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Watanabe Y, Hozawa K, Nakamura S. The modified interventional method of antegrade common femoral artery access closure using the Angio-Seal device: modified Angio-Seal haemostasis technique: Modified Angio-Seal haemostasis technique. ASIAINTERVENTION 2022; 8:52-55. [PMID: 35350793 PMCID: PMC8922454 DOI: 10.4244/aij-d-21-00032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 01/25/2022] [Indexed: 06/14/2023]
Abstract
AIMS Antegrade femoral puncture is frequently performed in endovascular therapy, with haemostasis achieved through manual compression. The aim of this paper is to report the novel method of achieving haemostasis using the Angio-Seal device for antegrade punctures of the femoral artery. METHODS AND RESULTS Between September 2017 and March 2018, a total of 50 consecutive patients who underwent endovascular therapies (EVT) through the common femoral artery with an antegrade puncture using a 6 Fr introducer sheath were retrospectively analysed. After EVT, all patients received a 6 Fr Angio-Seal STS Plus Vascular Closure Device. All procedures were performed using the following new technique. First, we inserted the Angio-Seal guidewire from the inserted EVT sheath into the artery. Second, we removed the EVT sheath and inserted the Angio-Seal sheath and then removed the dilator and Angio-Seal guidewire. Under angiography using an 18 G needle sheath, we pulled back the Angio-Seal sheath as near to the insertion site of the vessel as possible. Finally, a collagen sponge and plug were inserted as per the standard technique. In all patients, the Angio-Seal was successfully deployed, and haemostasis was achieved within several minutes. No major complications occurred. CONCLUSIONS We demonstrated the feasibility and efficacy of achieving haemostasis using the Angio-Seal device in an antegrade femoral puncture using the novel method.
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Affiliation(s)
- Yusuke Watanabe
- Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan
| | - Koji Hozawa
- Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan
| | - Sunao Nakamura
- Interventional Cardiology Unit, New Tokyo Hospital, Chiba, Japan
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Prouse A, Gunzburger E, Yang F, Morrison J, Valle JA, Armstrong EJ, Waldo SW. Contemporary Use and Outcomes of Arterial Closure Devices After Percutaneous Coronary Intervention: Insights From the Veterans Affairs Clinical Assessment, Reporting, and Tracking Program. J Am Heart Assoc 2020; 9:e015223. [PMID: 32063086 PMCID: PMC7070201 DOI: 10.1161/jaha.119.015223] [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] [Indexed: 12/03/2022]
Abstract
Background Arterial closure devices reduce the length of bedrest after invasive cardiac procedures via the femoral approach, but there are conflicting data on their association with major bleeding and vascular complications. We thus sought to evaluate the contemporary use of femoral arterial closure devices and their association with major bleeding among patients undergoing percutaneous coronary intervention. Methods and Results We identified patients undergoing percutaneous intervention via the femoral approach within the Veterans Affairs Healthcare System from December 2004 through September 2018. The association between arterial closure device use and major bleeding was evaluated using both propensity matching and instrumental variable analyses, incorporating contrast‐induced nephropathy as a falsification end point. We identified 132 373 percutaneous coronary interventions performed by 681 operators, with closure device use increasing 1.2% each year (linear trend P<0.001). In a propensity‐matched cohort, closure devices were associated with a 1.1% reduction in periprocedural bleeding (95% CI, −1.5% to −0.6%). Closure devices were also associated with a numerical decrease in contrast‐inducted nephropathy that did not reach statistical significance (−0.6%; 95% CI, −1.3% to 0.1%). In an instrumental variable analysis of closure device use, there was no difference in the bleeding rate between those who received a closure device and those who did not (0.2%; 95% CI, −0.9% to 1.2%). Conclusions Arterial closure devices are associated with a reduction in major bleeding within a propensity‐matched cohort. This association dissipates in an instrumental variable analysis, highlighting some of the methodologic limitations of comparative effectiveness research in observational analyses.
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Affiliation(s)
- Andrew Prouse
- Division of Cardiology Department of Medicine Denver Health Medical Center Denver CO.,Division of Cardiology Department of Medicine University of Colorado School of Medicine Aurora CO
| | - Elise Gunzburger
- Center of Innovation Rocky Mountain Regional VA Medical Center Aurora CO
| | - Fan Yang
- Center of Innovation Rocky Mountain Regional VA Medical Center Aurora CO
| | - Justin Morrison
- Division of Cardiology Department of Medicine University of Colorado School of Medicine Aurora CO
| | - Javier A Valle
- Division of Cardiology Department of Medicine University of Colorado School of Medicine Aurora CO.,Center of Innovation Rocky Mountain Regional VA Medical Center Aurora CO.,Division of Cardiology Department of Medicine Rocky Mountain Regional VA Medical Center Aurora CO
| | - Ehrin J Armstrong
- Division of Cardiology Department of Medicine University of Colorado School of Medicine Aurora CO.,Division of Cardiology Department of Medicine Rocky Mountain Regional VA Medical Center Aurora CO
| | - Stephen W Waldo
- Division of Cardiology Department of Medicine University of Colorado School of Medicine Aurora CO.,Center of Innovation Rocky Mountain Regional VA Medical Center Aurora CO.,Division of Cardiology Department of Medicine Rocky Mountain Regional VA Medical Center Aurora CO
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Han Y, Kwon JH, Park S. Korean single-center experience with femoral access closure using the ExoSeal device. World J Radiol 2018; 10:108-115. [PMID: 30310545 PMCID: PMC6177558 DOI: 10.4329/wjr.v10.i9.108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 08/06/2018] [Accepted: 08/24/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To report 17-mo experience of femoral artery puncture site closure during angiographic procedures using ExoSeal vascular closure devices (VCDs).
METHODS Between November 2015 and April 2017, we performed 179 diagnostic and interventional angiographic procedures via a common femoral arterial access. The ExoSeal VCD was used at the puncture site to achieve hemostasis in 125 patients. We evaluated the technical and procedural success rates, the complications, and the factors affecting the hemostasis time of the ExoSeal VCDs.
RESULTS Technical and procedural successes were achieved in 176 cases (98.0%) and 128 cases (71.5%), respectively. Device failure occurred in 3 (1.7%) cases. In 1 case (0.6%) a small hematoma developed, but there were no major complications. Among the hemostasis-relevant variables, a history of drinking alcohol, low platelet (PLT) count, and high prothrombin time-international normalized ratio (commonly known as PT-INR) values were the statistically significant predictors of the need for longer manual compression (MC). There was no difference in the success rates between the repeat and single ExoSeal procedure groups, and repeated use of the ExoSeal did not affect hemostasis time.
CONCLUSION The ExoSeal VCD effectively achieves hemostasis, with few complications. Longer light MC may be needed with alcohol drinkers, low PLT count, and high PT-INR values.
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Affiliation(s)
- Yoonhee Han
- Department of Radiology, Dongguk University Ilsan Hospital, Goyang-si 10326, Gyeonggi-do, South Korea
| | - Jae Hyun Kwon
- Department of Radiology, Dongguk University Ilsan Hospital, Goyang-si 10326, Gyeonggi-do, South Korea
| | - Surin Park
- Department of Radiology, Dongguk University Ilsan Hospital, Goyang-si 10326, Gyeonggi-do, South Korea
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Gabrielli R, Rosati MS, Millarelli M, Dante A, Maiorano M, Musilli A, Chiappa R, Ventura M. FemoSeal ® Device Use for Femoral Artery Closure by Different Techniques. Ann Vasc Surg 2018; 51:18-24. [PMID: 29678650 DOI: 10.1016/j.avsg.2018.02.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 02/03/2018] [Accepted: 02/09/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Common femoral artery is still the most frequently used site for vascular access, mostly for peripheral arterial interventions, and its puncture remains a significant source of patient's morbidity. Manual compression (MC) has been the gold standard for hemostasis after femoral catheterization until recently, but only in the last few years, vascular closure devices (VCDs) are replacing MC due to their rapid development. Nowadays, vascular surgeons (VSs) are also becoming familiar with VCDs. The purpose of this study was to investigate FemoSeal® arterial closure system use in terms of safety and efficacy in patients undergoing transfemoral peripheral procedure and evaluate the complication risk factors. METHODS A retrospective analysis to compare 2 different specialists and technique with systematic implantation of FemoSeal® VCD was performed in a cohort of vascular patients treated by endovascular procedure with femoral artery access site over a 2-year period and sheaths ranged from 6F to 8F. All the patients were on antiplatelet therapy and received heparin during the procedure. The FemoSeal® was deployed in common femoral arteries. All patients were examined for access site complication by VS in both groups 20-24 hrs after VCD deployment and 1 and 6 weeks after the procedure with clinical visit and ultrasound duplex scan. Complications, as minor and major hematomas, pseudoaneurysm formation, vessel occlusion or dissection, and infection were recorded. RESULTS During the study period, 130 FemoSeal® were deployed in 114 patients, 102 FemoSeal® in VS group, and 28 in interventionalist group. Mean age was 57 ± 24 years. There was no significant difference between the 2 groups in terms of comorbidities. Patient follow-up ranged from 1 to 15 months. All but 3 of the FemoSeal® devices were successfully deployed (all 3 cases in group 2). Mobilization time was 6 ± 4 hrs following interventions, and the discharge time ranged from 6 hrs to 7 days after procedure. Early discharge (within 6 hrs) was obtained in 23% of group 1 and in 0 cases of group 2 (P = 0.008). Delayed discharge was obtained in 74% of group 1 (67 pts) and in 70% of group 2 (18 pts) on postoperative day 1 (P = 0.47). Technical success was achieved in 99% of group 1 and in 93% of group 2 (P = 0.87). There were no perioperative deaths. There were no significant differences in terms of minor bleeding complications (P = 0.21) or infections or transfusion needing (P 0.06) in both groups. FemoSeal®-related complications occurred in 6 patients (1 in group 1 and 5 in group 2; P = 0.0017). All complications occurred following therapeutic intervention with 6F sheath introducer. Complication rate resulted significatively higher in group 2 in terms of pseudoaneurysm development (P < 0.0001) and transfusion needing (P = 0.03) in a subgroup analysis on peripheral arterial disease (Rutherford 3-5). Only chronic limb ischemia was found to be independent predictor of complications due to VCD use. CONCLUSIONS Our data suggest that when simple guidelines are observed, the device is safe, effective, and easy to deploy and allows for early ambulation and discharge. However, appropriate randomized clinical trials could clarify the correct guideline to minimize the complication rates.
