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Meijers TA, Nap A, Aminian A, Schmitz T, Dens J, Teeuwen K, van Kuijk JP, van Wely M, Bataille Y, Kraaijeveld AO, Roolvink V, Dambrink JHE, Gosselink ATM, Hermanides RS, Ottervanger JP, Tsilingiris I, van den Buijs DMF, van Royen N, van Leeuwen MAH. Ultrasound-guided versus fluoroscopy-guided large-bore femoral access in PCI of complex coronary lesions: the international, multicentre, randomised ULTRACOLOR Trial. EUROINTERVENTION 2024; 20:e876-e886. [PMID: 38742577 PMCID: PMC11228538 DOI: 10.4244/eij-d-24-00089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 04/10/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Transfemoral access is often used when large-bore guide catheters are required for percutaneous coronary intervention (PCI) of complex coronary lesions, especially when large-bore transradial access is contraindicated. Whether the risk of access site complications for these procedures may be reduced by ultrasound-guided puncture is unclear. AIMS We aimed to show the superiority of ultrasound-guided femoral puncture compared to fluoroscopy-guided access in large-bore complex PCI with regard to access site-related Bleeding Academic Research Consortium 2, 3 or 5 bleeding and/or vascular complications requiring intervention during hospitalisation. METHODS The ULTRACOLOR Trial is an international, multicentre, randomised controlled trial investigating whether ultrasound-guided large-bore femoral access reduces clinically relevant access site complications compared to fluoroscopy-guided large-bore femoral access in PCI of complex coronary lesions. RESULTS A total of 544 patients undergoing complex PCI mandating large-bore (≥7 Fr) transfemoral access were randomised at 10 European centres (median age 71; 76% male). Of these patients, 68% required PCI of a chronic total occlusion. The primary endpoint was met in 18.9% of PCI with fluoroscopy-guided access and 15.7% of PCI with ultrasound-guided access (p=0.32). First-pass puncture success was 92% for ultrasound-guided access versus 85% for fluoroscopy-guided access (p=0.02). The median time in the catheterisation laboratory was 102 minutes versus 105 minutes (p=0.43), and the major adverse cardiovascular event rate at 1 month was 4.1% for fluoroscopy-guided access and 2.6% for ultrasound-guided access (p=0.32). CONCLUSIONS As compared to fluoroscopy-guided access, the routine use of ultrasound-guided access for large-bore transfemoral complex PCI did not significantly reduce clinically relevant bleeding or vascular access site complications. A significantly higher first-pass puncture success rate was demonstrated for ultrasound-guided access. CLINICALTRIALS gov identifier: NCT04837404.
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Affiliation(s)
- Tom A Meijers
- Department of Cardiology, Isala Heart Center, Zwolle, the Netherlands
| | - Alexander Nap
- Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Adel Aminian
- Department of Cardiology, Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium
| | - Thomas Schmitz
- Department of Cardiology, Elisabeth Krankenhaus, Essen, Germany
| | - Joseph Dens
- Department of Cardiology, Hospital Oost-Limburg, Genk, Belgium
| | - Koen Teeuwen
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands
| | - Jan-Peter van Kuijk
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Marleen van Wely
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Yoann Bataille
- Department of Cardiology, Jessa Hospital, Hasselt, Belgium
| | - Adriaan O Kraaijeveld
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Vincent Roolvink
- Department of Cardiology, Isala Heart Center, Zwolle, the Netherlands
| | | | | | | | | | | | | | - Niels van Royen
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
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Meijers TA, Aminian A, Valgimigli M, Dens J, Agostoni P, Iglesias JF, Gasparini GL, Seto AH, Saito S, Rao SV, van Royen N, Brilakis ES, van Leeuwen MAH. Vascular Access in Percutaneous Coronary Intervention of Chronic Total Occlusions: A State-of-the-Art Review. Circ Cardiovasc Interv 2023; 16:e013009. [PMID: 37458110 DOI: 10.1161/circinterventions.123.013009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
The outcomes of chronic total occlusion percutaneous coronary intervention have considerably improved during the last decade with continued emphasis on improving procedural safety. Vascular access site bleeding remains one of the most frequent complications. Several procedural strategies have been implemented to reduce the rate of vascular access site complications. This state-of-the-art review summarizes and describes the current evidence on optimal vascular access strategies for chronic total occlusion percutaneous coronary intervention.
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Affiliation(s)
- Thomas A Meijers
- Department of Cardiology, Isala Heart Center, Zwolle, the Netherlands (T.A.M., M.A.H.v.L.)
| | - Adel Aminian
- Department of Cardiology, Centre Hospitalier Universitaire de Charleroi, Belgium (A.A.)
| | - Marco Valgimigli
- Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Università della Svizzera Italiana, Lugano, Switzerland (M.V.)
| | - Joseph Dens
- Department of Cardiology, Hospital Oost-Limburg, Genk, Belgium (J.D.)
| | | | - Juan F Iglesias
- Department of Cardiology, Geneva University Hospital, Switzerland (J.F.I.)
| | - Gabriele L Gasparini
- Department of Cardiology, Humanitas Clinical and Research Center, Milan, Italy (G.L.G.)
| | - Arnold H Seto
- Department of Cardiology, Veterans Affairs, Washington, DC (A.H.S.)
| | - Shigeru Saito
- Department of Cardiology, Shonan Kamakura General Hospital, Kanagawa, Japan (S.S.)
| | - Sunil V Rao
- Department of Cardiology, New York University Langone Health System (S.V.R.)
| | - Niels van Royen
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands (N.v.R.)
| | - Emmanouil S Brilakis
- Allina Health Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, MN (E.S.B.)
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Meijers TA, Nap A, Aminian A, Dens J, Teeuwen K, van Kuijk JP, van Wely M, Schmitz T, Bataille Y, Kraaijeveld AO, Roolvink V, Hermanides RS, Braber TL, van Royen N, van Leeuwen MAH. ULTrasound-guided TRAnsfemoral puncture in COmplex Large bORe PCI: study protocol of the UltraCOLOR trial. BMJ Open 2022; 12:e065693. [PMID: 36456007 PMCID: PMC9716808 DOI: 10.1136/bmjopen-2022-065693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Although recently published evidence favours transradial access (TRA) when using large-bore guiding catheters for percutaneous coronary intervention (PCI) of complex coronary lesions, the femoral artery will still be used in a considerate proportion of patients undergoing complex PCI, especially in PCI of chronic total occlusions (CTO). Ultrasound-guided puncture of the femoral artery may reduce clinically relevant access site complications, but robust evidence is lacking up to date. METHODS AND ANALYSIS A total of 542 patients undergoing complex PCI, defined as PCI of CTO, complex bifurcation, heavy calcified lesion or left main, in which the 7-F or 8-F transfemoral access is required, will be randomised to ultrasound-guided puncture or fluoroscopy-guided puncture. The primary outcome is the incidence of the composite end-point of clinically relevant access site related bleeding and/or vascular complications requiring intervention. Access site complications and major adverse cardiovascular events up to 1 month will also be compared between both groups. ETHICS AND DISSEMINATION Ethical approval for the study was granted by the local Ethics Committee ('Medisch Ethische Toetsing Commissie Isala Zwolle') for all Dutch sites, 'Comité Medische Ethiek Ziekenhuis Oost-Limburg' for Hospital Oost-Limburg, 'Comité d'éthique CHU-Charleroi-ISPPC' for Centre Hospilatier Universitaire de Charleroi and 'Ethik Kommission de Ärztekammer Nordrhein' for Elisabeth-Krankenhaus). The trial outcomes will be published in peer-reviewed journals of the concerned literature. The ultrasound guided transfemoral access in complex large bore PCI trial has been administered in the ClinicalTrials.gov database, reference number: NCT03846752. REGISTRATION DETAILS ClinicalTrials.gov identifier: NCT03846752.
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Affiliation(s)
- Thomas A Meijers
- Department of Cardiology, Isala Heart Centre, Zwolle, The Netherlands
| | - Alexander Nap
- Department of Cardiology, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
| | - Adel Aminian
- Department of Cardiology, Centre Hospitalier Universitaire de Charleroi, Charleroi, Belgium
| | - Joseph Dens
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Koen Teeuwen
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands
| | - Jan-Peter van Kuijk
- Department of Cardiology, Sint Antonius Hospital, Nieuwegein, The Netherlands
| | | | - Thomas Schmitz
- Department of Cardiology, Elisabeth-Krankenhaus-Essen GmbH, Essen, Germany
| | - Yoann Bataille
- Department of Cardiology, Jessa Ziekenhuis vwz, Hasselt, Belgium
| | - Adriaan O Kraaijeveld
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Vincent Roolvink
- Department of Cardiology, Isala Heart Centre, Zwolle, The Netherlands
| | | | - Thijs L Braber
- Department of Cardiology, Isala Heart Centre, Zwolle, The Netherlands
| | - Niels van Royen
- Department of Cardiology, Radboudumc, Nijmegen, The Netherlands
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Alrashidi S, d’Entremont MA, Alansari O, Winter J, Brochu B, Heenan L, Skuriat E, Tyrwhitt J, Raco M, Tsang MB, Valettas N, Velianou J, Sheth T, Sibbald M, Mehta SR, Pinilla-Echeverri N, Schwalm JD, Natarajan MK, Kelly A, Akl E, Tawadros S, Camargo M, Faidi W, Dutra G, Jolly SS. Design and Rationale of Routine Ultrasou Nd Gu Idance for Vascular Acc Ess fo R Cardiac Procedure s: A Randomized Tria L (UNIVERSAL). CJC Open 2022; 4:1074-1080. [PMID: 36562014 PMCID: PMC9764117 DOI: 10.1016/j.cjco.2022.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 08/22/2022] [Indexed: 12/25/2022] Open
Abstract
Background A significant limitation of femoral artery access for cardiac interventions is the increased risk of vascular complications and bleeding compared to radial access. Ultrasound (US)-guided femoral access may reduce major vascular complications and bleeding. We aim to determine whether routinely using US guidance for femoral arterial access for coronary angiography or intervention will reduce Bleeding Academic Research Consortium (BARC) 2, 3, or 5 bleeding or major vascular complications. Methods The Ultrasound Guidance for Vascular Access for Cardiac Procedures: A Randomized Trial (UNIVERSAL) is a multicentre, prospective, open-label, randomized trial with blinded outcomes assessment. Patients undergoing coronary angiography with or without intervention via a femoral approach with fluoroscopic guidance will be randomized 1:1 to US-guided femoral access, compared to no US. The primary outcome is the composite of major bleeding based on the BARC 2, 3, or 5 criteria or major vascular complications within 30 days. The trial is designed to have 80% power and a 2-sided alpha level of 5% to detect a 50% relative risk reduction for the primary outcome based on a control event rate of 14%. Results We completed enrollment on April 29, 2022, with 621 randomized patients. The patients had a mean age of 71 years (25.4% female), with a high rate of comorbidities, as follows: 45% had a prior percutaneous coronary intervention; 57% had previous coronary artery bypass surgery; and 18% had peripheral vascular disease. Conclusions The UNIVERSAL trial will be one of the largest randomized trials of US-guided femoral access and has the potential to change guidelines and increase US uptake for coronary procedures worldwide.
