Comparison between antegrade common femoral artery access and superficial femoral artery access in infrainguinal endovascular interventions

Transcatheter Aortic Valve Replacement: Full Unilateral Access Using the Ipsilateral Superficial Femoral Artery Is Effective

BACKGROUND

Access site complications are very common complications in transcatheter aortic valve replacement (TAVR). Usually, a second arterial sheath is placed either in the contralateral femoral artery or in the radial artery as a simplified approach. This study aimed to investigate the safety and effectiveness of a full unilateral access using the ipsilateral superficial femoral artery (iSFA) in TAVR and to determine whether it simplifies the procedure.

METHODS

This single-center retrospective audit analyzed the first 100 TAVR cases between February 2022 and January 2023 using iSFA as default secondary access. The primary outcomes included 30-day device success, bleeding, and vascular access-related complications. The last 100 bilateral cases and all bilateral cases (n = 656) served as controls.

RESULTS

Of the 143 transfemoral TAVRs performed during the study period, 43 patients were excluded. The remaining 100 patients (median age, 84 years; interquartile range, 80-89 years; median EuroSCORE II, 2.46; interquartile range, 1.65-3.97) were analyzed. The vascular access-related complication rates were 11% (main access, 55%; secondary access, 45%), with a 97% device success rate. In the control group of all bilateral cases, device success and vascular access-related complication rates were 93% and 17%, respectively. In the experimental group, access complications were promptly managed in the catheterization laboratory. All cases requiring interventions other than manual compression were successfully managed using iSFA.

CONCLUSIONS

The total unilateral approach using iSFA was safe and effective, shortening the time to address main access complications, providing ergonomic advantages for operators, and enhancing patient comfort.

Validity of Routinely Reported Rutherford Scores Reported by Clinicians as Part of Daily Clinical Practice

Routinely reported structured data from the electronic health record (EHR) are frequently used for secondary purposes. However, it is unknown how valid routinely reported data are for reuse. This study aimed to assess the validity of routinely reported Rutherford scores by clinicians as an indicator for the validity of structured data in the EHR. This observational study compared clinician-reported Rutherford scores with medical record review Rutherford scores for all visits at the vascular surgery department between April 1, 2016 and December 31, 2018. Free-text fields with clinical information for all visits were extracted for the assignment of the medical record review Rutherford score, after which the agreement with the clinician-reported Rutherford score was assessed using Fleiss' Kappa. A total of 6,633 visits were included for medical record review. Substantial agreement was shown between clinician-reported Rutherford scores and medical record review Rutherford scores for the left ( k  = 0.62, confidence interval [CI]: 0.60-0.63) and right leg ( k  = 0.62, CI: 0.60-0.64). This increased to the almost perfect agreement for left ( k  = 0.84, CI: 0.82-0.86) and right leg ( k  = 0.85, CI: 0.83-0.87), when excluding missing clinician-reported Rutherford scores. Expert's judgment was rarely required to be the deciding factor (11 out of 6,633). Substantial agreement between clinician-reported Rutherford scores and medical record review Rutherford scores was found, which could be an indicator for the validity of routinely reported data. Depending on its purpose, the secondary use of routinely collected Rutherford scores is a viable option.

FINE-NEEDLE ANGIOGRAPHY IN CHRONIC LIMB-THREATENING ISCHEMIA DIABETIC PATIENTS

OBJECTIVE

The aim: The features and efficiency of performing fine-needle angiography for Chronic Limb-Threatening Ischemia (CLTI) in Diabetic Patients diagnosis.