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Affiliation(s)
- Roberto Gabrielli
- Department of Vascular and Endovascular Surgery, "San Salvatore Hospital", L'Aquila, Italy.
| | - Maria Sofia Rosati
- Department of Vascular and Endovascular Surgery, "San Salvatore Hospital", L'Aquila, Italy
| | - Massiliano Millarelli
- Department of Vascular and Endovascular Surgery, "Policlinico Casilino Hospital", Rome, Italy
| | - Angelica Dante
- Department of Vascular and Endovascular Surgery, "San Salvatore Hospital", L'Aquila, Italy
| | - Maurizio Maiorano
- Department of Vascular and Endovascular Surgery, "San Salvatore Hospital", L'Aquila, Italy
| | - Aldo Musilli
- Department of Vascular and Endovascular Surgery, "San Salvatore Hospital", L'Aquila, Italy
| | - Roberto Chiappa
- Department of Vascular and Endovascular Surgery, "Policlinico Casilino Hospital", Rome, Italy
| | - Marco Ventura
- Department of Vascular and Endovascular Surgery, "San Salvatore Hospital", L'Aquila, Italy
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Angio-Seal™ Embolization: A Rare Etiology of an Acute Distal Limb Ischemia. Case Rep Vasc Med 2017; 2017:9613863. [PMID: 29181220 PMCID: PMC5664249 DOI: 10.1155/2017/9613863] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 08/01/2017] [Accepted: 09/17/2017] [Indexed: 11/21/2022] Open
Abstract
We herein report a serious vascular complication of diagnostic cardiac catheterization due to an embolization of an Angio-Seal closure device causing acute lower limb ischemia. The Angio-Seal was deployed via the right femoral artery following the catheterization which embolized several hours later to the right popliteal artery. Fogarty embolectomy restored perfusion to the right lower limb; however, compartment syndrome subsequently developed which required evacuation of a hematoma and repair of right popliteal artery.
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Patient Satisfaction After Femoral Arterial Access Site Closure Using the ExoSeal® Vascular Closure Device Compared to Manual Compression: A Prospective Intra-individual Comparative Study. Cardiovasc Intervent Radiol 2015; 39:21-7. [DOI: 10.1007/s00270-015-1204-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 08/16/2015] [Indexed: 01/13/2023]
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Comparison of Exo-Seal(®) and Angio-Seal (®) for arterial puncture site closure: A randomized, multicenter, single-blind trial. Herz 2015; 40:809-16. [PMID: 26070467 DOI: 10.1007/s00059-015-4306-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 12/22/2014] [Accepted: 01/11/2015] [Indexed: 01/27/2023]
Abstract
BACKGROUND The use of extravascular femoral closure devices in patients undergoing coronary angiography/intervention has not been sufficiently evaluated. We sought to define the impact of an extravascular polyglycolic acid (PGA) plug for the closure of a femoral access site in patients undergoing coronary angiography and/or percutaneous coronary intervention. METHODS In this prospective, single-blind, multicenter trial we randomly assigned 319 patients to vessel closure with Angio-Seal(®) or Exo-Seal(®). We hypothesized that the use of an extravascular closure device is not inferior to an anchor/plug-mediated device regarding the occurrence of the composite primary endpoint: hematoma > 5 cm, significant groin bleeding (TIMI major bleed), false aneurysm, and device failure. RESULTS There was no significant difference in patient baseline characteristics or procedural results. After 24 h the primary endpoint occurred in nine patients (5.6 %) in the Angio-Seal(®) group and in 13 patients (8.2 %) inthe Exo-Seal(®) group (p = 0.38). Hematoma > 5 cm was noted in three patients (1.9 %) receiving Angio-Seal(®) vs. two patients (1.3 %) receiving Exo-Seal(®) (p = 0.99). In one patient (0.6 %) of the Exo-Seal(®) group, TIMI major bleeding occurred, requiring transfusion (p = 0.49). There were four (2.5 %) false aneurysms found in patients treated with Angio-Seal(®) and two (1.3 %) in patients treated with Exo-Seal(®) (p = 0.68). There was a trend for a higher incidence of device failure in the Exo-Seal(®) group (1.2 vs. 5.2 %, p = 0.06). At telephone interview after 30 days, there was no significant difference found regarding the events readmission with surgery of puncture site, infection, bleeding, hematoma, or pain. CONCLUSION In the present study, there were no significant differences found regarding the occurrence of hematoma > 5 cm, major bleeding, false aneurysm, and device failure between Angio-Seal(®) and Exo-Seal(®) 24 h after device implantation.
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8
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Use of vascular closure device is safe and effective in electrophysiological procedures. J Interv Card Electrophysiol 2015; 43:193-5. [DOI: 10.1007/s10840-015-0005-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2014] [Accepted: 03/31/2015] [Indexed: 10/23/2022]
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Geis NA, Pleger ST, Chorianopoulos E, Müller OJ, Katus HA, Bekeredjian R. Feasibility and clinical benefit of a suture-mediated closure device for femoral vein access after percutaneous edge-to-edge mitral valve repair. EUROINTERVENTION 2015; 10:1346-53. [PMID: 24694560 DOI: 10.4244/eijv10i11a231] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
AIMS We assessed feasibility, efficacy and safety of a suture-mediated closure device, Perclose Proglide (Abbott Vascular Devices, Santa Clara, CA, USA), for closure of the femoral vein access after percutaneous MitraClip (Abbott Vascular Devices) implantation. METHODS AND RESULTS Venous access of 80 consecutive patients undergoing percutaneous mitral valve repair using the MitraClip device was managed either by manual compression, "figure eight" suture and compression bandage for 12 hours, or by applying the Proglide device for haemostasis after the procedure (40 patients each group). Patients with Proglide closure showed complete immediate haemostasis in 92.5% (37/40) and were immobilised with a compression bandage for only four hours. In the Proglide group, one arteriovenous fistula was observed and had to be treated by vascular surgery. The overall duration of stay on an intensive care unit was significantly reduced in the Proglide group (59.4±48.9 hours vs. 84.6±59.5 hours, p<0.005). CONCLUSIONS Using a suture-mediated closure device for the femoral vein after percutaneous MitraClip implantation is feasible and safe. This allows earlier patient mobilisation and may reduce post-interventional duration of stay on an intensive care unit.