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Affiliation(s)
- Sulaiman Alrashidi
- McMaster University, Hamilton, Ontario, Canada
- Hamilton Health Sciences, Hamilton, Ontario, Canada
- Niagara Health, St. Catharines, Ontario, Canada
| | - Marc-André d’Entremont
- Population Health Research Institute, Hamilton, Ontario, Canada
- Centre Hospitalier Universitaire de Sherbrooke (CHUS), Sherbrooke, Quebec, Canada
| | - Omar Alansari
- McMaster University, Hamilton, Ontario, Canada
- Hamilton Health Sciences, Hamilton, Ontario, Canada
- Niagara Health, St. Catharines, Ontario, Canada
| | - Jose Winter
- Clinica Alemana de Santiago, Santiago, Chile
| | - Bradley Brochu
- CK Hui Heart Centre, Royal Alexandra Hospital, Edmonton, Alberta, Canada
| | - Laura Heenan
- Population Health Research Institute, Hamilton, Ontario, Canada
| | | | | | - Michael Raco
- McMaster University, Hamilton, Ontario, Canada
- Hamilton Health Sciences, Hamilton, Ontario, Canada
- Niagara Health, St. Catharines, Ontario, Canada
| | - Michael B. Tsang
- McMaster University, Hamilton, Ontario, Canada
- Hamilton Health Sciences, Hamilton, Ontario, Canada
- Niagara Health, St. Catharines, Ontario, Canada
| | - Nicholas Valettas
- McMaster University, Hamilton, Ontario, Canada
- Hamilton Health Sciences, Hamilton, Ontario, Canada
- Niagara Health, St. Catharines, Ontario, Canada
| | - James Velianou
- McMaster University, Hamilton, Ontario, Canada
- Hamilton Health Sciences, Hamilton, Ontario, Canada
- Niagara Health, St. Catharines, Ontario, Canada
| | - Tej Sheth
- McMaster University, Hamilton, Ontario, Canada
- Hamilton Health Sciences, Hamilton, Ontario, Canada
- Niagara Health, St. Catharines, Ontario, Canada
- Population Health Research Institute, Hamilton, Ontario, Canada
| | - Matthew Sibbald
- McMaster University, Hamilton, Ontario, Canada
- Hamilton Health Sciences, Hamilton, Ontario, Canada
- Niagara Health, St. Catharines, Ontario, Canada
| | - Shamir R. Mehta
- McMaster University, Hamilton, Ontario, Canada
- Hamilton Health Sciences, Hamilton, Ontario, Canada
- Niagara Health, St. Catharines, Ontario, Canada
- Population Health Research Institute, Hamilton, Ontario, Canada
| | - Natalia Pinilla-Echeverri
- McMaster University, Hamilton, Ontario, Canada
- Hamilton Health Sciences, Hamilton, Ontario, Canada
- Niagara Health, St. Catharines, Ontario, Canada
- Population Health Research Institute, Hamilton, Ontario, Canada
| | - Jon David Schwalm
- McMaster University, Hamilton, Ontario, Canada
- Hamilton Health Sciences, Hamilton, Ontario, Canada
- Niagara Health, St. Catharines, Ontario, Canada
- Population Health Research Institute, Hamilton, Ontario, Canada
| | - Madhu K. Natarajan
- McMaster University, Hamilton, Ontario, Canada
- Hamilton Health Sciences, Hamilton, Ontario, Canada
- Niagara Health, St. Catharines, Ontario, Canada
- Population Health Research Institute, Hamilton, Ontario, Canada
| | - Andrew Kelly
- McMaster University, Hamilton, Ontario, Canada
- Hamilton Health Sciences, Hamilton, Ontario, Canada
- Niagara Health, St. Catharines, Ontario, Canada
| | - Elie Akl
- McGill University Health Centre, Montreal, Quebec, Canada
| | | | | | - Walaa Faidi
- Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Gustavo Dutra
- McMaster University, Hamilton, Ontario, Canada
- Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Sanjit S. Jolly
- McMaster University, Hamilton, Ontario, Canada
- Hamilton Health Sciences, Hamilton, Ontario, Canada
- Niagara Health, St. Catharines, Ontario, Canada
- Population Health Research Institute, Hamilton, Ontario, Canada
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Lansky A, Baron SJ, Grines CL, Tremmel JA, Al-Lamee R, Angiolillo DJ, Chieffo A, Croce K, Jacobs AK, Madan M, Maehara A, Mehilli J, Mehran R, Ng V, Parikh PB, Saw J, Abbott JD. SCAI Expert Consensus Statement on Sex-Specific Considerations in Myocardial Revascularization. JOURNAL OF THE SOCIETY FOR CARDIOVASCULAR ANGIOGRAPHY & INTERVENTIONS 2022; 1:100016. [PMID: 39132570 PMCID: PMC11307953 DOI: 10.1016/j.jscai.2021.100016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/21/2021] [Indexed: 08/13/2024]
Affiliation(s)
| | | | - Cindy L. Grines
- Northside Hospital Cardiovascular Institute, Atlanta, Georgia
| | | | | | | | - Alaide Chieffo
- University of Florida Health Sciences Center, Jacksonville, Florida
| | - Kevin Croce
- IRCCS San Raffaele Scientific Institute, Milan, Italy
- Brigham and Women's Hospital, Boston, Massachusetts
| | - Alice K. Jacobs
- Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts
| | - Mina Madan
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Akiko Maehara
- Columbia University College of Physicians and Surgeons, New York, New York
| | | | - Roxana Mehran
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Vivian Ng
- Columbia University Irving Medical Center, New York, New York
| | - Puja B. Parikh
- Stony Brook University Medical Center, Stony Brook, New York
| | - Jacqueline Saw
- Vancouver General Hospital, Vancouver, British Columbia, Canada
| | - J. Dawn Abbott
- Warren Alpert Medical School, Brown University, Providence, Rhode Island
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Benavidez M, Rossi NA, Rawl JW, Chaaban M. Retroperitoneal Hematoma as a Complication of Endovascular Embolization of Tumor Epistaxis: A Case Report. Cureus 2021; 13:e20759. [PMID: 35111445 PMCID: PMC8794427 DOI: 10.7759/cureus.20759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2021] [Indexed: 11/21/2022] Open
Abstract
Retroperitoneal hematomas are a rare and fatal complication of endovascular embolization. We report a case of an 89-year-old woman who was referred to interventional radiology for percutaneous embolization for intractable epistaxis as a result of a left nasal cavity mucosal melanoma. After successful embolization of the left sphenopalatine artery, the patient became hypotensive and was transferred to the intensive care unit. Post-operative CT abdomen and pelvis angiogram showed a large right perinephric hematoma, which is an extremely uncommon complication of endovascular embolization for epistaxis. Practitioners should be aware of this life-threatening complication in weighing the risks and benefits of embolization versus direct surgical ligation, and they should identify and intervene promptly if a retroperitoneal hematoma should occur.
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Brattain LJ, Pierce TT, Gjesteby LA, Johnson MR, DeLosa ND, Werblin JS, Gupta JF, Ozturk A, Wang X, Li Q, Telfer BA, Samir AE. AI-Enabled, Ultrasound-Guided Handheld Robotic Device for Femoral Vascular Access. BIOSENSORS 2021; 11:522. [PMID: 34940279 PMCID: PMC8699246 DOI: 10.3390/bios11120522] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 11/17/2021] [Accepted: 12/15/2021] [Indexed: 05/27/2023]
Abstract
Hemorrhage is a leading cause of trauma death, particularly in prehospital environments when evacuation is delayed. Obtaining central vascular access to a deep artery or vein is important for administration of emergency drugs and analgesics, and rapid replacement of blood volume, as well as invasive sensing and emerging life-saving interventions. However, central access is normally performed by highly experienced critical care physicians in a hospital setting. We developed a handheld AI-enabled interventional device, AI-GUIDE (Artificial Intelligence Guided Ultrasound Interventional Device), capable of directing users with no ultrasound or interventional expertise to catheterize a deep blood vessel, with an initial focus on the femoral vein. AI-GUIDE integrates with widely available commercial portable ultrasound systems and guides a user in ultrasound probe localization, venous puncture-point localization, and needle insertion. The system performs vascular puncture robotically and incorporates a preloaded guidewire to facilitate the Seldinger technique of catheter insertion. Results from tissue-mimicking phantom and porcine studies under normotensive and hypotensive conditions provide evidence of the technique's robustness, with key performance metrics in a live porcine model including: a mean time to acquire femoral vein insertion point of 53 ± 36 s (5 users with varying experience, in 20 trials), a total time to insert catheter of 80 ± 30 s (1 user, in 6 trials), and a mean number of 1.1 (normotensive, 39 trials) and 1.3 (hypotensive, 55 trials) needle insertion attempts (1 user). These performance metrics in a porcine model are consistent with those for experienced medical providers performing central vascular access on humans in a hospital.
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Affiliation(s)
- Laura J. Brattain
- Lincoln Laboratory, Massachusetts Institute of Technology, Lexington, MA 02421, USA; (L.J.B.); (L.A.G.); (M.R.J.); (N.D.D.); (J.S.W.); (J.F.G.)
| | - Theodore T. Pierce
- Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA; (T.T.P.); (A.O.); (X.W.); (Q.L.); (A.E.S.)
| | - Lars A. Gjesteby
- Lincoln Laboratory, Massachusetts Institute of Technology, Lexington, MA 02421, USA; (L.J.B.); (L.A.G.); (M.R.J.); (N.D.D.); (J.S.W.); (J.F.G.)
| | - Matthew R. Johnson
- Lincoln Laboratory, Massachusetts Institute of Technology, Lexington, MA 02421, USA; (L.J.B.); (L.A.G.); (M.R.J.); (N.D.D.); (J.S.W.); (J.F.G.)
| | - Nancy D. DeLosa
- Lincoln Laboratory, Massachusetts Institute of Technology, Lexington, MA 02421, USA; (L.J.B.); (L.A.G.); (M.R.J.); (N.D.D.); (J.S.W.); (J.F.G.)
| | - Joshua S. Werblin
- Lincoln Laboratory, Massachusetts Institute of Technology, Lexington, MA 02421, USA; (L.J.B.); (L.A.G.); (M.R.J.); (N.D.D.); (J.S.W.); (J.F.G.)
| | - Jay F. Gupta
- Lincoln Laboratory, Massachusetts Institute of Technology, Lexington, MA 02421, USA; (L.J.B.); (L.A.G.); (M.R.J.); (N.D.D.); (J.S.W.); (J.F.G.)
| | - Arinc Ozturk
- Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA; (T.T.P.); (A.O.); (X.W.); (Q.L.); (A.E.S.)
| | - Xiaohong Wang
- Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA; (T.T.P.); (A.O.); (X.W.); (Q.L.); (A.E.S.)
| | - Qian Li
- Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA; (T.T.P.); (A.O.); (X.W.); (Q.L.); (A.E.S.)
| | - Brian A. Telfer
- Lincoln Laboratory, Massachusetts Institute of Technology, Lexington, MA 02421, USA; (L.J.B.); (L.A.G.); (M.R.J.); (N.D.D.); (J.S.W.); (J.F.G.)
| | - Anthony E. Samir
- Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA; (T.T.P.); (A.O.); (X.W.); (Q.L.); (A.E.S.)
