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Oliny A, Bosse C, Charbonneau P, Haulon S, Fabre D. Closure Device Migration: An Unusual Cause of Acute Limb Ischaemia Following a Simple Endovascular Procedure. EJVES Vasc Forum 2024; 61:113-115. [PMID: 38884075 PMCID: PMC11177045 DOI: 10.1016/j.ejvsvf.2024.05.006] [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: 01/16/2024] [Revised: 03/16/2024] [Accepted: 05/08/2024] [Indexed: 06/18/2024] Open
Abstract
Introduction Acute limb ischaemia resulting from foreign body embolisation is an infrequent yet critical complication associated with vascular closure devices (VCDs). Despite the widespread use of VCDs, rare complications such as fragment emboli pose unique challenges, necessitating heightened clinical awareness. This case report presents a case of acute limb ischaemia caused by a VCD malfunction following an endovascular procedure. Report A 70 year old male who was diagnosed with a severe claudication of the lower extremity (Rutherford III) due to right common iliac stenosis, underwent angioplasty using a FemoSeal (Terumo Ltd., Surrey, UK) to close the right femoral artery access. Two weeks later, the patient presented with acute lower limb ischaemia due to a right popliteal-tibial occlusion. Emergency surgical thrombo-embolectomy was successfully performed from a medial popliteal approach, and the thrombus, which contained a polymer disc from the VCD at its distal end, was completely removed. Discussion Despite VCDs being proven safe and efficient, rare complications such as fragment emboli can occur, and physicians should be aware of the possible delayed onset of symptoms. Moreover, the radiolucent nature of the polymer disc in a FemoSeal complicates diagnostic imaging. While endovascular approaches exist, open surgery is a safe and effective strategy for retrieving fragments and treating the patient in acute limb ischaemia cases. Conclusion Physicians should remain vigilant for embolic risks associated with vascular closure devices, even with suitable anatomy and following guidelines, especially considering the trend toward early ambulation and discharge.
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Affiliation(s)
- Alexandre Oliny
- Aortic Centre, Marie Lannelongue Hospital, Le Plessis Robinson, France
| | - Côme Bosse
- Aortic Centre, Marie Lannelongue Hospital, Le Plessis Robinson, France
| | - Philippe Charbonneau
- Vascular Surgery Department, CHUM, Montreal, QC, Canada
- University of Montreal, Montréal, QC, Canada
| | - Stephan Haulon
- Aortic Centre, Marie Lannelongue Hospital, Le Plessis Robinson, France
- University of Paris-Saclay, Bâtiment Bréguet, Gif-sur-Yvette, France
| | - Dominique Fabre
- Aortic Centre, Marie Lannelongue Hospital, Le Plessis Robinson, France
- University of Paris-Saclay, Bâtiment Bréguet, Gif-sur-Yvette, France
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Li BL, An Z, Zhou W, Pan JJ, Wang J, Xu ZY, Han L. Comparation of the outcomes between ProGlide based post-closure technique and arteriotomy repair for veno-arterial extracorporeal membrane oxygenation decannulation. J Crit Care 2024; 79:154434. [PMID: 37742517 DOI: 10.1016/j.jcrc.2023.154434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 07/11/2023] [Accepted: 09/16/2023] [Indexed: 09/26/2023]
Abstract
PURPOSE To compare outcomes between post-closure technique based on ProGlide and arteriotomy repair for veno-arterial extracorporeal membrane oxygenation (VA-ECMO) decannulation in this study. MATERIALS AND METHODS Patients who received VA-ECMO treatment and successfully removed from its support in Changhai Hospital from January 2018 to December 2021 were included in this study. Patients was divided into post-closure group and surgical repair group according to the artery access closure method used. Clinical data of these patients were retrospectively collected and analyzed. RESULTS A total of 58 patients were eventually enrolled in this study, including 26 (44.83%) patients in post-closure group and 32 (55.17%) patients in surgical repair group. Post-closure group had shorter procedure time, less minor bleeding events, estimated blood loss and packed cells transfused compared with the surgical repair group. The intensive care unit (ICU) length of stay after decannulation and the hospital length of stay after ICU in post-closure group were both shorter than surgical repair group. Nine patients (15.52%) died of multiple system organ failure after decannulation in this cohort and there were no significant differences between two groups. CONCLUSIONS Our study showed the post-closure technique based on ProGlide for VA-ECMO decannulation is feasible, safe and effective.
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Affiliation(s)
- Bai-Ling Li
- Department of Cardiovascular Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Zhao An
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Wei Zhou
- Department of Cardiovascular Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Jia-Jun Pan
- Department of Cardiovascular Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Jun Wang
- Department of Cardiovascular Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Zhi-Yun Xu
- Department of Cardiovascular Surgery, Changhai Hospital, Naval Medical University, Shanghai, China.
| | - Lin Han
- Department of Cardiovascular Surgery, Changhai Hospital, Naval Medical University, Shanghai, China.
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Kwak J, Bum Cho S. Real-time ultrasound-guided hemostasis using suture-mediated closure device. J Vasc Access 2023:11297298231215843. [PMID: 38053258 DOI: 10.1177/11297298231215843] [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: 12/07/2023] Open
Abstract
PURPOSE Suture-mediated hemostasis device takes a long time to train and have limitations in finding appropriate compression point depending on the tactile sense of the hands. If the appropriate compression point is determined using ultrasound and the instrument is used under ultrasound guidance, it is expected to reduce the technical failure and additional manual compression. MATERIALS AND METHODS This retrospective study included 104 patients in whom the ProGlide vascular closure device (Abbott Vascular, Redwood City, CA, USA) was deployed to close common femoral artery access between January 2022 and June 2022. Ultrasound-guided hemostasis was performed in 54 patients and 50 conventional hemostasis was performed. We analyzed the medical records (procedure, patient body mass index, coagulation function, visual imaging, ultrasound imaging, time to achieve hemostasis) and post-treatment medical records (progress records, nursing records) to investigate the technical success rate and complications (hematoma, pseudoaneurysm formation, SFA occlusion, access site infection) of the procedure. RESULTS Technical success rate was 52/54 (Ultrasound guided group) and 47/50 (conventional group), respectively (p > 0.05). Mean hemostasis time was 271 s (US guided group) and 317 s (conventional group), respectively (p > 0.05). Additional manual compression was applied in 7/54 (US guided group) and 15/50 (conventional group) (p < 0.05). In both groups, complications such as hematoma formation, access site infection and SFA occlusion did not occur. CONCLUSION Using ultrasound guidance when using the suture mediated closing device reduces the frequency of additional manual compression without increased risk of complication.