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Affiliation(s)
- Nicolas A Geis
- Department of Internal Medicine III, University of Heidelberg, Heidelberg, Germany
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Boschewitz JM, Pieper CC, Andersson M, Nadal J, Schild HH, Meyer C. Efficacy and time-to-hemostasis of antegrade femoral access closure using the ExoSeal vascular closure device: a retrospective single-center study. Eur J Vasc Endovasc Surg 2014; 48:585-91. [PMID: 25201516 DOI: 10.1016/j.ejvs.2014.08.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 08/01/2014] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To retrospectively evaluate the efficacy and time-to-hemostasis of antegrade femoral access closure using the ExoSeal vascular closure device (VCD). DESIGN Retrospective, single-center analysis. MATERIALS AND METHODS Between September 2010 and February 2013, 148 ExoSeal VCD closures (5-7F) of antegrade femoral accesses were performed in 119 patients (70 males, mean age 71.6 years, range 40-97 years). In all cases initial diagnostic angiography was performed via an 18G/3.8F retrograde femoral access, which was left in place during intervention (in-house standard) and was used to obtain control angiography after successful closure of the antegrade access to determine hemostasis. Technical device success was defined as ExoSeal closure without major VCD-related complications; procedural success as hemostasis within 5 minutes. Statistical analysis was performed using a logistic regression model and correlation analyses. RESULTS 145/148 (98.0%) ExoSeal closures were technically successful (5F: n = 76; 6F: n = 65; 7F: n = 7). Angiographic control showed closure after 2 minutes in 130/145 cases. In a further 14 cases hemostasis was achieved after an additional 3 minutes MC, so that closure was successful within 5 minutes in 144/148 cases (97.3%). No major complication occurred. One minor complication was recorded in a 6F access case. Pre-interventional activated partial thromboplastin time (aPTT) was the only statistically significant predictor of necessary manual compression (MC) > 2 minutes (p = .01), but with an odds-ratio of only 1.038. The INR showed an odds-ratio of 2.455 for need for 5 minutes MC (NS). Significant correlations were found between the need for 5 minutes MC and medication with acetylsalicylic acid (p = .01), clopidogrel (p < .01), and abciximab (p < .001). CONCLUSION ExoSeal vascular closure of antegrade femoral punctures is safe and effective with a low complication rate. Two minutes of MC are sufficient to achieve hemostasis in the majority of cases. However, in patients on antiplatelet therapy, especially after abciximab, the authors advocate prolonging MC to 5 minutes.
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Affiliation(s)
- J M Boschewitz
- Department of Radiology, University of Bonn, Bonn, Germany
| | - C C Pieper
- Department of Radiology, University of Bonn, Bonn, Germany
| | - M Andersson
- Department of Radiology, University of Bonn, Bonn, Germany
| | - J Nadal
- Institute for Medical Biometry, Informatics and Epidemiology, University of Bonn, Bonn, Germany
| | - H H Schild
- Department of Radiology, University of Bonn, Bonn, Germany
| | - C Meyer
- Department of Radiology, University of Bonn, Bonn, Germany.
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Feasibility of vascular access closure in arteries other than the common femoral artery using the ExoSeal vascular closure device. Cardiovasc Intervent Radiol 2014; 37:1352-7. [PMID: 24525965 DOI: 10.1007/s00270-014-0853-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Accepted: 01/21/2014] [Indexed: 01/27/2023]
Abstract
PURPOSE To describe the feasibility of vascular access closure in arteries other than the common femoral artery (CFA) using the ExoSeal vascular closure device (VCD). MATERIALS AND METHODS Between December 2011 and August 2013, 8 patients (4 males, 4 females, mean age 64 years [range 42-81]) underwent 13 extrafemoral access site closure using the ExoSeal VCD (brachial artery n = 7, venous femoropopliteal bypass n = 3, femoropopliteal segment n = 2, proximal superficial femoral artery n = 1). Patient history, procedural characteristics, and complications were recorded. RESULTS Technical success was achieved in 12 of 13 VCD procedures. In 1 case of brachial puncture, safe plug-deployment was not possible, so manual compression was applied. In this case, angiographic and clinical control showed residual bleeding 5 min after the procedure. After additional manual compression for 5 min, the haemorrhage stopped, but a hematoma <3 cm was detectable (procedural success rate 12 of 13 closures). Overall no major complications were observed. Heparin, 5,000 IU, was administered in all cases. Six ExoSeal closures were performed under additional acetylsalicylic acid (ASS) and clopidogrel, three under additional ASS, and the remaining four under heparin only. International normalized ratio and thrombocytes were within normal values in all patients. CONCLUSION Successful vascular access closure using the ExoSeal VCD in puncture sites other than the CFA is feasible with a low complication rate. These applications, however, remain an "off-label" use in selected patients.
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Ruygrok PN, Chou TM. StarClose™ femoral arteriotomy closure device: an advance in arterial closure. Expert Rev Med Devices 2014; 2:247-52. [PMID: 16288587 DOI: 10.1586/17434440.2.3.247] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Millions of femoral arterial punctures are performed annually worldwide for the diagnosis and treatment of cardiovascular disease. Traditionally, hemostasis following arterial sheath removal has employed compression techniques but more recently, a number of arteriotomy closure devices have become available, none of which have been shown to produce an outcome superior to the standard technique of compression. The authors investigated a novel device, which utilizes a nitinol clip that gathers the artery from the outside producing a purse-string-like seal, with very promising results. The authors feel that this device has great potential, may impact significantly on the closure of arteriotomy sites and may also find application in other aspects of procedural medicine.
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Affiliation(s)
- Peter N Ruygrok
- Auckland City Hospital, Cardiology Department, Private Bag 92 024, Auckland 1001, New Zealand.
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13
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Boschewitz JM, Andersson M, Naehle CP, Schild HH, Wilhelm K, Meyer C. Retrospective evaluation of safety and effectiveness of the EXOSEAL vascular closure device for single vascular closure and closure after repeat puncture in diagnostic and interventional radiology: single-center experience. J Vasc Interv Radiol 2013; 24:698-702. [PMID: 23622041 DOI: 10.1016/j.jvir.2013.02.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Revised: 02/12/2013] [Accepted: 02/12/2013] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To retrospectively evaluate the safety and effectiveness of the EXOSEAL vascular closure device (VCD) for first or repeated closure after retrograde percutaneous femoral arterial access. MATERIALS AND METHODS A retrospective analysis of 417 patients (271 men; mean age, 64.1 y±12.8; age range, 22-94 y) who had undergone arterial closure with the EXOSEAL VCD was performed. Procedures with retrograde femoral access and closure with the 5-F, 6-F, or 7-F EXOSEAL VCD according to the manufacturer's instructions were included. The clinical indications included the full procedural portfolio of a radiologic department with a focus on transarterial hepatic procedures. After EXOSEAL VCD closure, patients were restricted to bed rest for 4 hours. RESULTS From August 2010 to March 2012, a total of 682 EXOSEAL VCDs (5-F, n = 276; 6-F, n = 394; 7-F, n = 12) were used in 659 procedures with a total of 404 repeated closures. The EXOSEAL VCD was used successfully in 676 of 682 procedures (99.1%). Hemostasis was achieved in 651 of 682 procedures (95.5%). No major complications were encountered. There were eight cases (1.17%) of minor complications despite a successful vascular closure procedure, none requiring further therapy. There were no complications in any of the 404 cases of repeated vascular closure. CONCLUSIONS The results of this study suggest that the EXOSEAL VCD is safe and effective in single and repeated closure of retrograde percutaneous femoral arterial access in interventional radiology cases.
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Affiliation(s)
- Jack M Boschewitz
- Department of Radiology, University of Bonn, Sigmund-Freud-Strasse 25, D-53105 Bonn, Germany
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JAN AFTAB, CREAN PETER, BULLESFELD LUTZ, COLEMAN JAMES, GRUBE EBERHARD, MULVIHILL NIALL. First Clinical Experience With Celt ACD
®
: A Femoral Arterial Puncture Closure Device. J Interv Cardiol 2013; 26:417-24. [DOI: 10.1111/joic.12046] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Wimmer NJ, Resnic FS, Mauri L, Matheny ME, Piemonte TC, Pomerantsev E, Ho KKL, Robbins SL, Waldman HM, Yeh RW. Risk-treatment paradox in the selection of transradial access for percutaneous coronary intervention. J Am Heart Assoc 2013; 2:e000174. [PMID: 23709565 PMCID: PMC3698780 DOI: 10.1161/jaha.113.000174] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Access site complications contribute to morbidity and mortality during percutaneous coronary intervention (PCI). Transradial arterial access significantly lowers the risk of access site complications compared to transfemoral arteriotomy. We sought to develop a prediction model for access site complications in patients undergoing PCI with femoral arteriotomy, and assess whether transradial access was selectively used in patients at high risk for complications. Methods and Results We analyzed 17 509 patients who underwent PCI without circulatory support from 2008 to 2011 at 5 institutions. Transradial arterial access was used in 17.8% of patients. In those who underwent transfemoral access, 177 (1.2%) patients had access site complications. Using preprocedural clinical and demographic data, a prediction model for femoral arteriotomy complications was generated. The variables retained in the model included: elevated age (P<0.001), female gender (P<0.001), elevated troponin (P<0.001), decreased renal function or dialysis (P=0.002), emergent PCI (P=0.01), prior PCI (P=0.005), diabetes (P=0.008), and peripheral artery disease (P=0.003). The model showed moderate discrimination (optimism‐adjusted c‐statistic=0.72) and was internally validated via bootstrap resampling. Patients with higher predicted risk of complications via transfemoral access were less likely to receive transradial access (P<0.001). Similar results were seen in patients presenting with and without ST‐segment myocardial infarction and when adjusting for individual physician operator. Conclusions We generated and validated a model for transfemoral access site complications during PCI. Paradoxically, patients most likely to develop access site complications from transfemoral access, and therefore benefit from transradial access, were the least likely to receive transradial access.