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Nef HM, Achenbach S, Birkemeyer R, Bufe A, Dörr O, Elsässer A, Gaede L, Gori T, Hoffmeister HM, Hofmann FJ, Katus HA, Liebetrau C, Massberg S, Pauschinger M, Schmitz T, Süselbeck T, Voelker W, Wiebe J, Zahn R, Hamm C, Zeiher AM, Möllmann H. Manual der Arbeitsgruppe Interventionelle Kardiologie (AGIK) der Deutschen Gesellschaft für Kardiologie – Herz- und Kreislaufforschung e.V. (DGK). DER KARDIOLOGE 2021. [DOI: 10.1007/s12181-021-00504-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Preoperative Risk Factors for Access Site Failure in Ultrasound-Guided Percutaneous Treatment of TASC C and D Aorto-Iliac Occlusive Disease. Ann Vasc Surg 2021; 79:130-138. [PMID: 34644647 DOI: 10.1016/j.avsg.2021.06.048] [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: 06/08/2021] [Revised: 06/30/2021] [Accepted: 06/30/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND At our institution, we adopted routinely ultrasound guided approach for all percutaneous procedures. The objective of this study was to describe the predictors of access site failures (ASFs) in patients undergoing percutaneous aorto iliac revascularization and to also evaluate whether other factors such as time period or different vascular devices may influence outcomes in terms of ASFs. METHODS We reviewed all consecutive percutaneous revascularizations performed for aortoiliac occlusion or stenosis at our institution from 2011 to 2020. All procedure were performed using an ultrasound (US) guided common femoral access. The primary outcome was ASFs, defined as bleeding or groin hematomas that required transfusions; pseduoaneurysm (diagnosed by US); retroperitoneal hematoma; artery laceration or ruptured (diagnosed intraoperatively); and thrombosis. Multivariable logistic regression was used to determine predictors of ASFs. RESULTS A total of 502 femoral arteries were accessed under DUS guidance with no failure in sheath placement. Technical success was achieved in 498 of 502 procedures (99.2%). ASFs occurred in 21 patients (7%); but year of procedure appear to be associated with an excess of ASFs as rates were different between the first and second period of the study (10.9% vs. 4.8%, P = 0.04). Results of multivariable logistic regression model indicated that independent predictors of ASFs were common femoral artery (CFA) calcification peripheral artery calcium scoring system (PACCS) grade (odds ratio [OR], 8.7; 95% confidence interval [CI], 5.5-13.7), and CFA diameter (OR, 0.46; 95% CI, 0.25-0.85). Compared to patients with successful percutaneous access, ASFs resulted in longer post-op lengths of stay (P = < 0.001). CONCLUSION Percutaneous US guided access can be safely performed in patients undergoing endovascular procedures for aorto iliac revascularization with TASC C and D lesions. CFA calcification PACCS grade greater than 3 and smaller femoral vessel diameter are independent risk factors for ASFs.
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Iannopollo G, Nobile G, Lanzilotti V, Capecchi A, Verardi R, Bruno M, Somaschini A, Rubboli A, Di Pasquale G, Casella G. Percutaneous artErial closure devices and ultrasound-guided Trans-femoRal puncture ObservatioNal InvestigatiOn: Insights from the PETRONIO registry. Catheter Cardiovasc Interv 2021; 99:795-803. [PMID: 34137485 DOI: 10.1002/ccd.29828] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 06/05/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To evaluate the safety of a single and combined use of ultrasound-guided femoral puncture (U) and percutaneous arterial closure devices (P) in femoral artery procedures (FAP) compared to fluoroscopic guidance (F) and manual compression (M) in a large radial-focused interventional centre. BACKGROUND U and P, taken individually, have improved safety in femoral arterial access procedures compared to traditional techniques. METHODS All FAP performed between July 2017 and December 2018 in our centre were divided into three phases: (a) control period with F and M mainly performed; (b) phase out period where U and P were introduced; (c) intervention period where a 6-month expertise on the novel techniques was acquired. The overall population was further stratified into subgroups: F/M, U/M, F/P, U/P. The primary study endpoint was in-hospital access site bleeding events (BE) according to the BARC criteria. The secondary endpoint was vascular site complications (VASC). RESULTS Four hundred eighteen procedures (14%) out of 3025 were performed via FA access during the study period. The overall access-site in-hospital BE were 97 (23%). Decreasing rates of BE (phase 1: n = 46, 29%; phase 2: n = 38, 22% e phase 3: n = 13, 15%; p = 0.027) and VASC were observed during the three periods. BE occurred significantly more often in F/M group (F/M: n = 48; 32%; U/M: n = 12, 16%; F/P: n = 18, 21%; U/P: n = 19, 17%; p = 0.008). F/M subgroup was an independent predictor of BE both in multivariable analysis and propensity score matching analysis. CONCLUSIONS The introduction of ultrasound-guided femoral puncture and percutaneous arterial closure devices has reduced access site bleedings with a progressive improvement after the first 6 months learning period.
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Affiliation(s)
| | | | | | | | | | - Matteo Bruno
- UOC Cardiologia, Ospedale Maggiore, Bologna, Italy
| | | | - Andrea Rubboli
- Divisione di Cardiologia, Ospedale Santa Maria delle Croci, Ravenna, Italy
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11
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Zhang H, Wang JY, Lv JH, Hu HB, Xie RG, Jin Q, Pang KJ, Xu L, Xu ZY, Zhang GJ, Pan XB. Transbrachial Access for Transcatheter Closure of Paravalvular Leak Following Prosthetic Valve Replacement. Front Cardiovasc Med 2021; 8:589947. [PMID: 33718443 PMCID: PMC7952318 DOI: 10.3389/fcvm.2021.589947] [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: 07/31/2020] [Accepted: 02/08/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Transcatheter closure of paravalvular leak (PVL) has evolved into an alternative to surgery in high-risk patients. In this study, we introduce a new access for transcatheter closure of PVL and seek to evaluate the feasibility and safety of this access. Methods: We retrospectively analyzed patients undergoing transbrachial access for transcatheter mitral or aortic PVL closure (August 2017–November 2019) at our hospital. All patients underwent puncture of the brachial artery under local anesthesia. Results: The study population included 11 patients, with an average age of 55.91 ± 14.82 years. Ten out of 11 patients were successfully implanted with devices via the brachial artery approach, and one patient was converted to the transseptal approach. The technical success rate of transbrachial access was 90.9%. Mean NYHA functional class improved from 3.1 ± 0.5 before the procedure to 1.9 ± 0.5 after PVL closure. Severe paravalvular regurgitation (PVR) in five patients and moderate PVR in six patients prior to the procedure were significantly reduced to mild in four patients and none in seven patients after the procedure. Complications included one case of pseudoaneurysm and one case of moderate hemolysis aggravation after closure. One patient had an unknown cause of sudden death within 24 h after the procedure. The half-year mortality rate during follow-up was 9.1% (1/11). Conclusions: Transbrachial access for transcatheter closure of PVL may be a feasible and safe treatment and should include well-selected patients. It has several potential advantages of simplifying the procedure process and reducing postprocedural bed rest time.
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Affiliation(s)
- Hui Zhang
- Department of Radiology, Zhengzhou University People's Hospital, Central China Fuwai Hospital, Heart Center of Henan Provincial People's Hospital, Zhengzhou, China
| | - Jing-Yan Wang
- Department of Cardiology, Yuncheng Central Hospital, Yuncheng, China
| | - Jian-Hua Lv
- Center of Structural Heart Disease, National Center for Cardiovascular Diseases, Chinese Academic of Medical Science and Peking Union Medical College, Fuwai Hospital, Beijing, China
| | - Hai-Bo Hu
- Center of Structural Heart Disease, National Center for Cardiovascular Diseases, Chinese Academic of Medical Science and Peking Union Medical College, Fuwai Hospital, Beijing, China
| | - Rui-Gang Xie
- Department of Radiology, Zhengzhou University People's Hospital, Central China Fuwai Hospital, Heart Center of Henan Provincial People's Hospital, Zhengzhou, China
| | - Qi Jin
- Center for Pulmonary Vascular Diseases, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, Beijing, China
| | - Kun-Jing Pang
- Department of Echocardiography, National Center for Cardiovascular Diseases, Chinese Academic of Medical Science and Peking Union Medical College, Fuwai Hospital, Beijing, China
| | - Liang Xu
- Center of Structural Heart Disease, National Center for Cardiovascular Diseases, Chinese Academic of Medical Science and Peking Union Medical College, Fuwai Hospital, Beijing, China
| | - Zhong-Ying Xu
- Center of Structural Heart Disease, National Center for Cardiovascular Diseases, Chinese Academic of Medical Science and Peking Union Medical College, Fuwai Hospital, Beijing, China
| | - Ge-Jun Zhang
- Center of Structural Heart Disease, National Center for Cardiovascular Diseases, Chinese Academic of Medical Science and Peking Union Medical College, Fuwai Hospital, Beijing, China
| | - Xiang-Bin Pan
- Center of Structural Heart Disease, National Center for Cardiovascular Diseases, Chinese Academic of Medical Science and Peking Union Medical College, Fuwai Hospital, Beijing, China
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Koide M, Fukui K, Sogabe K, Kitada T, Kogure M, Kato Y, Kitajima H, Akabame S. Endovascular treatment for iatrogenic rupture of an iliac artery with severe tortuosity. Radiol Case Rep 2020; 15:1348-1353. [PMID: 32636971 PMCID: PMC7327426 DOI: 10.1016/j.radcr.2020.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 06/01/2020] [Accepted: 06/02/2020] [Indexed: 11/09/2022] Open
Abstract
Retroperitoneal hemorrhage due to iatrogenic rupture of the iliac artery is a life-threatening complication associated with endovascular intervention. We present a case of iatrogenic iliac rupture after insertion of a sheath into a severely tortuous iliac artery during coil embolization of a cerebral aneurysm. Bleeding was controlled by resuscitative endovascular balloon occlusion of the aorta followed by placement of a balloon-expandable stent graft into the iliac artery. This resulted in complete repair of the ruptured iliac artery. The patient recovered without any neurological complications.
