1
|
Mousa MA, Zahwy SSE, Tamara AF, Samir W, Tantawy MA. A comparative study between surgical cut down and percutaneous closure devices in management of large bore arterial access. CVIR Endovasc 2023; 6:53. [PMID: 37899370 PMCID: PMC10613603 DOI: 10.1186/s42155-023-00395-6] [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: 06/27/2023] [Accepted: 09/26/2023] [Indexed: 10/31/2023] Open
Abstract
BACKGROUND Compared to conventional open surgery, minimally invasive catheter-based procedures have less post procedural complications. Transcatheter aortic valve implantation (TAVI) and endovascular aneurysm repair (EVAR) require large bore arterial access. Optimal site management of large bore arterial access is pivotal to reduce the hospital-acquired complications associated with large bore arterial access. We wanted to compare surgical cutdown versus percutaneous closure devices in site management of large bore arterial access. METHODS Participants planned for TAVI or EVAR with large bore arterial access more than 10 French were included, while participants with history of bypass surgery, malignancies, thrombophilia, or sepsis were excluded. A consecutive sample of 100 participants (mean age 74.66 ± 2.65 years, 61% males) was selected, underwent TAVI or EVAR with surgical cutdown (group 1) versus TAVI or EVAR with Proglide™ percutaneous closure device (group 2). RESULTS The incidence rate of hematoma was significantly lower in group 2 versus group 1 (p = 0.014), the mean procedure time (minutes) and the median hospital stay (days) were significantly higher in group 1 versus group 2 (t(98) = - 2.631, p = 0.01, and U = 2.403, p = 0.018, respectively), and the c-reactive protein pre-procedure and the c-reactive protein post-procedure were significantly lower in group 2 versus group 1 (U = -2.969, p = 0.003, and U = -2.674, p = 0.007, respectively). CONCLUSIONS Our study showed a lower incidence rate of large bore arterial access complications as hematoma, a shorter procedure time, and a shorter hospital stay with percutaneous closure devices compared to surgical cutdown.
Collapse
Affiliation(s)
- Mohamed Ahmed Mousa
- Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
| | | | - Ahmed Fathy Tamara
- Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Wafed Samir
- Deaprtment of Cardiology, Faculty of Medicine, Misr University for Science and Technology, 6th of October, Egypt
| | - Mahmoud Ahmed Tantawy
- Deaprtment of Cardiology, Faculty of Medicine, Misr University for Science and Technology, 6th of October, Egypt
| |
Collapse
|
2
|
Amouyal G, Tournier L, de Margerie-Mellon C, Bouda D, Pachev A, Assouline J, de Bazelaire C, Marques F, Le Strat S, Desgrandchamps F, De Kerviler E. Feasibility of Outpatient Transradial Prostatic Artery Embolization and Safety of a Shortened Deflation Protocol for Hemostasis. J Pers Med 2022; 12:jpm12071138. [PMID: 35887635 PMCID: PMC9316516 DOI: 10.3390/jpm12071138] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/05/2022] [Accepted: 07/12/2022] [Indexed: 11/16/2022] Open
Abstract
Background: to evaluate the safety and feasibility of a shorter time to hemostasis applied to outpatient transradial (TR) Prostatic Artery Embolization (PAE). Methods: a retrospective bi-institutional study was conducted between July 2018 and April 2022 on 300 patients treated by outpatient TR PAE. Indications included lower urinary tract symptoms, acute urinary retention, and hematuria. Mean patient height was 176 ± 6.3 (158–192) cm. The primary endpoint was safety of a 45 min deflation protocol for hemostasis. The secondary endpoint was the feasibility of PAE using TR access. Results: technical success was 98.7% (296/300). There was one failure due to patient height. Mean DAP/fluoroscopy times were 16,225 ± 12,126.3 (2959–81,608) μGy·m2/35 ± 14.7 (11–97) min, and mean time to discharge was 80 ± 6 (75–90) min. All access site and embolization-related adverse events were minor. Mild hematoma occurred in 10% (30/300), radial artery occlusion (RAO) in 10/300 (3.3%) cases, and history of smoking was a predictor for RAO. There was no major event. Conclusion: the safety of TR PAE using a 45 min time to hemostasis was confirmed, and TR PAE is feasible in most cases. Radial artery occlusion was still observed and may be favored by smoking.
Collapse
Affiliation(s)
- Gregory Amouyal
- Hôpital Privé Geoffroy Saint-Hilaire—Ramsay Santé, 75005 Paris, France; (F.M.); (S.L.S.)
- Radiology Department, Hôpital Saint-Louis, 75010 Paris, France; (L.T.); (C.d.M.-M.); (D.B.); (A.P.); (J.A.); (C.d.B.); (E.D.K.)
- Correspondence: ; Tel.: +33-670132138
| | - Louis Tournier
- Radiology Department, Hôpital Saint-Louis, 75010 Paris, France; (L.T.); (C.d.M.-M.); (D.B.); (A.P.); (J.A.); (C.d.B.); (E.D.K.)
- Faculté de Médecine, Université Paris cité, 75006 Paris, France;
| | - Constance de Margerie-Mellon
- Radiology Department, Hôpital Saint-Louis, 75010 Paris, France; (L.T.); (C.d.M.-M.); (D.B.); (A.P.); (J.A.); (C.d.B.); (E.D.K.)
- Faculté de Médecine, Université Paris cité, 75006 Paris, France;
| | - Damien Bouda
- Radiology Department, Hôpital Saint-Louis, 75010 Paris, France; (L.T.); (C.d.M.-M.); (D.B.); (A.P.); (J.A.); (C.d.B.); (E.D.K.)
- Faculté de Médecine, Université Paris cité, 75006 Paris, France;
| | - Atanas Pachev
- Radiology Department, Hôpital Saint-Louis, 75010 Paris, France; (L.T.); (C.d.M.-M.); (D.B.); (A.P.); (J.A.); (C.d.B.); (E.D.K.)
- Faculté de Médecine, Université Paris cité, 75006 Paris, France;
| | - Jessica Assouline
- Radiology Department, Hôpital Saint-Louis, 75010 Paris, France; (L.T.); (C.d.M.-M.); (D.B.); (A.P.); (J.A.); (C.d.B.); (E.D.K.)
- Faculté de Médecine, Université Paris cité, 75006 Paris, France;
| | - Cédric de Bazelaire
- Radiology Department, Hôpital Saint-Louis, 75010 Paris, France; (L.T.); (C.d.M.-M.); (D.B.); (A.P.); (J.A.); (C.d.B.); (E.D.K.)
- Faculté de Médecine, Université Paris cité, 75006 Paris, France;
| | - Florent Marques
- Hôpital Privé Geoffroy Saint-Hilaire—Ramsay Santé, 75005 Paris, France; (F.M.); (S.L.S.)
| | - Solenne Le Strat
- Hôpital Privé Geoffroy Saint-Hilaire—Ramsay Santé, 75005 Paris, France; (F.M.); (S.L.S.)
| | - François Desgrandchamps
- Faculté de Médecine, Université Paris cité, 75006 Paris, France;
- Urology Department, Hôpital Saint-Louis, 75010 Paris, France
- SRHI/CEA—Institut de Recherche Clinique Saint-Louis, Hôpital Saint-Louis, 75010 Paris, France
| | - Eric De Kerviler
- Radiology Department, Hôpital Saint-Louis, 75010 Paris, France; (L.T.); (C.d.M.-M.); (D.B.); (A.P.); (J.A.); (C.d.B.); (E.D.K.)