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Affiliation(s)
- Neil J Wimmer
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Byrne RA, Cassese S, Linhardt M, Kastrati A. Vascular access and closure in coronary angiography and percutaneous intervention. Nat Rev Cardiol 2012. [DOI: 10.1038/nrcardio.2012.160] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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17
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Hamid T, Rajagopal R, Pius C, Clarke B, Mahadevan VS. Preclosure of large-sized venous access sites in adults undergoing transcatheter structural interventions. Catheter Cardiovasc Interv 2012; 81:586-90. [DOI: 10.1002/ccd.24358] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2011] [Accepted: 02/02/2012] [Indexed: 12/19/2022]
Affiliation(s)
- Tahir Hamid
- Manchester Royal Infirmary; University of Central Manchester and Manchester University Children's Hospital; United Kingdom
| | - Rajinikanth Rajagopal
- Manchester Royal Infirmary; University of Central Manchester and Manchester University Children's Hospital; United Kingdom
| | - Charlene Pius
- Manchester Royal Infirmary; University of Central Manchester and Manchester University Children's Hospital; United Kingdom
| | - Bernard Clarke
- Manchester Royal Infirmary; University of Central Manchester and Manchester University Children's Hospital; United Kingdom
| | - Vaikom S. Mahadevan
- Manchester Royal Infirmary; University of Central Manchester and Manchester University Children's Hospital; United Kingdom
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18
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Tordini A, Polkampally PR, Jovin IS. Vascular closure devices in percutaneous coronary and peripheral interventions: rationale and results. Interv Cardiol 2012. [DOI: 10.2217/ica.12.56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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19
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Smilowitz NR, Kirtane AJ, Guiry M, Gray WA, Dolcimascolo P, Querijero M, Echeverry C, Kalcheva N, Flores B, Singh VP, Rabbani L, Kodali S, Collins MB, Leon MB, Moses JW, Weisz G. Practices and complications of vascular closure devices and manual compression in patients undergoing elective transfemoral coronary procedures. Am J Cardiol 2012; 110:177-82. [PMID: 22482861 DOI: 10.1016/j.amjcard.2012.02.065] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Revised: 02/28/2012] [Accepted: 02/28/2012] [Indexed: 11/26/2022]
Abstract
Femoral arterial puncture is the most common access method for coronary angiography and percutaneous coronary interventions (PCIs). Access complications, although infrequent, affect morbidity, mortality, costs, and length of hospital stay. Vascular closure devices (VCDs) are used for rapid hemostasis and early ambulation, but there is no consensus on whether VCDs are superior to manual compression (MC). A retrospective review and nested case-control study of consecutive patients undergoing elective transfemoral coronary angiography and PCI over 3 years was performed. Hemostasis strategy was performed according to the operators' discretion. Vascular complications were defined as groin bleeding (hematoma, hemoglobin decrease ≥3 g/dl, transfusion, retroperitoneal bleeding, or arterial perforation), pseudoaneurysm, arteriovenous fistula formation, obstruction, or infection. Patients with postprocedure femoral vascular access complications were compared to randomly selected patients without complication. Data were available for 9,108 procedures, of which PCI was performed in 3,172 (34.8%). MC was performed in 2,581 (28.3%) and VCDs (4 different types) were deployed in 6,527 procedures (71.7%). Significant complications occurred in 74 procedures (0.81%), with 32 (1.24%) complications with MC and 42 (0.64%) with VCD (p = 0.004). VCD deployment failed in 80 procedures (1.23%), of which 8 (10%) had vascular complications. VCD use was a predictor of fewer complications (odds ratio 0.52, 95% confidence interval 0.33 to 0.83). In the case-control analysis, older age and use of large (7Fr to 8Fr) femoral sheaths were independent predictors of complications. In conclusion, the retrospective analysis of contemporary hemostasis strategies and outcomes in elective coronary procedures identified a low rate of complications (0.81%), with superior results after VCD deployment. Careful selection of hemostasis strategy and closure device may further decrease complication rates.
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Georg Y, Thaveau F, Lejay A, Bajcz C, Bakassa S, Chakfe N, Kretz JG. Arterial thrombosis after using Angio-Seal. Ann Vasc Surg 2012; 25:1078-93. [PMID: 22023942 DOI: 10.1016/j.avsg.2010.11.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2010] [Revised: 10/04/2010] [Accepted: 11/09/2010] [Indexed: 12/17/2022]
Abstract
Percutaneous closure systems of arterial puncture sites are being used more and more in modern endovascular practice. In this article, we report five cases of thrombotic complications following Angio-Seal deployment which required to be treated in our department between June 2004 and January 2006. We carried out a computerized literature review using "vascular closure" as a keyword and elected 106 articles published between 1992 and 2007. The analysis of this literature review showed that the rate of percutaneous closure complications was similar to the rate of manual compression complications, which is still the reference method. The complications associated with the use of these systems were more complex and more often required surgical repair. The severity and frequency of these complications differ based on the type of closure systems. The vascular surgeon in charge must have a good knowledge of these systems and of the complications each of them entails to be able to treat them in the most appropriate way.
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Affiliation(s)
- Yannick Georg
- Service de Chirurgie Vasculaire, Nouvel Hôpital Civil, Strasbourg, France
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21
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Hvelplund A, Jeger R, Osterwalder R, Bredahl M, Madsen JK, Jensen JS, Kaiser C, Pfisterer M, Galatius S. The Angio-Seal™ femoral closure device allows immediate ambulation after coronary angiography and percutaneous coronary intervention. EUROINTERVENTION 2011; 7:234-41. [PMID: 21646066 DOI: 10.4244/eijv7i2a38] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Anders Hvelplund
- Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark.
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22
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Prada-Delgado Ó, Estévez-Loureiro R, Calviño-Santos R, Barge-Caballero E, Salgado-Fernández J, Piñón-Esteban P, Vázquez-Rodríguez JM, Aldama-López G, Flores-Ríos X, Soler-Martín MR, Vázquez-González N, Castro-Beiras A. Safety and efficacy of femoral vascular closure devices in patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction. Am Heart J 2011; 161:1207-13. [PMID: 21641370 DOI: 10.1016/j.ahj.2011.03.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Accepted: 03/07/2011] [Indexed: 11/20/2022]
Abstract
BACKGROUND The use of vascular closure devices (VCDs) for the reduction of access site complications following percutaneous coronary intervention (PCI) remains controversial. Patients undergoing primary PCI for acute ST-segment elevation myocardial infarction (STEMI) are at high risk of femoral artery complications. A lack of information exists regarding the use of VCDs in this group of patients because they have been routinely excluded from randomized trials. This study sought to evaluate the safety and efficacy of the routine use of VCDs after primary PCI. METHODS A total of 558 consecutive patients undergoing primary PCI for STEMI via femoral route were studied for in-hospital outcomes through a prospective registry from January 2003 to December 2008. The primary end point was the presence of major vascular complication (MVC) defined as a composite of fatal access site bleeding, access site complication requiring interventional or surgical correction, or access site bleeding with ≥3 g/dL drop in hemoglobin or requiring blood transfusion. RESULTS Of the total patients, 464 (83.2%) received a VCD; and manual compression was used in 94 patients (16.8%). Major vascular complication occurred in 5.2% of patients. The risk of MVC was significantly lower with VCDs compared with manual compression (4.3% vs 9.6%, P = .036). Multivariable logistic regression analysis determined that VCD use remained an independent predictor of lower rate of MVC (odds ratio 0.38, 95% CI 0.17-0.91). CONCLUSIONS The use of VCDs in patients undergoing primary PCI for STEMI is safe and is associated with lower rates of MVC compared with manual compression.
