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Hatzl J, Henning D, Böckler D, Hartmann N, Meisenbacher K, Uhl C. Comparing Different Registration and Visualization Methods for Navigated Common Femoral Arterial Access-A Phantom Model Study Using Mixed Reality. J Imaging 2024; 10:76. [PMID: 38667974 PMCID: PMC11051344 DOI: 10.3390/jimaging10040076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 03/17/2024] [Accepted: 03/20/2024] [Indexed: 04/28/2024] Open
Abstract
Mixed reality (MxR) enables the projection of virtual three-dimensional objects into the user's field of view via a head-mounted display (HMD). This phantom model study investigated three different workflows for navigated common femoral arterial (CFA) access and compared it to a conventional sonography-guided technique as a control. A total of 160 punctures were performed by 10 operators (5 experts and 5 non-experts). A successful CFA puncture was defined as puncture at the mid-level of the femoral head with the needle tip at the central lumen line in a 0° coronary insertion angle and a 45° sagittal insertion angle. Positional errors were quantified using cone-beam computed tomography following each attempt. Mixed effect modeling revealed that the distance from the needle entry site to the mid-level of the femoral head is significantly shorter for navigated techniques than for the control group. This highlights that three-dimensional visualization could increase the safety of CFA access. However, the navigated workflows are infrastructurally complex with limited usability and are associated with relevant cost. While navigated techniques appear as a potentially beneficial adjunct for safe CFA access, future developments should aim to reduce workflow complexity, avoid optical tracking systems, and offer more pragmatic methods of registration and instrument tracking.
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Affiliation(s)
- Johannes Hatzl
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Daniel Henning
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Dittmar Böckler
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Niklas Hartmann
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Katrin Meisenbacher
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Christian Uhl
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, 69120 Heidelberg, Germany
- Department of Vascular Surgery, University Hospital RWTH Aachen, 52074 Aachen, Germany
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2
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Androshchuk V, Chehab O, Prendergast B, Rajani R, Patterson T, Redwood S. Computed tomography derived anatomical predictors of vascular access complications following transfemoral transcatheter aortic valve implantation: A systematic review. Catheter Cardiovasc Interv 2024; 103:169-185. [PMID: 37994240 PMCID: PMC10915898 DOI: 10.1002/ccd.30918] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 10/17/2023] [Accepted: 11/12/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND Vascular complications after percutaneous transfemoral transcatheter aortic valve implantation (TAVI) are associated with adverse clinical outcomes and remain a significant challenge. AIMS The purpose of this review is to synthesize the existing evidence regarding the iliofemoral artery features predictive of vascular complications after TAVI on pre-procedural contrast-enhanced multidetector computed tomography (MDCT). METHODS A systematic search was performed in Embase and Medline (Pubmed) databases. Studies of patients undergoing transfemoral TAVI with MDCT were included. Studies with only valve-in-valve TAVI, planned surgical intervention and those using fluoroscopic assessment were excluded. Data on study cohort, procedural characteristics and significant predictors of vascular complications were extracted. RESULTS We identified 23 original studies involving 8697 patients who underwent TAVI between 2006 and 2020. Of all patients, 8514 (97.9%) underwent percutaneous transfemoral-TAVI, of which 8068 (94.8%) had contrast-enhanced MDCT. The incidence of major vascular complications was 6.7 ± 4.1% and minor vascular complications 26.1 ± 7.8%. Significant independent predictors of major and minor complications related to vessel dimensions were common femoral artery depth (>54 mm), sheath-to-iliofemoral artery diameter ratio (>0.91-1.19), sheath-to-femoral artery diameter ratio (>1.03-1.45) and sheath-to-femoral artery area ratio (>1.35). Substantial iliofemoral vessel tortuosity predicted 2-5-fold higher vascular risk. Significant iliofemoral calcification predicted 2-5-fold higher risk. The iliac morphology score was the only hybrid scoring system with predictive value. CONCLUSIONS Independent iliofemoral predictors of access-site complications in TAVI were related to vessel size, depth, calcification and tortuosity. These should be considered when planning transfemoral TAVI and in the design of future risk prediction models.