- Faculté de Médecine, Université Paris cité, 75006 Paris, France;
| |
Collapse
|
3
|
Abstract
PURPOSE OF REVIEW Vascular access and closure is a key part of endovascular procedures, and access site-related complications are an independent predictor of adverse procedural outcomes. The purpose of this review is to discuss the methods of vascular closure including manual compression, vascular closure devices (VCDs) for both arterial and venous arteriotomies, their mechanisms, and access site-related complications. RECENT FINDINGS Various VCDs have been approved over the last three decades. These devices have different mechanisms to achieve hemostasis and are generally categorized into active and passive approximators. Studies have largely found that they are non-inferior to manual compression. Uncomplicated vascular closure is pertinent to avoid adverse procedure-related outcomes. The emergence of VCDs has reduced time to hemostasis, facilitating early ambulation and discharge and reducing hospitalization cost with comparable complication rate to manual compression. Nonetheless, they should be used in favorable vascular anatomy and are not intended to reduce complications.
Collapse
Affiliation(s)
- Sukhdeep Bhogal
- Section of Interventional Cardiology, MedStar Washington Hospital Center, 110 Irving St.Suite 4B-1, Washington, NWDC, 20010, USA
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, 110 Irving St.Suite 4B-1, Washington, NWDC, 20010, USA.
| |
Collapse
|
4
|
Kretzschmar D, Möbius-Winkler S, Schulze PC, Ferrari MW. Concept and Design of a Novel Pulsatile Left Heart Assist Device-The PERKAT Left Ventricle System. ASAIO J 2022; 68:28-32. [PMID: 33709987 DOI: 10.1097/mat.0000000000001397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Cardiogenic shock is associated with high mortality. Patients often require temporary mechanical circulatory support. We aimed to develop a percutaneously implantable, assist device that unloads the left ventricle (LV) in a pulsatile way. The PERkutane KATheter pump technologie (PERKAT LV) device consists of a nitinol pump chamber, which is covered by foils carrying outflow valves. A flexible tube with a pigtail-shaped tip and inflow holes represents the distal part of the pump. The system is designed for 16F percutaneous implantation. The nitinol chamber is placed in the descending aorta while the flexible tube bypasses aortic arch and ascending aorta with its tip in the LV. An intra-aortic balloon pump is placed into the chamber and connected to a console. Balloon deflation generates a blood flow from the LV into the pump chamber. During balloon inflation, blood leaves the system through the outflow foil valves in the descending aorta. Under different afterload settings using a 30 cc intra-aortic balloon pump and varying inflation/deflations rates, we recorded flow rates up to 3.0 L/min. Based on this, we believe that PERKAT LV is a promising approach for temporary LV support. The proposed design and its excellent performance give basis for in vivo tests in an animal model.
Collapse
Affiliation(s)
- Daniel Kretzschmar
- From the Department of Internal Medicine I, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Sven Möbius-Winkler
- From the Department of Internal Medicine I, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - P Christian Schulze
- From the Department of Internal Medicine I, Jena University Hospital, Friedrich-Schiller-University Jena, Jena, Germany
| | - Markus W Ferrari
- HSK, Clinic of Internal Medicine I, Helios-Kliniken, Wiesbaden, Germany
| |
Collapse
|
5
|
Rudenko BA, Feshchenko DA, Vasiliev DK, Sitko IG, Shukurov FB, Shanoyan AS, Drapkina OM. Hemorrhagic complications after endovascular interventions and the effectiveness of vascular closure devices. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2021. [DOI: 10.15829/1728-8800-2021-3046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Aim. To identify the factors associated with hemorrhagic complications after endovascular interventions, as well as to assess the effectiveness of vascular closure devices.Material and methods. The study included 423 patients after endo - vascular intervention with femoral arterial access: 118 — manual compression, 305 — hemostasis using vascular closure devices (VCDs). The development of following complications was recorded: retroperitoneal hematoma, false aneurysm, arteriovenous fistula, bleeding, thigh soft-tissue hematoma. Time to hemostasis, immobilization period, and length of stay were assessed.Results. The complication rate was lower in VCD group compared to manual hemostasis (2,95 vs 11%, p=0,021). In VCD group, hemostasis characteristics significantly differed from the manual compression group: time to hemostasis — 3,1 vs 22,3 min (p=0,001), immobilization duration — 4,1 vs 20 hours (p=0,001), length of stay — 4 vs 8 days (p=0,001), respectively. The risk of complications increased with following factors: anticoagulant therapy, female sex, age >65 years, diabetes, body mass index >30 kg/m2 , vascular access calcification, introducer diameter >6 Fr, prior puncture. There were following independent predictors of complications: glycoprotein IIb/IIIa inhibitor therapy, superficial or deep femoral artery puncture.Conclusion. VCDs significantly reduces the hemorrhagic complication rate and improves hemostasis parameters as compared to manual compression.
Collapse
Affiliation(s)
- B. A. Rudenko
- National Medical Research Center for Therapy and Preventive Medicine
| | - D. A. Feshchenko
- National Medical Research Center for Therapy and Preventive Medicine
| | - D. K. Vasiliev
- National Medical Research Center for Therapy and Preventive Medicine
| | | | - F. B. Shukurov
- National Medical Research Center for Therapy and Preventive Medicine
| | - A. S. Shanoyan
- National Medical Research Center for Therapy and Preventive Medicine
| | - O. M. Drapkina
- National Medical Research Center for Therapy and Preventive Medicine
| |
Collapse
|
6
|
Ayuso SA, Shipp RC, Aladegbami BG, Farquharson D, Lawson D, Bassett R. AbsorbaSeal™ 5.6.7F vascular closure device: A good laboratory practice chronic study evaluating safety and efficacy in a healthy porcine model. Vascular 2021; 30:934-942. [PMID: 34459306 DOI: 10.1177/17085381211037883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Vascular closure devices (VCDs) are widely used for arteriotomy closure after percutaneous catheter-based procedures. In comparison to manual compression, VCDs have been associated with shorter time to hemostasis, shorter time to ambulation, and also decreased length of stay. Complexity of deployment, lack of immediate hemostasis, and residual deformity of the arterial wall remain as limitations of current VCDs. The aim of this study was to investigate the AbsorbaSeal™ 5.6.7F vascular closure device, a novel, completely bioabsorbable, intuitive, and easy to use VCD which uses a compressive, "sandwich"-type design comprising a low profile intravascular distal seal and gasket and an extravascular floating foot and proximal seal, in an open infrarenal aortic swine model. METHODS Eight fully heparinized swine at a good laboratory practices facility underwent AbsorbaSeal™ 5.6.7F VCD closure of three 6F arteriotomies each in the proximal, mid, and distal infrarenal aorta. Two swine underwent harvest at each of four time cohorts: 30, 60, 90, and 120 days. Acute and chronic procedural safety and efficacy, as well as target site vascular remodeling over time, were the primary outcomes evaluated. Secondary outcome measures included local and systemic inflammatory responses, end-organ tissue analysis, and device-related complications through the follow-up periods. Histopathological evaluation was performed by a blinded pathologist. Standard statistical methods were used. RESULTS In deployment of 24 AbsorbaSeal™ 5.6.7F VCDs, there were no device-related complications or mortalities. All deployments resulted in rapid arteriotomy seal (100% deployment success), with a mean time to hemostasis (cessation of arterial flow) of 21.5 s (median: 6.5 s) across a mean activated clotting time (ACT) of 356 s. Twenty of the 24 implant sites (83%) attained complete hemostasis within 20 s. Immediate post-implant and pre-termination angiographies at all time points were performed of all swine which demonstrated normal aortic appearance and tissue structure and normal downstream vascular beds. At 30 days, each implant's intravascular distal seal and gasket were removed from the circulation and completely covered with a smooth neointimal layer. Minimal inflammation and no intimal or luminal thrombus were observed at any site at every time point. CONCLUSIONS AbsorbaSeal™ 5.6.7F is a safe, effective, and secure VCD that demonstrates rapid hemostasis in a fully heparinized open aortic porcine model. Removal from circulation and complete coverage of the intravascular distal seal and gasket with neointima occurred within 30 days post-implant. Natural transmural vessel healing from the arteriotomy itself with minimal inflammation was noted for each implant at every time point.
