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Mousa MA, Zahwy SSE, Tamara AF, Samir W, Tantawy MA. A comparative study between surgical cut down and percutaneous closure devices in management of large bore arterial access. CVIR Endovasc 2023; 6:53. [PMID: 37899370 PMCID: PMC10613603 DOI: 10.1186/s42155-023-00395-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/26/2023] [Indexed: 10/31/2023] Open
Abstract
BACKGROUND Compared to conventional open surgery, minimally invasive catheter-based procedures have less post procedural complications. Transcatheter aortic valve implantation (TAVI) and endovascular aneurysm repair (EVAR) require large bore arterial access. Optimal site management of large bore arterial access is pivotal to reduce the hospital-acquired complications associated with large bore arterial access. We wanted to compare surgical cutdown versus percutaneous closure devices in site management of large bore arterial access. METHODS Participants planned for TAVI or EVAR with large bore arterial access more than 10 French were included, while participants with history of bypass surgery, malignancies, thrombophilia, or sepsis were excluded. A consecutive sample of 100 participants (mean age 74.66 ± 2.65 years, 61% males) was selected, underwent TAVI or EVAR with surgical cutdown (group 1) versus TAVI or EVAR with Proglide™ percutaneous closure device (group 2). RESULTS The incidence rate of hematoma was significantly lower in group 2 versus group 1 (p = 0.014), the mean procedure time (minutes) and the median hospital stay (days) were significantly higher in group 1 versus group 2 (t(98) = - 2.631, p = 0.01, and U = 2.403, p = 0.018, respectively), and the c-reactive protein pre-procedure and the c-reactive protein post-procedure were significantly lower in group 2 versus group 1 (U = -2.969, p = 0.003, and U = -2.674, p = 0.007, respectively). CONCLUSIONS Our study showed a lower incidence rate of large bore arterial access complications as hematoma, a shorter procedure time, and a shorter hospital stay with percutaneous closure devices compared to surgical cutdown.
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Affiliation(s)
- Mohamed Ahmed Mousa
- Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
| | | | - Ahmed Fathy Tamara
- Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Wafed Samir
- Deaprtment of Cardiology, Faculty of Medicine, Misr University for Science and Technology, 6th of October, Egypt
| | - Mahmoud Ahmed Tantawy
- Deaprtment of Cardiology, Faculty of Medicine, Misr University for Science and Technology, 6th of October, Egypt
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Yilmaz S, Kızıltan F, Kalender M, Parlar H, Şaşkın H, Barış Ö. Popliteal access for endovascular procedures in femoropopliteal artery occlusive disease. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2023; 19:277-283. [PMID: 37854961 PMCID: PMC10580849 DOI: 10.5114/aic.2023.131482] [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: 06/18/2023] [Accepted: 07/17/2023] [Indexed: 10/20/2023] Open
Abstract
Introduction Even though it has been reported that femoropopliteal artery endovascular revascularization is often performed with antegrade femoral artery interventions, which are technically relatively challenging, having the advantage of better control, it has also been reported that recanalization failure may occur in approximately 20% of patients and some materials have been developed for this reason. Aim To evaluate the safety of retrograde popliteal artery intervention and our procedural success rate for symptomatic femoropopliteal artery occlusive disease. Material and methods A total of 95 endovascular revascularization procedures were performed for treating symptomatic occlusive peripheral artery disease in the study period. Inclusion criteria were defined as patients who underwent endovascular revascularization procedures for symptomatic femoropopliteal artery occlusive disease. Patients who underwent a percutaneous endovascular procedure for iliac artery or below-knee arterial occlusive disease in the same session and patients who had previously undergone peripheral arterial bypass grafting or endovascular treatment for existing femoropopliteal artery disease were excluded. Results We evaluated 45 peripheral endovascular procedures performed on 39 patients with a mean age of 62.49 ±11.38 years in our hospital for chronic femoropopliteal artery occlusive disease. Twelve (26.7%) of the endovascular treatment procedures were performed with retrograde access through the popliteal artery (Group 2). In neither group were any complications of arterial rupture, distal embolism, early thrombosis, or pseudoaneurysms observed. Conclusions We are of the opinion that the retrograde popliteal artery technique is an effective and safe intervention option in endovascular revascularization, particularly in the revascularization of the long segment and complex femoropopliteal artery occlusions.