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Affiliation(s)
- JungWon Kwak
- Department of Radiology, Anam Hospital, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Sung Bum Cho
- Department of Radiology, Anam Hospital, College of Medicine, Korea University, Seoul, Republic of Korea
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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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Ibrahim K, Tongers J, Mangner N, Werner N, Tycinska A, Leick J, Oreglia J, Schröder J. Handling high-risk patients in the catheterization laboratory. Eur Heart J Suppl 2022; 24:J30-J36. [PMCID: PMC9730785 DOI: 10.1093/eurheartjsupp/suac063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Abstract
Protected percutaneous coronary intervention is considered a life-saving procedure for high-risk patients. Therefore it is important that the interventional cardiology team is prepared, the procedure is planned, and potential complications, as well as bail out strategies are considered. Throughout the procedure, it is critical to monitor the patient to identify any early signs of deterioration or changes in patient well-being to avoid any potential complications.
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Affiliation(s)
- Karim Ibrahim
- Department of Cardiology, Technische Universität Dresden, (Campus Chemnitz) , Klinikum Chemnitz, Flemmingstrasse 2, 09116 Chemnitz , Germany
| | - Jörn Tongers
- Department of Cardiology and Intensive Care Medicine, Mid-German Heart Center, University Hospital, Martin-Luther-University Halle-Wittenberg , 06120 Halle , Germany
| | - Norman Mangner
- Department of Internal Medicine and Cardiology, Herzzentrum Dresden, Technische Universitaet Dresden , Dresden , Germany
| | - Nikos Werner
- Department of Cardiology, Heart Centre Trier, Barmherzige Brüder Hospital , 54292 Trier , Germany
| | - Agnieszka Tycinska
- Department of Cardiology, Medical University of Bialystok , 15-276 Bialystok , Poland
| | - Jürgen Leick
- Department of Cardiology, Heart Centre Trier, Barmherzige Brüder Hospital , 54292 Trier , Germany
| | - Jacopo Oreglia
- Department of Cardiology and De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda , 20162 Milano , Italy
| | - Jörg Schröder
- Department of Cardiology, Angiology and Intensive Care, University Hospital RWTH Aachen , 52074 Aachen , Germany
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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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7
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Lemor A, Dabbagh MF, Cohen D, Villablanca P, Tehrani B, Alaswad K, Alqarqaz M, Lasorda D, Kaki A, Genereux P, O'Neill W, Basir MB. Rates and impact of vascular complications in mechanical circulatory support. Catheter Cardiovasc Interv 2022; 99:1702-1711. [PMID: 35266287 DOI: 10.1002/ccd.30150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/07/2022] [Accepted: 02/16/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Mechanical circulatory support (MCS) devices are increasingly used for hemodynamic support in cardiogenic shock or high-risk percutaneous coronary interventions. Vascular complications remain a major source of morbidity and mortality despite technological advances with percutaneous techniques. Little is known about the rates and predictors of vascular complications with large-bore access MCS in the contemporary era. METHODS The study cohort was derived from National Inpatient Sample using data from 2015 to 2019 for cardiac hospitalizations with the use of: intra-aortic balloon pump (IABP) Impella, and/or extracorporeal membrane oxygenation (ECMO). The rates of vascular complications and in-hospital outcomes were analyzed using multivariable logistic regression. RESULTS Of 221,700 hospitalizations with MCS use, the majority had only IABP (68%). The rates of vascular complications were greatest with ECMO (15.8%) when compared with IABP (3.0%) and Impella (5.6%). Among patients with vascular complications, in-hospital mortality was higher with ECMO (56.3%) when compared with IABP (26.2%) and Impella (33.8%). Peripheral arterial disease (PAD) was the strongest predictor of vascular complications, with 10 times higher odds when present (adjusted odds ratio [aOR] 10.96, p < 0.001). In risk-adjusted models, when compared with IABP, the use of Impella (aOR: 1.73, p < 0.001), ECMO (aOR: 5.35, p < 0.001), or a combination of MCS devices (aOR: 3.47, p < 0.001) was associated with higher odds of vascular complications. CONCLUSIONS In contemporary practice, the use of MCS is associated with significant vascular complications and in-hospital mortality. Predictors of vascular complications include larger arteriotomy size, female gender, and peripheral arterial disease. Vascular access management remains essential to prevent major complications.
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Affiliation(s)
- Alejandro Lemor
- Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, Michigan, USA
| | - Mohammed F Dabbagh
- Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, Michigan, USA
| | - David Cohen
- Saint Francis Hospital, Roslyn, NY, and Cardiovascular Research Foundation, New York, New York, USA
| | - Pedro Villablanca
- Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, Michigan, USA
| | - Behnam Tehrani
- Inova Heart and Vascular Institute, Falls Church, Virginia, USA
| | - Khaldoon Alaswad
- Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, Michigan, USA
| | - Mohammad Alqarqaz
- Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, Michigan, USA
| | - David Lasorda
- Department of Cardiology, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
| | - Amir Kaki
- Department of Cardiology, Ascension St. John Hospital-Detroit, Detroit, Michigan, USA
| | - Philippe Genereux
- Gagnon Cardiovascular Institute, Morristown Medical Center, Morristown, New Jersey, USA
| | - William O'Neill
- Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, Michigan, USA
| | - Mir B Basir
- Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, Michigan, USA
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Busch L, Stern M, Wolff G, Kelm M. Endovascular snare retrieval of an Angio-Seal causing acute limb ischemia. Clin Case Rep 2021; 9:e05170. [PMID: 34917378 PMCID: PMC8645166 DOI: 10.1002/ccr3.5170] [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: 10/08/2021] [Revised: 11/26/2021] [Accepted: 11/19/2021] [Indexed: 11/30/2022] Open
Abstract
Vascular complications (VCs) remain an important source of morbidity and mortality following percutaneous arterial catheterization. Vascular closure devices are popular and frequently used, but sometimes cause vessel occlusions that may require vascular surgery or complex endovascular procedures. In this case report, we describe the endovascular retrieval of an embolized Angio-Seal device causing acute limb ischemia in a severely diseased 75-year-old female patient. This case highlights the endovascular technique using a snare catheter and adds another example to the growing evidence of an endovascular approach to manage vascular access site complications in comorbid patients at risk.