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13
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Stone P, Campbell J, Thompson S, Walker J. A prospective, randomized study comparing ultrasound versus fluoroscopic guided femoral arterial access in noncardiac vascular patients. J Vasc Surg 2020; 72:259-267. [DOI: 10.1016/j.jvs.2019.09.051] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Accepted: 09/23/2019] [Indexed: 12/15/2022]
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Dhillan R, Kumar A, Anand V, Patra V, Swain P, Tripathy GN. Comparison of outcome of various modalities in trans-atlantic inter-society consensus d femoropopliteal disease. INDIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2020. [DOI: 10.4103/ijves.ijves_66_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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15
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Gopalakrishnan PP, Manoharan P, Shekhar C, Seto A, Sinha R, David M, Shah M, Nagajothi N. Redefining the fluoroscopic landmarks for common femoral arterial puncture during cardiac catheterization: Femoral angiogram and computed tomography angiogram (FACT) study of common femoral artery anatomy. Catheter Cardiovasc Interv 2019; 94:367-375. [PMID: 30537421 DOI: 10.1002/ccd.27991] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 10/03/2018] [Accepted: 10/29/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND The mid-femoral head (F50 ) is a common fluoroscopic target for common femoral artery (CFA) puncture during cardiac catheterization. Punctures above the inguinal ligament (marking the proximal end of CFA) increase the risk of retroperitoneal hemorrhage and are classified as high punctures. METHODS We retrospectively analyzed 114 CT angiograms for the anatomic relationship of the inguinal ligament to the femoral head (FH) and inferior epigastric artery (IEA). We analyzed 114 CT angiograms and 500 femoral angiograms, for the relation of the mid-point of CFA to F50 and F75 (the junction of upper 3/4th and lower 1/4th of FH). RESULTS The proximal third of femoral head (F33 ) (-1.4 mm) and IEA nadir (-2.9 mm) were closer approximations to the inguinal ligament than the IEA origin (-12.8 mm) or cranial end of FH (-15.2 mm). The inguinal ligament correlated better with the IEA nadir than F33 (R2 = 0.49 vs. 0.001). F75 was a closer approximation for the mid-point of the CFA than F50 (0.3 mm vs. -9.2 mm). Using F75 as the target for CFA puncture carried the lowest risk for non-CFA punctures (18.6%), while using F50 had a 41.2% risk for non-CFA punctures. F75 had an increased risk for low punctures (14.2%) but F50 had a far higher risk for high punctures (36.6%). CONCLUSIONS The nadir of IEA is the best landmark for identifying the inguinal ligament (the proximal end of CFA) and defining high punctures. F75 is a more accurate target for successful CFA puncture than F50.
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Affiliation(s)
| | | | | | - Arnold Seto
- Division of Cardiology, University of California, Irvine Medical Center, Orange, California
| | - Rahul Sinha
- Division of Cardiology, Allegheny Health Network, Pittsburgh, Pennsylvania
| | - Manova David
- Division of Cardiology, Aultman Hospital, Canton, Ohio
| | - Moneal Shah
- Division of Cardiology, Allegheny Health Network, Pittsburgh, Pennsylvania
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16
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Kleiman NS. Bleeding Edge Technology: Retroperitoneal Hemorrhage and Its Implications for Transradial Access. Circ Cardiovasc Interv 2018; 11:e006320. [PMID: 29445003 DOI: 10.1161/circinterventions.118.006320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Neal S Kleiman
- From the Houston Methodist DeBakey Heart and Vascular Center and Weill Cornell Medical College, Houston, TX.
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17
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Son SY, Cho KC, Cho P, Lee JH, Myoung SU, Choi JH. Prepuncture Ultrasound Examination Facilitates Safe and Accurate Common Femoral Artery Access for Transfemoral Cerebral Angiography. J Cerebrovasc Endovasc Neurosurg 2017; 19:276-283. [PMID: 29387628 PMCID: PMC5788835 DOI: 10.7461/jcen.2017.19.4.276] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Revised: 08/22/2017] [Accepted: 10/25/2017] [Indexed: 11/23/2022] Open
Abstract
Objective We aimed to introduce our method involving prepuncture ultrasound scan for cannulation of the common femoral artery (CFA) during transfemoral cerebral angiography (TFCA), and to assess the clinical and radiological outcomes. Material and Methods Our study included 90 patients who underwent prepuncture ultrasound examination of the inguinal area for TFCA between April 2015 and June 2015. Prior to skin preparation and draping of the inguinal area, we identified the CFA and its bifurcation using ultrasound. Based on the ultrasound findings, we marked cruciate lines in the inguinal area. Thereafter, we inserted a puncture needle at the interface between the horizontal and vertical lines at a 30-45° angle, simultaneously palpating the pulsation of the femoral artery. After TFCA was completed, femoral artery angiography was performed in the anteroposterior and oblique directions. Clinical and radiological parameters, including CFA cannulation, the ultrasound scan time, the first pass success rate, the time required for the passage of the wire, and complications, were evaluated. Results The mean ultrasound scan time of the CFA and its bifurcation was 72.6 seconds, and the mean time between administration of local anesthesia and wire passage was 67.44 seconds. The first pass success rate was 77.8% (70/90 patients), and the CFA puncture rate was 98.8% (89/90 patients). Although minor complications were noted in 7 patients, no patient reported serious complications (a large hematoma [≥ 5 cm], pseudoaneurysms, dissection, and/or a retroperitoneal hematoma.). Conclusion Prepuncture ultrasound examination might be a simple, safe, and accurate technique for cannulation of the CFA during TFCA.
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Affiliation(s)
- Seon Yong Son
- Department of Neurosurgery, Bundang Jesaeng General Hospital, Sungnam, Korea
| | - Kwang-Chun Cho
- Department of Neurosurgery, Bundang Jesaeng General Hospital, Sungnam, Korea
| | - Pyunggoo Cho
- Department of Neurosurgery, Bundang Jesaeng General Hospital, Sungnam, Korea
| | - Ju Hyung Lee
- Department of Neurosurgery, Bundang Jesaeng General Hospital, Sungnam, Korea
| | - Seong Uk Myoung
- Department of Radiology, Bundang Jesaeng General Hospital, Sungnam, Korea
| | - Jai Ho Choi
- Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
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Amaro E, Pophal S, Zoldos J. Vascular Reconstruction in a Neonate after Iatrogenic Injury during Cardiac Catheterization. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2017; 5:e1600. [PMID: 29632779 PMCID: PMC5889463 DOI: 10.1097/gox.0000000000001600] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 10/20/2017] [Indexed: 11/25/2022]
Abstract
As technology and interventional techniques continue to evolve, both the volume and complexity of cardiac catheterizations will increase, leading to a rise in the number of complications. One of the most morbid complications of cardiac catheterization is vascular injury. We report the case of a 31-day-old, 3.0-kg infant with hypoplastic left heart syndrome who experienced a left common iliac artery disruption during cardiac catheterization resulting in a retroperitoneal hemorrhage. The extent of the vascular injury combined with the vessel caliber posed a technically challenging surgical scenario. Ultimately, the vascular supply to the left lower extremity was reconstructed by the plastic surgery team with a reverse autologous vein graft. To our knowledge, this multidisciplinary approach with the involvement of plastic surgery represents a unique case.
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Affiliation(s)
- Emilie Amaro
- From the Vanderbilt School of Medicine, Nashville, Tenn.; Division of Cardiology, Phoenix Children’s Hospital Heart Center, Phoenix, Ariz.; College of Medicine, University of Arizona, Arizona Center for Hand Surgery, Phoenix, Ariz
| | - Stephen Pophal
- From the Vanderbilt School of Medicine, Nashville, Tenn.; Division of Cardiology, Phoenix Children’s Hospital Heart Center, Phoenix, Ariz.; College of Medicine, University of Arizona, Arizona Center for Hand Surgery, Phoenix, Ariz
| | - Jozef Zoldos
- From the Vanderbilt School of Medicine, Nashville, Tenn.; Division of Cardiology, Phoenix Children’s Hospital Heart Center, Phoenix, Ariz.; College of Medicine, University of Arizona, Arizona Center for Hand Surgery, Phoenix, Ariz
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Fabiani I, Calogero E, Pugliese NR, Di Stefano R, Nicastro I, Buttitta F, Nuti M, Violo C, Giannini D, Morgantini A, Conte L, Barletta V, Berchiolli R, Adami D, Ferrari M, Di Bello V. Critical Limb Ischemia: A Practical Up-To-Date Review. Angiology 2017; 69:465-474. [PMID: 29161885 DOI: 10.1177/0003319717739387] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Critical limb ischemia (CLI) is the most advanced form of peripheral artery disease. It is associated with significant morbidity and mortality and high management costs. It carries a high risk of amputation and local infection. Moreover, cardiovascular complications remain a major concern. Although it is a well-known entity and new technological and therapeutic advances have been made, this condition remains poorly addressed, with significantly heterogeneous management, especially in nonexperienced centers. This review, from a third-level dedicated inpatient and outpatient cardioangiology structure, aims to provide an updated summary on the topic of CLI of its complexity, encompassing epidemiological, social, economical and, in particular, diagnostic/imaging issues, together with potential therapeutic strategies (medical, endovascular, and surgical), including the evaluation of cardiovascular risk factors, the diagnosis, and treatment together with prognostic stratification.