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Affiliation(s)
- Seyhan Yilmaz
- Department of Cardiovascular Surgery, Faculty of Medicine, Giresun University, Giresun, Turkey
| | - Feryaz Kızıltan
- Department of Cardiovascular Surgery, Umraniye Education and Research Hospital, Istanbul, Turkey
| | - Mehmet Kalender
- Department of Cardiovascular Surgery, Derince Education and Research Hospital, Kocaeli, Turkey
| | - Hakan Parlar
- Department of Cardiovascular Surgery, Derince Education and Research Hospital, Kocaeli, Turkey
| | - Hüseyin Şaşkın
- Department of Cardiovascular Surgery, Derince Education and Research Hospital, Kocaeli, Turkey
| | - Özgür Barış
- Department of Cardiovascular Surgery, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
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Dubosq M, Renard R, Jayet J, Mercier L, Javerliat I, Castier Y, Coggia M, Coscas R. Single Primary Retrograde Access to Treat Femoro-Popliteal Occlusive Lesions. J Endovasc Ther 2023:15266028231188868. [PMID: 37515490 DOI: 10.1177/15266028231188868] [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: 07/31/2023]
Abstract
INTRODUCTION The retrograde puncture of a distal artery is considered a bailout procedure in case of anterograde approach failure for peripheral artery disease (PAD) treatment. A single primary retrograde access has been suggested as an efficient and safe option. As scant data are available, we present our results using this approach. MATERIAL AND METHODS Between August 2019 and October 2022, we performed this technique in selected patients with femoro-popliteal PAD. Chronic total occlusions (CTOs) were selected on the basis of the CTOP classification. An ultrasound-guided retrograde puncture of a tibial artery at the ankle level was performed, followed by the preferential use of 4F materials. Hemostasis of the puncture site was obtained using manual compression. Postoperative duplex scan examination systematically included an evaluation of the punctured artery. Demographics, intraoperative, and follow-up data were collected retrospectively. The results are expressed as means with standard deviations and numbers with percentages when appropriate. RESULTS In total, 55 procedures were performed in 46 patients (9 bilateral). Of these, 57% (N=26) were considered at risk for femoral puncture (obesity, history of groin surgery, challenging crossover approach) and 54% (N=25) presented with critical limb-threatening ischemia (CLTI). The TASC-II femoro-popliteal classification was generally B (60%) and also C (33%) or D (7%). Mean lesion length was 105.6±49.4 mm and 65% were CTOs. Most patients were operated in an outpatient setting (N=25; 54%) under potentialized local anesthesia (N=41, 89%). The punctured site was the posterior tibial artery in 73% (N=40). The procedure time was 65.1±25.7 minutes, and the fluoroscopy time was 10.7±8.5 minutes. The technical success rate was 100%. There were no intraoperative complications. All patients could walk the same day. One CLTI patient presented an erysipelas related to the puncture in postoperative period. At 30 days, the primary patency of the treated and the punctured arteries were 98% and 100%, respectively. CONCLUSION A single primary retrograde access can be used safely to treat femoro-popliteal PAD. It represents a valuable alternative to the femoral puncture and allows fast ambulation. Prospective and long-term studies on larger populations are necessary to confirm our results. CLINICAL IMPACT This study demonstrates that a single primary retrograde access can be used safely without damaging the punctured artery to treat femoro-popliteal lesions, especially in claudicant patients. Chronic total occlusions can be treated successfully using this technique. This approach represents a valuable alternative to the femoral puncture and allows fast ambulation without risk of major bleeding.
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Affiliation(s)
- Maxime Dubosq
- Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Régis Renard
- Department of Vascular and Thoracic Surgery, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jérémie Jayet
- Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Lucie Mercier
- Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Isabelle Javerliat
- Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Yves Castier
- Department of Vascular and Thoracic Surgery, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Marc Coggia
- Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Raphael Coscas
- Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
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Muhammad N, Sioutas GS, Gajjar A, Salem MM, Kandregula S, Srinivasan VM, Jankowitz BT, Burkhardt JK. Intraoperative angiography via popliteal artery access for spinal neurovascular lesions: an institutional experience and systematic review. J Neurointerv Surg 2023:jnis-2023-020071. [PMID: 37028944 DOI: 10.1136/jnis-2023-020071] [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: 01/17/2023] [Accepted: 03/22/2023] [Indexed: 04/09/2023]
Abstract
BACKGROUND Intraoperative DSA is used to confirm complete obliteration of neurovascular pathologies. For spinal neurovascular lesions, femoral access can be challenging given the need to flip the patient after sheath placement. Similarly, radial access can be complicated by arch navigation difficulties. Vascular access via the popliteal artery represents an appealing alternative option; however, data regarding its utility and efficacy in these cases are limited. METHODS A retrospective series of four consecutive patients between July 2016 and August 2022 who underwent intraoperative spinal DSA via the popliteal artery was analyzed. Additionally, a systematic review was conducted to collect previously reported such cases. Collective patient demographics and operative details are presented to consolidate the available evidence supporting popliteal access. RESULTS Four patients met the inclusion criteria from our institution. The systematic review yielded six previously published studies reporting 16 additional transpopliteal access cases. Of the 20 total cases (mean±SD age 60.8±17.2 years), 60% were men. Most treated lesions were dural arteriovenous fistulas (80%) located in the thoracic spine (55%) or cervical spine (25%). The left popliteal artery was most accessed and the highest visualized level was the craniocervical junction. All outcomes were either stable or improving after surgery, and no complications were observed. CONCLUSIONS We report the safety and feasibility of transpopliteal access for intraoperative DSA in the prone position in four cases in addition to 16 previously reported cases in the literature. Our case series highlights popliteal artery access as an alternative to transfemoral or transradial access in this setting.