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Affiliation(s)
- Lucas Busch
- Department of Cardiology, Pulmonology, and Vascular MedicineMedical FacultyUniversity DuesseldorfDuesseldorfGermany
| | - Manuel Stern
- Department of Cardiology, Pulmonology, and Vascular MedicineMedical FacultyUniversity DuesseldorfDuesseldorfGermany
| | - Georg Wolff
- Department of Cardiology, Pulmonology, and Vascular MedicineMedical FacultyUniversity DuesseldorfDuesseldorfGermany
| | - Malte Kelm
- Department of Cardiology, Pulmonology, and Vascular MedicineMedical FacultyUniversity DuesseldorfDuesseldorfGermany
- Cardiovascular Research Institute Duesseldorf (CARID)DuesseldorfGermany
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9
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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: 0] [Impact Index Per Article: 0] [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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10
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Seto AH, Tehrani DM. A stitch in time saves… uncontrollable blood loss. Catheter Cardiovasc Interv 2021; 98:578-579. [PMID: 34498394 DOI: 10.1002/ccd.29871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 07/02/2021] [Indexed: 11/06/2022]
Affiliation(s)
- Arnold H Seto
- Long Beach Veterans Administration Medical Center, Long Beach, California, United States
| | - David M Tehrani
- Ronald Reagan UCLA Medical Center, Los Angeles, California, United States
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11
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Weaver JJ, Chick JFB, Monroe EJ, Johnson GE. Life and Limb: Current Concepts in Endovascular Treatment of Extremity Trauma. Semin Intervent Radiol 2021; 38:64-74. [PMID: 33883803 DOI: 10.1055/s-0041-1724011] [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: 10/21/2022]
Abstract
Traumatic injury is the leading cause of death worldwide in younger patient populations and extremity trauma with associated vascular injury accounts for many trauma-related deaths. Iatrogenic injury is also a common cause of extremity vascular trauma and the incidence of iatrogenic injury will likely increase as endovascular techniques continue to become more ubiquitous. For many vascular injuries involving the extremities, surgical repair is viewed as the standard of care. Historically, endovascular techniques did not play a role in the treatment of these vascular injuries, rather they were utilized only as part of the diagnostic assessment; however, there is an increasing trend toward endovascular management of extremity vascular trauma. No validated, widely implemented algorithm to select patients for endovascular intervention exists. Transcatheter techniques, however, play an important role in the management of these patients. For arterial injuries, embolization can be used to rapidly achieve hemostasis if the vessel can be sacrificed. More advanced endovascular techniques such as stent-graft placement may be best employed in the context of isolated, proximal extremity injuries, although there is increasing literature supporting the use of advanced techniques for more distal arterial injuries. The management of peripheral venous trauma remains controversial; however, there is growing data describing successful endovascular management of some peripheral venous injuries. The purpose of this article is to review extremity vascular trauma, concepts of injury triage, endovascular techniques, and intraprocedural considerations.
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Affiliation(s)
- John J Weaver
- Division of Interventional Radiology, Department of Radiology, University of Washington, Seattle, Washington
| | - Jeffrey F B Chick
- Division of Interventional Radiology, Department of Radiology, University of Washington, Seattle, Washington
| | - Eric J Monroe
- Division of Interventional Radiology, Department of Radiology, University of Washington, Seattle, Washington.,Division of Interventional Radiology, Department of Radiology, Seattle Children's Hospital, Seattle, Washington
| | - Guy E Johnson
- Division of Interventional Radiology, Department of Radiology, University of Washington, Seattle, Washington
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12
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Durand E, Penso M, Hemery T, Levesque T, Moles G, Tron C, Bouhzam N, Bettinger N, Wong S, Dacher JN, Eltchaninoff H. Standardized Measurement of Femoral Artery Depth by Computed Tomography to Predict Vascular Complications After Transcatheter Aortic Valve Implantation. Am J Cardiol 2021; 145:119-127. [PMID: 33460601 DOI: 10.1016/j.amjcard.2020.12.089] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 12/22/2020] [Accepted: 12/29/2020] [Indexed: 12/20/2022]
Abstract
Vascular complications (VCs) are difficult to predict and remain an important issue after transfemoral (TF) transcatheter aortic valve implantation (TAVI) although their incidence has decreased with size reduction of introducers. We aimed to evaluate a standardized measurement of femoral artery depth (FAD) using computed tomography (CT) to predict VCs after TAVI. We performed a retrospective study of 679 TF TAVI patients. We evaluated a standardized CT method to measure FAD immediately above the bifurcation. Sheath-to-femoral-artery ratio (SFAR), calcification, and tortuosity were also evaluated. VCs were defined by the Valve Academic Research Consortium (VARC)-2. Receiver operating characteristic (ROC) curves were used to predict major VCs and the need for a stent-graft. The median values of FAD and SFAR were 49.0 (36.2 to 66.7) mm and 0.95 (0.81 to 1.18), respectively. Major VCs occurred in 37 (5.4%) patients and a stent-graft was required in 49 (7.1%) patients. FAD predicted the need for a stent-graft [0.61 (0.51 to 0.70), p = 0.04] but not major VCs [0.52 (0.40 to 0.63), p = 0.76]. In contrast, SFAR did not predict the need for a stent-graft [0.53 (0.43 to 0.62), p = 0.61] but predicted major VCs [0.70 (0.58 to 0.81), p = 0.001]. Calcification and tortuosity predicted neither major VCs nor the need for a stent-graft. In conclusion, the results of our study suggest that CT measurements of FAD and SFAR provide additional information to predict major VCs and the need for a femoral stent-graft after TF TAVI.