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Affiliation(s)
- Iacopo Fabiani
- 1 Cardioangiology Universitary Departmental Section, Cardio Thoracic and Vascular Department, A.O.U.P., University of Pisa, Pisa, Italy
| | - Enrico Calogero
- 1 Cardioangiology Universitary Departmental Section, Cardio Thoracic and Vascular Department, A.O.U.P., University of Pisa, Pisa, Italy
| | - Nicola Riccardo Pugliese
- 1 Cardioangiology Universitary Departmental Section, Cardio Thoracic and Vascular Department, A.O.U.P., University of Pisa, Pisa, Italy
| | - Rossella Di Stefano
- 1 Cardioangiology Universitary Departmental Section, Cardio Thoracic and Vascular Department, A.O.U.P., University of Pisa, Pisa, Italy
| | - Irene Nicastro
- 1 Cardioangiology Universitary Departmental Section, Cardio Thoracic and Vascular Department, A.O.U.P., University of Pisa, Pisa, Italy
| | - Flavio Buttitta
- 1 Cardioangiology Universitary Departmental Section, Cardio Thoracic and Vascular Department, A.O.U.P., University of Pisa, Pisa, Italy
| | - Marco Nuti
- 1 Cardioangiology Universitary Departmental Section, Cardio Thoracic and Vascular Department, A.O.U.P., University of Pisa, Pisa, Italy
| | - Caterina Violo
- 1 Cardioangiology Universitary Departmental Section, Cardio Thoracic and Vascular Department, A.O.U.P., University of Pisa, Pisa, Italy
| | - Danilo Giannini
- 1 Cardioangiology Universitary Departmental Section, Cardio Thoracic and Vascular Department, A.O.U.P., University of Pisa, Pisa, Italy
| | - Alessandro Morgantini
- 1 Cardioangiology Universitary Departmental Section, Cardio Thoracic and Vascular Department, A.O.U.P., University of Pisa, Pisa, Italy
| | - Lorenzo Conte
- 1 Cardioangiology Universitary Departmental Section, Cardio Thoracic and Vascular Department, A.O.U.P., University of Pisa, Pisa, Italy
| | - Valentina Barletta
- 1 Cardioangiology Universitary Departmental Section, Cardio Thoracic and Vascular Department, A.O.U.P., University of Pisa, Pisa, Italy
| | - Raffaella Berchiolli
- 2 Vascular Surgery Operative Unit, Cardio Thoracic and Vascular Department, A.O.U.P., University of Pisa, Pisa, Italy
| | - Daniele Adami
- 2 Vascular Surgery Operative Unit, Cardio Thoracic and Vascular Department, A.O.U.P., University of Pisa, Pisa, Italy
| | - Mauro Ferrari
- 2 Vascular Surgery Operative Unit, Cardio Thoracic and Vascular Department, A.O.U.P., University of Pisa, Pisa, Italy
| | - Vitantonio Di Bello
- 1 Cardioangiology Universitary Departmental Section, Cardio Thoracic and Vascular Department, A.O.U.P., University of Pisa, Pisa, Italy
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Awan MU, Omar B, Qureshi G, Awan GM. Successful Treatment of Iatrogenic External Iliac Artery Perforation With Covered Stent: Case Report and Review of the Literature. Cardiol Res 2017; 8:246-253. [PMID: 29118889 PMCID: PMC5667714 DOI: 10.14740/cr596w] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Accepted: 08/28/2017] [Indexed: 12/12/2022] Open
Abstract
Retroperitoneal hemorrhage from iliac artery injury is a potentially serious complication of vascular interventional procedures leading to hemorrhagic shock and death if not diagnosed early and treated promptly. We report a 70-year-old male admitted to our facility with non-ST-elevation myocardial infarction, whose heart catheterization revealed left anterior descending artery (LAD) with 80% proximal, 95% mid and 100% distal disease. The left circumflex and right coronary arteries were 100% occluded proximally and received collaterals from the LAD. The patient declined coronary artery bypass surgery; therefore, the decision was made to perform high-risk percutaneous coronary intervention (PCI) of the LAD with Impella left ventricular assist device support. Left femoral artery angiogram revealed severely tortuous and calcified aorta, left external iliac and left common iliac arteries, and was accessed with 14-inch Impella sheath. He developed groin pain with mild hypotension thought to be due to sedation, which responded to intravenous fluids and dopamine. He underwent successful rotational atherectomy of the proximal and mid LAD with deployment of drug-eluting stents. Following PCI, he suffered acute profound hypotension necessitating intravenous fluids and vasopressor support with epinephrine. Emergency transthoracic echocardiogram did not reveal any pericardial effusion, and showed normal left ventricle and right ventricle systolic function. The Impella device was removed and selective left common iliac angiogram from the right femoral access revealed a vascular injury site with shift of the bladder to the right indicative of retroperitoneal hematoma. A digital subtraction angiogram revealed extravasation of blood at the vascular injury site. An 8.0 × 59 mm iCAST covered stent was deployed to the left external iliac artery with successful sealing of the perforation. The Impella device site was closed with two Perclose devices. The patient required 4 units of packed red blood cell transfusion. His hospital course was complicated by transient acute kidney injury, with return of his renal function to baseline at discharge 10 days later. This case underscores the importance of prompt recognition and treatment of vascular complications associated with interventional procedures, and highlights some of the risk predictors of such complications, which should be anticipated and planned for prior to intervention.
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Affiliation(s)
- Muhammad Umer Awan
- Division of Cardiology, University of South Alabama, Mobile, AL 36617, USA
| | - Bassam Omar
- Division of Cardiology, University of South Alabama, Mobile, AL 36617, USA
| | - Ghazanfar Qureshi
- Division of Cardiology, University of South Alabama, Mobile, AL 36617, USA
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Factors affecting treatment, management and mortality in cases of retroperitoneal hematoma after cardiac catheterization: a single-center experience. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2017; 13:218-224. [PMID: 29056994 PMCID: PMC5644040 DOI: 10.5114/aic.2017.70189] [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: 03/03/2017] [Accepted: 04/19/2017] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION There is little information available on the clinical aspects, results, treatment and management of cardiac catheterization-related retroperitoneal hematoma. Data on the subject are rather limited, and current publications are based on a limited number of retrospective cohort studies and case reports. AIM To perform a retrospective analysis of the demographic, clinical, and in-hospital results of patients who developed retroperitoneal hematoma (RPH) after cardiac catheterization (CC). MATERIAL AND METHODS The cases of 124,064 patients who had CCs between January 2010 and October 2016 were retrospectively analyzed. Patients diagnosed with RPH were classified into three groups depending on the method of treatment: conservative (group 1), endovascular stenting (group 2), and surgery (group 3). The independent risk factors, based on RPH-related mortality, were determined by logistic regression analysis. RESULTS Of the 68 (0.054%) patients with RPH, 75% received conservative treatment, 13.2% underwent angiographic stent placement, and 11.7% had surgical treatment. Red blood cell packets (RBCPs) (p = 0.043), duration of hospitalization (p = 0.007), and mortality rates (p = 0.006) were statistically significantly higher in group 3 in comparison to the other groups. Multivariate subgroup analysis was conducted to determine mortality rates, with post-procedural highest creatinine ≥ 2 mg/dl and RBCPs ≥ 10 established as independent risk factors. CONCLUSIONS Hemodynamically stable patients with no active hemorrhaging are shown to have good results with conservative treatment. We believe that endovascular methods should be used initially for hemodynamically unstable patients, while surgical treatment should be employed in cases where endovascular methods fail or abdominal compartment syndrome develops.
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Bodagh N, Anwar MO, Timmis A. Emergency management of retroperitoneal haemorrhage using covered stents. Br J Hosp Med (Lond) 2017; 78:354-355. [PMID: 28614023 DOI: 10.12968/hmed.2017.78.6.354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Neil Bodagh
- Academic Foundation Year 2 Doctor, Department of Cardiology, St Bartholomew's Hospital, London EC1A 7BE
| | - Mohammed O Anwar
- Medical Student, Barts and the London School of Medicine and Dentistry, Queen Mary University London, London
| | - Adam Timmis
- Professor of Clinical Cardiology, Department of Cardiology, St Bartholomew's Hospital, London
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Lin SY, Lyu SY, Su TW, Chu SY, Chen CM, Hung CF, Chang CJ, Ko PJ. Predictive Factors for Additional ProGlide Deployment in Percutaneous Endovascular Aortic Repair. J Vasc Interv Radiol 2017; 28:570-575. [DOI: 10.1016/j.jvir.2016.12.1219] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 12/06/2016] [Accepted: 12/19/2016] [Indexed: 12/17/2022] Open
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Nawaz Y, Barvalia M, Rana G, Khakwani MZ, Azim K, Patel R, Idrees S, Baker G, Cohen M, Wasty N. Poorly recognized age-related downward deviation of the inguinal ligament. SAGE Open Med 2016; 4:2050312116675565. [PMID: 27826446 PMCID: PMC5084609 DOI: 10.1177/2050312116675565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 09/26/2016] [Indexed: 11/17/2022] Open
Abstract
Objective: To determine factors affecting actual inguinal ligament course in live human subjects. Introduction and hypothesis: Although the expected inguinal ligament course is supposedly a straight line extending from anterior superior iliac spine to pubic tubercle, the actual inguinal ligament course is frequently depicted a priori by a downward bowing dotted line. There are no studies in a live subject supporting this assumption. We hypothesized this assumption is indeed valid and is related to among other factors a lifelong effect of gravity and lax abdominal musculature on the inguinal ligament course. Methods: We retrospectively reviewed 54 consecutive computed tomography scans of the abdomen and pelvis randomly distributed across all age groups. Actual inguinal ligament course was visualized by reconstructing images using Terracon software. Vertical distance from the lowest point of actual inguinal ligament course to the expected inguinal ligament course was measured. We used multiple linear regression analysis to study the correlation between degree of inguinal ligament deviation and several variables. Results: Actual inguinal ligament course was below the expected inguinal ligament course in 52 of 54 patients. The mean deviation was 8.2 ± 5.9 mm. Advanced age was significantly associated with greater downward bowing of the inguinal ligament (p = 0.001). Conclusion: Actual inguinal ligament course is often well below the expected inguinal ligament course; this downward bowing of the inguinal ligament is especially pronounced with advancing age. Operators need to be mindful as this downward bowing can lead to supra-inguinal sticks causing vascular complications.
