascular complications in patients with a score < 3.
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Affiliation(s)
- Paola Severo Romero
- Universidade Federal do Rio Grande do Sul, Programa de Pós-Graduação em Cardiologia e Ciências Cardiovasculares, Porto Alegre, RS, Brazil.,Hospital de Clínicas de Porto Alegre, Divisão de Cardiologia, Porto Alegre, RS, Brazil
| | - Angelita Paganin Costanzi
- Hospital Unimed, Caxias do Sul, RS, Brazil.,Universidade Federal do Rio Grande do Sul, Escola de Enfermagem, Porto Alegre, RS, Brazil
| | - Vânia Naomi Hirakata
- Hospital de Clínicas de Porto Alegre, Divisão de Cardiologia, Porto Alegre, RS, Brazil
| | - Mariur Gomes Beghetto
- Universidade Federal do Rio Grande do Sul, Escola de Enfermagem, Porto Alegre, RS, Brazil
| | - Jaquelini Messer Sauer
- Fundação Universitária de Cardiologia, Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Eneida Rejane Rabelo-Silva
- Universidade Federal do Rio Grande do Sul, Programa de Pós-Graduação em Cardiologia e Ciências Cardiovasculares, Porto Alegre, RS, Brazil.,Hospital de Clínicas de Porto Alegre, Divisão de Cardiologia, Porto Alegre, RS, Brazil
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15
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Wang F, Su H, Wang X, Wu Q, Zhou Y, Xu H, Zhang R. Pituitrin use is associated with an increased risk of inguinal hematomas and pseudoaneurysms in patients undergoing femoral artery puncture. J Int Med Res 2019; 47:2976-2986. [PMID: 31119963 PMCID: PMC6683930 DOI: 10.1177/0300060519849785] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Objective Femoral artery puncture (FAP) is an effective method for interventional percutaneous vascular procedures. However, FAP leads to complications including hematomas and pseudoaneurysms. This study was performed to determine whether pituitrin infusion or vascular closure devices (VCDs) increase the risk of complications after FAP. Methods This single-center retrospective study included 3641 patients who underwent FAP. The patients were divided into two groups: a groin complication group (including hematomas and pseudoaneurysms) and a no-groin complication group. Results In the multivariate analysis, perioperative pituitrin infusion and the use of VCDs were strongly associated with inguinal hematomas and pseudoaneurysms. The complication rate was obviously higher in patients who underwent bronchial artery embolization (BAE). Because high dosages of pituitrin and VCDs were used in patients undergoing BAE, postoperative hematoma development occurred significantly earlier in these patients. Hematomas occurred within 14 days of the operation in all patients who underwent BAE. Conclusion Perioperative pituitrin infusion and the use of VCDs are associated with an increased risk of complications after FAP, including hematomas and pseudoaneurysms. Notably, patients who underwent BAE, who are subject to higher pituitrin and VCD use, showed a higher complication rate. The incidence of complications was highest within 2 weeks postoperatively.
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Affiliation(s)
- Fang Wang
- 1 Department of Nursing, Sir Run Run Shaw Hospital, Medical School of Zhejiang University, Hangzhou, China
| | - Hua Su
- 2 Department of Respiratory Medicine, Sir Run Run Shaw Hospital, Medical School of Zhejiang University, Hangzhou, China
| | - Xiaoxia Wang
- 1 Department of Nursing, Sir Run Run Shaw Hospital, Medical School of Zhejiang University, Hangzhou, China
| | - Qionghui Wu
- 1 Department of Nursing, Sir Run Run Shaw Hospital, Medical School of Zhejiang University, Hangzhou, China
| | - Yong Zhou
- 2 Department of Respiratory Medicine, Sir Run Run Shaw Hospital, Medical School of Zhejiang University, Hangzhou, China
| | - Hangdi Xu
- 2 Department of Respiratory Medicine, Sir Run Run Shaw Hospital, Medical School of Zhejiang University, Hangzhou, China
| | - Ruifeng Zhang
- 2 Department of Respiratory Medicine, Sir Run Run Shaw Hospital, Medical School of Zhejiang University, Hangzhou, China
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16
