1
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Fan R, Yang Z, Wang R, Liu H, Feng C, Wu F, Fan M. Hemostasis after transradial coronary intervention by rotary compression device with sterile gauze is associated with more adverse events: a retrospective study. Coron Artery Dis 2024; 35:14-22. [PMID: 38085858 DOI: 10.1097/mca.0000000000001303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
OBJECTIVE We investigated the relationship between using a rotary compression device (RCD) with or without sterile gauze and adverse events in transradial access (TRA) for coronary intervention. METHODS In this study involving 933 patients at Yueyang Hospital, we recorded TRA-related adverse events, such as bleeding, forearm hematoma, swollen palms, radial artery occlusion (RAO) and others. Logistic regression was applied to assess the association. RESULTS Of the 933 patients (66.7% males, average age 67.8 years), 511 used RCD with sterile gauze, whereas 422 used RCD without sterile gauze. The most common adverse events were radial artery hemorrhage (7.4%), hand swelling (4.8%) and RAO (4.6%). Logistic regression analysis revealed that the use of RCD with sterile gauze was associated with a higher prevalence of adverse events [odds ratio (OR), 1.74; 95% confidence interval (CI), 1.22-2.49), even with the adjustment of potential confounders (OR, 1.71; 95% CI, 1.19-2.45). Moreover, patients who used RCD with sterile gauze exhibited an increased risk of radial artery hemorrhage (OR, 1.83; 95% CI, 1.07-3.12), swelling of the hand (OR, 1.96; 95% CI, 1.02-3.75) and RAO (OR, 3.17; 95% CI, 1.49-6.72). CONCLUSIONS The use of RCD with sterile gauze in TRA is associated with a higher incidence of adverse events.
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Affiliation(s)
- Rong Fan
- Department of Cardiology, Yueyang Hospital Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine
| | - Zixuan Yang
- Department of Cardiology, Yueyang Hospital Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine
| | - Ruiping Wang
- Clinical Research Center, Shanghai Skin Diseases Hospital, Tongji University, Shanghai, China
| | - Haoqi Liu
- Department of Cardiology, Yueyang Hospital Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine
| | - Can Feng
- Department of Cardiology, Yueyang Hospital Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine
| | - Feng Wu
- Department of Cardiology, Yueyang Hospital Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine
| | - Min Fan
- Department of Cardiology, Yueyang Hospital Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine
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2
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Alonso AG, Kobzeva-Herzog A, Siracuse JJ. Alternative access for peripheral vascular interventions. J Vasc Surg Cases Innov Tech 2023; 9:101232. [PMID: 37408940 PMCID: PMC10319322 DOI: 10.1016/j.jvscit.2023.101232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 05/11/2023] [Indexed: 07/07/2023] Open
Abstract
Percutaneous endovascular interventions for advanced lower extremity peripheral arterial disease are becoming increasingly used, often as first-line treatment of chronic limb threatening ischemia. Advancements in endovascular techniques have provided safe and effective alternative revascularization options, especially for high-risk surgical patients. Although the classic transfemoral approach results in high technical success and patency rates, an estimated 20% of lesions remain challenging to access via an antegrade approach. As such, alternative access sites are important in the endovascular armamentarium for the management of chronic limb threatening ischemia. The goal of this review is to discuss alternative access sites, specifically the transradial, transpopliteal, and transpedal approaches, in addition to transbrachial and transaxillary access, and their outcomes in peripheral arterial disease and limb salvage.
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Affiliation(s)
| | | | - Jeffrey J. Siracuse
- Correspondence: Jeffrey J. Siracuse, MD, MBA, Department of Surgery, Boston University Chobanian and Avedisian School of Medicine, 85 E Concord St, Boston, MA 02118
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3
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E T, K G, P S, Afrin SA. Emerging Perspectives of Anatomical snuff box in Invasive Cardiology. J Geriatr Cardiol 2023; 20:238-241. [PMID: 37091263 PMCID: PMC10114194 DOI: 10.26599/1671-5411.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023] Open
Affiliation(s)
- Thirumurugan E
- Allied Health Science, DR MGR Educational and Research Institute, ACS Medical College, Chennai, Tamil Nadu, India
| | - Gomathi K
- Allied Health Science, DR MGR Educational and Research Institute, ACS Medical College, Chennai, Tamil Nadu, India
| | - Swathy P
- Allied Health Science, DR MGR Educational and Research Institute, ACS Medical College, Chennai, Tamil Nadu, India
| | - Syed Ali Afrin
- Allied Health Science, DR MGR Educational and Research Institute, ACS Medical College, Chennai, Tamil Nadu, India
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4
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Complications of catheter ablation for ventricular tachycardia. JOURNAL OF INTERVENTIONAL CARDIAC ELECTROPHYSIOLOGY : AN INTERNATIONAL JOURNAL OF ARRHYTHMIAS AND PACING 2023; 66:221-233. [PMID: 36053374 DOI: 10.1007/s10840-022-01357-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 08/20/2022] [Indexed: 11/09/2022]
Abstract
With the increasing literature demonstrating benefits of catheter ablation for ventricular tachycardia (VT), the number of patients undergoing VT ablation has increased dramatically. As VT ablation is being performed more routinely, operators must be aware of potential complications of VT ablation. This review delves deeper into the practice of VT ablation with a focus on periprocedural complications.
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5
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Hendrix P, Melamed I, Weiner GM, Goren O, Griessenauer CJ, Schirmer CM. Transradial Versus Transfemoral Intraoperative Cerebral Angiography for Open Cerebrovascular Surgery: Effectiveness, Safety, and Learning Curve. Oper Neurosurg (Hagerstown) 2022; 24:476-482. [PMID: 36701679 DOI: 10.1227/ons.0000000000000567] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 10/04/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Intraoperative cerebral angiography (IOA) is a valuable adjunct in open and hybrid cerebrovascular surgery. Commonly, transfemoral access (TFA) is used. Lately, transradial access (TRA) has gained popularity for neurointervention. However, the TRA has not yet been compared with the TFA for IOA. OBJECTIVE To compare the effectiveness and safety of the TRA and TFA for IOA. In addition, the learning curve for implementing the TRA for IOA was evaluated. METHODS Between July 2020 and 2022, 92/1787 diagnostic cerebral angiographies met inclusion criteria for IOA. Sheath run time to primary target vessel run time (STT), amount of contrast dye (CD), fluoroscopy time (FT), and dose-area products (DAPs) were compared between TRA and TFA, different aortic arch types, and both study years. RESULTS One case required transitioning from TRA to TFA (1/26, 3.8%) because of a minute proximal radial vasculature. The STT, CD, FT, and DAP were similar for the TRA (n = 25) and the TFA groups (n = 67) (p = ns). One groin hematoma (1.5%) was observed in the TFA group. No other complications or any change in modified Rankin Scale were observed. Aortic arch type II/III was associated with longer STT ( P = .032) but not CD, FT, or DAP. There was a nonsignificant decline of STTs among the TRA cases ( P = .104) but stable STTs among TFA cases ( P = .775). CONCLUSION The TRA and TFA represent equally effective and safe routes for IOA. In addition, expertise with the TRA can rapidly be gained and facilitates tailoring the access for IOA to patient's individual anatomy and surgeon's needs.