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Affiliation(s)
- Vitaliy Androshchuk
- School of Cardiovascular Medicine & Sciences, Faculty of Life Sciences & MedicineKing's College LondonLondonUK
- Department of CardiologySt Thomas’ Hospital, King's College LondonLondonUK
| | - Omar Chehab
- School of Cardiovascular Medicine & Sciences, Faculty of Life Sciences & MedicineKing's College LondonLondonUK
- Department of CardiologySt Thomas’ Hospital, King's College LondonLondonUK
| | | | - Ronak Rajani
- Department of CardiologySt Thomas’ Hospital, King's College LondonLondonUK
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences & MedicineKing's College LondonLondonUK
| | - Tiffany Patterson
- School of Cardiovascular Medicine & Sciences, Faculty of Life Sciences & MedicineKing's College LondonLondonUK
- Department of CardiologySt Thomas’ Hospital, King's College LondonLondonUK
| | - Simon Redwood
- School of Cardiovascular Medicine & Sciences, Faculty of Life Sciences & MedicineKing's College LondonLondonUK
- Department of CardiologySt Thomas’ Hospital, King's College LondonLondonUK
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3
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Eitan A, Sliman H, Shiran A, Jaffe R. Strategies for Facilitating Totally Percutaneous Transfemoral TAVR Procedures. J Clin Med 2022; 11:jcm11082104. [PMID: 35456197 PMCID: PMC9028438 DOI: 10.3390/jcm11082104] [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: 02/28/2022] [Revised: 04/05/2022] [Accepted: 04/05/2022] [Indexed: 02/01/2023] Open
Abstract
Transcatheter aortic valve replacement (TAVR) has transformed the treatment of aortic stenosis and should ideally be performed as a totally percutaneous procedure via the transfemoral (TF) approach. Peripheral vascular disease may impede valve delivery, and vascular access site complications are associated with adverse clinical outcome and increased mortality. We review strategies aimed to facilitate TF valve delivery in patients with hostile vascular anatomy and achieve percutaneous management of vascular complications.
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Chandel A, Desai M, Ryan LP, Clevenger L, Speir AM, Singh R. Preclosure technique versus arterial cutdown after percutaneous cannulation for venoarterial extracorporeal membrane oxygenation. JTCVS Tech 2022; 10:322-330. [PMID: 34977748 PMCID: PMC8691737 DOI: 10.1016/j.xjtc.2021.08.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 08/17/2021] [Indexed: 11/16/2022] Open
Abstract
Background Arteriotomy repair through the preclosure technique during elective arterial access procedures is well documented. Outcomes associated with application of this technique to the removal of arterial access cannulas in patients undergoing urgent venoarterial extracorporeal membrane oxygenation (VA-ECMO) have not previously been reported. Methods We reviewed the records of consecutive patients who required VA-ECMO for cardiogenic shock. Patients were compared by use of the preclosure device (Perclose ProGlide Suture-Mediated Closure System; Abbott Vascular, Abbott Park, Ill) at time of VA-ECMO cannulation. The rate of limb complications (composite of limb ischemia, infection, and site necrosis) and secondary end points of bleeding events, pseudoaneurysm, distal part embolization, and intensive care unit length of stay after decannulation were compared between the groups. Results Ninety-nine consecutive patients managed with VA-ECMO were identified and the preclosure device was utilized in 51 of these patients. Preclosure device failure occurred in 5 instances (9.8%) and was successfully managed with surgical repair in 4 cases and endovascular intervention in another. Use of the preclosure device was associated with both fewer limb complications (odds ratio, 0.19; 95% confidence interval, 0.03-0.78) and bleeding events (odds ratio, 0.21; 95% confidence interval, 0.04-0.89). Pseudoaneurysm (n = 0) and distal part embolization (n = 1) were infrequently encountered in the cohort and no difference in intensive care unit length of stay after decannulation was noted between the groups. Conclusions In this cohort, use of the preclosure technique in weaning from VA-ECMO was technically feasible, safe, and associated with an approximate 80% lower likelihood of limb complications and bleeding events compared with surgical removal.
