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Kim E, Sebastiao BG, Lee A, Ande S, Shankar J. Safety and effectiveness of vascular closure devices in interventional radiological procedures. Interv Neuroradiol 2023; 29:525-531. [PMID: 35538887 PMCID: PMC10549703 DOI: 10.1177/15910199221100628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 04/26/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Although it is well known that vascular closure devices (VCD) are commonly used in therapeutic interventional radiological procedures, standard use in diagnostic procedures is not as well studied. PURPOSE The aim of this study was to determine the real-world safety and effectiveness of the VCD in both diagnostic and therapeutic interventional radiological procedures. MATERIALS AND METHODS A retrospective, single center study included all patients where VCDs were used for either a diagnostic or therapeutic interventional procedure. Various demographic and clinical risk factors were recorded and examined for any significant association with successful deployment and complications. RESULTS A total of 2072 patients were included. VCDs were successfully deployed in 95.2% of the patients with 4.8% of perioperative complications, which included minor oozing from the puncture site, small hematoma less than or equal to 5 cm, large hematoma greater than 5 cm, pain, and loss of vascular access. Therapeutic (vascular interventional radiology (VIR) and neuro-interventional radiology (NIR)) procedures (OR 3.03, 95% CI 1.51-6.09, p = 0.002), use of Angioseal (OR 5.26, 95% CI 3.13-8.33), p < 0.001), and no use of antiplatelet medications (OR 0.47, 95% CI 0.22-0.97, p = 0.041) were independently associated with successful deployment of VCDs when controlled for other risk factors. Smoking (OR 3.50, 95% CI 2.00-6.05, p = <0.001), use of antiplatelet (OR 2.01, 95% CI 1.04-3.87, p = 0.037) and use of heparin (OR 1.78, 95% CI 1.10-2.86, p = 0.018) were independently associated with higher complication rates. CONCLUSION VCD's were successfully deployed in 95.2% of the patients with 4.8% of perioperative minor complications.
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Affiliation(s)
- Esther Kim
- Department of Radiology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Bruno Goncalves Sebastiao
- Department of Radiology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Amy Lee
- Department of Radiology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sudharshan Ande
- Department of Radiology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jai Shankar
- Department of Radiology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Ahmad FA, Hennessy MM, Nath AF. Fate of Asymptomatic Limb after Kissing Stents in Aortoiliac Occlusive Disease. Vasc Specialist Int 2022; 38:7. [PMID: 35361742 PMCID: PMC8971782 DOI: 10.5758/vsi.210074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/19/2021] [Accepted: 03/05/2022] [Indexed: 11/20/2022] Open
Abstract
Purpose Kissing stent angioplasty is an established endovascular treatment strategy for stenosis at the aortic bifurcation but not without its detractors. This study aimed to analyze the outcomes of kissing stents with regard to stent occlusion and complications in which an asymptomatic limb was treated. Methods Materials and A total of 106 patients undergoing aortic bifurcation intervention from January 2015 to November 2020 were retrospectively reviewed. Only patients with at least one common iliac artery (CIA) ostium and undergoing bilateral CIA intervention were included in the study.Results: Patients were followed up for a median period of 26 months (interquartile range, 21-51 months). The TransAtlantic InterSociety Consensus (TASC)-II classification of lesions was as follows: A, 49%; B, 41%; C, 6%; and D, 5%. The treatment indication was limited to one side in 53% of patients. Technical and procedural success rates were 99% and 90%, respectively. Ischemic events in an asymptomatic limb occurred in 6% of cases, 3% due to late stent thrombosis >30 days, and 3% due to progression of downstream infrainguinal disease. Primary and secondary patency rates at 1, 3, and 5 years were 98%, 87%, and 85%, and 99%, 94%, and 94%, respectively. Periprocedural mortality developed in two patients with no amputation. Conclusion Kissing stent deployment is a safe and effective strategy for the treatment of aortoiliac bifurcation disease. Unfavorable outcomes due to stenting in the asymptomatic iliac artery are very rare. Long-term surveillance is necessary due to the risk of late thrombosis or downstream disease progression.