Collapse
Affiliation(s)
- Sullivan A Ayuso
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, 22442Carolinas Medical Center, Charlotte, NC, USA
| | - R Caroline Shipp
- 171799The University of Tennessee at Chattanooga College of Arts and Sciences, Chattanooga, TN, USA
| | - Bola G Aladegbami
- Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, 22442Carolinas Medical Center, Charlotte, NC, USA
| | - Delton Farquharson
- General and Vascular Surgery, 58810Princess Margaret Hospital, Nassau, Bahamas
| | | | | |
Collapse
|
7
|
Reich R, Rabelo-Silva ER, Swanson E, Moorhead S, Almeida MDA. Development of a nursing outcome for a percutaneous procedure. Int J Nurs Knowl 2021; 33:84-92. [PMID: 34105879 DOI: 10.1111/2047-3095.12329] [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: 02/12/2021] [Revised: 04/29/2021] [Accepted: 05/03/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To develop a nursing outcome, consistent with the standardized format of outcomes within the nursing Outcomes Classification (NOC). This outcome will include an outcome label, an outcome definition, and clinical indicators. The proposed use for this outcome is to evaluate the access site of a percutaneous procedure. METHODS Concept analysis with a scoping review. Initially, content experts were recruited to validate the indicators of the proposed outcome in order to complete a consensus validation. After consensus validation, a review of the proposed outcome and its indicators was completed by two of the editors of the NOC team to confirm that the outcome label, definition, and indicators were consistent with the NOC taxonomy. During this review, edits were made on the label name and definition. FINDINGS After a series of reviews, the initial outcome of Vascular Status: Percutaneous Procedure Access was changed to Tissue Injury Severity: Percutaneous Procedure. In addition, the original definition of the condition of an access site for percutaneous procedure by venous or arterial puncture and health of surrounding tissues was edited to: Severity of complications from a needle-puncture access through the skin and into deeper tissues. The outcome has 11 indicators to be used to formulate a target rating for use in the clinical setting. The indicators were not edited over the course of the reviews. CONCLUSION The proposed outcome will assist nurses in evaluating the access site of percutaneous procedures and in identifying possible complications. IMPLICATIONS FOR THE NURSING PRACTICE This research contributes to the refinement of the NOC taxonomy by having a new outcome that meets clinical practice needs.
Collapse
Affiliation(s)
- Rejane Reich
- School of Nursing, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.,Cardiology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Eneida Rejane Rabelo-Silva
- School of Nursing, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.,Cardiology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | | | - Sue Moorhead
- College of Nursing, The University of Iowa, Iowa City, Iowa
| | - Miriam de Abreu Almeida
- School of Nursing, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| |
Collapse
|
8
|
Mikhailov IP, Kungurtsev EV, Arustamyan VA, Muslimov RS. [Surgical treatment of a patient with false aneurysm of the ulnar artery]. Khirurgiia (Mosk) 2021:70-72. [PMID: 33710830 DOI: 10.17116/hirurgia202103170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Today, the number of endovascular procedures is steadily growing. For example, there were 40.005 endovascular interventions in 2018. Most patients are discharged within 1-2 days after intervention due to its effectiveness and minimal invasiveness. However, physicians do not always note local postoperative complications. Multidisciplinary approach in follow-up and treatment of such patients is important. In particular, we talk about awareness of doctors of polyclinics about possible complications after arterial puncture. Effectiveness and favorable result of surgical treatment of local postoperative complications after arterial puncture are reported in the manuscript.
Collapse
Affiliation(s)
- I P Mikhailov
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
| | - E V Kungurtsev
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
| | - V A Arustamyan
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
| | - R Sh Muslimov
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
| |
Collapse
|
9
|
Qiao E, Wang Y, Yu J, Wang X, Luo X, Wang W. Short-term assessment of radial artery grafts with multidetector computed tomography. J Cardiothorac Surg 2021; 16:93. [PMID: 33865411 PMCID: PMC8052742 DOI: 10.1186/s13019-021-01465-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 04/05/2021] [Indexed: 12/05/2022] Open
Abstract
Background The clinical use of the radial artery (RA) in coronary artery bypass grafting (CABG) is still limited worldwide, although it has been recommended by several guidelines. Multidetector computed tomography (MDCT) is widely used to evaluate graft patency, as invasive coronary angiography could cause potentially serious risks including bleeding, dissection and stroke. This study aims to report the short-term results of the RA in CABG with MDCT. Methods The study population consists of 41 consecutive patients undergoing elective CABG with the RA graft between 2017 to 2018, with MDCT performed to evaluate graft patency during follow-up, and target vessels for the RA were non-left anterior descending coronary arteries with > 70% stenosis. Results A total of 150 grafts were assessed by MDCT during follow-up (mean, 8.9 ± 5.1 months). MDCT could clearly show the structure and patency of grafts, even for complex coronary artery revascularization. Graft patency of the left internal mammary artery was 92.9% (39/42), with the RA patency of 84.4% (38/45) and the patency of the saphenous vein graft of 81.1% (30/37). And the RA anastomosed to the left coronary artery system might have better patency than the RA anastomosed to the right coronary artery system (25/29, 86.2% vs 13/16, 81.3%, p = 0.686). Conclusions The short-term patency rate of RA grafts is good, and the RA might be associated with better patency when anastomosed to the left but not the right coronary artery. MDCT could provide excellent visualization of grafts in CABG.
Collapse
Affiliation(s)
- En Qiao
- Structural Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences, Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Yuetang Wang
- Structural Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences, Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Jun Yu
- Structural Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences, Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Xu Wang
- Structural Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences, Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Xinjin Luo
- Structural Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences, Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China
| | - Wei Wang
- Structural Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences, Peking Union Medical College, 167 Beilishi Road, Xicheng District, Beijing, 100037, China.
| |
Collapse
|
10
|
Case BC, Kumar S, Yerasi C, Forrestal BJ, Musallam A, Chezar-Azerrad C, Khalid N, Shlofmitz E, Chen Y, Khan JM, Satler LF, Ben-Dor I, Hashim H, Bernardo NL, Rogers T, Waksman R. Real-world experience of suture-based closure devices: Insights from the FDA Manufacturer and User Facility Device Experience. Catheter Cardiovasc Interv 2021; 98:572-577. [PMID: 33539651 DOI: 10.1002/ccd.29501] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 01/15/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVES We analyzed post-marketing surveillance data from the United States Food and Drug Administration (FDA) Manufacturer and User Facility Device Experience (MAUDE) database for suture-based vascular closure devices (VCDs) - Perclose ProGlide (Abbott, Chicago, Illinois) and Prostar XL (Abbott). BACKGROUND Suture-based VCDs are mostly used for large-bore femoral arterial access-site closure. Real-world, contemporary experience on the most commonly reported complications and modes of failure associated with these devices is limited. METHODS Post-marketing surveillance data from the FDA MAUDE database, for the ProGlide system and for the Prostar XL system, were analyzed, yielding 827 Perclose ProGlide reports and 175 Prostar XL reports. RESULTS Of the 827 reports of major complications involving the Perclose ProGlide devices, 404 reports involved injury, and one involved death related to the device. In the Prostar XL analysis, 94 reports involved injury, and one involved death. Bleeding from vessel injury was the most common adverse outcome described with both devices, followed by hematoma and thrombus. Surgical repair was the most commonly used treatment strategy. In terms of device malfunction, suture-related malfunction (212 reports) was most commonly seen in the Perclose ProGlide group, while failed deployment was most commonly seen in the Prostar XL group. CONCLUSIONS Our analysis of the MAUDE database demonstrates that in real-world practice, suture-based VCDs were found to be associated with complications, including vascular injury, difficulties with the device itself, and even death. Ongoing user education and pre-procedural patient selection are important to minimize risks associated with suture-based vascular closure devices.