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Affiliation(s)
- Philipp Hendrix
- Department of Neurosurgery, Geisinger, Wilkes-Barre, Pennsylvania, USA.,Department of Neurosurgery, Geisinger, Danville, Pennsylvania, USA.,Department of Neurosurgery, Saarland University Medical Center, Homburg, Germany
| | - Itay Melamed
- Department of Neurosurgery, Geisinger, Wilkes-Barre, Pennsylvania, USA
| | - Gregory M Weiner
- Department of Neurosurgery, Geisinger, Wilkes-Barre, Pennsylvania, USA
| | - Oded Goren
- Department of Neurosurgery, Geisinger, Danville, Pennsylvania, USA
| | - Christoph J Griessenauer
- Department of Neurosurgery, Geisinger, Danville, Pennsylvania, USA.,Department of Neurosurgery, Christian Doppler University Hospital, Paracelsus Medical University, Salzburg, Austria
| | - Clemens M Schirmer
- Department of Neurosurgery, Geisinger, Wilkes-Barre, Pennsylvania, USA.,Department of Neurosurgery, Geisinger, Danville, Pennsylvania, USA
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6
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Di Mario C, Mashayekhi KA, Garbo R, Pyxaras SA, Ciardetti N, Werner GS. Recanalisation of coronary chronic total occlusions. EUROINTERVENTION 2022; 18:535-561. [PMID: 36134683 DOI: 10.4244/eij-d-21-01117] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Percutaneous treatment of coronary chronic total occlusions (CTO) has advanced greatly since its advent in the late 1970s through the development of dedicated wires and microcatheters, the improved skills of highly experienced operators and the adoption of new sophisticated strategies to guide procedural planning. The contemporary procedural success rate is 80-90% with a reduction in complications. Although there has been no improvement in prognosis in randomised trials to date, they, and other controlled registries of thousands of patients, confirm the pivotal role of CTO recanalisation in the treatment of angina and dyspnoea and an improvement in quality of life. Despite this evidence, CTO recanalisation is grossly underutilised. This review reports a detailed overview of the history, indications and treatment strategies for CTO recanalisation and hopes to increase interest among new, and especially young, operators in this demanding, rapidly evolving field of interventional cardiology.
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Affiliation(s)
- Carlo Di Mario
- Structural Interventional Cardiology Division, Department of Clinical & Experimental Medicine, Careggi University Hospital, Florence, Italy
| | - Kambis A Mashayekhi
- Division of Cardiology and Angiology II, University Heart Center Freiburg - Bad Krozingen, Bad Krozingen, Germany
| | - Roberto Garbo
- GVM Care & Research, Maria Pia Hospital, Turin, Italy
| | | | - Niccolò Ciardetti
- Structural Interventional Cardiology Division, Department of Clinical & Experimental Medicine, Careggi University Hospital, Florence, Italy
| | - Gerald S Werner
- Department of Cardiology, Klinikum Darmstadt GmbH, Darmstadt, Germany
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7
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Alan B, Alan S. Evaluation of carotid artery stiffness in patients with coronary artery disease using acoustic radiation force impulse elastography. Vascular 2022; 31:564-572. [PMID: 35226579 DOI: 10.1177/17085381221076679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES We evaluated carotid artery stiffness in patients with coronary artery disease (CAD) using acoustic radiation force impulse (ARFI) elastography and investigated the relationship between stiffness and CAD. METHODS This study examined 76 CAD patients (aged 60.7 ± 11) and 70 healthy individuals (aged 59.6 ± 9). The left common carotid artery mean shear wave velocity (LCmeanSWV) and the right common carotid artery mean shear wave velocity (RCmeanSWV) of the anterior walls were measured using ARFI elastography, and the results of the patient group and the healthy group were compared. The common carotid intima-media thickness (CIMT) was measured in both groups and compared with mean SWV. RESULTS The RCmeanSWVs in the patient and healthy groups were 3.47 ± 1 m/s and 2.69 ± 0.90 m/s, respectively (p < 0.001). The LCmeanSWVs in the patient and healthy groups were 3.60 ± 0.9 m/s and 2.90 ± 0.80 m/s, respectively (p < 0.001). A significant correlation was found between the RCmeanSWV and the right CIMT values and between the LCmeanSWV and the left CIMT values (r = 0.231, p = 0.03 and r = 0.331, p = 0.002, respectively). CONCLUSIONS The mean SWV values of carotid arteries of CAD patients measured with ARFI elastography were significantly higher than the mean SWV values of the carotid arteries of healthy individuals. Thus, measurement of the carotid artery SWV could be a potential tool in the risk evaluation of cardiovascular disease. Nonetheless, new studies are required to determine whether this method serves as a useful additional tool.
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Affiliation(s)
- Bircan Alan
- Department of Radiology, 52942Bolu Abant İzzet Baysal University Medical Faculty, Bolu, Turkey
| | - Sait Alan
- Department of Cardiology, 52942Bolu Abant İzzet Baysal University Medical Faculty, Bolu, Turkey
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8
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Capodanno D, Bhatt DL, Gibson CM, James S, Kimura T, Mehran R, Rao SV, Steg PG, Urban P, Valgimigli M, Windecker S, Angiolillo DJ. Bleeding avoidance strategies in percutaneous coronary intervention. Nat Rev Cardiol 2022; 19:117-132. [PMID: 34426673 DOI: 10.1038/s41569-021-00598-1] [Citation(s) in RCA: 68] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/05/2021] [Indexed: 02/08/2023]
Abstract
For many years, bleeding has been perceived as an unavoidable consequence of strategies aimed at reducing thrombotic complications in patients undergoing percutaneous coronary intervention (PCI). However, the paradigm has now shifted towards bleeding being recognized as a prognostically unfavourable event to the same extent as having a new or recurrent ischaemic or thrombotic complication. As such, in parallel with progress in device and drug development for PCI, there is clinical interest in developing strategies that maximize not only the efficacy but also the safety (for example, by minimizing bleeding) of any antithrombotic treatment or procedural aspect before, during or after PCI. In this Review, we discuss contemporary data and aspects of bleeding avoidance strategies in PCI, including risk stratification, timing of revascularization, pretreatment with antiplatelet agents, selection of vascular access, choice of coronary stents and antithrombotic treatment regimens.