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Affiliation(s)
- Eric Durand
- Normandie Univ, UNIROUEN, Inserm U1096, CHU Rouen, Department of Cardiology, FHU CARNAVAL, F-76000 Rouen, France.
| | - Maryline Penso
- Normandie Univ, UNIROUEN, Inserm U1096, CHU Rouen, Department of Cardiology, FHU CARNAVAL, F-76000 Rouen, France
| | - Thibault Hemery
- Normandie Univ, UNIROUEN, Inserm U1096, CHU Rouen, Department of Cardiology, FHU CARNAVAL, F-76000 Rouen, France
| | - Thomas Levesque
- Normandie Univ, UNIROUEN, Inserm U1096, CHU Rouen, Department of Cardiology, FHU CARNAVAL, F-76000 Rouen, France
| | - Gustavo Moles
- Normandie Univ, UNIROUEN, Inserm U1096, CHU Rouen, Department of Cardiology, FHU CARNAVAL, F-76000 Rouen, France
| | - Christophe Tron
- Normandie Univ, UNIROUEN, Inserm U1096, CHU Rouen, Department of Cardiology, FHU CARNAVAL, F-76000 Rouen, France
| | - Najime Bouhzam
- Normandie Univ, UNIROUEN, Inserm U1096, CHU Rouen, Department of Cardiology, FHU CARNAVAL, F-76000 Rouen, France
| | - Nicolas Bettinger
- Normandie Univ, UNIROUEN, Inserm U1096, CHU Rouen, Department of Cardiology, FHU CARNAVAL, F-76000 Rouen, France
| | - Stephanie Wong
- Normandie Univ, UNIROUEN, Inserm U1096, CHU Rouen, Department of Radiology, FHU CARNAVAL, F-76000 Rouen, France
| | - Jean-Nicolas Dacher
- Normandie Univ, UNIROUEN, Inserm U1096, CHU Rouen, Department of Radiology, FHU CARNAVAL, F-76000 Rouen, France
| | - Hélène Eltchaninoff
- Normandie Univ, UNIROUEN, Inserm U1096, CHU Rouen, Department of Cardiology, FHU CARNAVAL, F-76000 Rouen, France
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13
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Femoral artery access site closure with perclose suture mediated device in coronary interventions. Indian Heart J 2020; 73:180-184. [PMID: 33865515 PMCID: PMC8065371 DOI: 10.1016/j.ihj.2020.12.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 11/11/2020] [Accepted: 12/23/2020] [Indexed: 02/06/2023] Open
Abstract
Objective To compare the outcome of suture mediated vascular closure device Perclose Proglide (PP) with manual compression (MC) following transfemoral access for coronary interventions (CI). Methods It is a retrospective, observational, single centre study from January 2018 to September 2019. Consecutive patients undergoing interventions through transfemoral access were divided into PP and MC groups. Those with less than 3 months follow up were excluded. Two groups were compared for baseline characteristics and various complications at 24 h and at 30 days. Results Out of 1743 patients studied, PP group included 1343 and MC group, 400 patients. Both groups were comparable in baseline characteristics, sheath size and use of antiplatelets and anticoagulation. PP group had significantly less minor bleeding (P = .01, CI 0.34–4.03) and hematoma (P = .0007, CI 0.95–5.10) at 24 h. At 30 days, minor bleeding (P < .0001, CI 0.97–4.25), hematoma (P = .0002, CI 1.05–4.93) and pseudo-aneurysm (P = .0095, CI 0.03–1.18) were also significantly less in PP group. Obesity (OR 3.5, CI 1.29–9.49) and hypertension (OR 2.41, CI 1.12–5.19) were associated with increased minor bleeding at 24 h. Device failure rate was 2.38%. Conclusions PP device is safe, effective and is associated with fewer complications than MC in CI. Device failure rate is low. Obesity and hypertension are associated with increased minor bleeding in both groups.
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Angio-Seal Vascular Closure Related Acute Limb Ischemia: A Case Report. AMERICAN JOURNAL OF MEDICAL CASE REPORTS 2020; 8:49-52. [PMID: 32154363 PMCID: PMC7062382 DOI: 10.12691/ajmcr-8-2-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Vascular Closure Devices (VCD) are routinely used in cardiac catheterization and other endovascular procedures in order to achieve immediate post-procedural hemostasis and sealing of the femoral artery puncture site. Unlike manual compression, VCD encompass a broad range of devices, with varying mechanisms, that offer the advantage of achieving rapid hemostasis, increased patient comfort and mobility, decreased reliance on hospital staff resources, and facilitate earlier hospital discharge. Complications of VCD have been well-described and include embolization, arterial occlusion, infection, or vascular obstruction. Here, we describe a case in which the Angio-Seal device was utilized during an elective cardiac catheterization resulted in acute lower extremity ischemia.
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15
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Aspiration Thrombectomy-Assisted Endovascular Retrieval of an Embolized Angio-Seal Device Causing Claudication. Ann Vasc Surg 2019; 60:476.e7-476.e11. [PMID: 31075451 DOI: 10.1016/j.avsg.2019.02.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Revised: 01/27/2019] [Accepted: 02/20/2019] [Indexed: 12/26/2022]
Abstract
The Angio-Seal vascular closure device is used to reduce time to hemostasis after femoral artery puncture. Although rare, complications associated with Angio-Seal are significant, including infection, pseudoaneurysm formation, symptomatic femoral artery stenosis, and separation and embolization, leading to limb-threatening ischemia. This report describes Angio-Seal polymer anchor embolization to the tibioperoneal trunk successfully retrieved using the 8-French Indigo Aspiration System.
