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Rassam S, Coscas R. Percutaneous Endovascular Reconstruction of the Common Femoral Artery and Its Bifurcation. J Clin Med 2024; 13:3169. [PMID: 38892880 PMCID: PMC11173178 DOI: 10.3390/jcm13113169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Revised: 05/16/2024] [Accepted: 05/23/2024] [Indexed: 06/21/2024] Open
Abstract
Occlusive lesions of the common femoral artery (CFA) and its bifurcation have traditionally been treated with open surgery. Although long-term patency rates after open surgery are excellent, such repairs are associated with substantial local and general morbidity. In recent years, different treatment options have emerged within percutaneous endovascular repair. We hereby present a narrative review on endovascular treatment modalities and a treatment algorithm for endovascular revascularisation of the CFA and its bifurcation. Lesion analysis, access issues, vessel preparation tools, and types of repairs with or without the involvement of the bifurcation are described. Based on current data, an interventional approach can result in high technical success and acceptable mid-term patency rates. Further comparative evidence with open surgery and/or between the different types of endovascular repairs is required to improve the current treatment algorithm.
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Affiliation(s)
- Stephanie Rassam
- Division of Vascular and Endovascular Surgery, Department of Heart, Vascular and Endovascular Surgery, Paracelsus Medical University, 5020 Salzburg, Austria;
| | - Raphaël Coscas
- Department of Vascular Surgery, Centre Hospitalier Universitaire Ambroise Paré, Assistance Publique Hôpitaux de Paris (AP-HP), 92104 Boulogne-Billancourt cedex, France
- UMR 1018, Inserm-Paris11—CESP, Versailles Saint-Quentin-en-Yvelines University, Paris-Saclay University, Paul Brousse Hospital, 94807 Villejuif, France
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2
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Zenunaj G, Traina L, Acciarri P, Mucignat M, Scian S, Alesiani F, Serra R, Gasbarro V. Superficial femoral artery access for infrainguinal antegrade endovascular interventions in the hostile groin: A prospective randomized study. Ann Vasc Surg 2022; 86:127-134. [PMID: 35460853 DOI: 10.1016/j.avsg.2022.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 04/01/2022] [Accepted: 04/08/2022] [Indexed: 11/01/2022]
Abstract
INTRODUCTION In a hostile groin, it may be difficult to perform antegrade endovascular procedures at the lower extremities using the ipsilateral common femoral artery as vascular access; therefore, the use of the ipsilateral superficial femoral artery (SFA) could be a useful alternative. In this study, we evaluated the feasibility and safety of ultrasound-guided SFA puncture versus traditional SFA cutdown to achieve arterial access. METHODS This prospective observational randomized study examined patients with symptomatic peripheral arterial disease who required endovascular interventions at the lower extremities. A hostile groin was defined as high femoral bifurcation, obesity, and surgical scarring due to previous surgical interventions. A 6-Fr sheath (12 cm long; ULTIMUM™ EV INTRODUCER; Abbott, Plymouth, MN, USA) was used in all procedures. In the percutaneous group, the puncture was performed under ultrasound guidance and hemostasis was performed using a percutaneous closure device (PCD) (Angioseal Vip 6-Fr; Terumo Medical Corporation, Somerset, NJ, USA). The primary endpoints were technical success and perioperative complications. The secondary endpoints were the time required for the management of vascular access and the type of anesthesia administered. RESULTS Between 2020 and 2021, 107 patients who underwent antegrade revascularization were enrolled. SFA was achieved in 50 cases by the femoral cutdown technique (c-group) and in 57 cases by percutaneous ultrasound-guided puncture (p-group). In the c-group, the time from incision to sheath introduction and the time of suturing the artery and wound closure was 35 ± 8 min. In the p-group, the time from skin puncture and sheath placement plus that from the sheath removal and hole closure with the PCD was 6 ± 3 min. For the c-group versus p-group, the following variables were as follows: high bifurcation, 10 vs. 6 cases (=p 0.2); severe obesity, 33 vs. 40 cases (p 0.46); and previous surgical groin interventions, 7 vs. 9 cases (p 0.53), respectively. The technical success rates were 100% vs. 96.49% for the c-group vs. p-group, respectively (p 0.63). Two percutaneous puncture failures were managed using the cutdown technique. In the p-group, two post-procedural hematomas were recorded, with only one requiring surgical treatment and two with SFA occlusion to intravascular cap hemostatic dislocation, which were subjected to surgical revision. A total of three percutaneous procedures in the p-group required surgical revision versus none in the c-group (p =0.1). Within 3 months, complications consisted of 6 cases of surgical wound complications in the c-group versus none in the p-group (p 0.009). All procedures in the p-group versus 72% of patients in the c-group were managed with local anesthesia (p<0.0001). CONCLUSIONS The femoral cutdown technique seems to be safe and successful approach for achieving vascular access in cases of hostile groin. Ultrasound-guided puncture and PCD make SFA puncture a successful and safe alternative with an acceptable complications rate. Moreover, it reduces the time required to manage vascular access and can be performed mainly under local anesthesia.