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Goland J, Doroszuk G. Transradial approach for endovascular diagnosis and treatment of ruptured cerebral aneurysms: A descriptive study. Surg Neurol Int 2019; 10:87. [PMID: 31528425 PMCID: PMC6744807 DOI: 10.25259/sni-44-2019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 01/23/2019] [Indexed: 01/10/2023] Open
Abstract
Background: For cardiovascular procedures, the transradial approach has been documented to yield fewer complications than the femoral approach. It has become the approach of choice for diagnostic and therapeutic interventions involving the coronary arteries. However, few published data exist on using this approach for neuroendovascular procedures and we describe a series of ruptured cerebral aneurysms diagnosed and treated using the transradial approach. Methods: All patients scheduled for cerebral angiography to diagnose and treat subarachnoid hemorrhages at our hospital from June 2016 to May 2018, by right radial artery access, were recruited and followed prospectively. The main outcomes of interest were the length of the procedure (in minutes), the success of treatment, and the incidence of postprocedural complications. Results: Over the observation period, 59 patients (66% women, mean age = 48 years) with a combined 61 aneurysms treated were identified who met inclusion criteria. Of the 61 aneurysms treated, eight (13%) were within the posterior circulation (13%) and 53 (87%) the anterior circulation. Average procedural duration was 64.9 min. No occlusion or spasm of the radial artery was observed during any procedure. All patients had immediate pre- and post-embolization angiography, which revealed the guide catheter coming from the right subclavian artery. A radial pulse was evident after all interventions. All procedures were considered successful at treating the ruptured aneurysm, and no patient experienced a clinically significant complication related to the approach. Conclusions: The transradial approach is a viable option for the diagnosis and endovascular treatment of acute cerebral aneurysms in different locations.
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Affiliation(s)
- Javier Goland
- Neurointervencionismo, Hospital El Cruce Néstor Kirchner, Florencio Varela, Buenos Aires, Argentina
| | - Gustavo Doroszuk
- Neurointervencionismo, Hospital El Cruce Néstor Kirchner, Florencio Varela, Buenos Aires, Argentina
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17
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Kaki A, Blank N, Alraies MC, Kajy M, Grines CL, Hasan R, Htun WW, Glazier J, Mohamad T, Elder M, Schreiber T. Access and closure management of large bore femoral arterial access. J Interv Cardiol 2018; 31:969-977. [PMID: 30456854 DOI: 10.1111/joic.12571] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 09/30/2018] [Accepted: 10/01/2018] [Indexed: 11/29/2022] Open
Abstract
Femoral and radial artery access continue to be the standard of care for percutaneous coronary interventions. Cardiac catheterization has progressed to encompass a wide range of diagnostic and interventional procedures including coronary, peripheral, endovascular, and structural heart disease interventions. Despite advanced technology to make these procedures safe, bleeding, and vascular complications continue to be a substantial source of morbidity, especially in patients undergoing large-bore access procedures. New variations of percutaneous devices have reduced complications associated with these procedures. However, safe vascular access with effective hemostasis requires special techniques which have not been well described in the literature. Large-bore femoral artery access is feasible, safe, and associated with low complication rates when a protocol is implemented. Wayne State University, Detroit Medical Center Heart Hospital is a tertiary care, high-volume center for endovascular, structural heart and complex high risk indicated procedures with more 150 procedures involving mechanical circulatory support (MCS) devices per year. In this manuscript, we describe our approach to femoral artery large-bore sheath insertion and management. Our protocol includes proper identification of the puncture site, device selection, insertion, assessment of limb perfusion while on prolong MCS support, and hemostasis techniques after sheath removal.