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Affiliation(s)
- Óscar Prada-Delgado
- Interventional Cardiology Unit, Department of Cardiology, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
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Stegemann E, Hoffmann R, Marso S, Stegemann B, Marx N, Lauer T. The frequency of vascular complications associated with the use of vascular closure devices varies by indication for cardiac catheterization. Clin Res Cardiol 2011; 100:789-95. [DOI: 10.1007/s00392-011-0313-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Accepted: 03/25/2011] [Indexed: 10/18/2022]
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Bechara CF, Annambhotla S, Lin PH. Access site management with vascular closure devices for percutaneous transarterial procedures. J Vasc Surg 2010; 52:1682-96. [DOI: 10.1016/j.jvs.2010.04.079] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2010] [Revised: 04/23/2010] [Accepted: 04/30/2010] [Indexed: 11/27/2022]
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Abstract
BACKGROUND AND RESEARCH OBJECTIVES Complex antiplatelet and antithrombotic regimens used in conjunction with percutaneous coronary intervention may increase the risk of vascular complications. The purpose of this study was to examine predictors of vascular complications following sheath removal for percutaneous coronary intervention. SUBJECTS AND METHODS This prospective cohort study enrolled 413 patients during a 7-month period. Data elements were collected by chart abstraction. Practice variable included pharmacological agents and method and duration of sheath removal procedure. Patient outcomes included hematoma formation, bleeding occurrence, pseudoaneurysm prevalence, incidence of arteriovenous fistula formation, and thrombosis. RESULTS AND CONCLUSIONS Of the 413 patients, 68 (16.5%) had a complication. Sixty-four (15.5%) developed hematomas ranging in size from 1 to 5 cm (n = 35, 8.5%) to greater than 5 cm (n = 29, 7.0%), 6 experienced bleeding (1.5%), 4 (1%) had arteriovenous fistulas, and 3 (0.7%) developed pseudoaneurysms. There were no significant differences for complications using manual, C-clamp, or arterial vascular closure device. Patients with a higher systolic blood pressure (135 vs 129; df = 410, P = .025) and of older age (66 vs 63; df = 411, P = .016) were significantly more likely to have complications. Clinically significant major vascular complications were low. Arterial closure devices, mechanical C-clamp, and manual compression all provide low and comparable complication risks following sheath removal in the era of antiplatelet and antithrombotic therapies. Patients who are older and those with elevated blood pressure should have their femoral access site closely monitored and be observed for vascular complications.
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26
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Islam MA, George AK, Norris M. Popliteal artery embolization with the Mynx closure device. Catheter Cardiovasc Interv 2010; 75:35-7. [PMID: 19708082 DOI: 10.1002/ccd.22203] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Several different arterial puncture closure devices are available for use after cardiovascular procedures. The main advantages include decrease need of manual compression, reduce patient discomfort, and the time to ambulation. Access site complications are not rare after vascular closure device use. We report a case of popliteal artery embolization after using an extravascular water soluble plug-mediated vascular puncture closure device.
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Affiliation(s)
- M Ashequl Islam
- Division of Cardiology, Department of Medicine, Baystate Medical Center, Springfield, Massachusetts, USA.
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27
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Wong SC, Bachinsky W, Cambier P, Stoler R, Aji J, Rogers JH, Hermiller J, Nair R, Hutman H, Wang H. A randomized comparison of a novel bioabsorbable vascular closure device versus manual compression in the achievement of hemostasis after percutaneous femoral procedures: the ECLIPSE (Ensure's Vascular Closure Device Speeds Hemostasis Trial). JACC Cardiovasc Interv 2009; 2:785-93. [PMID: 19695549 DOI: 10.1016/j.jcin.2009.06.006] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2009] [Accepted: 06/11/2009] [Indexed: 12/16/2022]
Abstract
OBJECTIVES This trial compared the performance of a novel bioabsorbable vascular closure device (VCD) versus manual compression (MC) for access site hemostasis in patients undergoing percutaneous trans-femoral coronary or peripheral procedures. BACKGROUND From a patient's perspective, access site management after percutaneous procedures remains challenging. METHODS Patients enrolled in this multicenter, nonblinded trial underwent 6-F diagnostic or interventional procedures were randomly assigned 2:1 to VCD versus MC. The primary efficacy end points were time to hemostasis (TTH) and time to ambulation (TTA), and the primary safety end points were periprocedural and 30-day incidence of arterial access-related complications. RESULTS The trial assigned 401 patients (mean age 62.7 +/- 10.9 years, 66.1% men) to VCD (n = 267) versus MC (n = 134) after 87 "roll-in" patients treated at 17 participating institutions. The baseline characteristics of the groups were similar. Procedural success was 91.8% in the VCD versus 91.0% in the MC group (p = NS). Mean TTH was 4.4 +/- 11.6 min in the VCD versus 20.1 +/- 22.5 min in the MC group (95% confidence interval: 19.0 to 12.3; p < 0.0001). Likewise, TTA was significantly shorter in the VCD (2.5 +/- 5.0 h) than in the MC (6.2 +/- 13.3 h) group (95% confidence interval: 5.5 to 1.9; p = 0.0028). No patient died or suffered a major access-site-related adverse event. Minor adverse events were few among all study groups. CONCLUSIONS After 6-F percutaneous invasive procedures, TTH and TTA were both significantly shorter in patients assigned to VCD than in patients managed with MC. The 30-day rates of access-site-related complications were remarkably low in all groups. (Safety and Effectiveness Study of the Ensure Medical Vascular Closure Device; NCT00345631).
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Affiliation(s)
- S Chiu Wong
- Weill Medical College of Cornell University, New York, New York, USA.
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Deuling J, Vermeulen R, Anthonio R, van den Heuvel A, Jaarsma T, Jessurun G, de Smet B, Tan E, Zijlstra F. Closure of the femoral artery after cardiac catheterization: A comparison of Angio-Seal, StarClose, and manual compression. Catheter Cardiovasc Interv 2008; 71:518-23. [DOI: 10.1002/ccd.21429] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Tam J, Given M, Lutjen P, Thomson K, Lyon S. Iatrogenic stenosis following suture-mediated closure device. AUSTRALASIAN RADIOLOGY 2007; 51 Suppl:B319-23. [PMID: 17991096 DOI: 10.1111/j.1440-1673.2007.01805.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The use of percutaneous closure devices post arterial punctures has been introduced to reduce time to haemostasis, reduce haemorrhage, improve patient comfort and reduce time to ambulation. Their increased use has been a result of larger access sites for more complicated procedures, periprocedural anticoagulation and concomitant use of anti-platelet therapy. Although complication rates are not increased with their use as compared with mechanical compression, complications may be more severe and are an important consideration in their use. We report two cases of iatrogenic stenoses secondary to suture-mediated closure device. The first managed with open surgical repair and the second with cutting balloon angioplasty.
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Affiliation(s)
- J Tam
- Radiology Department, Alfred Hospital, Prahan, Victoria, Australia
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Dauerman HL, Applegate RJ, Cohen DJ. Vascular Closure Devices. J Am Coll Cardiol 2007; 50:1617-26. [PMID: 17950141 DOI: 10.1016/j.jacc.2007.07.028] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2007] [Revised: 07/05/2007] [Accepted: 07/15/2007] [Indexed: 10/22/2022]
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Arora N, Matheny ME, Sepke C, Resnic FS. A propensity analysis of the risk of vascular complications after cardiac catheterization procedures with the use of vascular closure devices. Am Heart J 2007; 153:606-11. [PMID: 17383300 DOI: 10.1016/j.ahj.2006.12.014] [Citation(s) in RCA: 131] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2006] [Accepted: 12/26/2006] [Indexed: 01/08/2023]
Abstract
BACKGROUND Complications of vascular access are one of the most common adverse events after coronary angiography and percutaneous coronary intervention (PCI) and are reported to occur in 1% to 9% of cases. There are conflicting reports of the association of vascular complications with the use of vascular closure devices (VCDs). The purpose of this study was to assess femoral arterial access-related vascular outcomes after invasive cardiology procedures with the routine use of VCDs. METHODS A total of 12,937 consecutive patients were studied for inhospital outcomes through a prospective registry from January 2002 to December 2005. Of these, 6913 (53%) patients underwent PCI and 9996 (77%) patients received VCDs. Univariate and multivariate logistic regression analyses were used to determine the predictors of vascular complications. A propensity analysis of VCD use was performed to account for potential bias in the likelihood of using such devices. RESULTS Vascular complications occurred in 0.7% of diagnostic angiography and 2.7% of PCI patients. The risk of vascular complications was significantly lower with closure device use compared with manual compression in both diagnostic angiography (0.5% vs 1.1%, P = .01*) and PCI (2.4% vs 4.9%, P < .001*) groups. Multivariate logistic regression analysis, after accounting for the propensity to use such devices, revealed that VCD use was associated with a 58% (95% CI 19%-88%) reduction in the risk of vascular complications in diagnostic procedures catheterization and a 42% (95% CI 17%-59%) reduction in PCI patients. CONCLUSIONS In contemporary practice, VCDs offer reduced risk of vascular complications as compared with manual compression in appropriately selected patients undergoing diagnostic and therapeutic cardiac catheterizations.