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Affiliation(s)
- Gladiol Zenunaj
- Vascular Surgeon. Unit of Vascular and Endovascular Surgery, University Hospital of Ferrara, Italy.
| | - Luca Traina
- Vascular Surgeon. Unit of Vascular and Endovascular Surgery, University Hospital of Ferrara, Italy
| | - Pierfilippo Acciarri
- Vascular Surgeon. Unit of Vascular and Endovascular Surgery, University Hospital of Ferrara, Italy
| | - Marianna Mucignat
- Trainee in Vascular Surgery. School of Vascular Surgery, Department of Translational Medicine for Romagna, University of FerraraUniversity Hospital of Ferrara, Italy
| | - Sabrina Scian
- Trainee in Vascular Surgery. School of Vascular Surgery, Department of Translational Medicine for Romagna, University of FerraraUniversity Hospital of Ferrara, Italy
| | - Francesca Alesiani
- Trainee in Vascular Surgery. School of Vascular Surgery, Department of Translational Medicine for Romagna, University of FerraraUniversity Hospital of Ferrara, Italy
| | - Raffaele Serra
- Prof. Vascular Surgeon, Università Magna Graecia di Catanzaro, Italy
| | - Vincenzo Gasbarro
- Professor in Vascular Surgery Unit of Vascular and Endovascular Surgery, University Hospital of Ferrara, Italy
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Biagioni LC, Pereira L, Nasser F, Biagioni RB, Burihan MC, Wolosker N. Comparison between antegrade common femoral artery access and superficial femoral artery access in infrainguinal endovascular interventions. J Vasc Surg 2021; 74:763-770. [PMID: 33684479 DOI: 10.1016/j.jvs.2021.02.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 02/12/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Antegrade access for infrainguinal endovascular intervention can be achieved through the common femoral artery (CFA) or superficial femoral artery (SFA). A few studies with small sample sizes have shown similar efficacy and safety for antegrade puncture of the CFA and SFA. In the present study, we analyzed the feasibility of SFA access and the occurrence of complications between SFA and CFA ipsilateral access in a broader cohort. METHODS In the present retrospective study, we analyzed data from 462 patients with peripheral arterial disease (PAD) who had undergone peripheral angioplasty from 2009 to 2016. The inclusion criteria were PAD at Rutherford stage 3 to 6 and use of an endovascular approach. Patients with coagulation disorders, those receiving anticoagulant therapy, cases with deployment of closure devices, cases with more than one access on the same limb, and patients with inadequate bed rest after the procedure were excluded. A systematic analysis of all patients' electronic medical records was performed to evaluate the demographic aspects and technical success and identify the possible complications associated with CFA and SFA access. RESULTS Of the 462 patients, 290 had undergone SFA puncture and 172, CFA puncture. The demographic evaluation of both groups revealed no differences between the two groups, except that more patients with diabetes were in the CFA group and more patients with dyslipidemia and an advanced clinical presentation were in the SFA group. First puncture access was successful in 99.7% of the SFA group and 96.5% of the CFA group (P = .01). The hematoma rate in the SFA and CFA groups was 20.3% and 11%, respectively (P = .01). The incidence of major bleeding and clinically relevant nonmajor bleeding was not significantly different between the two groups (P = .215). Only three patients had developed a pseudoaneurysm, two of whom were in the SFA group. Female sex (odds ratio [OR], 2.572; 95% confidence interval [CI], 1.520-4.354; P < .001] and older age (OR, 1.034; 95% CI, 1.009-1.059; P = .007) were associated with an increased hematoma rate. CONCLUSIONS SFA access was associated with a higher overall rate of hematoma compared with CFA access. However, no significant difference was found in the incidence of major bleeding between the two access sites. Planned SFA access should be considered as an alternative to CFA access.