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Affiliation(s)
- Amir Kaki
- Wayne State University, School of Medicine, Detroit Medical Center, Detroit Heart Hospital, Detroit, Michigan
| | - Nimrod Blank
- Wayne State University, School of Medicine, Detroit Medical Center, Detroit Heart Hospital, Detroit, Michigan
| | - M Chadi Alraies
- Wayne State University, School of Medicine, Detroit Medical Center, Detroit Heart Hospital, Detroit, Michigan
| | - Marvin Kajy
- Wayne State University, School of Medicine, Detroit Medical Center, Detroit Heart Hospital, Detroit, Michigan
| | - Cindy L Grines
- Zucker School of Medicine at Hofstra Northwell Health, Northshore University Hospital, Manhasset, New York
| | | | - Wah Wah Htun
- Northwell Health, Lenox Hill Hospital, New York, New York
| | - James Glazier
- Wayne State University, School of Medicine, Detroit Medical Center, Detroit Heart Hospital, Detroit, Michigan
| | - Tamam Mohamad
- Wayne State University, School of Medicine, Detroit Medical Center, Detroit Heart Hospital, Detroit, Michigan
| | - Mahir Elder
- Wayne State University, School of Medicine, Detroit Medical Center, Detroit Heart Hospital, Detroit, Michigan
| | - Theodore Schreiber
- Wayne State University, School of Medicine, Detroit Medical Center, Detroit Heart Hospital, Detroit, Michigan
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18
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Castle EV, Rathod KS, Guttmann OP, Jenkins AM, McCarthy CD, Knight CJ, O'Mahony C, Mathur A, Smith EJ, Weerackody R, Timmis AD, Wragg A, Jones DA. Routine use of fluoroscopic guidance and up-front femoral angiography results in reduced femoral complications in patients undergoing coronary angiographic procedures: an observational study using an Interrupted Time-Series analysis. Heart Vessels 2018; 34:419-426. [PMID: 30264266 DOI: 10.1007/s00380-018-1266-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Accepted: 09/14/2018] [Indexed: 10/28/2022]
Abstract
Transradial access is increasingly used for coronary angiography and percutaneous coronary intervention, however, femoral access remains necessary for numerous procedures, including complex high-risk interventions, structural procedures, and procedures involving mechanical circulatory support. Optimising the safety of this approach is crucial to minimize costly and potentially life-threatening complications. We initiated a quality improvement project recommending routine fluoroscopic guidance (femoral head), and upfront femoral angiography should be performed to assess for location and immediate complications. We assessed the effect of these measures on the rate of vascular complications. Data were collected prospectively on 4534 consecutive patients undergoing femoral coronary angiographic procedures from 2015 to 2017. The primary end-point was any access complication. Outcomes were compared pre and post introduction including the use of an Interrupted Time-Series (ITS) analysis. 1890 patients underwent angiography prior to the introduction of routine fluoroscopy and upfront femoral angiography and 2644 post. All operators adopted these approaches. Baseline characteristics, including large sheath use, anticoagulant use and PCI rates were similar between the 2 groups. Fluoroscopy-enabled punctures were made in the 'safe zone' in over 91% of cases and upfront femoral angiography resulted in management changes i.e. procedural abandonment prior to heparin administration in 21 patients (1.1%). ITS analysis demonstrated evidence of a reduction in femoral complication rates after the introduction of the intervention, which was over and above the existing trend before the introduction (40% decrease RR 0.58; 95% CI: 0.25-0.87; P < 0.01). Overall these quality improvement measures were associated with a significantly lower incidence of access site complications (0.9% vs. 2.0%, P < 0.001). Routine fluoroscopy guided vascular access and upfront femoral angiography prior to anticoagulation leads to lower vascular complication rates. Thus, study shows that femoral intervention can be performed safely with very low access-related complication rates when fluoroscopic guidance and upfront angiography is used to obtain femoral arterial access.