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Affiliation(s)
- Najib Muhammad
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Georgios S Sioutas
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Avi Gajjar
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Mohamed M Salem
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | | | - Visish M Srinivasan
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Brian T Jankowitz
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Jan-Karl Burkhardt
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
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Diamantopoulos A, Nourzaie R, Mulholland D, Dolan SG, Ahmed I, Gkoutzios P, Thulasidasan N, Theodoulou I, Sabharwal T. Safety and efficacy of the Mynx Control vascular closure device in peripheral arterial procedures: A prospective study. Vascular 2023; 31:369-374. [PMID: 34958621 DOI: 10.1177/17085381211062745] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES This article aims to present a prospective study investigating the safety and efficacy of the Mynx Control extravascular closure device (Cordis Corporation, FL, USA), for femoral arterial closure in patients undergoing peripheral arterial procedures. METHODS Between January 2020 and February 2021, 100 Mynx Control devices were deployed in 91 consecutive patients (mean age: 67.5 ± 16.9 years) who underwent peripheral arterial procedures. We used ultrasound and/or fluoroscopy during Mynx Control deployment and ultrasound post-procedure to detect complications. Femoral artery punctures included 62 (62%) antegrade and 38 (38%) retrograde punctures. The mean activated clotting time at time of device deployment was 221s. The primary endpoints were technical success, device failure, and complication rates up to 30 days. RESULTS A 5F vascular sheath was used in 43 cases (43%) (36 (36%) 6F and 21 (21%) 7F). The majority of our cases had antegrade access (62%). Overall technical success rate was 97% in both antegrade and retrograde cases. In total, there were 4 minor complications: 3 (3%) cases of pseudoaneurysm and 1 (1%) case of haematoma. No major complications were recorded post-procedure or 30 days post index procedure. CONCLUSION The Mynx Control vascular closure device is safe and effective in achieving haemostasis in patients undergoing antegrade and retrograde peripheral angioplasty procedures.
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Affiliation(s)
- Athanasios Diamantopoulos
- Department of Interventional Radiology, 8945Guys' and St. Thomas' NHS Foundation Trust, London, UK.,School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, Kings College London, London, UK
| | - Romman Nourzaie
- Department of Interventional Radiology, 8945Guys' and St. Thomas' NHS Foundation Trust, London, UK
| | - Doug Mulholland
- Department of Interventional Radiology, 8945Guys' and St. Thomas' NHS Foundation Trust, London, UK
| | - Steven G Dolan
- Department of Interventional Radiology, 8945Guys' and St. Thomas' NHS Foundation Trust, London, UK
| | - Irfan Ahmed
- Department of Interventional Radiology, 8945Guys' and St. Thomas' NHS Foundation Trust, London, UK
| | - Panos Gkoutzios
- Department of Interventional Radiology, 8945Guys' and St. Thomas' NHS Foundation Trust, London, UK
| | - Narayanan Thulasidasan
- Department of Interventional Radiology, 8945Guys' and St. Thomas' NHS Foundation Trust, London, UK
| | - Iakovos Theodoulou
- Department of Interventional Radiology, 8945Guys' and St. Thomas' NHS Foundation Trust, London, UK
| | - Tarun Sabharwal
- Department of Interventional Radiology, 8945Guys' and St. Thomas' NHS Foundation Trust, London, UK
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Case BC, Kumar S, Medranda GA, Yerasi C, Forrestal BJ, Satler LF, Ben-Dor I, Hashim H, Bernardo NL, Rogers T, Waksman R. Contemporary post-marketing adverse events and modes of failure related to VASCADE Vascular Closure System: The utility of the MAUDE database. Catheter Cardiovasc Interv 2021; 99:822-826. [PMID: 34480524 DOI: 10.1002/ccd.29942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 07/12/2021] [Accepted: 08/23/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To analyze post-marketing surveillance data from the United States Food and Drug Administration (FDA) Manufacturer and User Facility Device Experience (MAUDE) database for the VASCADE Vascular Closure System (Cardiva Medical Inc., Santa Clara, CA). BACKGROUND The VASCADE Vascular Closure System is a closure device for femoral arterial and venous access-site closure that was approved by the FDA in 2013. However, post-marketing data and experience on the most commonly reported complications and modes of failure associated with the VASCADE Vascular Closure System are limited. METHODS Post-marketing surveillance data from the FDA MAUDE database from October 2013 through March 2020 were analyzed, yielding 201 reports. RESULTS Of the 201 reports of major complications involving VASCADE devices, 156 reports involved either injury (145) or death (11) related to the device. Of the 145 injury reports, bleeding was the most common adverse outcome described (85), followed by pseudoaneurysm (29) and pulselessness of an extremity (21). The device malfunction incidents (41 reports) were reported in three main categories, with deployment failure being the most commonly reported complication. CONCLUSIONS Our analysis of the MAUDE database demonstrates that in contemporary post-marketing practice, physicians should be well-trained and educated to use the VASCADE closure device because improper utilization is a common cause of device failure, and complications with the VASCADE device can have profound clinical implications.