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Stojanovic I, Schneider JE, Cooper J. Cost-impact of cardiac magnetic resonance imaging with Fast-SENC compared to SPECT in the diagnosis of coronary artery disease in the U.S. J Med Econ 2019; 22:430-438. [PMID: 30732489 DOI: 10.1080/13696998.2019.1580713] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
AIMS The purpose of this study is to assess the economic cost differences and the associated treatment resource changes between the developing coronary artery disease (CAD) diagnostic tool fast strain-encoded cardiac imaging (Fast-SENC) and the current commonly used stress test single-photon emission computed tomography (SPECT). MATERIALS AND METHODS A "payer perspective" model was created first, consisting of long-term and short-term components that used a hypothetical cohort of patients of average age (60.8 years) presenting with chest pain and suspected CAD to assess cost-impact. A cost impact model was then built that assessed likely savings from a "hospital perspective" from substituting Fast-SENC for a portion of SPECTs assuming an average number of annual SPECT tests performed in US hospitals. RESULTS In the payer model, using Fast-SENC followed by coronary angiography (CA) and percutaneous coronary intervention (PCI) treatment when necessary is less costly than the SPECT method when considering both direct and indirect costs of testing. Expected costs of the Fast-SENC were between $2,510 and $2,632 per correct diagnosis, while expected costs for the SPECT were between $3,157 and $4,078. Fast-SENC reduced false positives by 50% and false negatives by 86%, generating additional cost savings. The hospital model showed total costs per CAD patient visit of $825 for SPECT and $376 for Fast-SENC. LIMITATIONS Limitations of this study are that clinical data are sourced from other published clinical trials on how CAD diagnostic strategies impact clinical outcome, and that necessary assumptions were made which impact health outcomes. CONCLUSION The lower cost, higher sensitivity and specificity rates, and faster, less burdensome process for detecting CAD patients make Fast-SENC a more capable and economically beneficial stress test than SPECT. The payer model and hospital model demonstrate an alignment between payer and provider economics as Fast-SENC provides monetary savings for patients and resource benefits for hospitals.
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Affiliation(s)
| | | | - Jacie Cooper
- a Avalon Health Economics , Morristown , NJ , USA
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17
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Hall TC, Habib S. A Novel Intervention to Treat Failed Angio-Seal Footplate Deployment: Two Case Series. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2019; 12:1179547619828714. [PMID: 30792582 PMCID: PMC6376524 DOI: 10.1177/1179547619828714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 01/14/2019] [Indexed: 11/15/2022]
Abstract
Introduction Vascular closure devices are commonly used to achieve rapid haemostasis and early ambulation following arterial puncture for endovascular procedures. Although device failure rates are low, the consequences of arterial occlusion include severe limb ischaemia. We describe a novel endovascular technique for the treatment of Angio-Seal arterial closure device (Terumo, Europe NV) failure causing femoral artery occlusion. Materials and methods We describe 2 cases of lower limb angioplasty performed for critical limb ischaemia where the access site was closed using an Angio-Seal according to the manufacturer instructions for use (IFU). In both cases, however, ultrasound could not be used during deployment of the Angio-Seal due to body habitus and small subcutaneous haematoma. In both cases, the device failed and occluded the femoral artery. Results Access was achieved via a retrograde approach from the contralateral limb in one case and a retrograde approach from the ipsilateral profunda artery in the other case. Angiography confirmed that the footplate of the Angio-Seal had occluded the femoral artery. Subsequently, the occlusion was crossed and a short balloon-mounted bare metal stent placed to push the footplate against the arterial wall that resulted in resolution of the occlusion and haemorrhage control. Conclusions Crossing the occlusion caused by failure of the Angio-Seal closure device and subsequent stenting resulted in satisfactory relief of the femoral artery occlusion and haemostasis without the added risks of open surgical revascularisation and general anaesthetic.
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Affiliation(s)
- Thomas C Hall
- Department of Radiology, Queen's Medical Centre (QMC), Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Said Habib
- Department of Radiology, Queen's Medical Centre (QMC), Nottingham University Hospitals NHS Trust, Nottingham, UK
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Salem MM, Ascanio LC, Kicielinski KP, Cambria RP, Ogilvy CS, Alturki AY. Endovascular Trapping of Large Cervical Carotid Pseudoaneurysm in Marfan Syndrome Presenting with Progressive Respiratory Distress. World Neurosurg 2018; 123:323-327. [PMID: 30590218 DOI: 10.1016/j.wneu.2018.12.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 12/05/2018] [Accepted: 12/07/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Isolated cervical pseudoaneurysms of the internal carotid artery (ICA) in patients with Marfan syndrome are extremely rare. CASE DESCRIPTION A 73-year-old female with Marfan syndrome and history of multiple aortic aneurysms presented to an outside hospital with dysphagia, a mass in her neck, dizziness, nausea, and vomiting. A computed tomography angiogram showed bilateral cervical ICA pseudoaneurysms, more significant on the right side. A laryngoscopy demonstrated edematous vocal cords and a significant mass effect on the right side. She suffered from significant respiratory distress and aspiration, for which she had to be intubated and transferred to our institution for definitive care. The patient was taken for angiography for carotid artery test occlusion and endovascular trapping with coils and onyx embolization of the carotid pseudoaneurysm. The hospital course was complicated with femoral closure device failure, leading to groin hematoma, pneumonia, and respiratory failure requiring tracheostomy and percutaneous endoscopic gastrostomy. The patient was discharged to rehabilitation 34 days after admission. Stable exclusion of the large right pseudoaneurysm was observed at 3 months' follow-up with computed tomography angiography, as well as significant improvement in the last clinical follow-up obtained 6 months after the procedure. CONCLUSION Pseudoaneurysms of the cervical ICA associated with Marfan syndrome are rare. Carotid test occlusion and endovascular permanent embolization are possible in a patient with life-threatening symptoms. Cautious use of vascular closure devices, especially collagen plug-based ones, are required in such patients, given their abnormal extracellular matrix structure.
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Affiliation(s)
- Mohamed M Salem
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
| | - Luis C Ascanio
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Kimberly P Kicielinski
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Richard P Cambria
- Division of Vascular and Endovascular Surgery, St. Elizabeth's Medical Center, Brighton, Massachusetts, USA
| | - Christopher S Ogilvy
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Abdulrahman Y Alturki
- Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA; Department of Neurosurgery, The National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
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Govindarajulu U, Bedi S, Kluger A, Resnic F. Survival analysis of hierarchical learning curves in assessment of cardiac device and procedural safety. Stat Med 2018; 37:4185-4199. [PMID: 30062850 DOI: 10.1002/sim.7906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 06/14/2018] [Indexed: 11/07/2022]
Abstract
Many Americans rely on cardiac surgical procedures and devices such as pacemakers and thrombolytic catheters to treat or manage their cardiovascular diseases. However, the failure of these cardiac devices and procedures could have grave consequences. One reason cardiac devices tended to fail was due to physician error; there is a learning effect for the physician or operator to come up to speed in skillfully implanting devices and conducting procedures. In order to better understand these learning effects, we had previously modeled the resulting learning curve effects in simulations a hierarchical setting with physicians clustered within institutions using our unique methodology (see the work of Govindarajulu et al 2017). Previously, we had employed these in hierarchical linear modeling and also in generalized estimating equations. In this setting, we have demonstrated how to apply similar methodology but revised in a survival analytic framework or time-to-event analyses. Through simulations and real dataset applications, we found that, out of the three shapes modeled to fit the learning curve, the logarithmic shape tended to have the best fit, similar to previous work (see the work of Govindarajulu et al 2017). However, as seen before, modeling the learning rate can be dataset specific and one shape may be better than another. We learned that modeling the learning rate could also be applied in the survival analysis setting through this new methodology. The goal of this paper is to model cardiac device and procedure learning curve effects in a time-to-event setting so that this knowledge may allow for the improvement of both short and long-term patient survival.