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Affiliation(s)
- Faheem Asem Ahmad
- Department of Interventional Radiology, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Martin Michael Hennessy
- Department of Interventional Radiology, Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | - Alexander Fredrik Nath
- Department of Interventional Radiology, Queen Elizabeth University Hospital, Glasgow, United Kingdom
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Linti C, Doser M, Planck H, Oberhoffner S, Mueller E, Renardy M, Biesinger J, Neumann B, Stang K, Greiner TO, Schlensak C, Krajewski S, Wendel HP. Development, preclinical evaluation and validation of a novel quick vascular closure device for transluminal, cardiac and radiological arterial catheterization. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2018; 29:83. [PMID: 29892952 DOI: 10.1007/s10856-018-6092-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 05/26/2018] [Indexed: 06/08/2023]
Abstract
Following percutaneous coronary intervention, vascular closure devices (VCDs) are increasingly used to reduce time to ambulation, enhance patient comfort, and reduce potential complications compared with traditional manual compression. Newer techniques include complicated, more or less automated suture devices, local application of pads or the use of metal clips and staples. These techniques often have the disadvantage of being time consuming, expensive or not efficient enough. The VCD failure rate in association with vascular complications of 2.0-9.5%, depending on the type of VCD, is still not acceptable. Therefore, the aim of this study is to develop a self-expanding quick vascular closure device (QVCD) made from a bioabsorbable elastic polymer that can be easily applied through the placed introducer sheath. Bioabsorbable block-co-polymers were synthesized and the chemical and mechanical degradation were determined by in vitro tests. The best fitting polymer was selected for further investigation and for microinjection moulding. After comprehensive haemocompatibility analyses in vitro, QVCDs were implanted in arterial vessels following arteriotomy for different time points in sheep to investigate the healing process. The in vivo tests proved that the new QVCD can be safely placed in the arteriotomy hole through the existing sheath instantly sealing the vessel. The degradation time of 14 days found in vitro was sufficient for vessel healing. After 4 weeks, the remaining QVCD material was covered by neointima. Overall, our experiments showed the safety and feasibility of applying this novel QVCD through an existing arterial sheath and hence encourage future work with larger calibers.
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Affiliation(s)
- C Linti
- German Institutes of Textile and Fiber Research (DITF), Denkendorf, Germany
| | - M Doser
- German Institutes of Textile and Fiber Research (DITF), Denkendorf, Germany
| | - H Planck
- German Institutes of Textile and Fiber Research (DITF), Denkendorf, Germany
| | - S Oberhoffner
- German Institutes of Textile and Fiber Research (DITF), Denkendorf, Germany
| | - E Mueller
- ITV Denkendorf Produktservice GmbH, Denkendorf, Germany
| | - M Renardy
- ITV Denkendorf Produktservice GmbH, Denkendorf, Germany
| | - J Biesinger
- Department of Thoracic, Cardiac and Vascular Surgery, Clinical Research Laboratory, University Hospital Tuebingen, Tuebingen, Germany
| | - B Neumann
- Department of Thoracic, Cardiac and Vascular Surgery, Clinical Research Laboratory, University Hospital Tuebingen, Tuebingen, Germany
| | - K Stang
- Department of Thoracic, Cardiac and Vascular Surgery, Clinical Research Laboratory, University Hospital Tuebingen, Tuebingen, Germany
| | - T O Greiner
- Department of General, Visceral and Transplant Surgery, University Hospital of Tuebingen, Tuebingen, Germany
| | - C Schlensak
- Department of Thoracic, Cardiac and Vascular Surgery, Clinical Research Laboratory, University Hospital Tuebingen, Tuebingen, Germany
| | - S Krajewski
- Department of Thoracic, Cardiac and Vascular Surgery, Clinical Research Laboratory, University Hospital Tuebingen, Tuebingen, Germany
| | - H P Wendel
- Department of Thoracic, Cardiac and Vascular Surgery, Clinical Research Laboratory, University Hospital Tuebingen, Tuebingen, Germany.
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Groot Jebbink E, Holewijn S, Slump CH, Lardenoije JW, Reijnen MM. Systematic Review of Results of Kissing Stents in the Treatment of Aortoiliac Occlusive Disease. Ann Vasc Surg 2017; 42:328-336. [DOI: 10.1016/j.avsg.2017.01.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Revised: 11/07/2016] [Accepted: 01/23/2017] [Indexed: 12/20/2022]
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Single-center comparison of the efficacy and complications of arterial vascular closure devices in interventional radiology. J Vasc Access 2017; 18:339-344. [DOI: 10.5301/jva.5000623] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2016] [Indexed: 11/20/2022] Open
Abstract
Introduction Vascular closure devices (VCDs) are commonly used to achieve hemostasis of arterial access sites, but there is little comparative data on the variety of VCDs currently in clinical use. We reviewed the VCD experience at our institution to determine the safest and most effective VCD. Materials and Methods Retrospective analysis of 907 consecutive arterial procedures in interventional radiology from June 2012 to June 2014 was performed. Five VCDs were used: Angio-Seal (n = 478), FISH (n = 56), Mynx (n = 56), Perclose (n = 61), and Starclose (n = 68). Patients who underwent manual compression (n = 188) without use of VCDs were also studied as a comparison group. Patient demographics and pre-procedural laboratory parameters were recorded. The technical success rate for achievement of hemostasis and complication rates were noted. Results Complete hemostasis rate (aka technical success rate) was 93.5% for Angio-Seal, 83.9% for FISH, 53.6% for Mynx, 73.7% for Perclose, 76.5% for Starclose, and 91.5% for manual compression. The differences among the devices were statistically significant (p<0.001). Fourteen major complications (1.5%) were encountered: nine with Angio-Seal (1.9%), one with Mynx (1.8%), one with Starclose (1.5%), and three with manual compression (1.6%); these differences were not statistically significant. Of the demographic and laboratory parameters studied, none were significantly correlated with hemostasis failure or development of complications. Conclusions In our single-center institutional experience, Angio-Seal is the device with the best technical success rate. Major complications of VCDs were rare, with no statistically significant difference between devices.