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Affiliation(s)
- Emily V Castle
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, 2nd Floor, King George V Building, West Smithfield, London, EC1A 7BE, UK
| | - Krishnaraj S Rathod
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, 2nd Floor, King George V Building, West Smithfield, London, EC1A 7BE, UK.,Department of Clinical Pharmacology, William Harvey Research Institute, Queen Mary University, London, UK
| | - Oliver P Guttmann
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, 2nd Floor, King George V Building, West Smithfield, London, EC1A 7BE, UK
| | - Alice M Jenkins
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, 2nd Floor, King George V Building, West Smithfield, London, EC1A 7BE, UK
| | - Carmel D McCarthy
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, 2nd Floor, King George V Building, West Smithfield, London, EC1A 7BE, UK
| | - Charles J Knight
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, 2nd Floor, King George V Building, West Smithfield, London, EC1A 7BE, UK.,Department of Clinical Pharmacology, William Harvey Research Institute, Queen Mary University, London, UK
| | - Constantinos O'Mahony
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, 2nd Floor, King George V Building, West Smithfield, London, EC1A 7BE, UK
| | - Anthony Mathur
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, 2nd Floor, King George V Building, West Smithfield, London, EC1A 7BE, UK.,Department of Clinical Pharmacology, William Harvey Research Institute, Queen Mary University, London, UK
| | - Elliot J Smith
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, 2nd Floor, King George V Building, West Smithfield, London, EC1A 7BE, UK.,Department of Clinical Pharmacology, William Harvey Research Institute, Queen Mary University, London, UK
| | - Roshan Weerackody
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, 2nd Floor, King George V Building, West Smithfield, London, EC1A 7BE, UK.,Department of Clinical Pharmacology, William Harvey Research Institute, Queen Mary University, London, UK
| | - Adam D Timmis
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, 2nd Floor, King George V Building, West Smithfield, London, EC1A 7BE, UK.,Department of Clinical Pharmacology, William Harvey Research Institute, Queen Mary University, London, UK
| | - Andrew Wragg
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, 2nd Floor, King George V Building, West Smithfield, London, EC1A 7BE, UK.,Department of Clinical Pharmacology, William Harvey Research Institute, Queen Mary University, London, UK
| | - Daniel A Jones
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, 2nd Floor, King George V Building, West Smithfield, London, EC1A 7BE, UK. .,Department of Clinical Pharmacology, William Harvey Research Institute, Queen Mary University, London, UK.
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19
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Vascular Access-Related Complications in Women: Temporal Trends, Emerging Data, and the Current State of Interventional Cardiology Practice. Curr Atheroscler Rep 2018; 20:41. [DOI: 10.1007/s11883-018-0741-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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20
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Kim M, Kim MA, Kim HL, Lee WJ, Lim WH, Seo JB, Kim SH, Zo JH. Body mass index and the risk of low femoral artery puncture in coronary angiography under fluoroscopy guidance. Medicine (Baltimore) 2018; 97:e0070. [PMID: 29489670 PMCID: PMC5851760 DOI: 10.1097/md.0000000000010070] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
The inferior border of the femoral head (IBFH) is widely used as a landmark in femoral artery puncture during invasive coronary angiography (ICA). However, application of this technique can be challenging especially in obese patients. This study was performed to investigate the association between body mass index (BMI) and the risk of low puncture in femoral artery puncture.A total of 464 patients (64.8 ± 11.1 years, 55.8% male) who underwent ICA via trans-femoral access were retrospectively reviewed. IBFH was used as a landmark for a skin nick and the femoral artery cannulation site was confirmed by femoral angiography. Cannulation at the bifurcation of the common femoral artery (CFA) or below were considered low puncture.Twenty-nine patients (5.8%) were identified as having an angiographically high CFA bifurcation and low femoral artery puncture occurred in 27 (93.1%) patients of them. Among patients with normal bifurcation (n = 464), low puncture occurred in 74 (15.9%) patients. Underweight (BMI < 18.5 kg/m) or obese (BMI ≥ 30 kg/m) patients were more common in the low puncture group than in the proper puncture group (36.5% vs. 5.9%, P < .001). Multivariable analysis showed underweight or obesity (odd ratio, 9.10; 95% confidential interval, 4.77-17.35; P < .001) was an independent risk factor of low puncture even after controlling for clinical covariates. The average distance from IBFH to the CFA puncture site was shorter in patients with underweight (1.74 ± 0.71 cm) or obesity (1.75 ± 0.60 cm) than in those with normal BMI or overweight (2.07 ± 0.83 cm) (P = .030). Trigonometric calculation showed that the average distance from IBFH to the CFA puncture site was 0.5 to 2.59 cm (mean = 1.32 cm) shorter in underweight patients compared with those of normal weight or overweight patients.In patients with normal CFA bifurcation, underweight or obesity were associated with increased risk of low puncture. The puncture site should be chosen about 1 finger width more proximal to IBFH for ICA in such patients.