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Affiliation(s)
- Brian C Case
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Sant Kumar
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Giorgio A Medranda
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Charan Yerasi
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Brian J Forrestal
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Lowell F Satler
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Itsik Ben-Dor
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Hayder Hashim
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Nelson L Bernardo
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Toby Rogers
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA.,Cardiovascular Branch, Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
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Martin G, Covani M, Saab F, Mustapha J, Malina M, Patrone L. A systematic review of the ipsilateral retrograde approach to the treatment of femoropopliteal arterial lesions. J Vasc Surg 2021; 74:1394-1405.e4. [PMID: 34019987 DOI: 10.1016/j.jvs.2021.04.050] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 04/16/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The endovascular treatment of femoropopliteal lesions is an integral part of managing peripheral arterial disease. The antegrade approach is the most widely used technique with good evidence for its safety and efficacy. However, crossing a lesion, particularly chronic total occlusions (CTO), can be technically challenging and so the retrograde approach is increasingly used to maximize the chances of procedural success. The objective of this systematic review was, therefore, to assess the safety and effectiveness of the ipsilateral retrograde approach to femoropopliteal lesions. METHODS A systematic review conforming to the PRISMA standards was undertaken. MEDLINE, EMBASE, and The Cochrane Register were searched between January 1, 1988, and January 1, 2020. Full-text, English-language, peer-reviewed articles pertaining to peripheral arterial disease, endovascular intervention and access site were included. RESULTS A total of 8599 articles were screened, of which 38, involving 1940 patients undergoing 2184 retrograde procedures, were included. The mean number of patients per study was 51.1, with three studies including fewer than 10 and four more than 100 patients. The reported follow-up ranged from 30 days to 3 years, and six articles did not report any long-term outcome data. A retrograde approach was used as the primary access route in 45.% of procedures (648/1438) with relevant data. Primary technical success was achieved in 88% (1920/2184; 64%-100%) with a reported complication rate of 11% (235/2117; 0%-27%). Overall, the quality of evidence was poor, with just seven articles deemed to be of high quality with a low risk of bias. A meta-analysis was not deemed appropriate owing to heterogeneity of data. CONCLUSIONS An ipsilateral retrograde approach to femoropopliteal lesions has good primary technical success and a low rate of complications. It has a promising role as a bailout, or even a primary access technique, in complex lesions. Patient positioning, puncture site and technique, lesion anatomy, and the size of catheters and devices used are important considerations to achieve the best outcomes. There remains a paucity of robust evidence for its superiority over traditional antegrade approaches, and further work is required to identify the optimal technique and those patients who would benefit most from the approach.
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Affiliation(s)
- Guy Martin
- West London Vascular and Interventional Centre, London North West University Healthcare NHS Trust, London, United Kingdom; Department of Surgery and Cancer, Imperial College London, London, United Kingdom.
| | - Marco Covani
- Faculty of Medicine, University of Messina, Messina, Italy
| | - Fadi Saab
- Advanced Cardiac & Vascular Centers for Amputation Prevention, Grand Rapids, Mich
| | - Jihad Mustapha
- Advanced Cardiac & Vascular Centers for Amputation Prevention, Grand Rapids, Mich
| | - Martin Malina
- West London Vascular and Interventional Centre, London North West University Healthcare NHS Trust, London, United Kingdom
| | - Lorenzo Patrone
- West London Vascular and Interventional Centre, London North West University Healthcare NHS Trust, London, United Kingdom
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8
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Retrograde Popliteal Access for Challenging Superficial Femoral Artery Occlusion. Int J Vasc Med 2021; 2021:8833025. [PMID: 34055413 PMCID: PMC8149250 DOI: 10.1155/2021/8833025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 04/01/2021] [Accepted: 04/28/2021] [Indexed: 11/29/2022] Open
Abstract
Retrograde popliteal access has long been established as an alternative to the antegrade approach to occlusive lesions in the superficial femoral artery (SFA). However, early reports with high complication rates (dissection, hematomas, aneurysms, and arteriovenous shunts at the puncture site) reduced enthusiasm for this technique. In recent years, with the development of thinner sheaths and low profile angioplasty devices, retrograde popliteal access has resurfaced as a viable technique, mostly in combination with or after failure of the more classical antegrade approach. In this retrospective study, we will report the safety and efficacy of the retrograde popliteal approach in the treatment of superficial femoral artery chronic total occlusions, in 13 consecutive patients between January 2017 and January 2021. The results showed 100% successful puncture of the popliteal artery and 100% successful recanalization and stenting of the superficial femoral artery with a total of 2 complications related to the puncture site and zero periprocedural mortality. In conclusion, the retrograde popliteal approach appears to be an effective and safe alternative to the common SFA complete total occlusion (CTO) treatment approach.