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Affiliation(s)
- Davide Capodanno
- Division of Cardiology, Azienda Ospedaliero-Universitaria Policlinico "G. Rodolico-San Marco", University of Catania, Catania, Italy
| | - Deepak L Bhatt
- Department of Medicine, Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA, USA
| | - C Michael Gibson
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Stefan James
- Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University Hospital, Uppsala, Sweden
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Roxana Mehran
- Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sunil V Rao
- The Duke Clinical Research Institute, Durham, NC, USA
| | | | | | - Marco Valgimigli
- Cardiocentro Ticino Institute and Università della Svizzera italiana (USI), Lugano, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
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9
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Brenna CTA, Ku JC, Pasarikovski CR, Priola SM, Dyer EE, Howard P, Kumar A, da Costa L, Yang VXD. Access-site complications in ultrasound-guided endovascular thrombectomy: a single-institution retrospective cohort study. Neurosurg Focus 2021; 51:E3. [PMID: 34198250 DOI: 10.3171/2021.4.focus2198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 04/06/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Mechanical endovascular thrombectomy (EVT) is an increasingly relied-on treatment for clot retrieval in the context of ischemic strokes, which otherwise are associated with significant morbidity and mortality. Despite several known risks associated with this procedure, there is a high degree of technical heterogeneity across both centers and operators. The most common procedural complications occur at the point of transfemoral access (the common femoral artery), and include access-site hematomas, dissections, and pseudoaneurysms. Other interventional fields have previously popularized the use of ultrasound to enhance the anatomical localization of structures relevant to vascular access and thereby reducing access-site complications. In this study, the authors aimed to describe the ultrasound-guided EVT technique performed at a large, quaternary neurovascular referral center, and to characterize the effects of ultrasound guidance on access-site complications. METHODS A retrospective chart review of all patients treated with EVT at a single center between January 2013 and August 2020 was performed. Patients in this cohort were treated using a universal, unique, ultrasound-guided, single-wall puncture technique, which bears several theoretical advantages over the standard technique of arterial puncture via palpation. RESULTS There were 479 patients treated with EVT within the study period. Twenty patients in the cohort were identified as having experienced some form of access-site complication. Eight (1.67%) of these patients experienced minor access-site complications, all of which were groin hematomas and none of which were clinically significant, as defined by requiring surgical or interventional management or transfusion. The remaining 12 patients experienced arterial dissection (n = 5), arterial pseudoaneurysm (n = 4), retroperitoneal hematoma (n = 2), or arterial occlusion (n = 1), with only 1.04% (5/479) requiring surgical or interventional management or transfusion. CONCLUSIONS The authors found an overall reduction in total access-site complications as well as minor access-site complications in the study cohort compared with previously published randomized controlled trials and observational studies in the recent literature. The findings suggested that there may be a role for routine use of ultrasound-guided puncture techniques in EVT to decrease rates of complications.
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Affiliation(s)
| | - Jerry C Ku
- 2Division of Neurosurgery, Department of Surgery, University of Toronto.,3Division of Neurosurgery, Sunnybrook Health Sciences Centre, Toronto
| | - Christopher R Pasarikovski
- 2Division of Neurosurgery, Department of Surgery, University of Toronto.,3Division of Neurosurgery, Sunnybrook Health Sciences Centre, Toronto
| | - Stefano M Priola
- 4Department of Neurosurgery, Health Sciences North, Northern Ontario School of Medicine, Sudbury
| | - Erin E Dyer
- 5Division of Neurosurgery, Windsor Regional Hospital, Windsor; and
| | - Peter Howard
- 6Division of Neuroradiology, Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Ashish Kumar
- 2Division of Neurosurgery, Department of Surgery, University of Toronto.,3Division of Neurosurgery, Sunnybrook Health Sciences Centre, Toronto
| | - Leodante da Costa
- 2Division of Neurosurgery, Department of Surgery, University of Toronto.,3Division of Neurosurgery, Sunnybrook Health Sciences Centre, Toronto.,6Division of Neuroradiology, Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Victor X D Yang
- 2Division of Neurosurgery, Department of Surgery, University of Toronto.,3Division of Neurosurgery, Sunnybrook Health Sciences Centre, Toronto
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10
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Chang SW, Ma DS, Chang YR, Kim DH. Practical tips for performing resuscitative endovascular balloon occlusion of the aorta. HONG KONG J EMERG ME 2021. [DOI: 10.1177/1024907921994422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Hemorrhage is the leading cause of death in trauma settings. Non-compressible torso hemorrhage, which is caused by abdominopelvic and thoracic injuries, is an important cause of subsequent organ dysfunction and poor outcomes in multiple trauma patients. The management of hemodynamically unstable patients with non-compressible torso hemorrhage has changed, and the concept of damage control resuscitation has been developed in the last decades. Currently, resuscitative endovascular balloon occlusion of the aorta (REBOA) as a method of temporary stabilization is the modern evolution of bleeding control, and it is in the middle of a paradigm shift as a treatment for non-compressible torso hemorrhage. Despite its effectiveness in patients with hemorrhagic shock, the application of REBOA remains limited because of lack of experience and troubleshooting guidelines. Objectives: The aim of study was to provide useful tips for the implementing a step-by-step procedure for REBOA in various hospital settings and capabilities. Methods: We introduced REBOA procedures using a REBOA-customized 7 Fr balloon catheter through the animation models or radiography from preparation to access, catheter management, and device removal after procedure completed. Results: We have described REBOA procedures as follows: identification of the common femoral artery, arterial access for placement of a guidewire, precautions during a sheath insertion, guidewire and balloon positioning in the aorta, occlusion zones and adjustment of balloon location, REBOA strategy for extending the occlusion time, balloon deflation and removal, sheath removal, and medical records. Conclusion: We believe that the practical tips mentioned in this article will help in performing the REBOA procedure systematically and developing an effective REBOA framework.
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Affiliation(s)
- Sung Wook Chang
- Department of Thoracic and Cardiovascular Surgery, Trauma Center, Dankook University Hospital, Cheonan, Republic of Korea
| | - Dae Sung Ma
- Department of Thoracic and Cardiovascular Surgery, Trauma Center, Dankook University Hospital, Cheonan, Republic of Korea
| | - Ye Rim Chang
- Department of Trauma Surgery, Trauma Center, Dankook University Hospital, Cheonan, Republic of Korea
| | - Dong Hun Kim
- Department of Trauma Surgery, Trauma Center, Dankook University Hospital, Cheonan, Republic of Korea
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11
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Satish M, Sethi SS, Parikh S, Green P, Ratcliffe J. Dual alternate access sites for the treatment of an ostial left common iliac artery chronic total occlusion. SAGE Open Med Case Rep 2020; 8:2050313X20929194. [PMID: 32547765 PMCID: PMC7273553 DOI: 10.1177/2050313x20929194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Accepted: 04/30/2020] [Indexed: 11/17/2022] Open
Abstract
Growing endovascular strategies with TASC D lesions in aortoiliac disease reflect increasing technical success with evidenced safety and efficacy. In cases of failed transfemoral access, revascularization of iliac chronic total occlusions has prompted the utilization of other alternate access sites (e.g. transradial and transbrachial approaches) as important options in aortoiliac TASC D lesions. We describe a case of successful revascularization of an occluded ostial left common iliac artery in an 81-year-old man using a dual ulnar and tibioperoneal approach (absent radial artery). A Controlled Antegrade and Retrograde Tracking technique was performed where a balloon was advanced from the peroneal artery into the distal cap of the chronic total occlusion in the proximal common femoral artery. Balloon inflation was performed and a glidewire from transulnar access was advanced and re-entered into the true lumen in the common femoral artery. The wire was then snared and externalized out the transpedal access site creating a continuous true lumen from the ulnar artery to the peroneal artery. To reconstruct the aortic bifurcation, kissing balloon inflations were performed from the peroneal as well as the ulnar artery approaches. A 10 mm × 59 mm balloon expandable stent was placed in the ostial left common iliac artery and a 8 mm × 60 mm self-expanding stent was placed in the left external iliac artery successfully.