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Affiliation(s)
- Nipun Arora
- Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
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Resnic FS, Arora N, Matheny M, Reynolds MR. A cost-minimization analysis of the angio-seal vascular closure device following percutaneous coronary intervention. Am J Cardiol 2007; 99:766-70. [PMID: 17350361 PMCID: PMC1864959 DOI: 10.1016/j.amjcard.2006.10.032] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2006] [Revised: 10/30/2006] [Accepted: 10/30/2006] [Indexed: 10/23/2022]
Abstract
The Angio-Seal vascular closure device has been shown to be safe and effective in decreasing the time to hemostasis after percutaneous coronary intervention (PCI). The health economic implications of routinely using Angio-Seal after PCI have not been explored. We performed a cost-minimization analysis comparing routine Angio-Seal use after PCI with mechanical compression using a decision analytic model. The relative probabilities of 7 vascular access complications were derived from pooled analysis of published randomized trials. The incremental hospital cost of each vascular complication was estimated by a matched case-control analysis of 3,943 patients who underwent PCI at our center from January 2002 and December 2004. Appropriate sensitivity and uncertainty analyses were performed. After accounting for differences in expected rates of specific complications between the 2 strategies and the incremental costs of each vascular event, the routine use of Angio-Seal was associated with a lower cost per PCI procedure of 44 dollars. Probabilistic sensitivity analysis of all model assumptions using second-order Monte Carlo simulation confirmed the economic advantage of Angio-Seal in 74% of model replications. In conclusion, after PCI, the routine use of Angio-Seal for femoral vascular access management was associated with net cost savings compared with mechanical compression. This cost savings was in addition to the previously demonstrated advantages of Angio-Seal in terms of patient comfort and preference.
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Affiliation(s)
- Frederic S Resnic
- Cardiovascular Division, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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34
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Martin JL, Pratsos A, Magargee E, Mayhew K, Pensyl C, Nunn M, Day F, Shapiro T. A randomized trial comparing compression, perclose proglide™ and Angio-Seal VIP™ for arterial closure following percutaneous coronary intervention: The cap trial. Catheter Cardiovasc Interv 2007; 71:1-5. [DOI: 10.1002/ccd.21333] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Abstract
Vascular closure devices have demonstrated their ability to reduce hemostasis and ambulation times, as well as improve patient comfort, without increasing vascular complications in their initial industry-sponsored, randomized clinical trials. However, in the early years of first-generation closure devices, there was an initial concern about the risk of higher complication rates. As devices have improved, it appears that there may now be a trend towards reduced vascular complications compared with manual compression, especially in patients undergoing percutaneous coronary interventions.
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Affiliation(s)
- Timothy A Sanborn
- Northwestern University, Feinberg School of Medicine, Division of Cardiology, Evanston Northwestern Healthcare, 2650 Ridge Avenue, Evanston, IL 60201, USA
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Kim HY, Choo SW, Roh HG, Han H, Kim SS, Lee JY, Park YR, Lee SH, Shin SW, Park KB, Do YS, Cho SK, Lee IH, Kim SM, Byun HS, Jeon P. Efficacy of femoral vascular closure devices in patients treated with anticoagulant, abciximab or thrombolytics during percutaneous endovascular procedures. Korean J Radiol 2006; 7:35-40. [PMID: 16549954 PMCID: PMC2667575 DOI: 10.3348/kjr.2006.7.1.35] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE This study assessed the outcomes of using vascular closure devices following percutaneous transfemoral endovascular procedures in the patients who were treated with heparin, abciximab or thrombolytics (urokinase or t-PA) during the procedures. MATERIALS AND METHODS From March 28, 2003 to August 31, 2004, we conducted a prospective and randomized study in which 1,676 cases of 1,180 patients were treated with one of the two different closure devices (the collagen plug device was Angio-Seal; the suture-mediated closure device was The Closer S) at the femoral access site after instituting percutaneous endovascular procedures. Among the 1,676 cases, 108 cases (the drug group) were treated with heparin only (n = 94), thrombolytics only (n = 10), heparin and thrombolytics (n = 3), or abciximab and thrombolytics (n = 1) during the procedures; 1,568 cases (the no-drug group) were treated without any medication. We compared the efficacy and complications between the two groups. Of the drug group, 42 cases underwent arterial closures with the collagen plug devices and 66 cases underwent arterial closures with the suture-mediated closure devices. We also compared the efficacy and complications between these two groups. RESULTS The immediate hemostasis rates were 92.9% (1,456/1,568) in the no-drug group and 91.7% (99/108) in the drug group. Early complications occurred in four cases of the drug group. These included two episodes of rebleeding with using the Closer S, which required manual compression for at least 10 minutes, and two episodes of minor oozing with using one Angio-Seal and one Closer S, which required two hours of additional bed rest. There was no late complication. So, the total success rates were 90.8% (1,423/1,568) in the no-drug group and 88.0% (95/108) in the drug group. These results were not significantly different between the two groups (p = 0.34). In the drug group, the difference of the successful hemostasis rate between the collagen plug devices and the suture-mediated devices was also not statistically significant (92.9% vs. 84.8%, respectively; p = 0.21). CONCLUSION Arterial closure of the femoral access site with using vascular closure devices is both safe and effective, even in the patients who received heparin, abciximab or thrombolytics.
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Affiliation(s)
- Ha Young Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Korea
| | - Sung Wook Choo
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Korea
| | - Hong Gee Roh
- Department of Radiology, Konkuk University Hospital, Konkuk University School of Medicine, Seoul 143-914, Korea
| | - Heon Han
- Department of Radiology, Kangwon National University Hospital, Kangwon National University College of Medicine, Chunchon 200-701, Kangwondo, Korea
| | - Sam Soo Kim
- Department of Radiology, Kangwon National University Hospital, Kangwon National University College of Medicine, Chunchon 200-701, Kangwondo, Korea
| | - Ji Yeon Lee
- Department of Radiology, Kangwon National University Hospital, Kangwon National University College of Medicine, Chunchon 200-701, Kangwondo, Korea
| | - Yul Ri Park
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Korea
| | - Sung Hoon Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Korea
| | - Sung Wook Shin
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Korea
| | - Kwang Bo Park
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Korea
| | - Young Soo Do
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Korea
| | - Sung Ki Cho
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Korea
| | - In Ho Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Korea
| | - Sung Mok Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Korea
| | - Hong Sik Byun
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Korea
| | - Pyoung Jeon
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Korea
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37
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Abstract
This article summarizes the vascular closure device technologies that are available to physicians who perform percutaneous catheter-based procedures.
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Affiliation(s)
- Michael C Kim
- Cardiac Catheterization Laboratory, The Mount Sinai School of Medicine, 5 East 98th Street, 3rd Floor, New York, NY 10029, USA.
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38
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Germing A, Grewe P, Mügge A, Lindstaedt M. Large femoral aneurysm as a late complication after vessel closure device application. Clin Res Cardiol 2006; 95:334-7. [PMID: 16598390 DOI: 10.1007/s00392-006-0381-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2005] [Accepted: 02/21/2006] [Indexed: 11/30/2022]
Abstract
Four months after a diagnostic coronary angiography followed by application of a vascular closure device, a female patient presented with an acute femoral pulsing tumor with strong pain in the groin area. There was no prior trauma. Color duplex sonography showed a large pseudoaneurysm of the right femoral artery. In addition, signs of an old hematoma were documented. Due to the large tumor affecting the arterial perfusion of distal arteries, the pseudoaneurysm was treated immediately by thrombin injection. After this procedure, arterial perfusion in the tumor was not detectable anymore and local symptoms decreased rapidly. This is a rare case of late pseudoaneurysm after femoral artery puncture.
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Affiliation(s)
- Alfried Germing
- Medizinische Klinik II, Kardiologie und Angiologie, Berufsgenossenschaftliche Kliniken, Bergmannsheil, Ruhr-Universität Bochum, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Germany.
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Wille J, Vos JA, Overtoom TTC, Suttorp MJ, van de Pavoordt EDWM, de Vries JPPM. Acute Leg Ischemia: The Dark Side of a Percutaneous Femoral Artery Closure Device. Ann Vasc Surg 2006; 20:278-81. [PMID: 16550481 DOI: 10.1007/s10016-006-9005-3] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2005] [Revised: 02/12/2005] [Accepted: 01/24/2006] [Indexed: 10/24/2022]
Abstract
The use of femoral artery closure devices to obtain hemostasis after percutaneous catheterization has become widespread because of their proven feasibility in combination with patient-related advantages. Since 2002 more than 6,500 patients have undergone either diagnostic angiography or therapeutic intervention via the femoral route with an Angioseal closure device in our hospital. We were faced with six cases of limb-threatening complications, which are described here. Most (5/6) complications were of obstructive origin due to traumatic dissection or occlusion of the artery mainly caused by malpositioning of the device. Recommendations are made in order to prevent or successfully overcome this certainly increasing problem in the vascular field.