Collapse
Affiliation(s)
- Brian C Case
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Sant Kumar
- Department of Cardiology, Georgetown University School of Medicine, Washington, District of Columbia
| | - Charan Yerasi
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Brian J Forrestal
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Anees Musallam
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Chava Chezar-Azerrad
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Nauman Khalid
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Evan Shlofmitz
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Yuefeng Chen
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Jaffar M Khan
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia.,Cardiovascular Branch, Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Lowell F Satler
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Itsik Ben-Dor
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Hayder Hashim
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Nelson L Bernardo
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
| | - Toby Rogers
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia.,Cardiovascular Branch, Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia
| |
Collapse
|
11
|
Wang MT, Schembri M, Kok HK, Maingard J, Foo M, Lamanna A, Brooks M, Asadi H. Rendezvous endovascular common carotid artery stenting (RECCAS) technique for symptomatic steno-occlusive disease. CVIR Endovasc 2021; 4:17. [PMID: 33459863 PMCID: PMC7813902 DOI: 10.1186/s42155-020-00194-3] [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] [Accepted: 12/09/2020] [Indexed: 11/21/2022] Open
Abstract
This report describes a patient who presented with acute but transient right arm weakness and altered sensation secondary to severe stenosis of the left common carotid artery (CCA) origin. Endovascular stenting of the stenosed origin was achieved utilising a novel rendezvous technique through combined retrograde common carotid artery and anterograde transfemoral approaches. This technique has numerous potential advantages over traditional transfemoral endovascular and open retrograde common carotid artery approaches. It allows increased procedural control and success in traversing the stenosis and provides a smooth transition for the stent delivery catheter. An open cutdown procedure or open surgical technique is not required. Our patient recovered well from the procedure with no complications within the three-month follow up period.
Collapse
Affiliation(s)
- M T Wang
- Interventional Radiology and Neurointerventional Services, Department of Radiology, Austin Health, Melbourne, Australia.
| | - M Schembri
- Interventional Radiology and Neurointerventional Services, Department of Radiology, Austin Health, Melbourne, Australia
| | - H K Kok
- Interventional Radiology Service, Department of Radiology, Northern Health, Melbourne, Australia.,School of Medicine, Deakin University, Melbourne, Australia
| | - J Maingard
- School of Medicine, Deakin University, Melbourne, Australia.,Interventional Radiology and Neurointerventional Services, Department of Radiology, Monash Health, Melbourne, Australia
| | - M Foo
- Interventional Radiology and Neurointerventional Services, Department of Radiology, Austin Health, Melbourne, Australia
| | - A Lamanna
- Interventional Radiology and Neurointerventional Services, Department of Radiology, Austin Health, Melbourne, Australia
| | - M Brooks
- Interventional Radiology and Neurointerventional Services, Department of Radiology, Austin Health, Melbourne, Australia.,School of Medicine, Deakin University, Melbourne, Australia
| | - H Asadi
- Interventional Radiology and Neurointerventional Services, Department of Radiology, Austin Health, Melbourne, Australia.,School of Medicine, Deakin University, Melbourne, Australia.,Interventional Radiology and Neurointerventional Services, Department of Radiology, Monash Health, Melbourne, Australia
| |
Collapse
|
12
|
Higgins MCSS, Herpy JP. Medical Error, Adverse Events, and Complications in Interventional Radiology: Liability or Opportunity? Radiology 2020; 298:275-283. [PMID: 33320064 DOI: 10.1148/radiol.2020202341] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Mikhail C S S Higgins
- From the Department of Radiology, Boston Medical Center, 820 Harrison Ave, FGH Building 4th Floor, Boston, MA 02118 (M.C.S.S.H.); and Department of Radiology, Boston University School of Medicine, Boston, Mass (J.P.H.)
| | - James P Herpy
- From the Department of Radiology, Boston Medical Center, 820 Harrison Ave, FGH Building 4th Floor, Boston, MA 02118 (M.C.S.S.H.); and Department of Radiology, Boston University School of Medicine, Boston, Mass (J.P.H.)
| |
Collapse
|
13
|
Glanz L. Pseudaneurysm of the superolateral genicular artery following an anterior cruciate ligament reconstruction. Int J Surg Case Rep 2020; 72:628-631. [PMID: 32611535 PMCID: PMC7365774 DOI: 10.1016/j.ijscr.2020.02.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 02/19/2020] [Accepted: 02/24/2020] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Arthroscopic procedures are a safe way nowadays to do anterior cruciate ligament reconstruction. Rare complications involve injuries to popliteal vessels or one of its branches. PRESENTATION OF CASE We present a case of a young patient who undergone an anterior cruciate ligament reconstruction. This procedure was associated with a meniscal suture. The follow-up was marked by pseudoaneurysm of the supero-lateral genicular artery. DISCUSSION This is the first time a pseudoaneurysm of this branch is described in the literature as we discovered it. The treatment by an ultrasonography-guided embolization with thrombin was proceeded and suceeded. CONCLUSION We stress the fact with new arthroscopic procedures and techniques, new complications can occur, and we should be attentive to them and new symptoms consequently, as a painless mass on the lateral side of the knee, to ensure a fast and optimal treatment.
Collapse
Affiliation(s)
- L Glanz
- Department of Orthopedic Surgery and Musculoskeletal Trauma Care, University Hospitals Geneva, Geneva, Switzerland; Civil Hospices of Lyon, Université Claude Bernard Lyon 1, Lyon, France.
| |
Collapse
|
14
|
Mortensen C, Chung J, Liu D, Ho S, Legiehn G, Machan L, Klass D. Prospective Study on Total Fluoroscopic Time in Patients Undergoing Uterine Artery Embolization: Comparing Transradial and Transfemoral Approaches. Cardiovasc Intervent Radiol 2018; 42:441-447. [DOI: 10.1007/s00270-018-2100-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 10/17/2018] [Indexed: 10/28/2022]
|
15
|
Lindsay AC, Bishop J, Harron K, Davies S, Haxby E. Use of a safe procedure checklist in the cardiac catheterisation laboratory. BMJ Open Qual 2018; 7:e000074. [PMID: 30057949 PMCID: PMC6059321 DOI: 10.1136/bmjoq-2017-000074] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 04/04/2018] [Accepted: 04/20/2018] [Indexed: 11/28/2022] Open
Abstract
Background The use of the WHO safe surgery checklist has been shown to reduce morbidity and mortality from surgical procedures. However, whether a WHO-style safe procedure checklist can improve safety in the cardiac catheterisation laboratory (CCL) has not previously been investigated. Objectives The authors sought to design and implement a safe procedure checklist suitable for all CCL procedures, and to assess its impact over the course of 1 year. Methods In the first 3 months, weekly PDSA cycles (Plan-Do-Study-Act) were used to optimise the design of the checklist through testing and staff feedback, and team briefing sessions were introduced before each procedure list. The impact of the checklist and team briefs was assessed by analysing in-house procedural data subsequently submitted to national audit databases. Staff and patient questionnaires were performed throughout the year. Results Introduction of the checklist was associated with a significant reduction of 3 min in average turnaround time (95% CI 25 s to 6 min, p=0.027). Similarly, an initial reduction in patient radiation exposure was recorded (dose area product reduction of 641.5 cGy/cm2; 95% CI 255.9 to 1027.1, p=0.002). The rate of reported complications from all procedures fell significantly from 2.0% in 2012/2013 (95% CI 1.6% to 2.4%) to 0.8% in 2013/2014 (95% CI 0.6% to 1.1%, p≤0.001). Staff climate questionnaires showed that technicians and radiographers gave more positive responses at the end of the study period compared with the beginning (p=0.001). Conclusions The use of a team brief and WHO-derived safe procedure checklist in the CCL was associated with decreased radiation exposure, fewer procedural complications, faster turnarounds and improved staff experience.