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9
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Biagioni LC, Pereira L, Nasser F, Biagioni RB, Burihan MC, Wolosker N. Comparison between antegrade common femoral artery access and superficial femoral artery access in infrainguinal endovascular interventions. J Vasc Surg 2021; 74:763-770. [PMID: 33684479 DOI: 10.1016/j.jvs.2021.02.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 02/12/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Antegrade access for infrainguinal endovascular intervention can be achieved through the common femoral artery (CFA) or superficial femoral artery (SFA). A few studies with small sample sizes have shown similar efficacy and safety for antegrade puncture of the CFA and SFA. In the present study, we analyzed the feasibility of SFA access and the occurrence of complications between SFA and CFA ipsilateral access in a broader cohort. METHODS In the present retrospective study, we analyzed data from 462 patients with peripheral arterial disease (PAD) who had undergone peripheral angioplasty from 2009 to 2016. The inclusion criteria were PAD at Rutherford stage 3 to 6 and use of an endovascular approach. Patients with coagulation disorders, those receiving anticoagulant therapy, cases with deployment of closure devices, cases with more than one access on the same limb, and patients with inadequate bed rest after the procedure were excluded. A systematic analysis of all patients' electronic medical records was performed to evaluate the demographic aspects and technical success and identify the possible complications associated with CFA and SFA access. RESULTS Of the 462 patients, 290 had undergone SFA puncture and 172, CFA puncture. The demographic evaluation of both groups revealed no differences between the two groups, except that more patients with diabetes were in the CFA group and more patients with dyslipidemia and an advanced clinical presentation were in the SFA group. First puncture access was successful in 99.7% of the SFA group and 96.5% of the CFA group (P = .01). The hematoma rate in the SFA and CFA groups was 20.3% and 11%, respectively (P = .01). The incidence of major bleeding and clinically relevant nonmajor bleeding was not significantly different between the two groups (P = .215). Only three patients had developed a pseudoaneurysm, two of whom were in the SFA group. Female sex (odds ratio [OR], 2.572; 95% confidence interval [CI], 1.520-4.354; P < .001] and older age (OR, 1.034; 95% CI, 1.009-1.059; P = .007) were associated with an increased hematoma rate. CONCLUSIONS SFA access was associated with a higher overall rate of hematoma compared with CFA access. However, no significant difference was found in the incidence of major bleeding between the two access sites. Planned SFA access should be considered as an alternative to CFA access.
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Affiliation(s)
- Luisa Ciucci Biagioni
- Vascular, Endovascular, and Vascular Doppler Department, Hospital Santa Marcelina, São Paulo, São Paulo, Brazil.
| | - Leticia Pereira
- Vascular, Endovascular, and Vascular Doppler Department, Hospital Santa Marcelina, São Paulo, São Paulo, Brazil
| | - Felipe Nasser
- Vascular, Endovascular, and Vascular Doppler Department, Hospital Santa Marcelina, São Paulo, São Paulo, Brazil; Division of Vascular Surgery, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil
| | - Rodrigo Bruno Biagioni
- Vascular, Endovascular, and Vascular Doppler Department, Hospital Santa Marcelina, São Paulo, São Paulo, Brazil
| | - Marcelo Calil Burihan
- Vascular, Endovascular, and Vascular Doppler Department, Hospital Santa Marcelina, São Paulo, São Paulo, Brazil
| | - Nelson Wolosker
- Division of Vascular Surgery, Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil
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10
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Al-Ahmad A, Mittal S, DeLurgio D, Joseph Gallinghouse G, Horton RP, Preminger MW, David Burkhardt J, Natale A. Results from the prospective, multicenter AMBULATE-CAP trial: Reduced use of urinary catheters and protamine with hemostasis via the Mid-Bore Venous Vascular Closure System (VASCADE® MVP) following multi-access cardiac ablation procedures. J Cardiovasc Electrophysiol 2020; 32:191-199. [PMID: 33270306 DOI: 10.1111/jce.14828] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 11/04/2020] [Accepted: 11/16/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Manual compression (MC), historically the most common method to achieve hemostasis after percutaneous vascular procedures, is time consuming, requires prolonged bedrest, and is uncomfortable for patients and clinicians. Recent studies demonstrate the efficacy and safety of vascular closure devices and suggest shorter times to hemostasis and patient ambulation compared with MC. The current study evaluated the feasibility of the VASCADE® venous vascular closure system (VVCS) while allowing for urinary catheter (UC) elimination, and elimination of protamine and/or same calendar day discharge (SCDD). METHODS AND RESULTS In this prospective, multicenter trial, patients were enrolled and assigned to the following groups: no UC, no protamine, and/or SCDD (no co-enrollment in no protamine and SCDD). After completing the catheter-based cardiac procedure, access sites were closed using the VVCS. Outcomes included final hemostasis (all sites) without major access site-related complications at 30 days, rates of access site closure-related complications, device success, and study group success. All 168 patients had hemostasis without major access site-related complications through 30 days. In the no UC group, 160 out of 164 (97.6%) patients did not receive a UC. Additionally, 39 out of 41 (95.1%) patients received heparin without protamine reversal and no access site bleeding-related ambulation delays, and 18 out of 18 (100%) patients were discharged on the same day. There were no major access site closure-related complications, few minor complications, and adverse events were generally mild and well managed. CONCLUSION The VVCS was effective for achieving hemostasis following catheter-based procedures; access site closure-related complications and adverse events were well managed.