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Affiliation(s)
- Jan Wille
- Department of Vascular Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
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Applegate RJ, Sacrinty M, Kutcher MA, Gandhi SK, Baki TT, Santos RM, Little WC. Vascular Complications with Newer Generations of Angioseal Vascular Closure Devices. J Interv Cardiol 2006; 19:67-74. [PMID: 16483343 DOI: 10.1111/j.1540-8183.2006.00107.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES To evaluate the safety and efficacy of newer generations of a single vascular closure device (VCD), Angioseal, compared to contemporaneous manual compression. BACKGROUND Previous assessment of VCD safety and efficacy has been based primarily on outcomes associated with the original VCD. Few data exist comparing safety and efficacy of modifications of the original VCDs. METHODS We evaluated in-hospital outcomes of patients undergoing diagnostic cath and percutaneous coronary intervention at a single center: 3,898 with manual compression and 3,898 with the Angioseal VCD. Three generations of the Angioseal device were studied: Generation 1, 7/97-4/00; Generation 2, 5/00-6/02; and Generation 3, 7/02-12/03. Propensity analysis was used to match patients within each generation for clinical and procedural covariates. RESULTS Closure success was 98.5% for Generation 1, 98.6% for Generation 2, and 98.1% for Generation 3, P = NS. The odds ratio for any vascular complication comparing Angioseal to manual compression was 0.92 (0.42-2.01) for Generation 1; 0.83 (0.49-1.41) for Generation 2; and 0.75 (0.32-1.77) for Generation 3. Multivariate logistic regression identified closure success and Angioseal device Generation 3 versus Generation 1 as predictive of reduced vascular complications during the entire study period. CONCLUSION These data indicate that the newest generation of the Angioseal VCD is at least as effective as the original device. Moreover, use of the Angioseal VCD was associated with vascular complications similar to or lower than vascular complications following manual compression for each generation of Angioseal device analyzed.
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Affiliation(s)
- Robert J Applegate
- Section of Cardiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157-1045, USA.
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Applegate RJ, Sacrinty MT, Kutcher MA, Baki TT, Gandhi SK, Santos RM, Little WC. Propensity score analysis of vascular complications after diagnostic cardiac catheterization and percutaneous coronary intervention 1998–2003. Catheter Cardiovasc Interv 2006; 67:556-62. [PMID: 16532497 DOI: 10.1002/ccd.20677] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To evaluate the adjusted risk of vascular complications after manual compression and vascular closure devices for femoral artery access site management in a large contemporary cohort, using propensity score analysis. BACKGROUND Vascular closure devices (VCD) allow early ambulation after cardiac procedures involving femoral artery access, but whether the benefit of use of vascular closure devices (VCD) is offset by reduced safety in contemporary practice remains uncertain. METHODS Twenty one thousand eight hundred and forty one consecutive diagnostic cardiac catheterization (n = 13,124) and percutaneous coronary intervention procedures (n = 8,717) performed via a femoral access at a single site (WFUBMC) between 1998 and 2003 were evaluated. VCD's were used based on operator preference. Propensity to receive a vascular closure device (VCD) was calculated. The relative incidence of vascular complications was evaluated by logistic regression models, using the propensity score as a covariate. RESULTS Overall, the unadjusted incidence of any vascular complication was 1.3% for VCD use and 1.4% for manual compression, p = NS. The propensity score-adjusted odds ratio for any vascular complication comparing VCD (n = 8,707) to manual compression (n = 13,034) was 0.86 (0.67-1.11) for all procedures, 0.80 (0.53-1.21) for diagnostic procedure, and 0.90 (0.65-1.26) for interventional procedures. CONCLUSIONS In this large single-center, contemporary observational study, the risk-adjusted occurrence of vascular complications following VCD use for femoral artery access management is not increased by VCD use. Thus, in the current era, the benefit of VCD use is not offset by reduced safety.
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Affiliation(s)
- Robert J Applegate
- Section of Cardiology, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157-1045, USA.
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Pierot L, Herbreteau D, Bracard S, Berge J, Cognard C. An evaluation of immediate sheath removal and use of the Angio-Seal vascular closure device in neuroradiological interventions. Neuroradiology 2005; 48:45-9. [PMID: 16261336 DOI: 10.1007/s00234-005-0013-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2005] [Accepted: 06/06/2005] [Indexed: 10/25/2022]
Abstract
We set out to assess the effect of using an arteriotomy closure device in patients at high risk of access site complications. One-hundred nineteen patients with femoral artery access were prospectively included in five centers in France (56 males, 63 females, age range 20-84 years). The neurointerventional procedures were embolization of intracranial aneurysm (71.4%), carotid angioplasty (11.8%), cerebral angioplasty (1.7%), thrombolysis (0.8%), and other procedures (14.3%). Sheaths were removed and the closure device deployed immediately postprocedure. One patient developed a false aneurysm, and one developed a small hematoma. Neither required treatment. Postdevice deployment bleeding was experienced in three patients (2.5%), requiring minimal management. There were no major complications. Three patients died of causes unrelated to the vessel closure. Patient comfort was 2.2 on a scale of 1 (none) to 10 (severe). The results showed that immediate sheath removal followed by use of the closure device is safe in patients undergoing neurointerventional procedures and offers a low level of patient discomfort. In selected patients, early hospital discharge was possible.
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Affiliation(s)
- L Pierot
- Department of Radiology, Hôpital Maison Blanche, Reims, France
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Ruygrok PN, Ormiston JA, Stewart JT, Webster MWI, El Jack S, Simpson-Plaumann S, Kay IP, Chou TM. Initial experience with a new femoral artery closure device following percutaneous coronary intervention with glycoprotein IIb/IIIa inhibition. Catheter Cardiovasc Interv 2005; 66:185-91. [PMID: 16152652 DOI: 10.1002/ccd.20484] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The aim of the study was to determine the safety and efficacy of a novel femoral artery closure device (StarClose, Abbott Vascular Devices, Redwood City, CA) following percutaneous coronary intervention employing aspirin, heparin, and glycoprotein (GP) IIb/IIIa inhibition. A prospective nonrandomized single-center pilot study of the StarClose device included a subset of patients undergoing percutaneous coronary intervention utilizing GP IIb/IIIa inhibitors. Those that fulfilled the inclusion criteria (age < 80, no periprocedural haematoma, puncture above the superficial femoral and profunda femoralis artery bifurcation, no significant femoral artery disease) underwent closure of the femoral artery puncture site with a StarClose device immediately on completion of the procedure. Time to hemostasis (TTH), bleeding, mobilization, and short-term clinical follow-up data were collected, and an ultrasound scan of the femoral artery was performed 2 weeks later. Twenty-five patients were recruited, of whom 23 underwent percutaneous coronary intervention (PCI). Their mean age was 58 +/- 12 years, 84% were male, and 63% had unstable angina. All were on aspirin 100-150 mg daily and all PCI patients received i.v. heparin 4-10,000 units at commencement of the procedure and clopidogrel 600 mg on completion. Two patients were on a tirofiban infusion and 23 received a double bolus of eptifibatide, each 0.18 mg/kg, separated by 10 min. The procedural success was 100% and device success 23/25 (92%), with 1 failure due to technical error. The median device delivery time was 36 sec (range, 11-178) and median TTH 37 sec (range, 10-509 sec). There were no major adverse events. In 10 patients, a moderate amount of tract ooze required a short period of adjunctive manual compression. Follow-up ultrasound femoral artery scans revealed no compromise of the vessel lumen. Femoral artery closure with the device following coronary angiography and intervention using glycoprotein IIb/IIIa receptor inhibitors is safe and effective. A randomized trial of a larger number of patients is warranted.
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Affiliation(s)
- Peter N Ruygrok
- Catheterization Laboratory, Auckland City Hospital, Auckland, New Zealand.
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Germing A, Lindstaedt M, Ulrich S, Bojara W, Lawo T, Mügge A, Grewe P. Access-site complications after rescue percutaneous coronary intervention during thrombolysis for acute myocardial infarction. ACTA ACUST UNITED AC 2005; 94:23-7. [PMID: 15668826 DOI: 10.1007/s00392-005-0162-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2004] [Accepted: 08/11/2004] [Indexed: 11/27/2022]
Abstract
Aggressive antithrombotic medical therapy may increase the rate of access-site complications after percutaneous coronary intervention. Frequently, emergency coronary interventions have to be performed in a situation when thrombolysis therapy was administered as the first-line therapeutic approach in acute myocardial infarction but failed to achieve stable conditions. We analyzed the rate of femoral bleeding complications after emergency coronary intervention in 76 consecutive patients with unsuccessful thrombolysis in acute myocardial infarction. All invasive procedures were performed in a time period no longer than eight hours after thrombolysis was administered. Additional antithrombotic therapy with heparin and glycoprotein IIb/IIIa-inhibitors was given during intervention in 100% and 38.2% of patients, respectively. In three patients (3.9%) femoral hematomas without therapeutic consequences were documented; one patient (1.3%) developed a hematoma requiring blood transfusion. A pseudoaneurysm, fistula or surgical vascular intervention did not occur. Coronary interventional procedures in rescue situations can be performed with excellent safety with respect to access-site bleeding complications even under conditions of ongoing thrombolysis therapy and aggressive antithrombotic medical regimens.