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Affiliation(s)
- Luisa Ciucci Biagioni
- Vascular, Endovascular, and Vascular Doppler Department, Hospital Santa Marcelina, São Paulo, São Paulo, Brazil.
| | - Leticia Pereira
- Vascular, Endovascular, and Vascular Doppler Department, Hospital Santa Marcelina, São Paulo, São Paulo, Brazil
| | - Felipe Nasser
- Vascular, Endovascular, and Vascular Doppler Department, Hospital Santa Marcelina, São Paulo, São Paulo, Brazil; Division of Vascular Surgery, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil
| | - Rodrigo Bruno Biagioni
- Vascular, Endovascular, and Vascular Doppler Department, Hospital Santa Marcelina, São Paulo, São Paulo, Brazil
| | - Marcelo Calil Burihan
- Vascular, Endovascular, and Vascular Doppler Department, Hospital Santa Marcelina, São Paulo, São Paulo, Brazil
| | - Nelson Wolosker
- Division of Vascular Surgery, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil
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The superficial femoral artery: a novel site for arterial access. Br J Anaesth 2020; 125:e453-e455. [DOI: 10.1016/j.bja.2020.08.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 07/31/2020] [Accepted: 08/17/2020] [Indexed: 11/21/2022] Open
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Pezold M, Blumberg S, Sadek M, Maldonado T, Cayne N, Jacobowitz G, James H, Berland T. Antegrade Superficial Femoral Artery Access for Lower Extremity Arterial Disease Is Safe and Effective in the Outpatient Setting. Ann Vasc Surg 2020; 72:175-181. [PMID: 33271278 DOI: 10.1016/j.avsg.2020.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 09/17/2020] [Accepted: 10/04/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Antegrade superficial femoral artery (SFA) access for peripheral artery disease reduces the time, radiation, and contrast required with contralateral common femoral access (CFA). Yet, this technique remains underutilized in the treatment of SFA, popliteal and tibial disease, and there remains limited data on the safety and effectiveness of antegrade SFA access in the outpatient setting. METHODS A retrospective review of lower extremity peripheral arterial interventions in our office-based endovascular suite was conducted from 2013 to 2018. Interventions necessitating CFA access such as iliac, common femoral, or deep femoral artery revascularization were excluded (n = 206). In addition, interventions potentially requiring large sheaths not amenable to SFA access (e.g., popliteal aneurysm) were excluded. Relevant demographic and treatment variables including postoperative complications were abstracted. RESULTS We identified 718 patients, who underwent revascularization of the SFA, popliteal and tibial arteries. Antegrade SFA access was chosen in 448 patients (62.4%) with the remaining 270 patients having retrograde CFA access. Antegrade SFA access was achieved primarily with a 4-French sheath, while a majority of retrograde CFA interventions utilized a 6-French sheath for access (87.7% vs 69.5%, P < 0.001). Significantly less fluoroscopy (9.5 vs 16.4 min, P < 0.001) and contrast (25.4 vs 38.5 mL, P < 0.001) were used during SFA access compared with retrograde access. Technical success was achieved in 93.2% with antegrade SFA vs 94.8% retrograde CFA access (P = 0.42). The overall rate of complications was low for both cohorts (2.7% vs 3.7%, P = 0.78) and there were no statistical differences in access site complications (1.1% vs 1.5%, P = 0.94), hematoma (0.7% vs 1.1%, P = 0.84), and pseudoaneurysm (0.4% vs 0%, P = 0.98) between techniques. CONCLUSIONS Percutaneous antegrade SFA access can be performed safely in the outpatient setting and remains an effective alternative to retrograde CFA access with significantly less utilization of fluoroscopy and contrast.
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Affiliation(s)
- Michael Pezold
- Division of Vascular Surgery, New York University Langone Health, New York, NY
| | - Sheila Blumberg
- Division of Vascular Surgery, New York University Langone Health, New York, NY
| | - Mikel Sadek
- Division of Vascular Surgery, New York University Langone Health, New York, NY
| | - Thomas Maldonado
- Division of Vascular Surgery, New York University Langone Health, New York, NY
| | - Neal Cayne
- Division of Vascular Surgery, New York University Langone Health, New York, NY
| | - Glenn Jacobowitz
- Division of Vascular Surgery, New York University Langone Health, New York, NY
| | - Herbert James
- New York University School of Medicine, New York, NY
| | - Todd Berland
- Division of Vascular Surgery, New York University Langone Health, New York, NY.