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Affiliation(s)
- Amin Al-Ahmad
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - Suneet Mittal
- The Valley Health System, Ridgewood, New Jersey, USA
| | - David DeLurgio
- Emory Heart and Vascular Center, Emory Saint Joseph's Hospital, Atlanta, Georgia, USA
| | | | - Rodney P Horton
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | | | - J David Burkhardt
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
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11
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Hwang JH, Park SW, Yang WY, Kwon YW, Min J, Jang H, Kim JS. Safety and efficacy of Mynx vascular closure device for the closure of common femoral artery access after ipsilateral stent placement. J Vasc Access 2020; 23:24-31. [DOI: 10.1177/1129729820966946] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction: To evaluate the feasibility and safety of the Mynx vascular closure device (VCD) for arteriotomy closure after stent placement near the common femoral artery (CFA) access site. Methods: A total of 88 patients (73 men; mean age, 72 ± 9.2 years; 136 procedures) who underwent closure of CFA arteriotomy using the Mynx VCD after stent placement in proximal superficial femoral artery (SFA) with antegrade approach, or in common or external iliac artery with retrograde approach were retrospectively studied. Technical success and access site complication were evaluated. Body mass index (BMI), platelet count, international normalized ratio, prior history of ipsilateral CFA access, access direction, degree of CFA calcification, stent location and diameter, total procedure time, and sheath size were analyzed to evaluate their relationship with technical failure and development of bleeding complications. Results: Technical success was achieved in 94.9% (129/136) patients. The mean time to hemostasis was 0.7 ± 1.8 min. Technical failure was significantly associated with low BMI ( p = 0.001). Other variables presented no significant relationship with technical failure and development of complications. Ultrasonography on the day after the procedure revealed that 8 (5.9%) patients had hematoma. Conclusions: Mynx VCD for arteriotomy closure is feasible and provides hemostatic safety after stent placement near antegrade or retrograde CFA access. However, Mynx VCD may have a poor technical success rate among patients with low BMI.
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Affiliation(s)
- Jin Ho Hwang
- Department of Radiology, Konkuk University School of Medicine, Seoul, Korea
| | - Sang Woo Park
- Department of Radiology, Konkuk University School of Medicine, Seoul, Korea
| | - Woo Young Yang
- Department of Radiology, Konkuk University School of Medicine, Seoul, Korea
- Department of Radiology, Gimpo Woori Hospital, Gimpo-si, Gyeonggi-do, Korea
| | - Yong Wonn Kwon
- Department of Radiology, Konkuk University School of Medicine, Seoul, Korea
| | - Jeeyoung Min
- Department of Radiology, Konkuk University School of Medicine, Seoul, Korea
| | - Hyemin Jang
- Department of Radiology, Konkuk University School of Medicine, Seoul, Korea
| | - Jun Seok Kim
- Department of Thoracic and Cardiovascular Surgery, Konkuk University School of Medicine, Seoul, Korea
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12
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Mohanty S, Trivedi C, Beheiry S, Al-Ahmad A, Horton R, Della Rocca DG, Gianni C, Gasperetti A, Abdul-Moheeth M, Turakhia M, Natale A. Venous access-site closure with vascular closure device vs. manual compression in patients undergoing catheter ablation or left atrial appendage occlusion under uninterrupted anticoagulation: a multicentre experience on efficacy and complications. Europace 2020; 21:1048-1054. [PMID: 30726903 DOI: 10.1093/europace/euz004] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 01/14/2019] [Indexed: 12/25/2022] Open
Abstract
AIMS Manual compression (MC), widely used to achieve venous access haemostasis, needs prolonged immobilization and extended time-to-haemostasis. Vascular closure devices (VCD) have been reported to have significantly shorter time to haemostasis and ambulation in arterial access-site management. The current study aimed to evaluate the safety and efficacy as well as rate of urinary tract complications in patients receiving MC vs. VCD for venous access-site closure. METHODS AND RESULTS A total of 803 consecutive patients undergoing catheter ablation or left atrial appendage closure were classified into the VCD (n = 304) and the MC (n = 499) group, based on the methods used for haemostasis at the venous access site. Foley catheter was used for bladder-emptying in all MC cases and 15 VCD patients. At one site, VCD group patients with experience of MC in prior ablations were asked to describe their overall satisfaction level after comparing the past experience with the present. Haemostasis was achieved effectively in both populations. No VCD cases required >2 h bed rest, whereas 7 (1.4%) patients in the MC group needed prolonged immobilization (P = 0.04). Significantly higher incidence of access-site haematoma (P = 0.004) and urinary complications (P < 0.05) were observed in the MC group. Majority of VCD patients (68%) with prior experience of MC for haemostasis expressed satisfaction over the early ambulation and ability to void urine without bladder catheterization. CONCLUSION Vascular closure devices provided effective haemostasis, while reducing the access-site complications, ambulation time, and urinary complications.