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Affiliation(s)
- Usha Govindarajulu
- Department of Epidemiology and Biostatistics, SUNY Downstate School of Public Health, Brooklyn, New York
| | - Sandeep Bedi
- Department of Epidemiology and Biostatistics, SUNY Downstate School of Public Health, Brooklyn, New York
| | - Aaron Kluger
- Department of Epidemiology and Biostatistics, SUNY Downstate School of Public Health, Brooklyn, New York
| | - Frederic Resnic
- Department of Cardiology, Lahey Clinic, Burlington, Massachusetts
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Chaudhuri A. Prospective Audit of "Post-Close" Haemostasis Following Large Bore Femoral Arterial Punctures: A Second Look at the Double Angio-Seal Technique. EJVES Short Rep 2018; 40:12-14. [PMID: 30258992 PMCID: PMC6154436 DOI: 10.1016/j.ejvssr.2018.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 08/12/2018] [Accepted: 08/13/2018] [Indexed: 11/28/2022] Open
Abstract
Introduction This study aimed to prospectively audit the efficacy of the post-close technique for the achievement of haemostasis following large bore femoral arterial punctures. Report Twenty-five consecutive patients (16 males, 9 females, mean age 73.3 [SD 9.6] years) underwent aortoiliac or peripheral arterial interventions via large bore femoral arterial punctures from 2017 to the present. Given previous success with closing 12F defects with a single 8F Angio-Seal, only those defects closed using a double wire set up and double Angio-Seal deployments were assessed. Discussion A total of 60 Angio-Seal VCDs were deployed using standard double wire preparation in 30 groins for haemostasis in 30 corresponding large bore femoral punctures. This second round audit reinforces the post-close technique using two Angio-Seal VCDs as the author's choice of femoral arterial closure up to 16F. It also provides some early insight into using this approach in redo groins.
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21
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Jones LE, Yang KH, Feldtman RW, Uceda PV, Ferrara CA, Caruso JM, Richmond JL, Ahn SS. Safety and Efficacy of Arterial Closure Devices in an Office-Based Angiosuite. Ann Vasc Surg 2018; 51:10-17. [DOI: 10.1016/j.avsg.2018.02.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 01/11/2018] [Accepted: 02/19/2018] [Indexed: 12/20/2022]
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Scansen BA, Hokanson CM, Friedenberg SG, Khabiri H. Use of a vascular closure device during percutaneous arterial access in a dog with impaired hemostasis. J Vet Emerg Crit Care (San Antonio) 2017; 27:465-471. [PMID: 28544277 DOI: 10.1111/vec.12614] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 08/31/2015] [Accepted: 09/20/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To report the use of a vascular closure device (VCD) to provide rapid arterial hemostasis following percutaneous femoral arterial catheterization and diagnostic angiography in a thrombocytopenic and coagulopathic dog. CASE SUMMARY A 6-year-old female spayed Kai Ken Tora dog presented after vehicular trauma. The dog was diagnosed with traumatic pneumothorax, degloving wounds of the right antebrachium, subcutaneous hemorrhage within the axillary tissues of the left thoracic limb, and anemia and thrombocytopenia secondary to acute hemorrhage. Treatment included therapeutic thoracocentesis and open wound management of the right thoracic limb as well as packed RBC and fresh frozen plasma transfusions. Diagnostic angiography of the left brachial artery was performed via percutaneous femoral arterial access to investigate the source of a persistent axillary hematoma. The arterial access site was closed using an extraluminal VCD and hemostasis was immediate with normal femoral arterial blood flow documented by Doppler ultrasound. NEW OR UNIQUE INFORMATION PROVIDED This report describes use of a VCD for arterial closure following percutaneous access in a dog with impaired hemostasis; to the authors' knowledge, this is the first clinical report of a VCD used in a veterinary species.