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Affiliation(s)
- Mohan Satish
- Center for Interventional Vascular Therapy, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, NY, USA
| | - Sanjum S Sethi
- Center for Interventional Vascular Therapy, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, NY, USA
| | - Sahil Parikh
- Center for Interventional Vascular Therapy, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, NY, USA
| | - Philip Green
- Center for Interventional Vascular Therapy, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, NY, USA
| | - Justin Ratcliffe
- Center for Interventional Vascular Therapy, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, NY, USA
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12
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Vincent F, Spillemaeker H, Kyheng M, Belin-Vincent C, Delhaye C, Piérache A, Denimal T, Verdier B, Debry N, Moussa M, Schurtz G, Porouchani S, Cosenza A, Juthier F, Pamart T, Richardson M, Coisne A, Hertault A, Sobocinski J, Modine T, Pontana F, Duhamel A, Labreuche J, Van Belle E. Ultrasound Guidance to Reduce Vascular and Bleeding Complications of Percutaneous Transfemoral Transcatheter Aortic Valve Replacement: A Propensity Score-Matched Comparison. J Am Heart Assoc 2020; 9:e014916. [PMID: 32172643 PMCID: PMC7335526 DOI: 10.1161/jaha.119.014916] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background Ultrasound (US) guidance provides the unique opportunity to control the puncture zone of the artery during transfemoral transcatheter aortic valve replacement and may decrease major vascular complications (VC) and life-threatening or major bleeding complications. This study aimed to evaluate the clinical impact of US guidance using a propensity score-matched comparison. Methods and Results US guidance was implemented as the default approach for all transfemoral transcatheter aortic valve replacement cases in our institution in June 2013. We defined 3 groups of consecutive patients according to the method of puncture (fluoroscopic/US guidance) and the use of a transcatheter heart valve. Patients in the US-guided second-generation group (Sapien XT [Edwards Lifesciences, Irvine, CA], Corevalve [Medtronic, Dublin, Ireland]) were successfully 1:1 matched with patients in the fluoroscope-guided second-generation group (n=95) with propensity score matching. In a second analysis we described the consecutive patients of the US-guided third-generation group (Evolut-R [Medtronic], Sapien 3 [Edwards Lifesciences], n=308). All vascular and bleeding complications were reduced in the US-guided second-generation group compared with the fluoroscope-guided second-generation group: VC (16.8% versus 6.3%; P=0.023); life-threatening or major bleeding (22.1% versus 6%; P=0.004); and VC related to vascular access (12.6% versus 4.2%; P=0.052). In the US-guided third-generation group the rates of major VC and life-threatening or major bleeding were 3.2% (95% CI, 1.6% to 5.9%) and 3.6% (95% CI, 1.8% to 6.3%). In the overall population (n=546), life-threatening or major bleeding was associated with a 1.7-fold increased mortality risk (P=0.02). Conclusions We demonstrated that US guidance effectively reduced VC and bleeding complications for transfemoral transcatheter aortic valve replacement and should be considered the standard puncture method. Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT02628509.
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Affiliation(s)
- Flavien Vincent
- Cardiology Department of Interventional Cardiology for Coronary, Valves, and Structural Heart Diseases Institut Coeur Poumon CHU Lille Lille France.,Inserm U1011 Institut Pasteur de Lille EGID Lille France.,Université de Lille France
| | - Hugues Spillemaeker
- Cardiology Department of Interventional Cardiology for Coronary, Valves, and Structural Heart Diseases Institut Coeur Poumon CHU Lille Lille France.,Inserm U1011 Institut Pasteur de Lille EGID Lille France.,Université de Lille France
| | - Maéva Kyheng
- EA 2694-Santé Publique: Épidémiologie et Qualité des Soins CHU Lille University of Lille France
| | - Cassandre Belin-Vincent
- Cardiology Department of Interventional Cardiology for Coronary, Valves, and Structural Heart Diseases Institut Coeur Poumon CHU Lille Lille France
| | - Cédric Delhaye
- Cardiology Department of Interventional Cardiology for Coronary, Valves, and Structural Heart Diseases Institut Coeur Poumon CHU Lille Lille France
| | - Adeline Piérache
- EA 2694-Santé Publique: Épidémiologie et Qualité des Soins CHU Lille University of Lille France
| | - Tom Denimal
- Cardiology Department of Interventional Cardiology for Coronary, Valves, and Structural Heart Diseases Institut Coeur Poumon CHU Lille Lille France.,Inserm U1011 Institut Pasteur de Lille EGID Lille France.,Université de Lille France
| | - Basile Verdier
- Cardiology Department of Interventional Cardiology for Coronary, Valves, and Structural Heart Diseases Institut Coeur Poumon CHU Lille Lille France.,Inserm U1011 Institut Pasteur de Lille EGID Lille France.,Université de Lille France
| | - Nicolas Debry
- Cardiology Department of Interventional Cardiology for Coronary, Valves, and Structural Heart Diseases Institut Coeur Poumon CHU Lille Lille France.,Inserm U1011 Institut Pasteur de Lille EGID Lille France.,Université de Lille France
| | - Mouhamed Moussa
- Anesthésie et Réanimation Cardio-Vasculaire CHU Lille Lille France.,Inserm U1011 Institut Pasteur de Lille EGID Lille France.,Université de Lille France
| | - Guillaume Schurtz
- Cardiology Department of Interventional Cardiology for Coronary, Valves, and Structural Heart Diseases Institut Coeur Poumon CHU Lille Lille France
| | - Sina Porouchani
- Cardiology Department of Interventional Cardiology for Coronary, Valves, and Structural Heart Diseases Institut Coeur Poumon CHU Lille Lille France
| | - Alessandro Cosenza
- Cardiology Department of Interventional Cardiology for Coronary, Valves, and Structural Heart Diseases Institut Coeur Poumon CHU Lille Lille France
| | - Francis Juthier
- Chirurgie Cardiaque CHU Lille Lille France.,Inserm U1011 Institut Pasteur de Lille EGID Lille France.,Université de Lille France
| | - Thibault Pamart
- Cardiology Department of Interventional Cardiology for Coronary, Valves, and Structural Heart Diseases Institut Coeur Poumon CHU Lille Lille France.,Inserm U1011 Institut Pasteur de Lille EGID Lille France.,Université de Lille France
| | - Marjorie Richardson
- Cardiology Department of Interventional Cardiology for Coronary, Valves, and Structural Heart Diseases Institut Coeur Poumon CHU Lille Lille France
| | - Augustin Coisne
- Cardiology Department of Interventional Cardiology for Coronary, Valves, and Structural Heart Diseases Institut Coeur Poumon CHU Lille Lille France.,Inserm U1011 Institut Pasteur de Lille EGID Lille France.,Université de Lille France
| | | | | | - Thomas Modine
- Chirurgie Cardiaque CHU Lille Lille France.,Inserm U1011 Institut Pasteur de Lille EGID Lille France.,Université de Lille France
| | | | - Alain Duhamel
- EA 2694-Santé Publique: Épidémiologie et Qualité des Soins CHU Lille University of Lille France
| | - Julien Labreuche
- EA 2694-Santé Publique: Épidémiologie et Qualité des Soins CHU Lille University of Lille France
| | - Eric Van Belle
- Cardiology Department of Interventional Cardiology for Coronary, Valves, and Structural Heart Diseases Institut Coeur Poumon CHU Lille Lille France.,Inserm U1011 Institut Pasteur de Lille EGID Lille France.,Université de Lille France
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Radial Artery Access for Percutaneous Cardiovascular Interventions: Contemporary Insights and Novel Approaches. J Clin Med 2019; 8:jcm8101727. [PMID: 31635342 PMCID: PMC6833028 DOI: 10.3390/jcm8101727] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 10/12/2019] [Indexed: 12/11/2022] Open
Abstract
Since its introduction, the transradial access for percutaneous cardiovascular procedures has been associated with several advantages as compared to transfemoral approach, and has become the default for coronary angiography and intervention. In the last 30 years, a robust amount of evidence on the transradial approach has been mounted, promoting its diffusion worldwide. This article provides a comprehensive review of radial artery access for percutaneous cardiovascular interventions, including the evidence from clinical trials of transradial vs. transfemoral approach, technical considerations, access-site complications and limitations, alternative forearm accesses (e.g., ulnar and distal radial artery), and ultimately the use of the radial approach for structural interventions.