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Ruzsa Z, Csavajda Á, Nemes B, Deák M, Sótonyi P, Bertrand OF, Merkely B. Distal Radial Artery Access for Superficial Femoral Artery Interventions. JOURNAL OF ENDOVASCULAR THERAPY : AN OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ENDOVASCULAR SPECIALISTS 2020. [PMID: 33044111 DOI: 10.1177/1526602820963022.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To compare the acute success and complication rates of distal radial (DR) vs proximal radial (PR) artery access for superficial femoral artery (SFA) interventions. MATERIALS AND METHODS Between 2016 and 2019, 195 consecutive patients with symptomatic SFA stenosis were treated via DR (n=38) or PR (n=157) access using a sheathless guide. Secondary access was achieved through the pedal artery when necessary. The main outcomes were technical success, major adverse events (MAEs), and access site complications. Secondary outcomes were treatment success, fluoroscopy time, radiation dose, procedure time, and crossover rate to another puncture site. RESULTS Overall technical success was achieved in 188 patients (96.4%): 37 of 38 patients (97.3%) in the DR group and 151 of 157 patients (96.2%) in the PR group (p=0.9). Dual (transradial and transpedal) access was used in 14 patients (36.8%) in the DR group and 28 patients (18.9%) in the PR group (p<0.01). Chronic total occlusions were recanalized in 25 of 26 DR patients (96.1%) and in 79 of 81 PR patients (92.6%) (p=0.57). The crossover rate to femoral access was 0% in the DR group vs 3.2% in the PR group (p=0.59). Stents were implanted in the SFA in 15 DR patients (39.4%) and in 39 patients (24.8%) in the PR group (p=0.1). The contrast volume, fluoroscopy time, radiation dose, and procedure time were not statistically different between the DR and PR groups, nor were the rates of access site complications (2.6% and 7.0%, respectively). The cumulative incidences of MAE at 6 months in the DR and PR groups were 15.7% vs 14.6%, respectively (p=0.8). CONCLUSION SFA interventions can be safely and effectively performed using PR or DR access with acceptable morbidity and a high technical success rate. DR access is associated with few access site complications.
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Affiliation(s)
- Zoltán Ruzsa
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary.,Cardiology Division, Invasive Cardiology, Bács-Kiskun County Hospital, Kecskemét, Hungary
| | - Ádám Csavajda
- Cardiology Division, Invasive Cardiology, Bács-Kiskun County Hospital, Kecskemét, Hungary
| | - Balázs Nemes
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Mónika Deák
- Cardiology Division, Invasive Cardiology, Bács-Kiskun County Hospital, Kecskemét, Hungary
| | - Péter Sótonyi
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | | | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
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Ruzsa Z, Csavajda Á, Nemes B, Deák M, Sótonyi P, Bertrand OF, Merkely B. Distal Radial Artery Access for Superficial Femoral Artery Interventions. J Endovasc Ther 2020; 28:255-261. [PMID: 33044111 PMCID: PMC8044606 DOI: 10.1177/1526602820963022] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Purpose: To compare the acute success and complication rates of distal radial (DR) vs proximal radial (PR) artery access for superficial femoral artery (SFA) interventions. Materials and Methods: Between 2016 and 2019, 195 consecutive patients with symptomatic SFA stenosis were treated via DR (n=38) or PR (n=157) access using a sheathless guide. Secondary access was achieved through the pedal artery when necessary. The main outcomes were technical success, major adverse events (MAEs), and access site complications. Secondary outcomes were treatment success, fluoroscopy time, radiation dose, procedure time, and crossover rate to another puncture site. Results: Overall technical success was achieved in 188 patients (96.4%): 37 of 38 patients (97.3%) in the DR group and 151 of 157 patients (96.2%) in the PR group (p=0.9). Dual (transradial and transpedal) access was used in 14 patients (36.8%) in the DR group and 28 patients (18.9%) in the PR group (p<0.01). Chronic total occlusions were recanalized in 25 of 26 DR patients (96.1%) and in 79 of 81 PR patients (92.6%) (p=0.57). The crossover rate to femoral access was 0% in the DR group vs 3.2% in the PR group (p=0.59). Stents were implanted in the SFA in 15 DR patients (39.4%) and in 39 patients (24.8%) in the PR group (p=0.1). The contrast volume, fluoroscopy time, radiation dose, and procedure time were not statistically different between the DR and PR groups, nor were the rates of access site complications (2.6% and 7.0%, respectively). The cumulative incidences of MAE at 6 months in the DR and PR groups were 15.7% vs 14.6%, respectively (p=0.8). Conclusion: SFA interventions can be safely and effectively performed using PR or DR access with acceptable morbidity and a high technical success rate. DR access is associated with few access site complications.