Collapse
Affiliation(s)
- Alistair C Lindsay
- Cardiology, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Jeremy Bishop
- Department of Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Katie Harron
- Department of Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Simon Davies
- Department of Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Elizabeth Haxby
- Department of Statistics, London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
16
|
Reich R, Rabelo-Silva ER, Santos SMD, Almeida MDA. Vascular access complications in patients undergoing percutaneous procedures in hemodynamics: a scoping review. Rev Gaucha Enferm 2018; 38:e68716. [PMID: 29933427 DOI: 10.1590/1983-1447.2017.04.68716] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 03/28/2017] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To map the production of knowledge on vascular access complications in patients undergoing percutaneous procedures in hemodynamic laboratories. METHODS Scoping review study. The search strategy was developed in three stages, considering the period from July 2005 to July 2015 in the PubMed, CINAHL, Scopus, and LILACS databases. The collected data were analyzed and summarized in a narrative form. RESULTS One-hundred twenty-eight publications that made it possible to map the contexts of study of complications, occurrence according to access routes, as well as an understanding of diagnosis and clinical management, were included. Three theme categories were identified: complications; predictive factors; and diagnosis/treatment. CONCLUSION Vascular access site complications range according to the access route used. Knowledge of factors that permeate the occurrence of these events may contribute to early detection, planning, and monitoring of the care implemented.
Collapse
Affiliation(s)
- Rejane Reich
- Hospital de Clínicas de Porto Alegre (HCPA). Porto Alegre, Rio Grande do Sul, Brasil.,Universidade Federal do Rio Grande do Sul (UFRGS), Escola de Enfermagem, Programa de Pós-graduação em Enfermagem. Porto Alegre, Rio Grande do Sul, Brasil
| | - Eneida Rejane Rabelo-Silva
- Hospital de Clínicas de Porto Alegre (HCPA). Porto Alegre, Rio Grande do Sul, Brasil.,Universidade Federal do Rio Grande do Sul (UFRGS), Escola de Enfermagem, Programa de Pós-graduação em Enfermagem. Porto Alegre, Rio Grande do Sul, Brasil.,Universidade Federal do Rio Grande do Sul (UFRGS), Escola de Enfermagem. Departamento de Enfermagem Médico-Cirúrgica. Porto Alegre, Rio Grande do Sul, Brasil
| | - Simone Marques Dos Santos
- Hospital de Clínicas de Porto Alegre (HCPA). Porto Alegre, Rio Grande do Sul, Brasil.,Universidade Federal do Rio Grande do Sul (UFRGS), Escola de Enfermagem, Programa de Pós-graduação em Enfermagem. Porto Alegre, Rio Grande do Sul, Brasil
| | - Miriam de Abreu Almeida
- Hospital de Clínicas de Porto Alegre (HCPA). Porto Alegre, Rio Grande do Sul, Brasil.,Universidade Federal do Rio Grande do Sul (UFRGS), Escola de Enfermagem, Programa de Pós-graduação em Enfermagem. Porto Alegre, Rio Grande do Sul, Brasil.,Universidade Federal do Rio Grande do Sul (UFRGS), Escola de Enfermagem. Departamento de Enfermagem Médico-Cirúrgica. Porto Alegre, Rio Grande do Sul, Brasil
| |
Collapse
|
17
|
Tonolini M, Ierardi AM, Carrafiello G, Laganà D. Multidetector CT of iatrogenic and self-inflicted vascular lesions and infections at the groin. Insights Imaging 2018; 9:631-642. [PMID: 29675625 PMCID: PMC6108968 DOI: 10.1007/s13244-018-0613-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 02/14/2018] [Accepted: 02/19/2018] [Indexed: 12/19/2022] Open
Abstract
Abstract The number and complexity of endovascular procedures performed via either arterial or venous access are steadily increasing. Albeit associated with higher morbidity compared to the radial approach, the traditional common femoral artery remains the preferred access site in a variety of cardiac, aortic, oncologic and peripheral vascular procedures. Both transarterial and venous cannulation (for electrophysiology, intravenous laser ablation and central catheterisation) at the groin may result in potentially severe vascular access site complications (VASC). Furthermore, vascular and soft-tissue groin infections may develop after untreated VASC or secondarily to non-sterile injections for recreational drug use. VASC and groin infections require rapid diagnosis and appropriate treatment to avoid further, potentially devastating harm. Whereas in the past colour Doppler ultrasound was generally used, in recent years cardiologists, vascular surgeons and interventional radiologists increasingly rely on pelvic and femoral CT angiography. Despite drawbacks of ionising radiation and the need for intravenous contrast, multidetector CT rapidly and consistently provides a panoramic, comprehensive visualisation, which is crucial for correct choice between conservative, endovascular and surgical management. This paper aims to provide radiologists with an increased familiarity with iatrogenic and self-inflicted VASC and infections at the groin by presenting examples of haematomas, active bleeding, pseudoaneurysms, arterial occlusion, arterio-venous fistula, endovenous heat-induced thrombosis, septic thrombophlebitis, soft-tissue infections at the groin, and late sequelae of venous injuries. Teaching Points • Complications may develop after femoral arterial or venous access for interventional procedures. • Arterial injuries include bleeding, pseudoaneurysm, occlusion, arteriovenous fistula, dissection. • Endovenous heat-induced thrombosis is a specific form of iatrogenic venous complication. • Iatrogenic infections include groin cellulitis, abscesses and septic thrombophlebitis. • CT angiography reliably triages vascular access site complications and groin infections.
Collapse
Affiliation(s)
- Massimo Tonolini
- Department of Radiology, "Luigi Sacco" University Hospital, Via G.B. Grassi 74, 20157, Milan, Italy.
| | - Anna Maria Ierardi
- Diagnostic and Interventional Radiology Department, ASST Santi Paolo e Carlo, Via A di Rudinì 8, 20142, Milan, Italy
| | - Gianpaolo Carrafiello
- Diagnostic and Interventional Radiology Department, ASST Santi Paolo e Carlo, Via A di Rudinì 8, 20142, Milan, Italy
| | - Domenico Laganà
- Department of Radiology, "Magna Grecia" University, Viale Europa, 88100, Catanzaro, Italy
| |
Collapse
|
18
|
Gabrielli R, Rosati MS, Millarelli M, Dante A, Maiorano M, Musilli A, Chiappa R, Ventura M. FemoSeal ® Device Use for Femoral Artery Closure by Different Techniques. Ann Vasc Surg 2018; 51:18-24. [PMID: 29678650 DOI: 10.1016/j.avsg.2018.02.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 02/03/2018] [Accepted: 02/09/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Common femoral artery is still the most frequently used site for vascular access, mostly for peripheral arterial interventions, and its puncture remains a significant source of patient's morbidity. Manual compression (MC) has been the gold standard for hemostasis after femoral catheterization until recently, but only in the last few years, vascular closure devices (VCDs) are replacing MC due to their rapid development. Nowadays, vascular surgeons (VSs) are also becoming familiar with VCDs. The purpose of this study was to investigate FemoSeal® arterial closure system use in terms of safety and efficacy in patients undergoing transfemoral peripheral procedure and evaluate the complication risk factors. METHODS A retrospective analysis to compare 2 different specialists and technique with systematic implantation of FemoSeal® VCD was performed in a cohort of vascular patients treated by endovascular procedure with femoral artery access site over a 2-year period and sheaths ranged from 6F to 8F. All the patients were on antiplatelet therapy and received heparin during the procedure. The FemoSeal® was deployed in common femoral arteries. All patients were examined for access site complication by VS in both groups 20-24 hrs after VCD deployment and 1 and 6 weeks after the procedure with clinical visit and ultrasound duplex scan. Complications, as minor and major hematomas, pseudoaneurysm formation, vessel occlusion or dissection, and infection were recorded. RESULTS During the study period, 130 FemoSeal® were deployed in 114 patients, 102 FemoSeal® in VS group, and 28 in interventionalist group. Mean age was 57 ± 24 years. There was no significant difference between the 2 groups in terms of comorbidities. Patient follow-up ranged from 1 to 15 months. All but 3 of the FemoSeal® devices were successfully deployed (all 3 cases in group 2). Mobilization time was 6 ± 4 hrs following interventions, and the discharge time ranged from 6 hrs to 7 days after procedure. Early discharge (within 6 hrs) was obtained in 23% of group 1 and in 0 cases of group 2 (P = 0.008). Delayed discharge was obtained in 74% of group 1 (67 pts) and in 70% of group 2 (18 pts) on postoperative day 1 (P = 0.47). Technical success was achieved in 99% of group 1 and in 93% of group 2 (P = 0.87). There were no perioperative deaths. There were no significant differences in terms of minor bleeding complications (P = 0.21) or infections or transfusion needing (P 0.06) in both groups. FemoSeal®-related complications occurred in 6 patients (1 in group 1 and 5 in group 2; P = 0.0017). All complications occurred following therapeutic intervention with 6F sheath introducer. Complication rate resulted significatively higher in group 2 in terms of pseudoaneurysm development (P < 0.0001) and transfusion needing (P = 0.03) in a subgroup analysis on peripheral arterial disease (Rutherford 3-5). Only chronic limb ischemia was found to be independent predictor of complications due to VCD use. CONCLUSIONS Our data suggest that when simple guidelines are observed, the device is safe, effective, and easy to deploy and allows for early ambulation and discharge. However, appropriate randomized clinical trials could clarify the correct guideline to minimize the complication rates.