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Affiliation(s)
- Abhimanyu Chandel
- Department of Pulmonary and Critical Care, Walter Reed National Military Medical Center, Bethesda, Md
| | - Mehul Desai
- Department of Critical Care, Pulmonary, Allergy, and Immunology, Inova Health System, Fairfax, Va
| | - Liam P Ryan
- Department of Cardiac Surgery, Inova Heart and Vascular Institute, Fairfax, Va
| | - Lindsay Clevenger
- Department of Critical Care, Pulmonary, Allergy, and Immunology, Inova Health System, Fairfax, Va
| | - Alan M Speir
- Department of Cardiac Surgery, Inova Heart and Vascular Institute, Fairfax, Va
| | - Ramesh Singh
- Department of Cardiac Surgery, Inova Heart and Vascular Institute, Fairfax, Va
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de Boer M, Shiraev T, Loa J. Use of Suture-Mediated Closure Devices for Closure of Punctures in Prosthetic Patches or Grafts is Associated With High Rates of Technical Success and Low Complication Rates. Vasc Endovascular Surg 2022; 56:263-268. [PMID: 34982601 DOI: 10.1177/15385744211068626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Despite the increasing use of endovascular techniques in the management of peripheral vascular disease, there is little data on the safety of percutaneous closure devices in punctures of synthetic vascular material. Our paper sought to address this paucity in the literature by reviewing the incidence of complications occurring in patients in whom the ProGlide device was utilised to achieve haemostasis post-percutaneous puncture of vascular patches and graft materials. METHODS A retrospective review of patient records was conducted at a tertiary referral centre. Patients who had undergone percutaneous punctures of prosthetic bypass grafts or patch angioplasties between January 2011 and December 2020 were identified from a prospectively collected database. Medical records and post-procedural imaging were reviewed to assess the occurrence of post-procedural complications such as pseudoaneurysms, puncture site stenosis and further interventions for access complications. RESULTS A total of 73 punctures of prosthetic material were performed in 42 patients, of which 39 utilised ProGlides. Median age of included patients was 72 years. There was male predominance in the cohort (69.8%), and most punctures (87.3%) were through polyurethane patches. Device success rate was 95%, and no patients required open repair. There was a low incidence of complications, with no patients developing pseudoaneurysms, arteriovenous fistulas, ischaemic limbs or > 50% stenosis when either manual pressure or the ProGlide device was used to achieve haemostasis. Furthermore, there were no returns to theatre or further interventions performed for access site complications. CONCLUSION The use of the ProGlide closure device has a low incidence of complications and its safety appears to be equivalent to manual compression when used to achieve haemostasis in percutaneous punctures of synthetic vascular material in select patients. To our knowledge, this is the only article to date to assess the safety of the ProGlide in this setting.
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Affiliation(s)
- Madeleine de Boer
- Department of Vascular Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Timothy Shiraev
- Department of Vascular Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.,School of Medicine, University of Notre Dame, Darlinghurst, NSW, Australia
| | - Jacky Loa
- Department of Vascular Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
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Glaser N, O'Sullivan CJ, Saleh N, Verouhis D, Settergren M, Linder R, Rück A. Transcatheter aortic valve replacement using the iSleeve expandable sheath in small femoral arteries. Open Heart 2021; 8:openhrt-2021-001703. [PMID: 34642241 PMCID: PMC8513271 DOI: 10.1136/openhrt-2021-001703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 09/23/2021] [Indexed: 12/17/2022] Open
Abstract
Background Small femoral arteries have been associated with a higher risk of vascular complications in transfemoral transcatheter aortic valve replacement (TAVR). We investigated the feasibility and safety of TAVR in patients with small femoral arteries. Methods In this observational study, we included 82 patients who underwent transfemoral TAVR with the ACURATE neo system using the expandable 14F iSleeve sheath between 2018 and 2019 at Karolinska University Hospital, Sweden. Of these, 41 patients had a minimal femoral artery diameter of ≥5.5 mm (mean 6.5, range 5.5–9.2), and 41 patients had a minimal femoral artery diameter <5.5 mm (mean 4.9, range 3.9–5.4). Results There was no significant difference in major vascular and bleeding complications between the small femoral artery group (7%) and the normal femoral artery group (2%) (p=0.62). The total of major and minor vascular complications did not differ significantly according to femoral artery size (17% vs 5%) (p=0.16). The iSleeve sheath was not correlated with any of the complications. The use of the iSleeve sheath was unsuccessful in four patients (5%), of which one patient had a small femoral artery diameter. Conclusion Transfemoral TAVR with the ACURATE neo system using the iSleeve sheath is a promising method for patients with small femoral arteries even though we found a trend towards higher rates of complications in these patients. The use of expandable sheaths may expand the spectrum of patients that can be treated with transfemoral TAVR, and thus may improve the prognosis in patients with severe aortic valve stenosis.