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Affiliation(s)
- Yassir Nawaz
- Cardiac Catheterization Lab, Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ, USA
| | - Mihir Barvalia
- Cardiac Catheterization Lab, Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ, USA
| | - Gurinder Rana
- Cardiac Catheterization Lab, Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ, USA
| | - M Zain Khakwani
- Cardiac Catheterization Lab, Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ, USA
| | - Khizr Azim
- Cardiac Catheterization Lab, Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ, USA
| | - Rahul Patel
- Cardiac Catheterization Lab, Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ, USA
| | - Sohira Idrees
- Cardiac Catheterization Lab, Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ, USA
| | - Gail Baker
- Cardiac Catheterization Lab, Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ, USA
| | - Marc Cohen
- Cardiac Catheterization Lab, Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ, USA
| | - Najam Wasty
- Cardiac Catheterization Lab, Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ, USA
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Seto AH, Tyler J, Suh WM, Harrison AT, Vera JA, Zacharias SJ, Daly TS, Sparling JM, Patel PM, Kern MJ, Abu-Fadel M. Defining the common femoral artery: Insights from the femoral arterial access with ultrasound trial. Catheter Cardiovasc Interv 2016; 89:1185-1192. [PMID: 27566991 DOI: 10.1002/ccd.26727] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 05/16/2016] [Accepted: 08/01/2016] [Indexed: 11/06/2022]
Abstract
OBJECTIVE We sought to establish the typical location of the common femoral artery (CFA) bifurcation, the origin and most inferior reflection of the inferior epigastric artery (IEA) relative to the femoral head (FH) and whether patient demographics predicted anatomical variations. BACKGROUND In the absence of ultrasound guidance or prior imaging, the precise location of the CFA bifurcation and IEA can only be determined following access site angiography. Fluoroscopic landmarks are commonly used to estimate the location of the CFA bifurcation, but the position of the IEA is less well characterized. METHODS Prospectively collected data on 989 patients with femoral angiography in the FAUST trial were analyzed. The level of CFA bifurcation and the origin and most inferior reflection of the IEA were classified by angiography. Logistic regression was used to explore whether baseline demographics were associated with anatomic variations. RESULTS The CFA bifurcation occurs below the middle 1/3rd of the femoral head in 95% of patients, and no patient factors are predictive of a high bifurcation. The IEA origin has a more variable anatomically pattern, with high BSA, male gender, and white race associated with a low IEA origin. CONCLUSION Operators should attempt to access the CFA at the level of the middle 1/3rd of the FH to maximize the chance of CFA cannulation. However, this location carries an 11% risk of being at or above the IEA origin. Baseline demographics were of limited utility for predicting anatomic variants of the CFA bifurcation and the course of the IEA. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Arnold H Seto
- Department of Medicine, Veterans Affairs Long Beach Health Care System, Long Beach, California.,Department of Medicine, University of Califonia, Irvine Medical Center, Orange, California
| | - Jeffrey Tyler
- Department of Medicine, University of California, San Francisco Medical Center, San Francisco, California
| | - William M Suh
- Department of Medicine, University of California, Los Angeles Medical Center, Los Angeles, California
| | | | - Jesus A Vera
- Cardiothoracic Department, St Jude Medical Center, Fullerton, California
| | | | - Timothy S Daly
- Department of Cardiology, INTEGRIS Heart Hospital, Oklahoma City, Oklahoma
| | - Jeffrey M Sparling
- Department of Cardiology, INTEGRIS Heart Hospital, Oklahoma City, Oklahoma
| | - Pranav M Patel
- Department of Medicine, University of Califonia, Irvine Medical Center, Orange, California
| | - Morton J Kern
- Department of Medicine, Veterans Affairs Long Beach Health Care System, Long Beach, California.,Department of Medicine, University of Califonia, Irvine Medical Center, Orange, California
| | - Mazen Abu-Fadel
- Department of Medicine, Cardiovascular section, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
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Vilke GM, Kass P. Retroperitoneal Hematoma After Femoral Arterial Catheterization. J Emerg Med 2015; 49:338-9. [PMID: 26153033 DOI: 10.1016/j.jemermed.2015.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 05/14/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Gary M Vilke
- Department of Emergency Medicine, University of California at San Diego Medical Center, San Diego, California
| | - Peter Kass
- Department of Emergency Medicine, University of California at San Diego Medical Center, San Diego, California
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Mehta V, Pandit BN, Mehra P, Nigam A, Vyas A, Yusuf J, Mukhopadhyay S, Trehan V. Massive Bleeding from Guidewire Perforation of an External Iliac Artery: Treatment with Hand-made Stent-Graft Placement. Cardiovasc Intervent Radiol 2015; 39:106-10. [PMID: 26021596 DOI: 10.1007/s00270-015-1125-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 04/22/2015] [Indexed: 11/26/2022]
Abstract
We report life-threatening bleeding from an external iliac artery perforation following guidewire manipulation in a patient with atherosclerotic iliac artery disease. This complication was successfully managed by indigenous hand-made stent-graft made from two peripheral stents in the catheterization laboratory.
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Affiliation(s)
- Vimal Mehta
- G.B. Pant Institute of Postgraduate Medical Education and Research, New Delhi, India.
- Room No. 133, Department of Cardiology, G.B. Pant Institute of Postgraduate Medical Education and Research, Jawahar Lal Nehru Marg, New Delhi, 110002, India.
| | - Bhagya Narayan Pandit
- G.B. Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Pratishtha Mehra
- G.B. Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Arima Nigam
- G.B. Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Aniruddha Vyas
- G.B. Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Jamal Yusuf
- G.B. Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Saibal Mukhopadhyay
- G.B. Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Vijay Trehan
- G.B. Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
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Yun SJ, Nam DH, Ryu JK. Femoral Artery Access Using the US-Determined Inguinal Ligament and Femoral Head as Reliable Landmarks: Prospective Study of Usefulness and Safety. J Vasc Interv Radiol 2015; 26:552-9. [DOI: 10.1016/j.jvir.2014.12.613] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2014] [Revised: 12/17/2014] [Accepted: 12/22/2014] [Indexed: 10/23/2022] Open
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Evaluation of a structured training program for arterial femoral sheath removal after percutaneous arterial catheter procedures by assistant personnel. Am J Cardiol 2015; 115:879-83. [PMID: 25661570 DOI: 10.1016/j.amjcard.2015.01.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 01/06/2015] [Accepted: 01/06/2015] [Indexed: 11/24/2022]
Abstract
After cardiac catheterization procedures, arterial closure can be achieved by manual compression (MC), using external mechanical compression devices, or by applying vascular closure devices (VCDs) with comparable vascular access site-related complication rates. The aim of the present study was to assess vascular access site-related complications during the implementation of structured sheath removal and MC by paramedics after catheterization procedures. After an observational phase of 3 months to assess the baseline complication rate, a structured 4-level training program was implemented to train assistant personnel, in this case paramedics, in the management of sheath removal by MC. Access site-related complication rates after sheath removal were assessed prospectively and MC by paramedics compared with MC by physicians and application of VCDs. To account for imbalances in procedure- and patient-related risk factors of access-site complications, propensity score-based matching analysis was performed (ClinicalTrials.gov identifier NCT00825331). All consecutive percutaneous transfemoral arterial cardiac catheterization procedures were prospectively assessed over a period of 8 months (n = 3,503). MC was performed in 2,315 cases, of which 180 were performed by paramedics and 2,135 by physicians; VCDs were applied in 1,188 procedures. Rates of access site-related complications were significantly lower for paramedics compared with physicians (p = 0.03) and similar between paramedics and VCDs (p = 0.77). In conclusion a structured program for paramedics to be trained in sheath removal after percutaneous cardiac catheterization procedures can be readily implemented during clinical routine with low in-hospital complication rates.
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Allende R, Urena M, Cordoba JG, Ribeiro HB, Amat-Santos I, DeLarochellière R, Paradis JM, Doyle D, Mohammadi S, Côté M, Abdul-Jawad O, del Trigo M, Ortas MR, Laflamme L, Laflamme J, DeLarochellière H, Dumont E, Rodés-Cabau J. Impact of the use of transradial versus transfemoral approach as secondary access in transcatheter aortic valve implantation procedures. Am J Cardiol 2014; 114:1729-34. [PMID: 25439451 DOI: 10.1016/j.amjcard.2014.09.009] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2014] [Revised: 09/06/2014] [Accepted: 09/06/2014] [Indexed: 12/20/2022]
Abstract
No data exist on the impact of vascular complications related to the secondary access site in transcatheter aortic valve implantation (TAVI). The objectives of this nonrandomized study were to determine the rate of vascular complications related to the secondary access site in TAVI procedures and to evaluate the clinical impact of using the radial versus femoral approach as a secondary access in such procedures. A total of 462 consecutive patients (mean age 79 ± 9 years, 50% men) who underwent TAVI were included. The femoral approach (FA) was used as the secondary access (for the insertion of a 5F pigtail catheter) in 335 patients and the radial approach (RA) in 127 patients. Thirty-day events were prospectively collected. There were no baseline differences between groups, except for a higher prevalence of women and peripheral disease in the FA group (p <0.05 for both). A total of 74 vascular access site complications occurred in 70 patients (15%), and 23% of them (29% in the FA group) were related to the secondary access. The use of FA as secondary access was associated with a higher rate of vascular complications (5.0% vs 0% in the RA group, p = 0.005, adjusted p = 0.014). All major vascular complications related to the secondary access occurred in the FA group (3% vs 0% in the RA group, p = 0.040, adjusted p = 0.049), and this translated into a higher rate of major and/or life-threatening bleeding events related to the secondary access in the FA group (3% vs 0% in the RA group, p = 0.040, adjusted p = 0.049). In conclusion, about 1/4 of vascular access site complications in TAVI are related to the secondary access. The use of the RA as a secondary access was associated with a major reduction in vascular complications. These results highlight the impact of secondary access vascular complications in TAVI procedures and support the use of the RA as the preferred secondary access.
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Routine use of ultrasound-guided access reduces access site-related complications after lower extremity percutaneous revascularization. J Vasc Surg 2014; 61:405-12. [PMID: 25240244 DOI: 10.1016/j.jvs.2014.07.099] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Accepted: 07/28/2014] [Indexed: 02/08/2023]
Abstract
OBJECTIVE We sought to elucidate the risks for access site-related complications (ASCs) after percutaneous lower extremity revascularization and to evaluate the benefit of routine ultrasound-guided access (RUS) in decreasing ASCs. METHODS We reviewed all consecutive percutaneous revascularizations (percutaneous transluminal angioplasty or stent) performed for lower extremity atherosclerosis at our institution from 2002 to 2012. RUS began in September 2007. Primary outcome was any ASC (bleeding, groin or retroperitoneal hematoma, vessel rupture, or thrombosis). Multivariable logistic regression was used to determine predictors of ASC. RESULTS A total of 1371 punctures were performed on 877 patients (43% women; median age, 69 [interquartile range, 60-78] years) for claudication (29%), critical limb ischemia (59%), or bypass graft stenosis (12%) with 4F to 8F sheaths. There were 72 ASCs (5%): 52 instances of bleeding or groin hematoma, nine pseudoaneurysms, eight retroperitoneal hematomas, two artery lacerations, and one thrombosis. ASCs were less frequent when RUS was used (4% vs 7%; P = .02). Multivariable predictors of ASC were age >75 years (odds ratio [OR], 2.0; 95% confidence interval [CI], 1.1-3.7; P = .03), congestive heart failure (OR, 1.9; 95% CI, 1.1-1.3; P = .02), preoperative warfarin use (OR, 2.0; 95% CI, 1.1-3.5; P = .02), and RUS (OR, 0.4; 95% CI, 0.2-0.7; P < .01). Vascular closure devices (VCDs) were not associated with lower rates of ASCs (OR, 1.1; 95% CI, 0.6-1.9; P = .79). RUS lowered ASCs in those >75 years (5% vs 12%; P < .01) but not in those taking warfarin preoperatively (10% vs 13%; P = .47). RUS did not decrease VCD failure (6% vs 4%; P = .79). CONCLUSIONS We were able to decrease the rate of ASCs during lower extremity revascularization with the implementation of RUS. VCDs did not affect ASCs. Particular care should be taken with patients >75 years old, those with congestive heart failure, and those taking warfarin.