Collapse
Affiliation(s)
- Roberto Gabrielli
- Department of Vascular and Endovascular Surgery, "San Salvatore Hospital", L'Aquila, Italy.
| | - Maria Sofia Rosati
- Department of Vascular and Endovascular Surgery, "San Salvatore Hospital", L'Aquila, Italy
| | - Massiliano Millarelli
- Department of Vascular and Endovascular Surgery, "Policlinico Casilino Hospital", Rome, Italy
| | - Angelica Dante
- Department of Vascular and Endovascular Surgery, "San Salvatore Hospital", L'Aquila, Italy
| | - Maurizio Maiorano
- Department of Vascular and Endovascular Surgery, "San Salvatore Hospital", L'Aquila, Italy
| | - Aldo Musilli
- Department of Vascular and Endovascular Surgery, "San Salvatore Hospital", L'Aquila, Italy
| | - Roberto Chiappa
- Department of Vascular and Endovascular Surgery, "Policlinico Casilino Hospital", Rome, Italy
| | - Marco Ventura
- Department of Vascular and Endovascular Surgery, "San Salvatore Hospital", L'Aquila, Italy
| |
Collapse
|
19
|
Residual rivaroxaban exposure after discontinuation of anticoagulant therapy in patients undergoing cardiac catheterization. Eur J Clin Pharmacol 2018; 74:611-618. [PMID: 29376194 DOI: 10.1007/s00228-018-2421-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 01/18/2018] [Indexed: 10/18/2022]
Abstract
PURPOSE Patients treated with direct oral anticoagulants (DOACs) frequently undergo interventional procedures requiring temporary discontinuation of anticoagulant therapy. Little is known about remaining peri-procedural exposure to rivaroxaban in real-world patients. METHODS Fifty-six patients with rivaroxaban treatment and scheduled cardiac catheterization were included in this prospective, observational, and single-center study. Rivaroxaban concentrations were determined by LC-MS/MS and a chromogenic anti-Xa assay. Population pharmacokinetic modeling was carried out on LC-MS/MS concentration data using NONMEM software, and results were applied to Monte Carlo simulations to predict appropriate rivaroxaban discontinuation intervals. RESULTS Rivaroxaban concentrations ranged from <LLOQ to 300.6 ng/ml at the time of admission to hospital and from <LLOQ to 55.5 ng/ml at the beginning of the procedure. Times since last rivaroxaban intake were (mean ± SD) 51.0 ± 31.7 h (admission) and 85.5 ± 36.8 h (start catheterization). LC-MS/MS and anti-Xa assay results were in good agreement (r = 0.958); however, the anti-Xa assay may underestimate low rivaroxaban concentrations and overestimate rivaroxaban exposure when performed on plasma samples contaminated with heparins. Pharmacokinetics of rivaroxaban were adequately described, and simulations predicted that 95% of patients will have rivaroxaban concentrations ≤ 28.4 ng/ml (15 mg dose group) and ≤ 31.9 ng/ml (20 mg dose group) after 48 h of discontinuation. CONCLUSIONS In the majority of patients, rivaroxaban plasma concentrations dropped below 30 ng/ml after 48 h of treatment discontinuation which is considered hemostatically safe before surgery with high bleeding risk. For accurate determination of low rivaroxaban concentrations, LC-MS/MS is the preferred choice.
Collapse
|
20
|
Thakor AS, Alshammari MT, Liu DM, Chung J, Ho SGF, Legiehn GM, Machan L, Fischman AM, Patel RS, Klass D. Transradial Access for Interventional Radiology: Single-Centre Procedural and Clinical Outcome Analysis. Can Assoc Radiol J 2017; 68:318-327. [PMID: 28396005 DOI: 10.1016/j.carj.2016.09.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Revised: 08/16/2016] [Accepted: 09/11/2016] [Indexed: 01/23/2023] Open
Abstract
PURPOSE The study sought to describe a single centre's technical approach to transradial intervention and report on clinical outcomes and safety. METHODS A total of 749 transradial access (TRA) procedures were performed at a single hospital in 562 patients (174 women and 388 men). Procedures included 445 bland embolizations or chemoembolizations of the liver, 88 uterine artery embolizations, and 148 procedures for Selective Internal Radiation Therapy (Y90), which included mapping and administration. The mean age of the patients was 62 years (range 27-96 years). RESULTS Four cases (0.5%) required crossover to transfemoral (tortuous anatomy, inability to secure a stable position for embolization, vessel spasm and base catheter not being of a sufficient length). A single asymptomatic, short-segment radial artery occlusion occurred (0.3%), 3 patients (0.4%) developed small hematomas postprocedurally, and 2 patients (0.7%) had transient neurological pain, which was resolved within a week without treatment. It was found that 98% of patients who had a previous femoral access procedure would choose radial access for subsequent procedures. CONCLUSIONS Transradial access is a safe, effective technique, with a learning curve; however, this procedure has the potential to significantly improve departmental workflow and cost savings for the department and patient experience.
Collapse
Affiliation(s)
- Avnesh S Thakor
- Department of Interventional Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada; Department of Radiology, Stanford University Medical Center, Palo Alto, California, USA
| | - Mohammed T Alshammari
- Department of Interventional Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada; Department of Interventional Radiology, Security Forces Hospital, Riyadh, Saudi Arabia
| | - David M Liu
- Department of Interventional Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - John Chung
- Department of Interventional Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Stephen G F Ho
- Department of Interventional Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Gerald M Legiehn
- Department of Interventional Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lindsay Machan
- Department of Interventional Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Aaron M Fischman
- Department of Interventional Radiology, The Mount Sinai Health System, New York, New York, USA
| | - Rahul S Patel
- Department of Interventional Radiology, The Mount Sinai Health System, New York, New York, USA
| | - Darren Klass
- Department of Interventional Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
| |
Collapse
|
21
|
Davies J, Metcalfe J, Ward R. Posterior common femoral branch pseudoaneurysm: an unusual arterial complication following femoral venous access. BJR Case Rep 2016; 2:20150335. [PMID: 30364477 PMCID: PMC6195930 DOI: 10.1259/bjrcr.20150335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 10/20/2015] [Accepted: 10/23/2015] [Indexed: 11/25/2022] Open
Abstract
A 70-year-old male presented with groin pain and swelling 11 days following a pulmonary vein isolation procedure via an unguided femoral venous puncture for atrial fibrillation. On the fourth visit, his haemoglobin level had dropped from 14.2 gl−1 to 10.7g l−1. Repeat duplex imaging revealed a large haematoma with deep flow. A CT angiogram revealed a pseudoaneurysm of a right common femoral branch artery. A subsequent angiogram revealed active bleeding, and the feeding artery was coiled. Pseudoaneurysms are recognized complications of vascular intervention, but more commonly occur anteriorly in major vessels. This elusive presentation reminds us of several important points. First, with the increasing use of interventional techniques across all medical specialties, the use of image guidance to aid vessel access is paramount for safety; not all specialties currently practise this routinely. Furthermore, we should consider arterial injury in all patients, including those who have had venous puncture. Injuries may not necessarily occur at the anterior vessel wall, and may well be deeper. Finally, there should be a low threshold for alternative imaging if symptoms are out of context with clinical findings.