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Affiliation(s)
- Zoltán Ruzsa
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary.,Cardiology Division, Invasive Cardiology, Bács-Kiskun County Hospital, Kecskemét, Hungary
| | - Ádám Csavajda
- Cardiology Division, Invasive Cardiology, Bács-Kiskun County Hospital, Kecskemét, Hungary
| | - Balázs Nemes
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Mónika Deák
- Cardiology Division, Invasive Cardiology, Bács-Kiskun County Hospital, Kecskemét, Hungary
| | - Péter Sótonyi
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | | | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
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Hwang JH, Park SW, Kwon YW, Min J, Chee HK, Shin JK. Ultrasonography-guided antegrade common femoral artery approach: Factors associated with access time. J Vasc Access 2020; 22:364-369. [PMID: 32669031 DOI: 10.1177/1129729820942053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION The aim of this study was to evaluate the feasibility and safety of ultrasonography-guided antegrade common femoral artery puncture and subsequent superficial femoral artery access without the aid of fluoroscopy. Factors that could affect access time were also assessed. METHODS A total of 294 cases from 218 consecutive patients (163 men, 55 women; mean age: 66.9 ± 12.7 years) who underwent lower extremity endovascular procedures were retrospectively evaluated. The time between the injection of local anesthetic and the insertion of the microsheath into the superficial femoral artery was measured. The common femoral artery diameter, cutis thickness, distance between arterial puncture site and common femoral artery bifurcation, degree of common femoral artery calcification, body mass index, and history of previous access were investigated to assess their relationship with access time. Furthermore, all cases were assessed with ultrasonography for access-site complications before discharge. RESULTS Technical success was achieved in 293 of 294 procedures (99.7%). The mean time for superficial femoral artery access was 1.9 ± 0.8 min (range, 0.7-3.7 min). Additional fluoroscopic guidance was needed in one case. There were moderately positive correlations of body mass index (r = 0.75; p < 0.001) and cutis thickness (r = 0.58; p < 0.001) with access time. The other variables failed to reveal significant correlations with access time. Five groin hematomas occurred after percutaneous transluminal angioplasty. Complications such as pseudoaneurysm, arteriovenous fistula, or retroperitoneal hematoma were not observed. CONCLUSION Antegrade common femoral artery puncture with subsequent superficial femoral artery access conducted solely under ultrasonography guidance was feasible and safe. In addition, the antegrade access time showed positive correlations with body mass index and cutis thickness.
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Affiliation(s)
- Jin Ho Hwang
- Department of Radiology, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Sang Woo Park
- Department of Radiology, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Yong Wonn Kwon
- Department of Radiology, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Jeeyoung Min
- Department of Radiology, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Hyun Keun Chee
- Department of Thoracic and Cardiovascular Surgery, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Je Kyoun Shin
- Department of Thoracic and Cardiovascular Surgery, Konkuk University School of Medicine, Seoul, Republic of Korea
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Oliver LA, Oliver JA, Ohanyan S, Park W, Benelyahoo A, Vadivelu N. Ultrasound for peripheral and arterial access. Best Pract Res Clin Anaesthesiol 2019; 33:523-537. [PMID: 31791568 DOI: 10.1016/j.bpa.2019.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 10/17/2019] [Indexed: 12/27/2022]
Abstract
Peripheral venous access is perhaps the most commonly performed procedure in hospitals, urgent care, or surgical centers across the country. The ability to obtain peripheral intravenous (IV) access, and in a timely manner, is arguably one of the most important skill sets to be mastered by health care professionals. While skill and experience play a role in successful and timely vascular access, numerous patient factors such as obesity, diabetes, IV drug use, and chronic kidney disease may pose unique challenges to even the most skilled health care professional. In patients with difficult access, there are often multiple attempts, which can be both time consuming for the provider and painful for the patients. Direct visualization of blood vessels using ultrasonography has an advantage over the standard landmark technique and can improve the success rate of peripheral IV or arterial line placement in this patient population. Given the success of ultrasound guidance with access placement, it is imperative that all health care profesionals become proficient with this technique. The aim of this review article is to provide concise and practical information on the basics of ultrasound and its application to obtain peripheral venous and arterial access.
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Affiliation(s)
- Lori-Ann Oliver
- Department of Anesthesiology, 333 Cedar Street, TMP 3, New Haven, CT, 06520, United States
| | - Jodi-Ann Oliver
- Department of Anesthesiology, 333 Cedar Street, TMP 3, New Haven, CT, 06520, United States
| | - Sargis Ohanyan
- Department of Anesthesiology, 333 Cedar Street, TMP 3, New Haven, CT, 06520, United States
| | - William Park
- Department of Anesthesiology, 333 Cedar Street, TMP 3, New Haven, CT, 06520, United States
| | - Aharon Benelyahoo
- Department of Anesthesiology, 333 Cedar Street, TMP 3, New Haven, CT, 06520, United States
| | - Nalini Vadivelu
- Department of Anesthesiology, 333 Cedar Street, TMP 3, New Haven, CT, 06520, United States.