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Affiliation(s)
- Brian A Scansen
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, OH, 43210
| | - Caitlin M Hokanson
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, OH, 43210
| | - Steven G Friedenberg
- Department of Veterinary Clinical Sciences, The Ohio State University, Columbus, OH, 43210
| | - Hooman Khabiri
- The Wexner Medical Center, The Ohio State University, Columbus, OH, 43210
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A Retrospective Analysis of Surgical Femoral Artery Closure Techniques: Conventional versus Purse Suture Technique. Ann Vasc Surg 2017; 44:103-112. [PMID: 28483631 DOI: 10.1016/j.avsg.2017.04.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 04/13/2017] [Accepted: 04/14/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Different techniques have been reported for the exploration and repair of femoral artery (FA) in patients who undergo minimally invasive cardiac surgery (MICS) and endovascular aortic surgery. We used a modified approach alternative to the conventional technique (group CT) since May 2013, which specifies a shorter groin incision and diamond-shaped hemostatic purse sutures for arteriotomy closure without the requirement of cross-clamping (group PT [purse suture technique]) and evaluated early outcomes and the complication profiles of the 2 techniques for femoral access. METHODS In our clinic, between May 2011 and December 2015, 503 FA cannulations were performed on 345 patients who underwent MICS (n = 109, mean age 64.1 ± 17.6 years, female/male ratio 71/38), endovascular abdominal aneurysm repair (n = 158, mean age 71.3 ± 10.2 years, female/male ratio 63/95), thoracal endovascular aneurysm repair (n = 50, mean age 65.0 ± 15.3 years, female/male ratio 15/35), and transaortic valve implantation (n = 28, mean age 80.8 ± 5.9 years, female/male ratio 13/15). A total of 295 FAs were exposed via mini incision and were repaired with the PT. We compared the duration of femoral closure (FC), wound infection, and vascular complications including bleeding hematoma, thromboembolic and ischemic events, pseudoaneurysm, seroma, surgical reintervention rates, delayed hospital stay for groin complications, and existence of postoperative local luminal narrowing (LLN) at the intervention site over 25% for both groups. RESULTS FC time (CT 14.9 ± 3.16 min, PT 6.5 ± 1.12 min, P < 0.0001), bleeding hematoma frequency (CT 6.2%, PT 1.7%, P = 0.01), and prolonged hospital stay for groin complications (CT 14.9%, PT 3.4%, P < 0.0001) were significantly lower in the PT group. Rate of technical success (CT 80.3%, PT 87.4%, P = 0.03) and event-free patient (CT 66.1%, PT 77.5%, P = 0.03) were significantly better in the PT group. There were no differences between groups in terms of ischemic events, wound infection rates, development of pseudoaneurysm and seroma, surgical reintervention rates, and LLN of FA over 25% at 6-month duplex evaluation. CONCLUSIONS The comparison of the 2 approaches revealed the advantages of the PT in terms of bleeding hematoma and shortening in FC time and the length of hospital stay. We suggest performing a smaller skin incision for FA access and utilizing purse sutures, which allows completing the procedure without cross-clamping, thus providing a favorable approach and excellent comfort for the surgeon.
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Kumar V, Soni P, Chadha S, Malik B. Penoscrotal haematoma after cardiac catheterisation. BMJ Case Rep 2017; 2017:bcr-2016-218934. [PMID: 28476905 DOI: 10.1136/bcr-2016-218934] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Scrotal haematoma is an extremely rare complication after cardiac catheterisation (CC) with only few cases reported in literature. We report a 56-year-old patient who developed large scrotal haematoma after CC via transfemoral approach requiring blood transfusion due to haemodynamic instability. After an uneventful elective procedure, he was discharged with a collagen plug-based vascular closure device (Angio-Seal). He developed sudden onset, excruciating groin pain with scrotal swelling and shock. Bleeding was stopped with manual compression over the femoral artery and 2 units of packed red blood cells were transfused. CT angiogram revealed scrotal haematoma without active bleeding. Testicular blood supply remained intact. Scrotal swelling improved with conservative management and patient got discharged 3 days later in a stable condition. The review of literature suggests that penoscrotal haematoma is unusual after CC but may result from arterial injury or bleeding into the fascial planes. Majority of patients require observation but surgery is indicated in selected cases for vascular complications.
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Affiliation(s)
- Vivek Kumar
- Internal Medicine, Maimonides Medical Center, Brooklyn, New York, USA
| | - Parita Soni
- Internal Medicine, Maimonides Medical Center, Brooklyn, New York, USA
| | - Sameer Chadha
- Cardiology, Maimonides Medical Center, Brooklyn, New York, USA
| | - Bilal Malik
- Cardiology, Maimonides Medical Center, Brooklyn, New York, USA
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Govindarajulu US, Stillo M, Goldfarb D, Matheny ME, Resnic FS. Learning curve estimation in medical devices and procedures: hierarchical modeling. Stat Med 2017; 36:2764-2785. [PMID: 28470678 DOI: 10.1002/sim.7309] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 03/22/2017] [Indexed: 12/17/2022]
Abstract
In the use of medical device procedures, learning effects have been shown to be a critical component of medical device safety surveillance. To support their estimation of these effects, we evaluated multiple methods for modeling these rates within a complex simulated dataset representing patients treated by physicians clustered within institutions. We employed unique modeling for the learning curves to incorporate the learning hierarchy between institution and physicians and then modeled them within established methods that work with hierarchical data such as generalized estimating equations (GEE) and generalized linear mixed effect models. We found that both methods performed well, but that the GEE may have some advantages over the generalized linear mixed effect models for ease of modeling and a substantially lower rate of model convergence failures. We then focused more on using GEE and performed a separate simulation to vary the shape of the learning curve as well as employed various smoothing methods to the plots. We concluded that while both hierarchical methods can be used with our mathematical modeling of the learning curve, the GEE tended to perform better across multiple simulated scenarios in order to accurately model the learning effect as a function of physician and hospital hierarchical data in the use of a novel medical device. We found that the choice of shape used to produce the 'learning-free' dataset would be dataset specific, while the choice of smoothing method was negligibly different from one another. This was an important application to understand how best to fit this unique learning curve function for hierarchical physician and hospital data. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Usha S Govindarajulu
- Department of Epidemiology and Biostatistics, SUNY Downstate School of Public Health, Brooklyn, NY, U.S.A
| | - Marco Stillo
- Department of Epidemiology and Biostatistics, SUNY Downstate School of Public Health, Brooklyn, NY, U.S.A
| | - David Goldfarb
- Department of Epidemiology and Biostatistics, SUNY Downstate School of Public Health, Brooklyn, NY, U.S.A
| | - Michael E Matheny
- Geriatrics Research Education & Clinical Center (GRECC), Tennessee Valley Healthcare System (TVHS), Veteran's Health Administration, Nashville, TN, U.S.A
- Vanderbilt University School of Medicine, Department of Biomedical Informatics, TN, U.S.A
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Babaev A, Gokhale R, Zavlunova S, Attubato M. Treatment of Angio-Seal-Related Femoral Artery Occlusion Using Directional Atherectomy-Primary Results and Midterm Follow-Up. Vasc Endovascular Surg 2016; 50:541-546. [PMID: 27852881 DOI: 10.1177/1538574416679520] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE We describe a novel approach for the endovascular treatment of femoral artery occlusion as a result of Angio-Seal closure device deployment. BACKGROUND Angio-Seal is the most commonly used vascular closure device following percutaneous coronary and peripheral catheterizations worldwide. A rare complication of Angio-Seal deployment is an occlusion of the femoral artery leading to limb ischemia requiring revascularization. Given its unique ability to cut both atherosclerotic plaque and the Angio-Seal anchor with a collagen plug at operator-directed planes, TurboHawk/HawkOne atherectomy device can be a fast and effective approach to treat Angio-Seal-associated femoral artery occlusions. METHODS We studied 13 consecutive patients who developed Angio-Seal-associated femoral artery occlusions that occurred from 3 hours to several weeks after catheterization. These patients were successfully treated with TurboHawk/HawkOne directional atherectomy followed by balloon angioplasty with no complications. During a mean follow-up period of 20.4 ± 17.3 months, 12 patients remained claudication free with no evidence of obstructive arterial disease of the treated segment on imaging studies. One patient developed restenosis that was treated with repeat atherectomy and balloon angioplasty following which he was asymptomatic at follow-up. CONCLUSION The use of directional atherectomy followed by balloon angioplasty is a quick, safe, and effective endovascular approach to treating Angio-Seal-associated femoral artery occlusions. It is associated with an excellent success rate, no complications, and good midterm outcomes.