Collapse
Affiliation(s)
- James Davies
- Department of Vascular Surgery, Dorset County Hospital, Dorchester, UK
| | - James Metcalfe
- Department of Vascular Surgery, Dorset County Hospital, Dorchester, UK
| | - Robert Ward
- Department of Clinical and Interventional Radiology, Dorset County Hospital, Dorchester, UK
| |
Collapse
|
22
|
Sawan N, Eitel C, Thiele H, Tilz R. [Ablation of supraventricular tachycardias : Complications and emergencies]. Herzschrittmacherther Elektrophysiol 2016; 27:143-50. [PMID: 27206630 DOI: 10.1007/s00399-016-0422-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Catheter ablation is an established treatment of supraventricular tachycardias (SVT) with high success rates of > 95 %. Complication rates range from 3 to 5 %, with serious complications occurring in about 0.8 %. There are general complications caused either by the vascular access or the catheters (e. g. hematomas, hemo-pneumothorax, embolism, thrombosis and aspiration) und specific ablation related complications (e. g. AV block during ablation of the slow pathway). The complication risk is elevated in elderly and multimorbid patients. Furthermore, the experience of the treating physician and the respective team plays an essential role. The purpose of this article is to give an overview on incidences, causes and management as well as prevention strategies of complications associated with catheter ablation of SVT.
Collapse
Affiliation(s)
- N Sawan
- Medizinische Klinik II (Kardiologie, Angiologie, Intensivmedizin) - Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein (UKSH), Ratzeburger Allee 160, 23538, Lübeck, Deutschland
| | - C Eitel
- Medizinische Klinik II (Kardiologie, Angiologie, Intensivmedizin) - Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein (UKSH), Ratzeburger Allee 160, 23538, Lübeck, Deutschland
| | - H Thiele
- Medizinische Klinik II (Kardiologie, Angiologie, Intensivmedizin) - Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein (UKSH), Ratzeburger Allee 160, 23538, Lübeck, Deutschland
| | - R Tilz
- Medizinische Klinik II (Kardiologie, Angiologie, Intensivmedizin) - Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein (UKSH), Ratzeburger Allee 160, 23538, Lübeck, Deutschland.
| |
Collapse
|
23
|
Alshehri AM, Elsharawy M. Comparison of Angioseal and Manual Compression in Patients Undergoing Transfemoral Coronary and Peripheral Vascular Interventional Procedures. Int J Angiol 2015; 24:133-6. [PMID: 26060385 DOI: 10.1055/s-0035-1547449] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Vascular closure devices (VCDs) were introduced in the early 1990s with the goal of limiting the time, labor, bed rest, and patient discomfort associated with manual compression (MC) for hemostasis after cardiovascular interventions. However, its advantage over MC has not been extensively studied after interventional procedures. The aim of this study was to do prospective, randomized study comparing the safety and efficacy of the Angio-Seal (AS) to that of MC in patients undergoing transfemoral coronary and peripheral vascular interventional procedure. A prospective, randomized trial was undertaken on consecutive series of patients admitted to King Fahd Hospital of the University for transfemoral coronary and peripheral vascular interventional procedures over 1 year. The study was designed to compare the hemostasis time in minutes and the incidence of vascular complications in patients receiving AS with those undergoing MC. All patients were on antiplatelets and received heparin during the procedure. During the study period, 160 patients were included, 80 in each group. There was a significant difference in mean time to hemostasis in minutes (15.83 ± 1.63 minutes for MC and 0.42 ± 0.04 minutes for the AS; p < 0.001), time to ambulation in minutes (280 ± 15 for MC and 120 for AS; p = 0.04) and in minor complications (33.8% in MC vs. AS 5%; p < 0.001). However, the major complication rate did not significantly differ between the two groups (0% in AS vs. 2.5% in MC; p = 0.15). AS was found to achieve rapid closure of the femoral access site safely in patients undergoing coronary and peripheral vascular interventional procedures under antiplatelets and systemic heparinization.
Collapse
Affiliation(s)
- Abdullah M Alshehri
- Division of Cardiology, Department of Internal Medicine, University of Dammam, Saudi Arabia
| | - Mohamed Elsharawy
- Division of Vascular Surgery, Department of General Surgery, University of Dammam, Saudi Arabia
| |
Collapse
|
24
|
Krishnasamy VP, Hagar MJ, Scher DJ, Sanogo ML, Gabriel GE, Sarin SN. Vascular Closure Devices: Technical Tips, Complications, and Management. Tech Vasc Interv Radiol 2015; 18:100-12. [DOI: 10.1053/j.tvir.2015.04.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
|
25
|
Percutaneous versus femoral cutdown access for endovascular aneurysm repair. J Vasc Surg 2015; 62:16-21. [PMID: 25827969 DOI: 10.1016/j.jvs.2015.01.058] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 01/29/2015] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Prior studies suggest that percutaneous access for endovascular abdominal aortic aneurysm repair (pEVAR) offers significant operative and postoperative benefits compared with femoral cutdown (cEVAR). National data on this topic, however, are limited. We compared patient selection and outcomes for elective pEVAR and cEVAR. METHODS We identified all patients undergoing either pEVAR (bilateral percutaneous access, whether successful or not) or cEVAR (at least one planned groin cutdown) for abdominal aortic aneurysms from January 2011 to December 2013 in the Targeted Vascular data set from the American College of Surgeons National Surgical Quality Improvement Program database. Emergent cases, ruptures, cases with an iliac conduit, and cases with a preoperative wound infection were excluded. Groups were compared by χ(2) test or t-test or the Mann-Whitney test where appropriate. RESULTS We identified 4112 patients undergoing elective EVAR, 3004 cEVAR patients (73%) and 1108 pEVAR patients (27%). Of all EVAR patients, 26% had bilateral percutaneous access; 1.0% had attempted percutaneous access converted to cutdown (4% of pEVARs); and the remainder had a planned cutdown, 63.9% bilateral and 9.1% unilateral. There were no significant differences in age, gender, aneurysm diameter, or prior open abdominal surgery. Patients undergoing cEVAR were less likely to have congestive heart failure (1.5% vs 2.4%; P = .04) but more likely to undergo any concomitant procedure during surgery (32% vs 26%; P < .01) than patients undergoing pEVAR. Postoperatively, pEVAR patients had shorter operative time (mean, 135 vs 152 minutes; P < .01), shorter length of stay (median, 1 day vs 2 days; P < .01), and fewer wound complications (2.1% vs 1.0%; P = .02). On multivariable analysis, the only predictor of percutaneous access failure was performance of any concomitant procedure (odds ratio, 2.0; 95% confidence interval, 1.0-4.0; P = .04). CONCLUSIONS Currently, one in four patients treated at Targeted Vascular National Surgical Quality Improvement Program centers are getting pEVAR, which is associated with a high success rate, shorter operation time, shorter length of stay, and fewer wound complications compared with cEVAR.