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14
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Roberts JS, Niu J, Pastor-Cervantes JA. Comparison of Hemostasis Times with a Chitosan-Based Hemostatic Pad (Clo-SurPlus Radial™) vs Mechanical Compression (TR Band®) Following Transradial Access: A pilot Study. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 20:871-874. [DOI: 10.1016/j.carrev.2018.11.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 11/30/2018] [Indexed: 01/04/2023]
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15
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Osbun JW, Patel B, Levitt MR, Yahanda AT, Shah A, Dlouhy KM, Thatcher JP, Chicoine MR, Kim LJ, Zipfel GJ. Transradial intraoperative cerebral angiography: a multicenter case series and technical report. J Neurointerv Surg 2019; 12:170-175. [PMID: 31484699 DOI: 10.1136/neurintsurg-2019-015207] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 08/09/2019] [Accepted: 08/12/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND Use of the radial artery as an access site for neurointerventional procedures is gaining popularity after several studies in interventional cardiology have demonstrated superior patient safety, decreased length of stay, and patient preference compared with femoral artery access. The transradial approach has yet to be characterized for intraoperative cerebral angiography. OBJECTIVE To report a multicenter experience on the use of radial artery access in intraoperative cerebral angiography, including case series and discussion of technical nuances. METHODS 27 patients underwent attempted transradial cerebral angiography betweenMay 2017 and May 2019. Data were collected regarding technique, patient positioning, vessels selected, technical success rate, and access site complications. RESULTS 24 of the 27 patients (88.8%) underwent successful transradial intraoperative cerebral angiography. 18 patients (66.7%) were positioned supine, 6 patients (22.2%) were positioned prone, 1 patient (3.7%) was positioned lateral, and 2 patients (7.4%) were positioned three-quarters prone. A total of 31 vessels were selected including 13 right carotid arteries (8 common, 1 external, 4 internal), 11 left carotid arteries (9 common and 2 internal), and 6 vertebral arteries (5 right and 1 left). Two patients (7.4%) required conversion to femoral access in order to complete the intraoperative angiogram (1 due to arterial vasospasm and 1 due to inadvertent venous catheterization). One procedure (3.7%) was aborted because of inability to obtain the appropriate fluoroscopic views due to patient positioning. No patient experienced stroke, arterial dissection, or access site complication. CONCLUSIONS Transradial intraoperative cerebral angiography is safe and feasible with potential for improved operating room workflow ergonomics, faster patient mobility in the postoperative period, and reduced costs.
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Affiliation(s)
- Joshua W Osbun
- Department of Neurosurgery, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
| | - Bhuvic Patel
- Department of Neurosurgery, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
| | - Michael R Levitt
- Neurological Surgery, Radiology and Mechanical Engineering, University of Washington, Seattle, Washington, USA
| | - Alexander T Yahanda
- Department of Neurosurgery, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
| | - Amar Shah
- Department of Neurosurgery, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
| | - Kathleen M Dlouhy
- Department of Neurosurgery, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
| | - Joshua P Thatcher
- Mallinckrodt Institute of Radiology, Washington University, St Louis, Missouri, USA
| | - Michael R Chicoine
- Department of Neurosurgery, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
| | - Louis J Kim
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Gregory J Zipfel
- Department of Neurosurgery, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
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16
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Wei X, Han T, Sun Y, Sun X, Wu Y, Wang S, Zhou J, Zhao Z, Jing Z. A Retrospective Study Comparing the Effectiveness and Safety of EXOSEAL Vascular Closure Device to Manual Compression in Patients Undergoing Percutaneous Transbrachial Procedures. Ann Vasc Surg 2019; 62:310-317. [PMID: 31449959 DOI: 10.1016/j.avsg.2019.06.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 06/10/2019] [Accepted: 06/16/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND This study aimed to assess the safety and efficacy of EXOSEAL vascular closure device (EVCD) insertion by comparing its performance with manual compression (MC) in achieving hemostasis at the brachial artery puncture site. METHODS A retrospective study of brachial artery access by using either MC or EVCD for achieving hemostasis from March 2016 to October 2017 was conducted. Patients with Stanford type B aortic dissection (TBAD) undergoing percutaneous transbrachial procedures were included. Time to hemostasis (TTH) was the primary efficacy end point. Seven-day incidence of major access site-related complications was the primary safety end point. TTH and major and minor complications associated with treatment of these 2 groups were also evaluated. RESULTS A total of 157 patients with TBAD undergoing percutaneous transbrachial procedures entered the analysis. Of these, 107 patients underwent EVCD insertion and 50 patients underwent MC. The baseline characteristics of the 2 groups were similar. TTH was significantly shorter for EVCD over MC (P < 0.05). The TTH ≥10 min in the MC group was 100.0% (n = 50), but in the EVCD group, it was ≤2 min, 87.9% (n = 107); 2-5 min, 7.5% (n = 107); and ≥10 min, 4.7% (n = 107). The EVCD group had several major complications, while the MC group had none. Two patients (1.9%, n = 107) required vascular repair, one patient (0.6%, n = 107) required blood transfusion, and 1 patient (0.6%, n = 107) developed upper limb numbness and weakness after EVCD deployment. Minor complication such as the occurrence of hematoma (≤5 cm) in the MC group was 4 (8.0%) but was also 4 (3.7%) in the EVCD group, showing statistically significant difference (P = 0.030). The incidence of ecchymosis was 8 (7.5%) in the EVCD group when compared with 13 (26.0%) in the MC group, which showed statistically significant difference (P = 0.001). Other major and minor complications showed no significant differences between these 2 groups. CONCLUSIONS After invasive procedures by 6F percutaneous access via the brachial artery in preprocedurally fully anticoagulated patients, TTH was significantly reduced in patients who underwent EVCD when compared with patients who underwent MC. MC is a safer and more convenient way to achieve hemostasis but has higher incidence of minor complications.
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Affiliation(s)
- Xiaolong Wei
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Tonglei Han
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Yudong Sun
- Department of General Surgery, Nanjing General Hospital of Eastern Theater Command, Nanjing, China
| | - Xiuli Sun
- Department of ophthalmology, Jinan Aier Eye hospital, Jinan, China
| | - Yani Wu
- Department of Breast and Thyroid Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Shiying Wang
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Jian Zhou
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China.
| | - Zhiqing Zhao
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China.
| | - Zaiping Jing
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China.