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Affiliation(s)
- Sanghamitra Mohanty
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. I-35, Suite 720, Austin, TX, USA
- Department of Internal Medicine, Dell Medical School, University of Texas, Austin, TX, USA
| | - Chintan Trivedi
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. I-35, Suite 720, Austin, TX, USA
| | - Salwa Beheiry
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. I-35, Suite 720, Austin, TX, USA
| | - Amin Al-Ahmad
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. I-35, Suite 720, Austin, TX, USA
| | - Rodney Horton
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. I-35, Suite 720, Austin, TX, USA
| | - Domenico G Della Rocca
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. I-35, Suite 720, Austin, TX, USA
| | - Carola Gianni
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. I-35, Suite 720, Austin, TX, USA
| | | | | | - Mintu Turakhia
- Division of Cardiology, Stanford University, Palo Alto, CA, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. I-35, Suite 720, Austin, TX, USA
- Department of Internal Medicine, Dell Medical School, University of Texas, Austin, TX, USA
- Division of Cardiology, Stanford University, Palo Alto, CA, USA
- Case Western Reserve University, Cleveland, OH, USA
- Interventional Electrophysiology, Scripps Clinic, San Diego, CA, USA
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13
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Kim SH, Litt HI. Surveillance Imaging following Endovascular Aneurysm Repair: State of the Art. Semin Intervent Radiol 2020; 37:356-364. [PMID: 33041481 DOI: 10.1055/s-0040-1715882] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Endovascular aneurysmal repair (EVAR) has become a prominent modality for the treatment of abdominal aortic aneurysm. Surveillance imaging is important for the detection of device-related complications, which include endoleak, structural abnormalities, and infection. Currently used modalities include ultrasound, X-ray, computed tomography, magnetic resonance imaging, and angiography. Understanding the advantages and drawbacks of each modality, as well available guidelines, can guide selection of the appropriate technique for individual patients. We review complications following EVAR and advances in surveillance imaging modalities.
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Affiliation(s)
- Stephanie H Kim
- Department of Radiology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Harold I Litt
- Department of Radiology, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, Pennsylvania
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14
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Stomp W, Eefting D, van Schaik J, Sudiono DR, van der Meer RW. Antegrade common femoral artery access site closure using the MANTA vascular closure device. Radiol Case Rep 2020; 15:2205-2207. [PMID: 32952759 PMCID: PMC7486571 DOI: 10.1016/j.radcr.2020.08.053] [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: 08/16/2020] [Revised: 08/24/2020] [Accepted: 08/24/2020] [Indexed: 11/26/2022] Open
Abstract
In antegrade peripheral endovascular procedures, the use of covered stents may require a large sheath size, which precludes the use of regular closure devices. The MANTA vascular closure device is a collagen plug-based vascular closure device for large bore percutaneous arterial interventions, which is normally used to close retrograde vascular access sites. We describe successful antegrade common femoral access site closure with the MANTA vascular closure device in 2 patients, a 68-year-old male and an 89-year-old male, both with a popliteal artery aneurysm which was treated by percutaneous endovascular stentgraft placement. Use of the MANTA vascular closure device simplifies large-bore antegrade common femoral artery access and avoids the need for surgical artery cutdown.