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Lee MS, Applegate B, Rao SV, Kirtane AJ, Seto A, Stone GW. Minimizing femoral artery access complications during percutaneous coronary intervention: a comprehensive review. Catheter Cardiovasc Interv 2014; 84:62-9. [PMID: 24677734 DOI: 10.1002/ccd.25435] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 01/11/2014] [Accepted: 02/11/2014] [Indexed: 11/10/2022]
Abstract
Major bleeding complications after percutaneous coronary intervention (PCI) increase patient morbidity, prolong the hospital stay and costs, and are associated with reduced survival. Transfemoral access is still preferred at many centers given its familiarity and ease of use and is necessary in cases where large bore access is needed. Multimodality imaging with fluoroscopy, ultrasonography, and angiography can facilitate proper puncture of the common femoral artery. A proper technique (which includes femoral artery puncture and vascular access site closure) associated with adequate pharmacotherapy (both during PCI and peri-procedural, for the treatment of the underlying coronary artery disease) has been shown to reduce the risk of bleeding and vascular complications associated with femoral artery access. Avoiding the use of arterial sheaths >6 French may further reduce the risk of bleeding. Data with vascular closure devices as a bleeding avoidance strategy are evolving but when used appropriately may further reduce the risk of bleeding and vascular access complications, and in this regard are synergistic with bivalirudin. Randomized trials to confirm these recommendations are needed.
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Affiliation(s)
- Michael S Lee
- Division of Cardiology, UCLA Medical Center, Los Angeles, California
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33
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Anatomía angiográfica femoral y complicaciones derivadas del cateterismo cardiaco. ANGIOLOGIA 2014. [DOI: 10.1016/j.angio.2013.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Nguyen CT, Lee E, Luo H, Siegel RJ. Echocardiographic guidance for diagnostic and therapeutic percutaneous procedures. Cardiovasc Diagn Ther 2013; 1:11-36. [PMID: 24282682 DOI: 10.3978/j.issn.2223-3652.2011.09.02] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Accepted: 09/24/2011] [Indexed: 11/14/2022]
Abstract
Echocardiographic guidance has an important role in percutaneous cardiovascular procedures and vascular access. The advantages include real time imaging, portability, and availability, which make it an effective imaging modality. This article will review the role of echocardiographic guidance for diagnostic and therapeutic percutaneous procedures, specifically, transvenous and transarterial access, pericardiocentesis, endomyocardial biopsy, transcatheter pulmonary valve replacement, pulmonary valve repair, transcatheter aortic valve implantation, and percutaneous mitral valve repair. We will address the ways in which echocardiographic guidance provides these procedures with detailed information on anatomy, adjacent structures, and intraprocedural instrument position, thus resulting in improvement in procedural efficacy, safety and patient outcomes.
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Affiliation(s)
- Cam Tu Nguyen
- Cedars Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, USA
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Harold JG, Bass TA, Bashore TM, Brindiss RG, Brush JE, Burke JA, Dehmers GJ, Deychak YA, Jneids H, Jolliss JG, Landzberg JS, Levine GN, McClurken JB, Messengers JC, Moussas ID, Muhlestein JB, Pomerantz RM, Sanborn TA, Sivaram CA, Whites CJ, Williamss ES, Halperin JL, Beckman JA, Bolger A, Byrne JG, Lester SJ, Merli GJ, Muhlestein JB, Pina IL, Wang A, Weitz HH. ACCF/AHA/SCAI 2013 Update of the Clinical Competence Statement on Coronary Artery Interventional Procedures. Catheter Cardiovasc Interv 2013; 82:E69-111. [DOI: 10.1002/ccd.24985] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - John G. Harold
- American College of Cardiology Foundation representative
| | - Theodore A. Bass
- Society for Cardiovascular Angiography and Interventions representative
| | | | | | | | | | | | | | | | | | | | | | | | | | - Issam D. Moussas
- Society for Cardiovascular Angiography and Interventions representative
| | | | | | | | | | | | | | | | - Joshua A. Beckman
- Former Task Force member during the writing effort; Authors with no symbol by their name were included to provide additional content expertise
| | | | | | | | | | | | - Ileana L. Pina
- Former Task Force member during the writing effort; Authors with no symbol by their name were included to provide additional content expertise
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ACCF/AHA/SCAI 2013 Update of the Clinical Competence Statement on Coronary Artery Interventional Procedures. J Am Coll Cardiol 2013; 62:357-96. [DOI: 10.1016/j.jacc.2013.05.002] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Eisen A, Kornowski R, Vaduganathan M, Lev E, Vaknin-Assa H, Bental T, Orvin K, Brosh D, Rechavia E, Battler A, Assali A. Retroperitoneal bleeding after cardiac catheterization: a 7-year descriptive single-center experience. Cardiology 2013; 125:217-22. [PMID: 23797048 DOI: 10.1159/000351090] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Accepted: 04/02/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Retroperitoneal bleeding (RPB) is an unusual but potentially fatal vascular complication occurring after cardiac catheterization (CC). Contemporary data of RPB in the era of dual antiplatelet therapy and vascular closure devices are lacking. METHODS We retrospectively examined all RPB cases that occurred after CC in the Rabin Medical Center between the years 2005 and 2011. RESULTS Of 26,487 patients who underwent CC, a total of 48 patients (mean age 60.9 ± 13.8 years, 52.1% female) with RPB were identified (0.18%). The indication for CC was acute coronary syndrome (43.7%), myocardial infarction (35.4%), stable angina pectoris (8.3%), hemodynamic studies for valvular heart disease (10.4%) and others (2.1%). Coronary intervention was performed in 34 patients (70.9%) and a vascular closure device (VCD) was used in 16 patients (33.3%). Seventy-seven percent of patients were treated with clopidogrel, 20.8% with glycoprotein IIb-IIIa inhibitors and 85.4% with anticoagulation during CC. Median time to diagnosis of bleeding was 9.0 h, while the median time to bleeding differed between patients with and without a VCD (12 vs. 5 h, respectively). The clinical presentation of RPB was hemorrhagic shock in 39.6% of patients and 50.0% required at least one blood transfusion. Patients were managed either with conservative treatment (79.2%), angiography stenting (14.6%) or vascular surgery (6.2%). A total of 3 patients died during hospitalization, of which RPB was the etiology in 2 (4.2%). CONCLUSIONS RPB which is a rare complication of CC is associated with younger age and female gender, as compared to patients without RPB. Onset of bleeding can be delayed in patients with VCDs. With careful and early diagnosis, most patients with RPB after CC can be managed conservatively.
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Affiliation(s)
- Alon Eisen
- Department of Cardiology, Rabin Medical Center, Petah-Tikva, Tel-Aviv University, Tel-Aviv, Israel
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Harold JG, Bass TA, Bashore TM, Brindis RG, Brush JE, Burke JA, Dehmer GJ, Deychak YA, Jneid H, Jollis JG, Landzberg JS, Levine GN, McClurken JB, Messenger JC, Moussa ID, Muhlestein JB, Pomerantz RM, Sanborn TA, Sivaram CA, White CJ, Williams ES. ACCF/AHA/SCAI 2013 update of the clinical competence statement on coronary artery interventional procedures: a report of the American College of Cardiology Foundation/American Heart Association/American College of Physicians Task Force on Clinical Competence and Training (writing committee to revise the 2007 clinical competence statement on cardiac interventional procedures). Circulation 2013; 128:436-72. [PMID: 23658439 DOI: 10.1161/cir.0b013e318299cd8a] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Sajnani N, Bogart DB. Retroperitoneal hemorrhage as a complication of percutaneous intervention: report of 2 cases and review of the literature. Open Cardiovasc Med J 2013; 7:16-22. [PMID: 23569466 PMCID: PMC3617546 DOI: 10.2174/1874192401307010016] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 09/01/2012] [Indexed: 11/22/2022] Open
Abstract
Retroperitoneal hemorrhage (RPH) is an infrequent but serious complication of transfemoral percutaneous procedures. We present 2 cases and review the literature regarding the incidence, risk factors, clinical features and complications of RPH. We propose a management strategy for this problem emphasizing an anatomical based interventional approach if the patient does not stabilize with volume resuscitation.
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Affiliation(s)
- Nitin Sajnani
- Truman Medical Center, University of Missouri-Kansas City, 2301 Holmes, Kansas City, Missouri, USA
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Mustapha J, Saab F, Diaz L, Karenko B, Richards L, Laeder T, Heaney CM, Das T. Utility and feasibility of ultrasound-guided access in patients with critical limb ischemia. Catheter Cardiovasc Interv 2013; 81:1204-11. [DOI: 10.1002/ccd.24757] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Accepted: 11/07/2012] [Indexed: 12/21/2022]
Affiliation(s)
- J.A. Mustapha
- Department of Internal Medicine, Metro Heart and Vascular; Michigan State University; School of Medicine; Metro Health Hospital; Wyoming; Michigan
| | - Fadi Saab
- Department of Internal Medicine, Metro Heart and Vascular; Michigan State University; School of Medicine; Metro Health Hospital; Wyoming; Michigan
| | - Larry Diaz
- Department of Internal Medicine, Metro Heart and Vascular; Michigan State University; School of Medicine; Metro Health Hospital; Wyoming; Michigan
| | - Barbara Karenko
- Department of Internal Medicine, Metro Heart and Vascular; Michigan State University; School of Medicine; Metro Health Hospital; Wyoming; Michigan
| | - Lance Richards
- Department of Internal Medicine, Metro Heart and Vascular; Michigan State University; School of Medicine; Metro Health Hospital; Wyoming; Michigan
| | - Theresa Laeder
- Department of Internal Medicine, Metro Heart and Vascular; Michigan State University; School of Medicine; Metro Health Hospital; Wyoming; Michigan
| | - Carmen M. Heaney
- Department of Internal Medicine, Metro Heart and Vascular; Michigan State University; School of Medicine; Metro Health Hospital; Wyoming; Michigan
| | - Tony Das
- Department of Internal Medicine, Metro Heart and Vascular; Michigan State University; School of Medicine; Metro Health Hospital; Wyoming; Michigan
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Vascular closure device failure in contemporary practice. JACC Cardiovasc Interv 2013; 5:837-44. [PMID: 22917455 DOI: 10.1016/j.jcin.2012.05.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2011] [Revised: 04/12/2012] [Accepted: 05/12/2012] [Indexed: 11/22/2022]
Abstract
OBJECTIVES The goal of this study was to assess the frequency and predictors of vascular closure device (VCD) deployment failure, and its association with vascular complications of 3 commonly used VCDs. BACKGROUND VCDs are commonly used following percutaneous coronary intervention on the basis of studies demonstrating reduced time to ambulation, increased patient comfort, and possible reduction in vascular complications as compared with manual compression. However, limited data are available on the frequency and predictors of VCD failure, and the association of deployment failure with vascular complications. METHODS From a de-identified dataset provided by Massachusetts Department of Health, 23,813 consecutive interventional coronary procedures that used either a collagen plug-based (n = 18,533), a nitinol clip-based (n = 2,284), or a suture-based (n = 2,996) VCD between June 2005 and December 2007 were identified. The authors defined VCD failure as unsuccessful deployment or failure to achieve immediate access site hemostasis. RESULTS Among 23,813 procedures, the VCD failed in 781 (3.3%) procedures (2.1% of collagen plug-based, 6.1% of suture-based, 9.5% of nitinol clip-based VCDs). Patients with VCD failure had an excess risk of "any" (7.7% vs. 2.8%; p < 0.001), major (3.3% vs. 0.8%; p < 0.001), or minor (5.8% vs. 2.1%; p < 0.001) vascular complications compared with successful VCD deployment. In a propensity score-adjusted analysis, when compared with collagen plug-based VCD (reference odds ratio [OR] = 1.0), nitinol clip-based VCD had 2-fold increased risk (OR: 2.0, 95% confidence interval [CI]: 1.8 to 2.3, p < 0.001) and suture-based VCD had 1.25-fold increased risk (OR: 1.25, 95% CI: 1.2 to 1.3, p < 0.001) for VCD failure. VCD failure was a significant predictor of subsequent vascular complications for both collagen plug-based VCD and nitinol clip-based VCD, but not for suture-based VCD. CONCLUSIONS VCD failure rates vary depending upon the type of VCD used and are associated with significantly higher vascular complications as compared with deployment successes.