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Affiliation(s)
- Anvar Babaev
- 1 Division of Cardiology, Department of Medicine, New York University, NY, USA
| | - Rohit Gokhale
- 1 Division of Cardiology, Department of Medicine, New York University, NY, USA
| | - Susanna Zavlunova
- 1 Division of Cardiology, Department of Medicine, New York University, NY, USA
| | - Michael Attubato
- 1 Division of Cardiology, Department of Medicine, New York University, NY, USA
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Singh M. Bleeding Avoidance Strategies During Percutaneous Coronary Interventions. J Am Coll Cardiol 2015; 65:2225-38. [DOI: 10.1016/j.jacc.2015.03.567] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 03/31/2015] [Accepted: 03/31/2015] [Indexed: 12/27/2022]
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Barbetta I, van den Berg JC. Access and hemostasis: femoral and popliteal approaches and closure devices-why, what, when, and how? Semin Intervent Radiol 2014; 31:353-60. [PMID: 25435661 DOI: 10.1055/s-0034-1393972] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This article reviews the arterial access sites used in the treatment of peripheral arterial disease, including common femoral, superficial femoral, and popliteal arterial puncture. The optimal approach and techniques for arterial puncture will be described and technical tips and tricks will be discussed. An overview of the currently available vascular closure devices will also be presented. Indications, contraindications, and complications will be discussed. Results of the use of vascular closure devices compared with manual compression will be presented.
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Affiliation(s)
- Iacopo Barbetta
- Service of Interventional Radiology, Ospedale Regionale di Lugano, Lugano, Switzerland
| | - Jos C van den Berg
- Service of Interventional Radiology, Ospedale Regionale di Lugano, Lugano, Switzerland
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Schelp V, Freitag-Wolf S, Hinzmann D, Bramlage P, Frey N, Frank D. Large-scale experience with an anchorless vascular closure device in a real-life clinical setting. Clin Res Cardiol 2014; 104:145-53. [PMID: 25293675 DOI: 10.1007/s00392-014-0766-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 09/26/2014] [Indexed: 12/11/2022]
Abstract
AIMS This study was designed to evaluate safety and effectiveness of the vascular closure device Exoseal (Cordis) for hemostatic control following cardiac catheterization in a real-life clinical setting. METHODS AND RESULTS This prospective, single-center study enrolled n = 2,031 consecutive patients who underwent coronary angiography via the femoral artery ± PCI (n = 801). Patients were excluded if they had radial access, percutaneous repair of structural heart disease, or if they had severe peripheral artery disease. If clinical abnormalities were discovered at the access site, color Doppler ultrasound was performed. The composite primary endpoint was defined as bleeding/vascular complications and device failure, and it was experienced by 5.4 % (n = 110) of patients. The most frequent complications were pseudoaneurysm (2.9 %, n = 58) and access-site hematoma >6 cm (1.8 %, n = 37). The overall device failure rate was 0.7 % (n = 14). Multiple logistic regression analysis demonstrated that the strongest independent predictors of bleeding/vascular complications and/or device failure were procedure duration (OR 2.1, CI 1.4-3.2), PCI (OR 2.7, CI 1.7-4.2), GP IIb/IIIa inhibitors (OR 2.9, CI 1.5-5.7), and age (OR 2.2, CI 1.4-3.5). CONCLUSIONS These results indicate that Exoseal was safe in a broad collective of patients. However, lengthy procedures, PCIs, the use of GP IIb/IIIa inhibitors, and elderly patients require special attention.
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Affiliation(s)
- Verena Schelp
- Department of Cardiology and Angiology, University Hospital Schleswig-Holstein, Campus Kiel Schittenhelmstr. 12, 24105, Kiel, Germany
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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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Dato I, Burzotta F, Trani C, Crea F, Ussia GP. Percutaneous management of vascular access in transfemoral transcatheter aortic valve implantation. World J Cardiol 2014; 6:836-846. [PMID: 25228962 PMCID: PMC4163712 DOI: 10.4330/wjc.v6.i8.836] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 06/01/2014] [Accepted: 06/18/2014] [Indexed: 02/06/2023] Open
Abstract
Transcatheter aortic valve implantation (TAVI) using stent-based bioprostheses has recently emerged as a promising alternative to surgical valve replacement in selected patients. The main route for TAVI is retrograde access from the femoral artery using large sheaths (16-24 F). Vascular access complications are a clinically relevant issue in TAVI procedures since they are reported to occur in up to one fourth of patients and are strongly associated with adverse outcomes. In the present paper, we review the different types of vascular access site complications associated with transfemoral TAVI. Moreover, we discuss the possible optimal management strategies with particular attention to the relevance of early diagnosis and prompt treatment using endovascular techniques.
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Rekik S, Brunet J, Bayet G, Hager FX, Meille L, Quatre JM, Sainsous J. Percutaneous Management of Lower Limb Ischemia After the Use of Vascular Closure Devices. Can J Cardiol 2013; 29:1448-53. [DOI: 10.1016/j.cjca.2013.06.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 06/10/2013] [Accepted: 06/11/2013] [Indexed: 10/26/2022] Open
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A Review of JACC Journal Articles on the Topic of Interventional Cardiology: 2011–2012. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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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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