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Affiliation(s)
- Natalie Glaser
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden .,Department of Cardiology, Stockholm South General Hospital, Stockholm, Sweden
| | - Crochan J O'Sullivan
- Department of Cardiology, Bon Secours Hospital, Cork, Ireland.,Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Nawzad Saleh
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden.,Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Dinos Verouhis
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden.,Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Settergren
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden.,Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Rickard Linder
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden.,Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Andreas Rück
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden.,Department of Medicine, Karolinska Institutet, Stockholm, Sweden
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Totally Percutaneous Transfemoral Transcatheter Aortic Valve Replacement Despite Failure to Deploy a Vascular Closure Device: A Single-Center Case Series. Heart Lung Circ 2021; 31:390-394. [PMID: 34607752 DOI: 10.1016/j.hlc.2021.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 07/27/2021] [Accepted: 09/09/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) is preferably performed as a completely percutaneous procedure via transfemoral access. Suture-mediated vascular closure devices are deployed prior to sheath insertion (pre-closure). Inability to perform pre-closure may necessitate surgical vascular repair of the femoral artery. Patients at increased risk of vascular surgery complications may benefit from a percutaneous method for achieving access site haemostasis. Stent graft implantation is commonly used for treating access site injury following TAVR. This study assessed the feasibility of a strategy of planned stent graft implantation within the femoral artery for achieving access site haemostasis in patients undergoing transfemoral TAVR and in whom vascular pre-closure was not possible. METHODS A prospective institutional TAVR registry was retrospectively analysed and a cohort of patients were identified who were selected for transfemoral valve delivery and in whom pre-closure failed and access site haemostasis was achieved by stent graft implantation. RESULTS This strategy was used for achieving access site haemostasis in 11 patients (1.5% of 744 patients undergoing transfemoral TAVR). These patients were considered to be at increased risk of vascular surgery complications due to advanced age, frailty, comorbidities, or immobility. Stent graft implantation achieved access site haemostasis in all patients. During follow-up, 30-day mortality was zero, 1-year mortality was 27%, and none of the patients required additional vascular interventions. CONCLUSION The preliminary data suggest that planned stent graft implantation within the femoral artery may achieve access site haemostasis and enable a totally percutaneous TAVR procedure, despite failure to perform pre-closure with a suture-based vascular closure device.
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Del Prete A, Della Rocca DG, Calcagno S, Di Pietro R, Del Prete G, Biondi-Zoccai G, Raponi M, Scappaticci M, Di Matteo A, Natale A, Versaci F. Perclose Proglide™ for vascular closure. Future Cardiol 2020; 17:269-282. [PMID: 32915065 DOI: 10.2217/fca-2020-0065] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
In the past 20 years, numerous percutaneous vascular closure devices have been tested and compared with manual compression and to surgical cut-down. The suture-mediated closure device Perclose ProGlide™ system (Abbott Vascular, CA, USA) emerged as a safe and effective alternative for many procedures requiring either small or large bore vascular accesses. In this review, we will discuss the characteristics of this vascular closure device and the main studies that proved its potential to reduce vascular complications, time to deambulation, time to discharge and patient discomfort.
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Affiliation(s)
| | | | - Simone Calcagno
- Division of Cardiology, S. Maria Goretti Hospital, Latina, Italy
| | | | | | - Giuseppe Biondi-Zoccai
- Department of Medico-Surgical Sciences & Biotechnologies, Sapienza University of Rome, Latina, Italy.,Mediterranea Cardiocentro, Napoli, Italy
| | - Massimo Raponi
- Division of Cardiology, S. Maria Goretti Hospital, Latina, Italy
| | | | | | - Andrea Natale
- Texas Cardiac Arrythmia Institute, St David's Medical Center, Austin, TX 78705, USA
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