Collapse
|
26
|
Pinho-Gomes AC, Goatman C, Byott S, Seriki D, Ghosh J. Endobridging of Iliac Artery Avulsion Complicating Endovascular Aortic Aneurysm Repair. EJVES Short Rep 2015. [DOI: 10.1016/j.ejvssr.2015.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
27
|
Massmann A, Kunihara T, Fries P, Schneider G, Buecker A, Schäfers HJ. Uncovered stent implantation in complicated acute aortic dissection type B. J Thorac Cardiovasc Surg 2014; 148:3003-11. [DOI: 10.1016/j.jtcvs.2014.07.053] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Revised: 06/24/2014] [Accepted: 07/08/2014] [Indexed: 12/01/2022]
|
28
|
Ruzsa Z, Tóth K, Jambrik Z, Kovács N, Nardai S, Nemes B, Hüttl K, Merkely B. Transradial access for renal artery intervention. Interv Med Appl Sci 2014; 6:97-103. [PMID: 25243074 DOI: 10.1556/imas.6.2014.3.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Revised: 06/02/2014] [Accepted: 06/02/2014] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION Percutaneous interventional procedures in the renal arteries are usually performed using a femoral or brachial vascular access. The transradial approach is becoming more popular for peripheral interventions, but limited data exists for renal artery angioplasty and stenting. METHODS We have analyzed the clinical, angiographic and technical results of renal artery stenting performed from radial artery access between 2012 and 2013. The radial artery anatomy was identified with aortography using 100 cm pig tail catheter. After engagement of the renal artery ostium with a 6F Multipurpose or 6F JR5 guiding catheter, the stenosis was passed with a 0.014" guidewire followed by angioplasty and stent implantation. RESULTS In 27 patients (mean age: 65.4 ± 9.17) with hemodynamically relevant renal artery stenosis (mean diameter stenosis: 77.7 ± 10.6%; right, n = 7; left, n = 20), interventional treatment with angioplasty and stenting was performed using a left (n = 3) or right (n = 24) radial artery access. Direct stenting was successfully performed in 13 (48%) cases, and predilatations were required in ten cases 10 (37%). Primary technical success (residual stenosis <30%) could be achieved in all cases. The mean contrast consumption was 119 ± 65 ml and the mean procedure time was 30 ± 8.2 min. There were no major periprocedural vascular complications and in one patient transient creatinine level elevation was observed (3.7%). In one patient asymptomatic radial artery occlusion was detected (3.7%). CONCLUSION Transradial renal artery angioplasty and stenting is technically feasible and safe procedure.
Collapse
|
29
|
Zakko J, Scali S, Beck AW, Klodell CT, Beaver TM, Martin TD, Huber TS, Feezor RJ. Percutaneous thoracic endovascular aortic repair is not contraindicated in obese patients. J Vasc Surg 2014; 60:921-8. [PMID: 24845111 DOI: 10.1016/j.jvs.2014.04.051] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 04/15/2014] [Indexed: 12/17/2022]
Abstract
OBJECTIVE There are limited data describing the preclose technique with the Perclose ProGlide device (Abbott Vascular, Redwood City, Calif) in percutaneous thoracic endovascular aortic repair (P-TEVAR), particularly in obese patients, in whom use of this technique is thought to be relatively contraindicated. The purpose of this analysis was to describe our experience with P-TEVAR and to compare outcomes in patients with or without obesity. METHODS All TEVAR procedures at a single institution from 2005 to 2011 were reviewed, and P-TEVAR patients were stratified by body mass index (obesity ≥ 30 kg/m2). Preoperative computed tomography scans were analyzed for access vessel depth, calcification, and morphology. Technical success was defined as the ability to achieve hemostasis and to maintain limb perfusion without the need for common femoral artery exposure or obligate surgical repair of the vessel within a 30-day postoperative period. Generalized estimating equations and stepwise logistic regression were used to develop prediction models of preclose failure. RESULTS The review identified 536 patients, in whom 355 (66%) P-TEVAR procedures were completed (366 arteries; n = 40 [11%] bilateral). Compared with nonobese patients (n = 264), obese patients (n = 91) were typically younger (59 ± 16 years vs. 66 ± 16 years; P = .0004) and more likely to have renal insufficiency (28% vs. 17%; P = .05) or diabetes mellitus (19% vs. 9%; P = .02). The number of Perclose deployments was similar between groups (P = NS). Mean sheath size (25.4F vs 25.0F; P = .04), access vessel inner diameters (8.5 ± 1.9 mm vs. 7.9 ± 2.0 mm; P = .02), and vessel depth (50 ± 20 mm vs. 30 ± 13 mm; P < .0001) were greater in obese patients. Adjunctive iliac stents were used in 7% of cases (10 [11%] in obese patients vs 16 [6%] in nonobese patients; P = .2). Overall technical success was 92% (92% for nonobese patients vs 93% for obese patients; P = .7). Three patients required subsequent operations for access complications, two obese patients (2%) and one nonobese patient (0.4%) (P = .3). Independent predictors of failure were adjunctive iliac stent (odds ratio [OR], 9.5; 95% confidence interval [CI], 3.3-27.8; P < .0001), more than two Perclose devices (OR, 7.0; 95% CI, 2.3-21; P = .0005), and smaller access vessel diameter to sheath size ratio (OR multiplies by 1.1 for each .01 decrease in ratio; 95% CI, 1.02-1.2; P = .007) (area under the receiver operating characteristic curve = .75). CONCLUSIONS Obesity is not a contraindication to P-TEVAR. P-TEVAR can be performed safely, despite the need for larger diameter sheaths. However, patients predicted to need adjunctive stenting or possessing smaller access vessel diameter to sheath size ratios are at highest risk of preclose failure with the Perclose ProGlide device, and selective use of this technique is recommended.
Collapse
Affiliation(s)
- Jason Zakko
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, Fla
| | - Salvatore Scali
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, Fla.
| | - Adam W Beck
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, Fla
| | - Charles T Klodell
- Division of Thoracic and Cardiovascular Surgery, University of Florida, Gainesville, Fla
| | - Thomas M Beaver
- Division of Thoracic and Cardiovascular Surgery, University of Florida, Gainesville, Fla
| | - Tomas D Martin
- Division of Thoracic and Cardiovascular Surgery, University of Florida, Gainesville, Fla
| | - Thomas S Huber
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, Fla
| | - Robert J Feezor
- Division of Vascular Surgery and Endovascular Therapy, University of Florida, Gainesville, Fla
| |
Collapse
|
30
|
Dawson J, Fitridge R. Update on aneurysm disease: current insights and controversies: peripheral aneurysms: when to intervene - is rupture really a danger? Prog Cardiovasc Dis 2013; 56:26-35. [PMID: 23993236 DOI: 10.1016/j.pcad.2013.05.002] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Peripheral artery aneurysms are rarer than abdominal aortic aneurysms (AAA), although the true prevalence is not well known. They often coexist with aortic and other peripheral artery aneurysms. In contrast to AAA, where the principal risk is that of rupture, thromboembolism is more common, contributing a bigger risk in the more common lesions. Although rupture does occur, with incidence related to anatomical site, aneurysm diameter cannot be used to guide management with the same confidence as in AAA. In addition, the rarity of these lesions results in a paucity of evidence with which to guide intervention. Consequently they are difficult lesions to manage, and numerous aneurysm and patient factors must be considered to provide treatment individualised for each case. We discuss popliteal, femoral, carotid, subclavian, upper limb, visceral and false aneurysms, focussing on the risk of rupture and thromboembolism, and current thresholds for intervention, based on the available published literature.
Collapse
Affiliation(s)
- Joe Dawson
- Discipline of Surgery, University of Adelaide, and Vascular Unit, The Queen Elizabeth Hospital, Adelaide, Australia
| | | |
Collapse
|
31
|
Bakker ALM, Swaans MJ, van der Heyden JAS, Eefting FD, Rensing BJWM, Post MC. Complications during percutaneous edge-to-edge mitral valve repair. Herz 2013; 38:484-9. [PMID: 23797375 DOI: 10.1007/s00059-013-3860-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Transcatheter edge-to-edge mitral valve repair is an approach for treating mitral regurgitation, which is an alternative for surgery in patients with a high surgical risk. Although the safety and efficacy of the technique have been demonstrated, it is still associated with potentially life-threatening complications. The aim of this paper is to discuss the nature, management, and prevention of the most important procedural complications associated with this procedure.
Collapse
Affiliation(s)
- A L M Bakker
- Department of Cardiology, St. Antonius Hospital, Koekoekslaan 1, Nieuwegein, The Netherlands.
| | | | | | | | | | | |
Collapse
|