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Affiliation(s)
- Minsuk Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam
- Seoul National University College of Medicine
| | - Myung-A Kim
- Seoul National University College of Medicine
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul, Korea
| | - Hack-Lyoung Kim
- Seoul National University College of Medicine
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul, Korea
| | - Won-Jae Lee
- Division of Cardiology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam
- Seoul National University College of Medicine
| | - Woo-Hyun Lim
- Seoul National University College of Medicine
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul, Korea
| | - Jae-Bin Seo
- Seoul National University College of Medicine
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul, Korea
| | - Sang-Hyun Kim
- Seoul National University College of Medicine
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul, Korea
| | - Joo-Hee Zo
- Seoul National University College of Medicine
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, Seoul, Korea
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21
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Shoeib O, Burzotta F, Aurigemma C, Paraggio L, Viccaro F, Porto I, Leone AM, Bruno P, Trani C. Percutaneous transcatheter aortic valve replacement induces femoral artery shrinkage: angiographic evidence and predictors for a new side effect. Catheter Cardiovasc Interv 2017; 91:938-944. [DOI: 10.1002/ccd.27248] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 07/22/2017] [Indexed: 12/19/2022]
Affiliation(s)
- Osama Shoeib
- Institute of Cardiology, Catholic University of the Sacred HeartRome Italy
| | - Francesco Burzotta
- Institute of Cardiology, Catholic University of the Sacred HeartRome Italy
| | - Cristina Aurigemma
- Institute of Cardiology, Catholic University of the Sacred HeartRome Italy
| | - Lazzaro Paraggio
- Institute of Cardiology, Catholic University of the Sacred HeartRome Italy
| | - Fausta Viccaro
- Institute of Cardiology, Catholic University of the Sacred HeartRome Italy
| | - Italo Porto
- Institute of Cardiology, Catholic University of the Sacred HeartRome Italy
| | | | - Piergiorgio Bruno
- Institute of Cardiology, Catholic University of the Sacred HeartRome Italy
| | - Carlo Trani
- Institute of Cardiology, Catholic University of the Sacred HeartRome Italy
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22
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Goland J, Doroszuk GF, Garbugino SL, Ypa MP. Transradial approach to treating endovascular cerebral aneurysms: Case series and technical note. Surg Neurol Int 2017; 8:73. [PMID: 28584676 PMCID: PMC5445653 DOI: 10.4103/sni.sni_393_16] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Accepted: 02/09/2017] [Indexed: 12/03/2022] Open
Abstract
Background: Several benefits have been described over the years of the transradial versus femoral endovascular approach to cardiac interventions. Consequently, its use has become habitual at most centers that perform cardiac catheterizations. This paper details a right transradial approach, incorporating a variety of coils or flow diverters, which can be utilized for the endovascular treatment of different cerebral aneurysms. Methods: From 2014 to 2016, we performed 40 endovascular procedures to treat cerebral aneurysms adopting the same right transradial approach. Five aneurysms were treated with flow diverters and 35 were treated with coils. Seven of these aneurisms were asymptomatic, whereas 33 had already ruptured. Results: Satisfactory treatment was achieved in all cases through the same approach in the absence of any complications. Conclusions: A right transradial approach may be satisfactory for the endovascular treatment of different cerebral aneurysms, including aneurysms in either hemisphere. This is the largest series of cerebral aneurysms treated through a transradial approach.
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Affiliation(s)
- Javier Goland
- Hospital El Cruce Néstor Kirchner, Florencio Varela, Buenos Aires, Argentina.,Hospital de Clínicas José de San Martín, CABA, Argentina
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23
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Fairley SL, Lucking AJ, McEntegart M, Shaukat A, Smith D, Chase A, Hanratty CG, Spratt JC, Walsh SJ. Routine Use of Fluoroscopic-Guided Femoral Arterial Puncture to Minimise Vascular Complication Rates in CTO Intervention: Multi-centre UK Experience. Heart Lung Circ 2016; 25:1203-1209. [DOI: 10.1016/j.hlc.2016.04.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 02/24/2016] [Accepted: 04/02/2016] [Indexed: 10/21/2022]