PATIENTS AND METHODS

Materials and methods: From 2015-2020, a total of 180 angiography procedures were performed in below-the-knee (BTK) arterial disease diabetic patients with CLTI (Rutherford category 4 to 6). Relative contraindications such as severe heart failure, myocardial infarction (MI), arterial hypertension, impaired renal function, allergy to contrast media and intolerance to antiplatelet therapy we carefully evaluated and compared with the major amputation risks. Patients were selected with adequate inflow to the common and popliteal arterys, as defined by presence of normal ipsilateral femoral and popliteal pulse, biphasic or triphasic Doppler waveform. Ultrasound controlled fine-needle angiography, by retrograde puncture of the superficial femoral artery (SFA) was performed with an 18G-70mm angiographic needle in 96 patients (1st group). Antegrade angiography using femoral sheath in 84 patients (2nd group).

RESULTS

Results: We have obtained adequate visualization BTK vessels by administering "Omnipak 300" 70% solution 9 mL with a power injector at a 3 mL/sec rate through the needle. Through the sidearm of the femoral sheath a total of contrast 15 mL, administered at 5 mL/sec rate. Fine-needle angiography 2.16 times reduces the injected contrast amount in patients. The hemorrhagic events frequency in the 1st group was significantly lower.

CONCLUSION

Conclusions: Fine-needle angiography is recommended for CLTI Diabetic Patients diagnosis.

Superficial femoral artery access for infrainguinal antegrade endovascular interventions in the hostile groin: A prospective randomized study

INTRODUCTION

In a hostile groin, it may be difficult to perform antegrade endovascular procedures at the lower extremities using the ipsilateral common femoral artery as vascular access; therefore, the use of the ipsilateral superficial femoral artery (SFA) could be a useful alternative. In this study, we evaluated the feasibility and safety of ultrasound-guided SFA puncture versus traditional SFA cutdown to achieve arterial access.

METHODS

This prospective observational randomized study examined patients with symptomatic peripheral arterial disease who required endovascular interventions at the lower extremities. A hostile groin was defined as high femoral bifurcation, obesity, and surgical scarring due to previous surgical interventions. A 6-Fr sheath (12 cm long; ULTIMUM™ EV INTRODUCER; Abbott, Plymouth, MN, USA) was used in all procedures. In the percutaneous group, the puncture was performed under ultrasound guidance and hemostasis was performed using a percutaneous closure device (PCD) (Angioseal Vip 6-Fr; Terumo Medical Corporation, Somerset, NJ, USA). The primary endpoints were technical success and perioperative complications. The secondary endpoints were the time required for the management of vascular access and the type of anesthesia administered.

RESULTS

Between 2020 and 2021, 107 patients who underwent antegrade revascularization were enrolled. SFA was achieved in 50 cases by the femoral cutdown technique (c-group) and in 57 cases by percutaneous ultrasound-guided puncture (p-group). In the c-group, the time from incision to sheath introduction and the time of suturing the artery and wound closure was 35 ± 8 min. In the p-group, the time from skin puncture and sheath placement plus that from the sheath removal and hole closure with the PCD was 6 ± 3 min. For the c-group versus p-group, the following variables were as follows: high bifurcation, 10 vs. 6 cases (=p 0.2); severe obesity, 33 vs. 40 cases (p 0.46); and previous surgical groin interventions, 7 vs. 9 cases (p 0.53), respectively. The technical success rates were 100% vs. 96.49% for the c-group vs. p-group, respectively (p 0.63). Two percutaneous puncture failures were managed using the cutdown technique. In the p-group, two post-procedural hematomas were recorded, with only one requiring surgical treatment and two with SFA occlusion to intravascular cap hemostatic dislocation, which were subjected to surgical revision. A total of three percutaneous procedures in the p-group required surgical revision versus none in the c-group (p =0.1). Within 3 months, complications consisted of 6 cases of surgical wound complications in the c-group versus none in the p-group (p 0.009). All procedures in the p-group versus 72% of patients in the c-group were managed with local anesthesia (p<0.0001).

CONCLUSIONS

The femoral cutdown technique seems to be safe and successful approach for achieving vascular access in cases of hostile groin. Ultrasound-guided puncture and PCD make SFA puncture a successful and safe alternative with an acceptable complications rate. Moreover, it reduces the time required to manage vascular access and can be performed mainly under local anesthesia.