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10
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Li C, You H, Zhang H, Liu Y, Li W, Wang X, Zhang Y. Application of relay puncture technique in treating patients with complicated lower extremity arterial diseases. PeerJ 2019; 7:e6345. [PMID: 30783567 PMCID: PMC6377597 DOI: 10.7717/peerj.6345] [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: 06/25/2018] [Accepted: 12/24/2018] [Indexed: 11/20/2022] Open
Abstract
Objective This study aimed to introduce and evaluate the safety and efficacy of the relay puncture technique in patients with complicated lower extremity arterial diseases. Methods A total of 21 patients (16 male and five female patients; median age: 68.5 years old), who had suffered from lower extremity arterial diseases between December 2014 and July 2017, were retrospectively collected. For all patients, the contralateral femoral artery was not available for puncture access, and the length of the devices was too short for the brachial artery approach. Therefore, the relay puncture technique, in which the first puncture was performed on the brachial artery, followed by an antegrade puncture on the femoral artery, was used to accomplish the endovascular therapy. Percutaneous transluminal angioplasty and/or percutaneous transluminal stenting were/was used to assess the efficacy of the relay puncture technique. The ankle–brachial index (ABI) and Rutherford clinical classification were used to evaluate the improvement of symptoms after treatment. Patients were followed up for 1, 3, 6, and 12 months, and annually (mean: 16.6 months) after discharge. Results The relay puncture treatment had a 100% technical success rate, and immediately decreased the ischemic symptoms of patients after the procedure. The ABI significantly increased from 0.33 ± 0.18 to 0.75 ± 0.21 at the 1-year follow-up time point (P < 0.05). No serious complications occurred during the follow-up period. The 1-year primary patency rate was 71.43%. Conclusion The relay puncture technique is a feasible technique in the hands of experienced and skilled equipment operators for the treatment of lower extremity arterial diseases, when the contralateral femoral artery is not available for puncture, and the length of the device is too short to treat the distal lesion of the femoral artery and popliteal artery through the brachial artery approach.
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Affiliation(s)
- Chengzhi Li
- Department of Interventional Radiology and Vascular Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Huimin You
- Department of Endocrinology, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.,Medical Imaging Center, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Hong Zhang
- Department of Interventional Radiology and Vascular Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Yulong Liu
- Department of Interventional Radiology and Vascular Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Wanghai Li
- Department of Interventional Radiology and Vascular Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Xiaobai Wang
- Department of Interventional Radiology and Vascular Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Yan Zhang
- Department of Interventional Radiology and Vascular Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
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Sandoval Y, Burke MN, Lobo AS, Lips DL, Seto AH, Chavez I, Sorajja P, Abu-Fadel MS, Wang Y, Poulouse A, Gössl M, Mooney M, Traverse J, Tierney D, Brilakis ES. Contemporary Arterial Access in the Cardiac Catheterization Laboratory. JACC Cardiovasc Interv 2018; 10:2233-2241. [PMID: 29169493 DOI: 10.1016/j.jcin.2017.08.058] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 07/03/2017] [Accepted: 08/02/2017] [Indexed: 11/18/2022]
Abstract
Obtaining femoral and radial arterial access in the cardiac catheterization laboratory using state-of-the-art techniques is essential to optimize outcomes, patient satisfaction, and procedural efficiency. Although transradial access is increasingly used for coronary angiography and percutaneous coronary intervention, femoral access remains necessary for numerous procedures, many requiring large-bore access, including complex high-risk coronary interventions, structural procedures, and procedures involving mechanical circulatory support. For femoral access, contemporary access techniques should combine the use of fluoroscopy, ultrasound, micropuncture needle, femoral angiography, and vascular closure devices, when feasible. For radial access, ultrasound may reveal important anatomic features and expedite access. Despite randomized controlled trials supporting use of routine ultrasound guidance for femoral and/or radial arterial access, ultrasound remains underused in cardiac catheterization laboratories. This article reviews contemporary techniques to achieve optimal arterial access in the cardiac catheterization laboratory.