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24
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Sekhar A, Sutton BS, Raheja P, Mohsen A, Anggelis E, Anggelis CN, Keith MC, Dawn B, Straton S, Flaherty MP. Femoral arterial closure using ProGlide® is more efficacious and cost-effective when ambulating early following cardiac catheterization. IJC HEART & VASCULATURE 2016; 13:6-13. [PMID: 28616553 PMCID: PMC5454184 DOI: 10.1016/j.ijcha.2016.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 09/08/2016] [Accepted: 09/24/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This was a prospective, single-center study evaluating the efficacy and cost-effectiveness of early ambulation (within 30 min) following femoral artery closure with the ProGlide® suture-mediated vascular closure device (PD) in patients undergoing diagnostic cardiac catheterization compared with manual compression. BACKGROUND It is unclear whether early ambulation with ProGlide is safe or is associated with patient satisfaction and cost savings as compared with manual compression (MC). METHODS AND RESULTS Inclusion criteria were met in 170 patients (85 PD and 85 MC patients). Patients ambulated 20 ft. within 30 min (PD) or after the requisite 4 h recumbent time (MC) if feasible. Primary endpoint was time-to-ambulation (TTA) following device closure. We also directly compared the safety of closure, times-to-hemostasis (TTH), -ambulation (TTA) and -discharge (TTD) with MC and, using a fully allocated cost model, performed cost analysis for both strategies. Multivariate analysis was used to determine predictors of patient satisfaction. The primary endpoint of safe, early ambulation was achieved following closure (mean of 27.1 ± 14.9 min; 95% confidence interval [CI] 25.2-30.2). Predictors of patient satisfaction in the PD group were absence of pain during closure, decreased TTA, and drastic reductions in TTD; the latter contributed indirectly to significant cost savings in the PD group (1250.3 ± 146.4 vs. 2248.1 ± 910.2 dollars, respectively; P < 0.001) and incremental cost savings by strategy also favored closure over MC ($84,807). CONCLUSIONS ProGlide is safe and effective for femoral artery closure in patients who ambulate within 30 min after cardiac catheterization; translating into improved patient satisfaction and substantial cost savings.
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Affiliation(s)
- Aravind Sekhar
- Division of Cardiovascular Medicine, University of Louisville, Louisville, KY, United States
- Jewish Hospital Heart and Lung Institute, Louisville, KY, United States
| | - Brad S. Sutton
- Division of Cardiovascular Medicine, University of Louisville, Louisville, KY, United States
- Jewish Hospital Heart and Lung Institute, Louisville, KY, United States
| | - Prafull Raheja
- Division of Cardiovascular Medicine, University of Louisville, Louisville, KY, United States
- Jewish Hospital Heart and Lung Institute, Louisville, KY, United States
| | - Amr Mohsen
- Division of Cardiovascular Medicine, University of Louisville, Louisville, KY, United States
- Jewish Hospital Heart and Lung Institute, Louisville, KY, United States
| | - Emily Anggelis
- Division of Cardiovascular Medicine, University of Louisville, Louisville, KY, United States
- Jewish Hospital Heart and Lung Institute, Louisville, KY, United States
| | - Chris N. Anggelis
- Division of Cardiovascular Medicine, University of Louisville, Louisville, KY, United States
- Jewish Hospital Heart and Lung Institute, Louisville, KY, United States
| | - Matthew C. Keith
- Division of Cardiovascular Medicine, University of Louisville, Louisville, KY, United States
- Jewish Hospital Heart and Lung Institute, Louisville, KY, United States
| | - Buddhadeb Dawn
- Division of Cardiovascular Diseases, Kansas University Medical Center, Kansas City, KS, United States
| | - Samantha Straton
- Division of Cardiovascular Medicine, University of Louisville, Louisville, KY, United States
- Jewish Hospital Heart and Lung Institute, Louisville, KY, United States
| | - Michael P. Flaherty
- Division of Cardiovascular Medicine, University of Louisville, Louisville, KY, United States
- Jewish Hospital Heart and Lung Institute, Louisville, KY, United States
- Corresponding author at: Physiology & Biophysics, Division of Cardiovascular Medicine, University of Louisville School of Medicine, Rudd Heart and Lung Center, 201 Abraham FlexnerWay, Suite 800, Louisville, KY 40202, United States.Physiology & BiophysicsDivision of Cardiovascular MedicineUniversity of Louisville School of MedicineRudd Heart and Lung Center201 Abraham FlexnerWay, Suite 800LouisvilleKY40202United States
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25