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17
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Marquis‐Gravel G, Zeitouni M, Kochar A, Jones WS, Sketch MH, Rao SV, Patel MR, Ohman EM. Technical consideration in acute myocardial infarction with cardiogenic shock: A review of antithrombotic and PCI therapies. Catheter Cardiovasc Interv 2019; 95:924-931. [DOI: 10.1002/ccd.28455] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 07/15/2019] [Accepted: 08/06/2019] [Indexed: 12/19/2022]
Affiliation(s)
- Guillaume Marquis‐Gravel
- Duke Clinical Research Institute Durham North Carolina
- Division of CardiologyDuke University Medical Center Duke Heart Center, Durham North Carolina
| | | | - Ajar Kochar
- Duke Clinical Research Institute Durham North Carolina
- Division of CardiologyDuke University Medical Center Duke Heart Center, Durham North Carolina
| | - W. Schuyler Jones
- Duke Clinical Research Institute Durham North Carolina
- Division of CardiologyDuke University Medical Center Duke Heart Center, Durham North Carolina
| | - Michael H. Sketch
- Duke Clinical Research Institute Durham North Carolina
- Division of CardiologyDuke University Medical Center Duke Heart Center, Durham North Carolina
| | - Sunil V. Rao
- Duke Clinical Research Institute Durham North Carolina
- Division of CardiologyDuke University Medical Center Duke Heart Center, Durham North Carolina
| | - Manesh R. Patel
- Duke Clinical Research Institute Durham North Carolina
- Division of CardiologyDuke University Medical Center Duke Heart Center, Durham North Carolina
| | - E. Magnus Ohman
- Duke Clinical Research Institute Durham North Carolina
- Division of CardiologyDuke University Medical Center Duke Heart Center, Durham North Carolina
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18
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Meertens MM, Ng E, Loh SEK, Samuel M, Mees BME, Choong AMTL. Transradial Approach for Aortoiliac and Femoropopliteal Interventions: A Systematic Review and Meta-analysis. J Endovasc Ther 2018; 25:599-607. [PMID: 30086665 PMCID: PMC6136071 DOI: 10.1177/1526602818792854] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE To present a systematic review and meta-analysis comparing the transradial approach for aortoiliac and femoropopliteal interventions to the traditional transfemoral access. METHODS A search of the public domain databases MEDLINE, SCOPUS, Web of Science, and Cochrane Library Databases was performed to identify studies related to the use of the transradial approach for infra-aortic procedures. Meta-analysis was used to compare the transradial to the transfemoral route in terms of procedure success, complications, procedure parameters, and hospital length of stay. Results are presented as the odds ratio (OR) and 95% confidence interval (CI). RESULTS Nineteen studies containing 638 patients with transradial access for lower limb interventions were selected. Lesions were treated from the aortic bifurcation down to the popliteal artery. The mean technical success rate was 90.9%, conversion to a transfemoral approach was necessary in 9.9%, and complications were reported in 1.9%. The meta-analysis included 4 comparative studies involving 114 transradial and 208 transfemoral procedures. There was no significant advantage of either approach in terms of procedure success (OR 5.0, 95% CI 0.49 to 50.83, p=0.17), but the risk of developing a complication was significantly lower (OR 0.25, 95% CI 0.07 to 0.86, p=0.03) with the transradial approach. CONCLUSION Transradial access for lower limb endovascular interventions can be performed with comparable technical success and a lower overall complication profile compared to transfemoral access.
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Affiliation(s)
- Max M. Meertens
- SingVaSC, Singapore Vascular Surgical
Collaborative, Singapore
- Department of Vascular Surgery,
Maastricht University Medical Center, Maastricht, the Netherlands
- European Vascular Center
Aachen-Maastricht, Aachen, Germany
| | - Eugene Ng
- SingVaSC, Singapore Vascular Surgical
Collaborative, Singapore
- Department of Vascular Surgery, Westmead
Hospital, Westmead, NSW, Australia
| | - Stanley E. K. Loh
- SingVaSC, Singapore Vascular Surgical
Collaborative, Singapore
- Department of Diagnostic Imaging,
National University Hospital, Singapore
| | - Miny Samuel
- SingVaSC, Singapore Vascular Surgical
Collaborative, Singapore
- Systematic Review Unit, Yong Loo Lin
School of Medicine, National University of Singapore
| | - Barend M. E. Mees
- Department of Vascular Surgery,
Maastricht University Medical Center, Maastricht, the Netherlands
- European Vascular Center
Aachen-Maastricht, Aachen, Germany
| | - Andrew M. T. L. Choong
- SingVaSC, Singapore Vascular Surgical
Collaborative, Singapore
- Division of Vascular Surgery, National
University Heart Centre, Singapore
- Department of Surgery, Yong Loo Lin
School of Medicine, National University of Singapore
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19
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Castle EV, Rathod KS, Guttmann OP, Jenkins AM, McCarthy CD, Knight CJ, O'Mahony C, Mathur A, Smith EJ, Weerackody R, Timmis AD, Wragg A, Jones DA. Routine use of fluoroscopic guidance and up-front femoral angiography results in reduced femoral complications in patients undergoing coronary angiographic procedures: an observational study using an Interrupted Time-Series analysis. Heart Vessels 2018; 34:419-426. [PMID: 30264266 DOI: 10.1007/s00380-018-1266-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Accepted: 09/14/2018] [Indexed: 10/28/2022]
Abstract
Transradial access is increasingly used for coronary angiography and percutaneous coronary intervention, however, femoral access remains necessary for numerous procedures, including complex high-risk interventions, structural procedures, and procedures involving mechanical circulatory support. Optimising the safety of this approach is crucial to minimize costly and potentially life-threatening complications. We initiated a quality improvement project recommending routine fluoroscopic guidance (femoral head), and upfront femoral angiography should be performed to assess for location and immediate complications. We assessed the effect of these measures on the rate of vascular complications. Data were collected prospectively on 4534 consecutive patients undergoing femoral coronary angiographic procedures from 2015 to 2017. The primary end-point was any access complication. Outcomes were compared pre and post introduction including the use of an Interrupted Time-Series (ITS) analysis. 1890 patients underwent angiography prior to the introduction of routine fluoroscopy and upfront femoral angiography and 2644 post. All operators adopted these approaches. Baseline characteristics, including large sheath use, anticoagulant use and PCI rates were similar between the 2 groups. Fluoroscopy-enabled punctures were made in the 'safe zone' in over 91% of cases and upfront femoral angiography resulted in management changes i.e. procedural abandonment prior to heparin administration in 21 patients (1.1%). ITS analysis demonstrated evidence of a reduction in femoral complication rates after the introduction of the intervention, which was over and above the existing trend before the introduction (40% decrease RR 0.58; 95% CI: 0.25-0.87; P < 0.01). Overall these quality improvement measures were associated with a significantly lower incidence of access site complications (0.9% vs. 2.0%, P < 0.001). Routine fluoroscopy guided vascular access and upfront femoral angiography prior to anticoagulation leads to lower vascular complication rates. Thus, study shows that femoral intervention can be performed safely with very low access-related complication rates when fluoroscopic guidance and upfront angiography is used to obtain femoral arterial access.