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Affiliation(s)
- Yader Sandoval
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota; Division of Cardiology, Hennepin County Medical Center, Minneapolis, Minnesota
| | - M Nicholas Burke
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Angie S Lobo
- Department of Medical Education, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Daniel L Lips
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Arnold H Seto
- Division of Cardiology, Department of Medicine, Veterans Affairs Long Beach Healthcare System and University of California, Irvine Medical Center, Long Beach, California
| | - Ivan Chavez
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Paul Sorajja
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Mazen S Abu-Fadel
- Department of Medicine, Cardiovascular Section, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Yale Wang
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Anil Poulouse
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Mario Gössl
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Michael Mooney
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Jay Traverse
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - David Tierney
- Division of Cardiology, Hennepin County Medical Center, Minneapolis, Minnesota
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota.
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Vatakencherry G, Gandhi R, Molloy C. Endovascular Access for Challenging Anatomies in Peripheral Vascular Interventions. Tech Vasc Interv Radiol 2016; 19:113-22. [DOI: 10.1053/j.tvir.2016.04.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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13
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Vascular access in critical limb ischemia. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2016; 17:190-8. [DOI: 10.1016/j.carrev.2016.02.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 02/04/2016] [Indexed: 11/22/2022]
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14
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Barbetta I, van den Berg JC. Access and hemostasis: femoral and popliteal approaches and closure devices-why, what, when, and how? Semin Intervent Radiol 2014; 31:353-60. [PMID: 25435661 DOI: 10.1055/s-0034-1393972] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This article reviews the arterial access sites used in the treatment of peripheral arterial disease, including common femoral, superficial femoral, and popliteal arterial puncture. The optimal approach and techniques for arterial puncture will be described and technical tips and tricks will be discussed. An overview of the currently available vascular closure devices will also be presented. Indications, contraindications, and complications will be discussed. Results of the use of vascular closure devices compared with manual compression will be presented.
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Affiliation(s)
- Iacopo Barbetta
- Service of Interventional Radiology, Ospedale Regionale di Lugano, Lugano, Switzerland
| | - Jos C van den Berg
- Service of Interventional Radiology, Ospedale Regionale di Lugano, Lugano, Switzerland
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15
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Rimon U, Khaitovich B, Yakubovich D, Bensaid P, Golan G, Silverberg D. The Use of ExoSeal Vascular Closure Device for Direct Antegrade Superficial Femoral Artery Puncture Site Hemostasis. Cardiovasc Intervent Radiol 2014; 38:560-4. [PMID: 25209597 DOI: 10.1007/s00270-014-0984-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 07/26/2014] [Indexed: 12/14/2022]
Abstract
PURPOSE This study was designed to assess the efficacy and safety of the ExoSeal vascular closure device (VCD) to achieve hemostasis in antegrade access of the superficial femoral artery (SFA). METHODS We retrospectively reviewed the outcome of ExoSeal VCD used for hemostasis in 110 accesses to the SFA in 93 patients between July 2011 and July 2013. All patients had patent proximal SFA based on computer tomography angiography or ultrasound duplex. Arterial calcifications at puncture site were graded using fluoroscopy. The SFA was accessed in an antegrade fashion with ultrasound or fluoroscopic guidance. In all patients, 5-7F vascular sheaths were used. The ExoSeal VCD was applied to achieve hemostasis at the end of the procedure. All patients were clinically examined and had ultrasound duplex exam for any puncture site complications during the 24 h postprocedure. RESULTS In all procedures, the ExoSeal was applied successfully. We did not encounter any device-related technical failure. There were four major complications in four patients (3.6 %): three pseudoaneurysms, which were treated with direct thrombin injection, and one hematoma, which necessitated transfusion of two blood units. All patients with complications were treated with anticoagulation preprocedure or received thrombolytic therapy. CONCLUSIONS The ExoSeal VCD can be safely used for antegrade puncture of the SFA, with a high procedural success rate (100 %) and a low rate of access site complications (3.6 %).