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Naidu SS, Aronow HD, Box LC, Duffy PL, Kolansky DM, Kupfer JM, Latif F, Mulukutla SR, Rao SV, Swaminathan RV, Blankenship JC. SCAI expert consensus statement: 2016 best practices in the cardiac catheterization laboratory: (Endorsed by the cardiological society of india, and sociedad Latino Americana de Cardiologia intervencionista; Affirmation of value by the Canadian Associatio. Catheter Cardiovasc Interv 2016; 88:407-23. [DOI: 10.1002/ccd.26551] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 03/17/2016] [Indexed: 12/13/2022]
Affiliation(s)
- Srihari S. Naidu
- Division of Cardiology, Winthrop University Hospital, Mineola, New York
| | - Herbert D. Aronow
- Warren Alpert Medical School of Brown University, Cardiovascular Institute, Providence, RI
| | | | | | - Daniel M. Kolansky
- Cardiovascular Medicine Division, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Joel M. Kupfer
- University of Illinois School of Medicine-Peoria, Peoria, IL
| | - Faisal Latif
- University of Oklahoma and VA Medical Center, Oklahoma City, OK
| | - Suresh R. Mulukutla
- University of Pittsburgh and VA Pittsburgh Healthcare System, Pittsburgh, PA
| | | | - Rajesh V. Swaminathan
- Weill Cornell Medical College, New York-Presbyterian Hospital, Greenberg Division of Cardiology, New York, NY
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26
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Madhavan MV, Généreux P, Kirtane AJ, Xu K, Witzenbichler B, Mehran R, Stone GW. Is routine post-procedural anticoagulation warranted after primary percutaneous coronary intervention in ST-segment elevation myocardial infarction? Insights from the HORIZONS-AMI trial. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2015; 6:650-658. [DOI: 10.1177/2048872615592246] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Mahesh V Madhavan
- Columbia University Medical Center, New York-Presbyterian Hospital, USA
| | - Philippe Généreux
- Columbia University Medical Center, New York-Presbyterian Hospital, USA
- Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Canada
| | - Ajay J Kirtane
- Columbia University Medical Center, New York-Presbyterian Hospital, USA
- Cardiovascular Research Foundation, USA
| | - Ke Xu
- Cardiovascular Research Foundation, USA
| | | | - Roxana Mehran
- Cardiovascular Research Foundation, USA
- Icahn School of Medicine at Mount Sinai, USA
| | - Gregg W Stone
- Columbia University Medical Center, New York-Presbyterian Hospital, USA
- Cardiovascular Research Foundation, USA
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27
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Mu W, Chen M, Gong Z, Zheng F, Xing Q. Expression of vascular cell adhesion molecule-1 in the aortic tissues of atherosclerotic patients and the associated clinical implications. Exp Ther Med 2015; 10:423-428. [PMID: 26622332 PMCID: PMC4509110 DOI: 10.3892/etm.2015.2540] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 04/13/2015] [Indexed: 11/05/2022] Open
Abstract
The aim of this study was to investigate the expression level of vascular cell adhesion molecule-1 (VCAM-1) in the aortic tissues of atherosclerotic patients and to explore the associated clinical implications. Full-thickness aortic wall tissue samples were collected from atherosclerotic patients. Biochemical analysis was used for the detection of the serum levels of triglycerides (TG), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), lipoprotein (a) [Lp (a)], apolipoprotein (Apo) AI and Apo-B. Coronary angiography and SYNTAX scoring were used to determine the extent and severity of the disease. Immunohistochemistry was employed for the detection of the VCAM-1 protein expression levels in the arterial tissues. Significant differences were observed in the blood lipid levels between atherosclerotic patients and control subjects. Immunohistochemistry indicated that the aortic VCAM-1 expression level in atherosclerotic patients was 0.23±0.06 optical density (OD) units, which was significantly higher than that in the control subjects (0.08±0.03 OD units). In the atherosclerotic patients, the aortic VCAM-1 expression was positively correlated with the serum levels of TG (r=0.347), TC (r=0.469), LDL-C (r=0.463), Lp (a) (r=0.507) and Apo-B (r=0.384), while VCAM-1 and HDL-C were negatively correlated (r=-0.319). Furthermore, a higher SYNTAX score was accompanied by a higher VCAM-1 expression level (r=0.532), and an elevated aortic VCAM-1 expression was associated with certain cardiovascular risk factors. In conclusion, aortic VCAM-1 expression is associated with the severity of atherosclerosis and cardiovascular risk factors, indicating that VCAM-1 plays a role in the pathogenesis of atherosclerosis.