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Affiliation(s)
- Emily V Castle
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, 2nd Floor, King George V Building, West Smithfield, London, EC1A 7BE, UK
| | - Krishnaraj S Rathod
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, 2nd Floor, King George V Building, West Smithfield, London, EC1A 7BE, UK.,Department of Clinical Pharmacology, William Harvey Research Institute, Queen Mary University, London, UK
| | - Oliver P Guttmann
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, 2nd Floor, King George V Building, West Smithfield, London, EC1A 7BE, UK
| | - Alice M Jenkins
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, 2nd Floor, King George V Building, West Smithfield, London, EC1A 7BE, UK
| | - Carmel D McCarthy
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, 2nd Floor, King George V Building, West Smithfield, London, EC1A 7BE, UK
| | - Charles J Knight
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, 2nd Floor, King George V Building, West Smithfield, London, EC1A 7BE, UK.,Department of Clinical Pharmacology, William Harvey Research Institute, Queen Mary University, London, UK
| | - Constantinos O'Mahony
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, 2nd Floor, King George V Building, West Smithfield, London, EC1A 7BE, UK
| | - Anthony Mathur
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, 2nd Floor, King George V Building, West Smithfield, London, EC1A 7BE, UK.,Department of Clinical Pharmacology, William Harvey Research Institute, Queen Mary University, London, UK
| | - Elliot J Smith
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, 2nd Floor, King George V Building, West Smithfield, London, EC1A 7BE, UK.,Department of Clinical Pharmacology, William Harvey Research Institute, Queen Mary University, London, UK
| | - Roshan Weerackody
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, 2nd Floor, King George V Building, West Smithfield, London, EC1A 7BE, UK.,Department of Clinical Pharmacology, William Harvey Research Institute, Queen Mary University, London, UK
| | - Adam D Timmis
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, 2nd Floor, King George V Building, West Smithfield, London, EC1A 7BE, UK.,Department of Clinical Pharmacology, William Harvey Research Institute, Queen Mary University, London, UK
| | - Andrew Wragg
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, 2nd Floor, King George V Building, West Smithfield, London, EC1A 7BE, UK.,Department of Clinical Pharmacology, William Harvey Research Institute, Queen Mary University, London, UK
| | - Daniel A Jones
- Barts Interventional Group, Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, 2nd Floor, King George V Building, West Smithfield, London, EC1A 7BE, UK. .,Department of Clinical Pharmacology, William Harvey Research Institute, Queen Mary University, London, UK.
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20
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Mulukutla SR, Babb JD, Baran DA, Boudoulas KD, Feldman DN, Hall SA, Jennings HS, Kapur NK, Rao SV, Reginelli J, Schussler JM, Yang EH, Cigarroa JE. A quality framework for the role of invasive, non‐interventional cardiologists in the present‐day cardiac catheterization laboratory: A multidisciplinary SCAI/HFSA expert consensus statement. Catheter Cardiovasc Interv 2018; 92:1356-1364. [DOI: 10.1002/ccd.27841] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 07/29/2018] [Indexed: 01/06/2023]
Affiliation(s)
- Suresh R. Mulukutla
- Department of Medicine, UPMC Heart and Vascular InstituteUniversity of Pittsburgh Pittsburgh Pennsylvania
| | - Joseph D. Babb
- East Carolina Heart InstituteEast Carolina University, Brody School of Medicine Greenville North Carolina
| | - David A. Baran
- Advanced Heart Failure and TransplantSentara Heart Hospital Norfolk Virginia
| | | | - Dmitriy N. Feldman
- Division of Cardiology, Department of MedicineWeill Cornell Medical College New York
| | - Shelley A. Hall
- Baylor Scott & White Heart and Vascular HospitalBaylor University Medical Center Dallas Texas
| | - Henry S. Jennings
- Division of Cardiovascular MedicineVanderbilt University Heart and Vascular Institute Nashville Tennessee
| | - Navin K. Kapur
- Division of Cardiology, Department of MedicineTufts Medical Center Boston Massachusetts
| | - Sunil V. Rao
- The Duke Clinical Research InstituteDuke University Health System Durham North Carolina
| | | | - Jeffrey M. Schussler
- Baylor Scott & White Heart and Vascular HospitalBaylor University Medical Center Dallas Texas
- Division of CardiologyTexas A&M College of Medicine Dallas Texas
| | - Eric H. Yang
- Division of Cardiology, Department of MedicineUniversity of California Los Angeles Los Angeles California
| | - Joaquin E. Cigarroa
- Knight Cardiovascular InstituteOregon Health and Science University Portland Oregon
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21
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De Fina B, Nasser F, Cavalcante RN, Campos CA, Galastri FL, Affonso BB, Wolosker N, Perin MA. Safety and Effectiveness of Suture-mediated Arterial Closure Device in Hepatocellular Carcinoma Patients Who Underwent Drug-Eluting Beads Transarterial Chemoembolization. Ann Vasc Surg 2018; 55:203-209. [PMID: 30217703 DOI: 10.1016/j.avsg.2018.05.077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 03/20/2018] [Accepted: 05/02/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND The number of transarterial percutaneous procedures has risen over the years, consequently reducing puncture site related complications has become a necessity. To this end, the use of arterial closure devices has been growing progressively and their benefits have become a focus of research. The purpose of this study is to assess the safety and effectiveness of a suture-mediated closure device, Perclose ProGlide® (Abbott Vascular, Redwood City, CA), in patients with liver disease and hepatocellular carcinoma who underwent transarterial liver chemoembolization with drug-eluting beads. MATERIALS AND METHODS A cohort of 253 hepatocellular carcinoma patients who underwent 449 procedures of transarterial liver chemoembolization with drug-eluting beads using the Perclose Proglide device was prospectively studied. The main endpoints evaluated were the technical success of the device, defined as complete hemostasis achieved within 3 min after the closure, and the incidence of puncture-site complications. The secondary endpoints evaluated were the correlation between epidemiological factors, coagulation profile and degree of liver disease, and the occurrence of complications. RESULTS Technical success was achieved in 96% of the cases. Among patients who underwent repeated procedures using the same vascular access, this rate was 95.3%. Puncture-site complications were observed in 7 procedures (1.56%); 4 (0.89%) were due to hemorrhage, 2 (0.44%) hematomas and 2 (0.44%) pseudoaneurysms; 2 (0.44%) due to limb ischemia; and 1 (0.22%) due to arterial dissection. Among them, 3 cases required intervention. The statistical analysis of demographic characteristics, Child-Pugh classification, and coagulation status did not show a significant correlation with the occurrence of complications. Of the 449 procedures, only 4 (0.89%) needed hospitalization due to puncture-site complications. CONCLUSIONS The use of Perclose Proglide is safe and effective in patients with liver disease and hepatocellular carcinoma who underwent transarterial liver chemoembolization with drug-eluting beads.
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Affiliation(s)
- Bruna De Fina
- Department of Interventional Radiology, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | - Felipe Nasser
- Department of Interventional Radiology, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Rafael N Cavalcante
- Department of Interventional Radiology, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Carlos A Campos
- Department of Interventional Cardiology, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Francisco L Galastri
- Department of Interventional Radiology, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Breno B Affonso
- Department of Interventional Radiology, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Nelson Wolosker
- Department of Vascular Surgery, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Marco A Perin
- Department of Interventional Radiology, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
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22
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Sandoval Y, Burke MN, Lobo AS, Lips DL, Seto AH, Chavez I, Sorajja P, Abu-Fadel MS, Wang Y, Poulouse A, Gössl M, Mooney M, Traverse J, Tierney D, Brilakis ES. Contemporary Arterial Access in the Cardiac Catheterization Laboratory. JACC Cardiovasc Interv 2018; 10:2233-2241. [PMID: 29169493 DOI: 10.1016/j.jcin.2017.08.058] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 07/03/2017] [Accepted: 08/02/2017] [Indexed: 11/18/2022]
Abstract
Obtaining femoral and radial arterial access in the cardiac catheterization laboratory using state-of-the-art techniques is essential to optimize outcomes, patient satisfaction, and procedural efficiency. Although transradial access is increasingly used for coronary angiography and percutaneous coronary intervention, femoral access remains necessary for numerous procedures, many requiring large-bore access, including complex high-risk coronary interventions, structural procedures, and procedures involving mechanical circulatory support. For femoral access, contemporary access techniques should combine the use of fluoroscopy, ultrasound, micropuncture needle, femoral angiography, and vascular closure devices, when feasible. For radial access, ultrasound may reveal important anatomic features and expedite access. Despite randomized controlled trials supporting use of routine ultrasound guidance for femoral and/or radial arterial access, ultrasound remains underused in cardiac catheterization laboratories. This article reviews contemporary techniques to achieve optimal arterial access in the cardiac catheterization laboratory.