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Affiliation(s)
- A Germing
- Medizinische Klinik II, Kardiologie und Angiologie, Berufsgenossenschaftliche Kliniken Bergmannsheil, Ruhr-Universität Bochum, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany.
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Gutierrez MJ, Aggarwal A, Gilbert K, Sobel BE, Dauerman HL. Bleeding Complications After Contemporary Pharmacoinvasive Therapy for ST Elevation Myocardial Infarction. J Thromb Thrombolysis 2004; 18:187-92. [PMID: 15815880 DOI: 10.1007/s11239-005-0344-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Pharmacoinvasive therapy for the treatment of ST elevation myocardial infarction (STEMI) is a strategy that combines early restoration of coronary flow via pharmacologically induced thrombolysis with subsequent, prompt percutaneous coronary intervention (PCI). Prior studies suggesting a heightened bleeding risk of PCI performed early after fibrinolysis predated contemporary pharmacoinvasive practice including use of femoral closure devices (CD), fibrin specific thrombolytics, lower doses of heparin and stents. METHODS Consecutive patients were included in this retrospective registry study if they underwent emergent PCI for ST elevation myocardial infarction (STEMI) followed by immediate use of a groin closure device. Between Oct 1, 2002 and Jan 1, 2003, 27 patients were treated with immediate use of CD after post-thrombolytic PCI, performed within 12 hours of thrombolysis (pharmacoinvasive group). 58 patients were treated with immediate use of CD after primary PCI for STEMI. The two groups were compared with respect to the incidence of successful groin closure, bleeding complications, and clinical outcomes. Bleeding events were categorized according to the TIMI criteria. All baseline clinical and treatment variables were compared between the two groups to determine and the association of these variables (including use of thromblytic therapy) with TIMI major and TIMI minor bleeding was determined. RESULTS Pharmacoinvasive recanalization with PCI occurred 348 +/- 183 minutes after initiation of fibrinolytic therapy. Glycoprotein IIb/IIIa inhibitors were used less frequently in the patients treated with a thrombolytic agent (59% vs. 90%, p < 0.01). Successful immediate hemostasis was obtained with CD in greater than 85% of patients in both groups (89% for pharmacoinvasive group vs. 86% for primary PCI group, p = 0.89). No patient required vascular surgical intervention. TIMI major bleeding and transfusion requirements were less than 5% in both groups. Antecedent thrombolytic therapy was not a predictor of bleeding complications after PCI. CONCLUSIONS Use of CD as part of a contemporary pharmacoinvasive strategy is associated with a low rate of major bleeding complications.
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Cox N, Resnic FS, Popma JJ, Simon DI, Eisenhauer AC, Rogers C. Comparison of the risk of vascular complications associated with femoral and radial access coronary catheterization procedures in obese versus nonobese patients. Am J Cardiol 2004; 94:1174-7. [PMID: 15518615 DOI: 10.1016/j.amjcard.2004.07.088] [Citation(s) in RCA: 96] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2004] [Revised: 07/09/2004] [Accepted: 07/09/2004] [Indexed: 11/25/2022]
Abstract
In this retrospective review of 5,234 cardiac catheterizations and percutaneous coronary interventions, the rate of vascular complications was highest in extremely thin and morbidly obese patients and lowest in moderately obese patients, consistent with the previously reported "obesity paradox." The use of transradial access and arterial access closure devices was associated with reduced vascular complications in the population of obese patients.
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Affiliation(s)
- Nicholas Cox
- Cardiovascular Division (Cardiac Catheterization Laboratory), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA
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Abstract
The use of arterial closure devices offers significant benefits over manual compression in achieving groin hemostasis following catheter-based procedures. Several currently available devices provide rapid puncture site closure with complication rates similar to that of manual compression. Closure devices allow for early times to ambulation and hospital discharge, and have a high degree of patient satisfaction. Their use may be of particular benefit inpatients that are anticoagulated. We believe that their use should be strongly considered in all patients following femoral artery catheterization.
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Affiliation(s)
- Steven G Katz
- Keck-USC School of Medicine, 1975 Zonal Ave., Los Angeles, CA 90033, USA.
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Abstract
BACKGROUND As vascular surgeons perform increasing numbers of percutaneous catheter-based procedures, they will need to become familiar with varying methods of femoral artery closure. Few studies on closure devices have included significant numbers of patients with peripheral arterial disease. It is the purpose of this study to determine whether the Angioseal device (St. Jude Medical) is a satisfactory method of achieving femoral artery puncture site hemostasis in these patients. METHODS The records of all patients undergoing Angioseal closure of femoral artery puncture by a single vascular surgeon were reviewed. Indication, type of intervention, and size of the vascular sheath employed were recorded. Times to mobilization and discharge were determined. Patients were seen before discharge and 1, 4, and 12 weeks after the procedure, and at 3- month intervals thereafter. Complications including hemorrhage, pseudoaneurysm, infection, and vessel occlusion were noted. RESULTS Between February 1, 2002, and August 31, 2003, 220 Angioseal collagen plugs were deployed in 188 patients. Attempts were made to deploy Angioseal devices in 92% of patients undergoing percutaneous procedures during this time period. One hundred forty-four procedures were diagnostic and 74 procedures included 76 therapeutic interventions. One hundred forty-four 5F sheaths, 47 6F sheaths, and 29 7F sheaths were employed during the procedures. Time to mobilization and discharge was 58 +/- 19 minutes and 102 +/- 31 minutes in patients undergoing diagnostic studies, 68 +/- 22 minutes and 146 +/- 42 minutes following interventions using 6F sheaths, and 127 +/- 18 minutes and 219 +/- 37 minutes when interventions were performed using 7F sheaths. No patient developed a major hematoma or infection following the use of an Angioseal. There were 2 complications related to device deployment. One patient developed a 1.4-cm false aneurysm at the femoral artery puncture site that resolved spontaneously. A second patient required operation for vessel occlusion when an Angioseal was deployed in a markedly diseased femoral artery. These adverse events occurred early in our experience. CONCLUSIONS The Angioseal provides a secure method of achieving hemostasis following femoral artery puncture. It is easy to deploy, has a high level of patient satisfaction, and allows for early ambulation and hospital discharge. When simple guidelines are observed, the device can be safely used in the great majority of patients with peripheral vascular disease. It offers considerable advantages over the traditional method of manual compression.
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Affiliation(s)
- Alan Abando
- Department of Surgery, Division of Vascular Surgery, University of Southern California Keck School of Medicine, Huntington Memorial Hospital, Pasadena, USA
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Díaz de la Llera LS. Respuesta. Rev Esp Cardiol (Engl Ed) 2004. [DOI: 10.1016/s0300-8932(04)77273-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Sanborn TA, Ogilby JD, Ritter JM, Stone GW, Klugherz BD, Fields RH, White CC, Wilensky RL. Reduced vascular complications after percutaneous coronary interventions with a nonmechanical suture device: Results from the randomized RACE study†. Catheter Cardiovasc Interv 2004; 61:327-32. [PMID: 14988890 DOI: 10.1002/ccd.10774] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The objective of this study was to evaluate the safety and efficacy of a novel nonmechanical percutaneous suture device, X-Press, after diagnostic catheterization and percutaneous coronary interventions (PCIs) in the setting of glycoprotein IIb/IIIa inhibitor usage. Current percutaneous vascular suture devices remain mechanically complex and expensive and have not been shown to reduce major vascular complications. Using a 2:1 randomization scheme (2:1 ratio, device vs. compression), 393 patients undergoing diagnostic catheterization (n = 133) or PCI (n = 260) were randomized in the prospective Rapid Ambulation After Closure (RACE) study and evaluated for time to ambulation, time to hemostasis, treatment success, and incidence of major vascular complications. Glycoprotein IIb/IIIa inhibitors were used in 52% of PCI patients. There was a significant reduction in the primary efficacy endpoint of median time to ambulation for device compared to control with both diagnostic (2.2 vs. 6.2 hr; P = 0.0001) and PCI patients (4.1 vs. 14.7 hr; P = 0.0001). Device malfunction occurred in 3.1% patients without clinical sequalae. Equivalence in the primary safety endpoint, the incidence of major complications (vascular repair, ultrasound-guided compression, transfusion, or infection) at 14 days, was observed with the X-Press device (1/261; 0.4%) compared to control (3/132; 2.3%; P = 0.11). In PCI patients, half of whom received glycoprotein IIb/IIIa inhibitors, there was a significant reduction in the incidence of vascular complications in patients using the device (0/172; 0%) compared to control (3/88; 3.4%; P = 0.037). In diagnostic catheterization and PCI, a novel nonmechanical suture device reduced the time to ambulation and demonstrated equivalence in major complications compared to conventional compression techniques. The incidence of major complications after PCI was reduced with the device.
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