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Affiliation(s)
- Wei Mu
- Department of Cardiology, Shandong Provincial Qianfoshan Hospital, Shandong University, Ji'nan, Shandong 250014, P.R. China
| | - Mingyou Chen
- Department of Cardiology, Shandong Provincial Qianfoshan Hospital, Shandong University, Ji'nan, Shandong 250014, P.R. China
| | - Zushun Gong
- Department of Cardiology, Shandong Provincial Qianfoshan Hospital, Shandong University, Ji'nan, Shandong 250014, P.R. China
| | - Fei Zheng
- Department of Cardiology, Shandong Provincial Qianfoshan Hospital, Shandong University, Ji'nan, Shandong 250014, P.R. China
| | - Qichong Xing
- Department of Cardiology, Shandong Provincial Qianfoshan Hospital, Shandong University, Ji'nan, Shandong 250014, P.R. China
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28
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Abstract
The hybrid algorithim approach, together with innovative new technologies, has lead to increased interest in chronic total occlusion (CTO) percutaneous coronary intervention (PCI) and increasing procedural success rates. Unlike non-CTO PCI, there is an increased rate of femoral access. When considering arterial access in CTO PCI, a balance is needed between anticipated procedural difficulty, planned CTO strategy and the desire to minimise the risk of vascular access-related complications. We review the evidence for best practice with respect to femoral puncture technique and also assess the technologies and techniques available to place larger inner diameter catheters into the radial artery.
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Affiliation(s)
- David Smith
- Regional Cardiac Centre, Morriston Hospital, Swansea, UK
| | - Ahmed Hailan
- Regional Cardiac Centre, Morriston Hospital, Swansea, UK
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29
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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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30
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Truesdell AG, Delgado GA, Blakeley SW, Bachinsky WB. Transradial peripheral vascular intervention: challenges and opportunities. Interv Cardiol 2015. [DOI: 10.2217/ica.14.67] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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31
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Schelp V, Freitag-Wolf S, Hinzmann D, Bramlage P, Frey N, Frank D. Large-scale experience with an anchorless vascular closure device in a real-life clinical setting. Clin Res Cardiol 2014; 104:145-53. [PMID: 25293675 DOI: 10.1007/s00392-014-0766-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 09/26/2014] [Indexed: 12/11/2022]
Abstract
AIMS This study was designed to evaluate safety and effectiveness of the vascular closure device Exoseal (Cordis) for hemostatic control following cardiac catheterization in a real-life clinical setting. METHODS AND RESULTS This prospective, single-center study enrolled n = 2,031 consecutive patients who underwent coronary angiography via the femoral artery ± PCI (n = 801). Patients were excluded if they had radial access, percutaneous repair of structural heart disease, or if they had severe peripheral artery disease. If clinical abnormalities were discovered at the access site, color Doppler ultrasound was performed. The composite primary endpoint was defined as bleeding/vascular complications and device failure, and it was experienced by 5.4 % (n = 110) of patients. The most frequent complications were pseudoaneurysm (2.9 %, n = 58) and access-site hematoma >6 cm (1.8 %, n = 37). The overall device failure rate was 0.7 % (n = 14). Multiple logistic regression analysis demonstrated that the strongest independent predictors of bleeding/vascular complications and/or device failure were procedure duration (OR 2.1, CI 1.4-3.2), PCI (OR 2.7, CI 1.7-4.2), GP IIb/IIIa inhibitors (OR 2.9, CI 1.5-5.7), and age (OR 2.2, CI 1.4-3.5). CONCLUSIONS These results indicate that Exoseal was safe in a broad collective of patients. However, lengthy procedures, PCIs, the use of GP IIb/IIIa inhibitors, and elderly patients require special attention.
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Affiliation(s)
- Verena Schelp
- Department of Cardiology and Angiology, University Hospital Schleswig-Holstein, Campus Kiel Schittenhelmstr. 12, 24105, Kiel, Germany
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32
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Lee MS. Re-examination of the antithrombotic regimen in the STEMI-RADIAL trial. J Am Coll Cardiol 2014; 64:1296. [PMID: 25236527 DOI: 10.1016/j.jacc.2014.04.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 04/03/2014] [Indexed: 11/18/2022]
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