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Affiliation(s)
- Yader Sandoval
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota; Division of Cardiology, Hennepin County Medical Center, Minneapolis, Minnesota
| | - M Nicholas Burke
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Angie S Lobo
- Department of Medical Education, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Daniel L Lips
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Arnold H Seto
- Division of Cardiology, Department of Medicine, Veterans Affairs Long Beach Healthcare System and University of California, Irvine Medical Center, Long Beach, California
| | - Ivan Chavez
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Paul Sorajja
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Mazen S Abu-Fadel
- Department of Medicine, Cardiovascular Section, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Yale Wang
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Anil Poulouse
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Mario Gössl
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Michael Mooney
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Jay Traverse
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - David Tierney
- Division of Cardiology, Hennepin County Medical Center, Minneapolis, Minnesota
| | - Emmanouil S Brilakis
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota.
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Steppich B, Stegmüller F, Rumpf PM, Pache J, Sonne C, Lesevic H, Braun D, Hausleiter J, Kasel AM, Ott I. Vascular complications after percutaneous mitral valve repair and venous access closure using suture or closure device. J Interv Cardiol 2017; 31:223-229. [DOI: 10.1111/joic.12459] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 09/29/2017] [Accepted: 10/03/2017] [Indexed: 11/28/2022] Open
Affiliation(s)
- Birgit Steppich
- Deutsches Herzzentrum der Technischen Universität München; München Germany
| | - Felix Stegmüller
- Deutsches Herzzentrum der Technischen Universität München; München Germany
| | | | - Jürgen Pache
- Deutsches Herzzentrum der Technischen Universität München; München Germany
| | - Carolin Sonne
- Deutsches Herzzentrum der Technischen Universität München; München Germany
| | - Hasema Lesevic
- Deutsches Herzzentrum der Technischen Universität München; München Germany
| | - Daniel Braun
- Kardiologie der Ludwigs-Maximilians-University München; München Germany
- Partner Site Munich Heart Alliance; DZHK (German Heart Centre for Cardiovascular Research); Munich Germany
| | - Jörg Hausleiter
- Kardiologie der Ludwigs-Maximilians-University München; München Germany
- Partner Site Munich Heart Alliance; DZHK (German Heart Centre for Cardiovascular Research); Munich Germany
| | | | - Ilka Ott
- Deutsches Herzzentrum der Technischen Universität München; München Germany
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Roberts JS, Niu J. A novel technique for simultaneous hemostasis of ipsilateral radial and ulnar artery access sites. Catheter Cardiovasc Interv 2017; 91:901-904. [DOI: 10.1002/ccd.27351] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 08/28/2017] [Accepted: 08/31/2017] [Indexed: 11/05/2022]
Affiliation(s)
- Jonathan S. Roberts
- Memorial Cardiac and Vascular Institute, Memorial Regional Hospital, Memorial Healthcare SystemHollywood Florida
| | - Jianli Niu
- Memorial Cardiac and Vascular Institute, Memorial Regional Hospital, Memorial Healthcare SystemHollywood Florida
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25
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Muser D, Liang JJ, Santangeli P. Electrical Storm in Patients with Implantable Cardioverter-defibrillators: A Practical Overview. J Innov Card Rhythm Manag 2017; 8:2853-2861. [PMID: 32477756 PMCID: PMC7252660 DOI: 10.19102/icrm.2017.081002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Accepted: 07/30/2017] [Indexed: 12/17/2022] Open
Abstract
Electrical storm (ES) is an increasingly common medical emergency characterized by clustered episodes of sustained ventricular arrhythmias (VAs) that lead to repeated appropriate implantable cardioverter-defibrillator (ICD) therapies. A diagnosis of ES can be made with the occurrence of three or more sustained episodes of VAs, or of three or more appropriate ICD therapies within 24 hours in patients with implanted devices. ES is associated with poor outcomes in patients with structural heart disease, particularly those with severe left ventricular dysfunction. In large clinical trials involving patients with ICDs for primary and secondary prevention, ES appears to be a predictor of cardiac death, with notably higher rates of mortality soon after the event. ES management is challenging and requires special medical attention with accurate patient risk stratification and a multidisciplinary approach that includes the use of pharmacologic therapies such as antiarrhythmic drugs (AADs) and interventional approaches like catheter ablation, surgical ablation, or sympathetic neuromodulation. Initial management involves determining and addressing the underlying ischemia, any electrolyte imbalances, and/or other causative factors. Hemodynamic support needs to be considered in high-risk patients with unstable VAs or those with severe comorbidities such as low left ventricular ejection fraction, advanced New York Heart Association class, and/or chronic pulmonary disease. Following the acute phase of ES, treatment should shift towards maximizing therapeutic efforts to address heart failure, performing revascularization, and preventing subsequent VAs. In the present manuscript, we offer an overview of the most relevant clinical aspects of ES with regard to novel therapeutic strategies.
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Affiliation(s)
- Daniele Muser
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Jackson J Liang
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Pasquale Santangeli
- Electrophysiology Section, Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, PA
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26
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Kang SH, Han D, Kim S, Yoon CH, Park JJ, Suh JW, Cho YS, Youn TJ, Chae IH. Hemostasis pad combined with compression device after transradial coronary procedures: A randomized controlled trial. PLoS One 2017; 12:e0181099. [PMID: 28742134 PMCID: PMC5524363 DOI: 10.1371/journal.pone.0181099] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 06/21/2017] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Arterial access and hemostasis are important processes during percutaneous coronary procedures. In this study, we tested if the use of chitosan-based pads on top of compression devices could improve hemostasis efficacy compared with compression devices alone after transradial coronary angiography or interventions. METHODS This study was a single-center open-label randomized controlled trial. Patients who underwent coronary angiography or intervention with the transradial approach were randomly assigned to the study (compression device and a chitosan-based pad) or control (compression devices alone) group in a 2:1 fashion. The primary endpoint was time to hemostasis, categorized into ≤5, 6-10, 11-20, and >20 minutes. RESULTS Between April and July 2016, 95 patients were enrolled (59 were assigned to the study arm and 36 to the control arm). Time to hemostasis, the primary endpoint, was significantly lower in the study group than in the control group (p<0.001). Both groups showed low rates of vascular complications. CONCLUSIONS This study suggests that the use of a hemostasis pad in combination with rotatory compression devices is a safe and effective hemostasis strategy after radial artery access. TRIAL REGISTRATION ClinicalTrials.gov NCT02954029.
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Affiliation(s)
- Si-Hyuck Kang
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Donghoon Han
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Sehun Kim
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Chang-Hwan Yoon
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Jin-Joo Park
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Jung-Won Suh
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Young-Seok Cho
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - Tae-Jin Youn
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
| | - In-Ho Chae
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul National University and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam-si, Republic of Korea
- * E-mail:
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