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Affiliation(s)
- Wouter Stomp
- Department of Radiology, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, the Netherlands
| | - Daniël Eefting
- Department of Surgery, Leiden University Medical Center, 2300 RC, Leiden, the Netherlands.,Department of Surgery, Haaglanden Medical Center, 2501 CK, The Hague, the Netherlands
| | - Jan van Schaik
- Department of Surgery, Leiden University Medical Center, 2300 RC, Leiden, the Netherlands
| | - Davy R Sudiono
- Department of Radiology, Haaglanden Medical Center, 2501 CK, The Hague, the Netherlands
| | - Rutger W van der Meer
- Department of Radiology, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, the Netherlands
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15
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Rizk T, Patel D, Dimitri NG, Mansour K, Ramakrishnan V. Iatrogenic Arterial Perforation During Endovascular Interventions. Cureus 2020; 12:e10018. [PMID: 32983713 PMCID: PMC7515740 DOI: 10.7759/cureus.10018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The use of minimally invasive endovascular procedures has increased, and as such, the frequency of associated vascular complications has also increased. Regardless of the access site location, rarely, arterial perforation can occur, which can be fatal if not properly managed. Interventionalists should be aware of the risk factors for perforation, commonly perforated vessels, and how different sites of perforation are diagnosed and managed. Rapid recognition and endovascular management reduce the need for open surgical repair, and thus reduce the morbidity and mortality of these complications. This review outlines the presentation, diagnosis, and management of iatrogenic perforations of the subclavian artery, thyrocervical trunk (TT), common carotid artery, superficial femoral artery (SFA), and external iliac artery.
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Mujer MT, Al-Abcha A, Flores J, Saleh Y, Robinson P. A comparison of figure-of-8-suture versus manual compression for venous access closure after cardiac procedures: An updated meta-analysis. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 43:856-865. [PMID: 32638389 DOI: 10.1111/pace.14008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/09/2020] [Accepted: 07/05/2020] [Indexed: 01/21/2023]
Abstract
BACKGROUND Manual compression (MC) is the current standard to achieve postprocedural hemostasis in patients who need venous vascular access closure after cardiovascular procedures. Figure-of-8 (F8) suture for venous access closure has been reported to be a safe and efficacious alternative to MC. METHODS A systematic search was done using PubMed, Google Scholar, EMBASE, SCOPUS, and ClinicalTrials.gov without language restriction up until April 15, 2020 for studies comparing F8 suture versus MC. Risk ratio (RR) and mean difference (MD) with 95% confidence interval (CI) were calculated using a random effects model. RESULTS Time to achieve hemostasis was significantly reduced in the F8 arm [MD -21.04 min (95% CI: -35.66 to -6.42; P = .005)]. Access site bleeding was significantly lower in the F8 group [RR 0.35 (95% CI: 0.18 to 0.66; P = .001)] along with a lower incidence of hematoma formation [RR 0.42 (95% CI: 0.26 to 0.67; P = .0003)]. There was no significant difference in rates of fistula or pseudoaneurysm formation between the two groups. Overall access site complications were lower in the F8 arm [RR 0.38 (95% CI: 0.26 to 0.55; P < .00001)] and the effect was more pronounced for sheaths ≥10 Fr [RR 0.33 (95% CI: 0.18 to 0.60; P = .0003)]. There was lower postprocedural protamine use in the F8 group [RR 0.07 (95% CI: 0.01 to 0.36; P = .001)]. CONCLUSION For large-bore venous access closure, the F8 suture results in a shortened time to achieve hemostasis along with a lower overall risk of access site complications and postprocedural protamine use.
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Affiliation(s)
- Mark Terence Mujer
- Department of Medicine, Michigan State University, East Lansing, Michigan
| | - Abdullah Al-Abcha
- Department of Medicine, Michigan State University, East Lansing, Michigan
| | - Jairus Flores
- University of the Philippines College of Medicine, Manila, Philippines
| | - Yehia Saleh
- Department of Medicine, Michigan State University, East Lansing, Michigan
| | - Peter Robinson
- Pat and Jim Calhoun Cardiology Center, University of Connecticut, Farmington, Connecticut
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Ramírez Vélez A, Gaviria Valencia S, Jaramillo Gómez N, Contreras Martínez H, Cardona Vélez J. Accesos vasculares femoral y radial en intervenciones coronarias percutáneas en síndrome coronario agudo y enfermedad crónica inestabilizada. REVISTA COLOMBIANA DE CARDIOLOGÍA 2018. [DOI: 10.1016/j.rccar.2018.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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18
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Retrograde popliteal access to treat femoropopliteal artery occlusive disease. J Vasc Surg 2018; 68:161-167. [DOI: 10.1016/j.jvs.2017.12.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 12/03/2017] [Indexed: 12/18/2022]
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Dou E, Winokur RS, Sista AK. Venous Access Site Closures Using the VASCADE Vascular Closure System. J Vasc Interv Radiol 2016; 27:1885-1888. [DOI: 10.1016/j.jvir.2016.07.029] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 07/27/2016] [Accepted: 07/27/2016] [Indexed: 10/20/2022] Open
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Krishnasamy VP, Hagar MJ, Scher DJ, Sanogo ML, Gabriel GE, Sarin SN. Vascular Closure Devices: Technical Tips, Complications, and Management. Tech Vasc Interv Radiol 2015; 18:100-12. [DOI: 10.1053/j.tvir.2015.04.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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