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Affiliation(s)
- Uri Rimon
- Diagnostic and Interventional Imaging Department, Chaim Sheba Medical Center, Tel-Hashomer, Affiliated to the Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel,
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16
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Jones DW, Meltzer AJ, Schneider DB. Hybrid Approach to Limb Salvage in the Setting of an Infected Femoral–Femoral Bypass Graft. Ann Vasc Surg 2014; 28:1565.e9-13. [DOI: 10.1016/j.avsg.2014.01.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Revised: 01/04/2014] [Accepted: 01/08/2014] [Indexed: 11/28/2022]
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17
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Fontcuberta J. El acceso femoral anterógrado: soluciones simples a problemas comunes. ANGIOLOGIA 2014. [DOI: 10.1016/j.angio.2014.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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18
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Katsanos K, Tepe G, Tsetis D, Fanelli F. Standards of Practice for Superficial Femoral and Popliteal Artery Angioplasty and Stenting. Cardiovasc Intervent Radiol 2014; 37:592-603. [DOI: 10.1007/s00270-014-0876-3] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 09/04/2013] [Indexed: 11/30/2022]
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19
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Benninger B. Novel femoral artery terminology: Integrating anatomy and clinical procedures leading to standardized intuitive nomenclature. Clin Anat 2014; 27:1085-8. [DOI: 10.1002/ca.22298] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 06/14/2013] [Accepted: 06/14/2013] [Indexed: 11/10/2022]
Affiliation(s)
- Brion Benninger
- Department of Medical Anatomical Sciences; Western University of Health Sciences; COMP-Northwest Lebanon Oregon
- Department of Neuromuscular Medicine; Western University of Health Sciences; COMP-Northwest Lebanon Oregon
- Department of Family Practice; Western University of Health Sciences; COMP-Northwest Lebanon Oregon
- Faculty of Dental Medicine; College of Dental Medicine; Pomona California
- Department of Orthopaedics; Samaritan Health Services; Corvallis Oregon. Department of General Surgery; Samaritan Health Services; Corvallis Oregon. Department of Oral Maxillofacial Surgery; Oregon Health & Science University; Portland Oregon. Department of Surgery; Oregon Health & Science University; Portland Oregon. Department of Orthopaedics and Rehabilitation; Oregon Health & Science University; Portland Oregon
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20
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Comparison of a 21G Micropuncture Needle and a Regular 19G Access Needle for Antegrade Arterial Access into the Superficial Femoral Artery. Cardiovasc Intervent Radiol 2013; 37:343-7. [DOI: 10.1007/s00270-013-0669-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2013] [Accepted: 05/03/2013] [Indexed: 10/26/2022]
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21
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Stone PA, Campbell JE, Mousa AY, Aburahma AF. Basic data underlying clinical decision making in vascular surgery: arterial access for percutaneous procedures. Ann Vasc Surg 2013; 27:379-88. [PMID: 23498311 DOI: 10.1016/j.avsg.2012.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2012] [Revised: 08/18/2012] [Accepted: 10/08/2012] [Indexed: 12/17/2022]
Abstract
Percutaneous arterial access has become a mainstay in the armamentarium of vascular specialists. Vascular surgeons for decades have managed iatrogenic complications sustained by other specialists and now are more frequently performing catheter-based procedures themselves. A thorough understanding of the basic data underlying complications related to these procedures is imperative and is thoroughly reviewed.
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Affiliation(s)
- Patrick A Stone
- West Virginia University, Department of Surgery, Division of Vascular and Endovascular Surgery, Charleston, WV 25304, USA.
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22
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Stone PA, Campbell JE. Complications Related to Femoral Artery Access for Transcatheter Procedures. Vasc Endovascular Surg 2012; 46:617-23. [DOI: 10.1177/1538574412457475] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Percutaneous-based procedures continue to increase as endovascular techniques improve and provide a less morbid approach than the open vascular procedures. The most common complications associated with either cardiac interventions or peripheral interventions involve the access point of the procedure. The retrograde femoral access has and is currently the most frequently used arterial access. Vascular surgeons have been responsible for management of complications following femoral-based procedures and now are a significant contributor to catheter-based diagnostic and interventional procedures. This review provides in-depth review of the literature on specific complications encountered during percutaneous femoral artery puncture. This review includes access complications related to the method of obtaining access (ie, best pulse fluoroscopic guided), direction of access either retrograde or antegrade, risk factors and incidence of complications based on best literature sources, and management strategies for specific complications.
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Affiliation(s)
- Patrick A. Stone
- Division of Vascular & Endovascular Surgery, WVU, Charleston, WV, USA
| | - John E. Campbell
- Division of Vascular & Endovascular Surgery, WVU, Charleston, WV, USA
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Antegrade Superficial Femoral Artery versus Common Femoral Artery Punctures for Infrainguinal Occlusive Disease. J Vasc Interv Radiol 2012; 23:1160-4. [DOI: 10.1016/j.jvir.2012.06.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Revised: 05/31/2012] [Accepted: 06/04/2012] [Indexed: 11/23/2022] Open
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Gutzeit A, van Schie B, Schoch E, Hergan K, Graf N, Binkert CA. Feasibility and Safety of Vascular Closure Devices in an Antegrade Approach to Either the Common Femoral Artery or the Superficial Femoral Artery. Cardiovasc Intervent Radiol 2012; 35:1036-40. [DOI: 10.1007/s00270-012-0454-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Accepted: 07/12/2012] [Indexed: 10/28/2022]
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