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Kamusella PC, Lüdtke CW, Scheer F, Andresen R, Wissgott C. Haemostasis with the FISH Vascular Closure Device after 6 French Transfemoral Accesses in Interventional Radiology: Clinical Results. J Clin Diagn Res 2017; 11:TC05-TC07. [PMID: 28384956 DOI: 10.7860/jcdr/2017/21939.9372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 10/06/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Endovascular procedures have increased for different indications over the recent years. To achieve a safe haemostasis after arterial puncture and for more comfort for the patients different vascular closure devices have been developed. AIM To evaluate the effectiveness and safety of a percutaneous closure system based on a matrix patch for achieving haemostasis. MATERIALS AND METHODS In this study from 2014 to 2015 a percutaneous vascular closure system Femoral Introducer Sheath and Haemostasis (FISH) was used in 54 patients (mean age 69.0±10.7 years), in an antegrade and retrograde technique within the context of an angiographic intervention. The system was used in conjunction with transfemoral approaches with a sheath size of 6F. Postinterventionally (on the following day and after 6 weeks), follow-up was conducted clinically and using colour coded ultrasound. RESULTS Immediate haemostasis was achieved in 50/54 patients (92.6 %). In 4 cases, an immediate haemostasis was not achieved. In these cases, manual compression was successful. There was one major complication, a retroperitoneal bleeding requiring transfusion. Minor complications were not observed. CONCLUSION Safe and effective haemostasis is possible with the percutaneous FISH closure system at puncture sizes of 6 F. An immediate re-puncture after using FISH is possible.
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Affiliation(s)
- Peter C Kamusella
- Dr. med. Institute of Diagnostic and Interventional Radiology/ Neuroradiology Westküstenklinikum Heide - Academic Teaching Hospital of the Universities of Kiel , Lübeck and Hamburg, Heide, Germany
| | - Christopher W Lüdtke
- Dr. med. Institute of Diagnostic and Interventional Radiology/ Neuroradiology Westküstenklinikum Heide - Academic Teaching Hospital of the Universities of Kiel , Lübeck and Hamburg, Heide, Germany
| | - Fabian Scheer
- Dr. med. Institute of Diagnostic and Interventional Radiology/ Neuroradiology Westküstenklinikum Heide - Academic Teaching Hospital of the Universities of Kiel , Lübeck and Hamburg, Heide, Germany
| | - Reimer Andresen
- Professor, Institute of Diagnostic and Interventional Radiology/ Neuroradiology Westküstenklinikum Heide - Academic Teaching Hospital of the Universities of Kiel , Lübeck and Hamburg, Heide, Germany
| | - Christian Wissgott
- PD Dr. med. Institute of Diagnostic and Interventional Radiology/ Neuroradiology Westküstenklinikum Heide - Academic Teaching Hospital of the Universities of Kiel , Lübeck and Hamburg, Heide, Germany
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Closure Devices for Iatrogenic Thoraco-Cervical Vascular Injuries. Cardiovasc Intervent Radiol 2016; 40:381-387. [PMID: 27896414 PMCID: PMC5288421 DOI: 10.1007/s00270-016-1506-z] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 11/09/2016] [Indexed: 12/19/2022]
Abstract
Introduction The unintentional arterial placement of a central venous line can have catastrophic complications. The purpose of this systematic review is to assess and analyse the available evidence regarding the use of the various vascular closure devices (VCDs) for the management of iatrogenic thoraco-cervical arterial injuries (ITCAI). Methods A systematic review was performed according to PRISMA guidelines. Results Thirty-two relevant case series and case reports were identified with a total of 69 patients having being studied. In the majority of the studies, plug-based VCDs were used (81%) followed by suture-based devices (19%). The majority of studies reported successful outcomes from the use of VCDs in terms of achieving immediate haemostasis without any acute complications. Long-term follow-up data were only available in nine studies with only one case of carotid pseudoaneurysm being reported after 1-month post-procedure. All other cases had no reported long-term complications. Five studies performed direct or indirect comparisons between VCDs and other treatments (open surgery or stent grafting) suggesting no significant differences in safety or effectiveness. Conclusion Although there is limited evidence, VCDs appear to be safe and effective for the management of ITCAIs. Further research is warranted regarding the effectiveness of this approach in comparison to surgery and in order to identify those patients who are more likely to benefit from this minimally invasive approach.
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