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Vascular closure device failure: we are getting better but not there yet. JACC Cardiovasc Interv 2013; 5:845-7. [PMID: 22917456 DOI: 10.1016/j.jcin.2012.06.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Accepted: 06/15/2012] [Indexed: 11/22/2022]
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Maluenda G, Mitulescu L, Ben-Dor I, Sardi G, Romaguera R, Satler LF, Pichard AD, Waksman R, Bernardo NL. Transcatheter "thrombin-blood patch" injection: a novel and effective approach to treat catheterization-related arterial perforation. Catheter Cardiovasc Interv 2012; 80:1025-32. [PMID: 23024065 DOI: 10.1002/ccd.24389] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Accepted: 02/20/2012] [Indexed: 11/11/2022]
Abstract
OBJECTIVE This study aimed to describe the safety and feasibility of transcatheter "thrombin-blood patch" (TBP) injection to treat catheterization-related arterial vascular access perforation. BACKGROUND Vascular access complications are infrequent but potentially life threatening conditions related to percutaneous procedures. Surgical vascular repair are associated with high rates of morbidity and mortality due to advanced cardiovascular disease. METHODS From October 2007 to July 2010 we studied 23 patients who presented active access arterial bleeding after percutaneous procedures and underwent transcatheter angiographic guided TBP injection across the entry site of the arterial perforation as a primary approach. RESULTS The mean age of the population was 67 years, predominantly female (78.3%) with high rate of comorbidities including diabetes (30.4%), prior coronary revascularization (50.0%), chronic renal failure (43.5%), and heart failure (56.5%). Thirteen patients (56.5%) developed severe hypotension after the index procedure. The repair procedure had a mean duration of 82 ± 57 minutes. TBP was injected in all patients. One case additionally required covered-stent to obtain hemostasis. Angiographic success was achieved in the 23 patients; however, one case required a second intervention due to recurrent bleeding, which was effectively treated using covered-stent. All patients were discharged alive and no major cardiovascular events, including myocardial infarction/stroke, were observed. CONCLUSIONS Transcatheter "thrombin-blood patch" injection is a safe, novel technique that allows prompt percutaneous approach to treat catheterization-related arterial perforation. This strategy appears particularly attractive to treat patients who cannot tolerate "open" vascular reconstruction and repair.
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Affiliation(s)
- Gabriel Maluenda
- Division of Cardiology, Department of Internal Medicine, Washington Hospital Center, Washington, District of Columbia 20010, USA
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Tremmel JA, Tibayan YD, O'Loughlin AJC, Chan T, Fearon WF, Yeung AC, Lee DP. Most accurate definition of a high femoral artery puncture: aiming to better predict retroperitoneal hematoma in percutaneous coronary intervention. Catheter Cardiovasc Interv 2012; 80:37-42. [PMID: 22511409 DOI: 10.1002/ccd.23175] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2010] [Accepted: 03/26/2011] [Indexed: 11/09/2022]
Abstract
BACKGROUND Retroperitoneal hematoma (RPH) increases morbidity and mortality in percutaneous coronary intervention (PCI). High femoral arteriotomy is an independent predictor of RPH, but the optimal angiographic criterion for defining a high puncture is unknown. METHODS We retrospectively identified 557 consecutive PCI cases with femoral angiograms. Arteriotomy sites were categorized as high based on three angiographic criteria: at or above the proximal third of the femoral head (criterion A), at or above the most inferior border of the inferior epigastric artery (criterion B), and at or above the origin of the inferior epigastric artery (criterion C). Cases of RPH were then identified. RESULTS Of the 557 PCI patients, 26 had a high femoral arteriotomy by criterion A, 17 by criterion B, and 6 by criterion C. Among these patients with a high arteriotomy, RPH occurred in four with criterion A, in three with criterion B, and in one with criterion C. Of the three criteria, criterion A most strongly correlated with RPH (odds ratio [OR] 96, 95% confidence interval [CI] 10.3-898.4; p < 0.0001) compared with criterion B (OR 58, 95% CI 8.9 to 372.6; p < 0.0001) or C (OR 27, 95% CI 2.6 to 290.1; p = 0.053). All criteria had high specificity (A, 96%; B, 97%; C, 99%), but the sensitivity was higher with criterion A (80%) than criterion B (60%) or C (20%), and statistically, the use of criterion A led to the most accurate risk-stratification for RPH (A, κ = 0.79; B, κ = 0.59; C, κ = 0.19). CONCLUSIONS Among the three common definitions of high arteriotomy, femoral artery puncture at or above the proximal third of the femoral head is the landmark that most accurately risk stratifies PCI patients for development of RPH.
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Affiliation(s)
- Jennifer A Tremmel
- Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, California 94305, USA.
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Desborough M, Stanworth S. Plasma transfusion for bedside, radiologically guided, and operating room invasive procedures. Transfusion 2012; 52 Suppl 1:20S-9S. [DOI: 10.1111/j.1537-2995.2012.03691.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Turi ZG. Vascular occlusion and vascular closure devices: definitely associated, but still no idea how often or why. Catheter Cardiovasc Interv 2012; 79:944-5. [PMID: 22511380 DOI: 10.1002/ccd.24432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Maluenda G, Waksman R, Bernardo NL. Accepted TCT challenging case: common femoral artery perforation after primary percutaneous coronary intervention successfully treated with a novel transcatheter "thrombin-blood patch" injection technique. Catheter Cardiovasc Interv 2012; 79:805-8. [PMID: 21061252 DOI: 10.1002/ccd.22882] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2010] [Accepted: 10/19/2010] [Indexed: 11/11/2022]
Abstract
Severe vascular access complications are infrequent, yet potentially life-threatening, conditions related to percutaneous procedures approached via the femoral artery. Surgical vascular repair of such complications are associated with high rates of morbimortality due to advanced cardiovascular disease. Endovascular repair of the injured vessel appears to be the treatment of choice for patients who cannot tolerate vascular reconstruction and bleeding due to severe cardiovascular disease. We report a case that illustrates the feasibility of a novel technique: transcatheter "thrombin-blood patch" injection to access perforated arteries.
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Affiliation(s)
- Gabriel Maluenda
- Department of Internal Medicine, Division of Cardiology, Washington Hospital Center, Washington, DC 20010, USA
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Valgimigli M, Saia F, Guastaroba P, Menozzi A, Magnavacchi P, Santarelli A, Passerini F, Sangiorgio P, Manari A, Tarantino F, Margheri M, Benassi A, Sangiorgi MG, Tondi S, Marzocchi A. Transradial Versus Transfemoral Intervention for Acute Myocardial Infarction. JACC Cardiovasc Interv 2012; 5:23-35. [DOI: 10.1016/j.jcin.2011.08.018] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Accepted: 08/04/2011] [Indexed: 10/14/2022]
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Resnic FS, Wang TY, Arora N, Vidi V, Dai D, Ou FS, Matheny ME. Quantifying the Learning Curve in the Use of a Novel Vascular Closure Device. JACC Cardiovasc Interv 2012; 5:82-9. [PMID: 22230153 DOI: 10.1016/j.jcin.2011.09.017] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Revised: 08/16/2011] [Accepted: 09/03/2011] [Indexed: 01/31/2023]
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Maluenda G, Mitulescu L, Ben-Dor I, A Gaglia M, Weissman G, Torguson R, F Satler L, Pichard AD, Bernardo NL, Waksman R. Retroperitoneal hemorrhage after percutaneous coronary intervention in the current practice era: clinical outcomes and prognostic value of abdominal/pelvic computed tomography. Catheter Cardiovasc Interv 2011; 80:29-36. [PMID: 21735521 DOI: 10.1002/ccd.23200] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Accepted: 03/31/2011] [Indexed: 11/06/2022]
Abstract
BACKGROUND Retroperitoneal hemorrhage (RPH) is a serious but infrequent complication of percutaneous coronary intervention (PCI). This study aimed to describe the clinical outcomes of patients who developed RPH following PCI in the current practice era, with particular focus on treatment strategies and the related prognostic value of abdominal/pelvic computed tomography (CT). METHODS Among 20,904 patients undergoing PCI, we identified 93 RPH (0.45%) confirmed by CT or by unequivocal surgical findings. We identified three groups with RPH for comparison: patients who developed refractory shock (systolic blood pressure <80 mm Hg for ≥30 min despite fluids and vasopressors, n = 16 [17.2%]); patients with transient hypotension (<30 min, n = 34 [36.6%]); and patients without hypotension (n = 43 [46.2%]). The primary endpoint was a composite of in-hospital mortality, myocardial infarction, and cerebral vascular accident (CVA). RESULTS Baseline clinical, angiographic, and procedural characteristics were similar among the three groups. Patients who developed refractory shock had significantly more bleeding quantified by abdominal/pelvic CT (P < 0.001), had a higher rate and amount of red blood cell transfusion (P < 0.001), and were managed invasively more frequently (68.7%) than the rest of the population. The primary endpoint trended higher in patients presenting with refractory shock; however, this difference was not statistically significant. The volume of bleeding quantified by CT and the timing of imaging diagnosis did not correlate with the primary endpoint. Red blood cell transfusion, but not clopidogrel discontinuation, was associated with the primary endpoint. CONCLUSIONS RPH remains as a serious complication of PCI and is associated with high rates of mortality and morbidity independently of the therapeutic strategy. In patients who were hemodynamically stable, RPH volume as quantified by non-contrast abdominal/pelvic CT did not contribute to prognosis.
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Affiliation(s)
- Gabriel Maluenda
- Department of Cardiology, Washington Hospital Center, Washington, DC, USA
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