1
|
Oikonomou K, Kvataia A, Pfister K, Zygouridou E, Betz T, Schierling W, Sachsamanis G. Percutaneous Approach in Endovascular Aortic Procedures Using a Suture-Mediated Closure Device. J Clin Med 2022; 11:jcm11226660. [PMID: 36431136 PMCID: PMC9695263 DOI: 10.3390/jcm11226660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 11/05/2022] [Accepted: 11/07/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The purpose of this study is to assess the efficacy of a suture-mediated closure device during percutaneous endovascular aortic repair. METHODS A single-center, retrospective analysis of patients undergoing endovascular repair for infrarenal, thoracic and thoracoabdominal aortic aneurysms and aortic dissections via percutaneous femoral access between April 2017 and June 2021 was performed. The primary endpoint of the study was the efficacy and technical success of the Perclose ProGlide closure device during percutaneous endovascular procedures. The secondary endpoints were intraoperative and postoperative inguinal and vascular complications during and after device use. RESULTS A total of 376 punctures were performed in 263 patients with the deployment of the ProGlide vascular closure system. Twenty-two cases involved percutaneous re-puncture as part of a staged procedure. The primary and secondary technical success rates were 93.1% (350/376) and 94.7% (356/376), respectively. In 20 patients (5.3%), intraoperative femoral exposure due to complications was required. Postoperative complications occurred in 13 cases (3.5%), 2 of which required surgical reintervention. There was no statistical significance between the type of endovascular procedure and primary technical success (p = 0.56). The introduction of larger-diameter sheaths was not associated with increased intraoperative and postoperative complication rates (p = 0.75 and p = 0.78, respectively). Percutaneous re-puncture of the vascular access site did not result in a lower overall technical success rate (20/22, 90.9% primary technical success rate, p = 0.67; 21/22, 95.5% secondary technical success rate, p = 0.86) or an increased number of perioperative complications (1/22, 4.5% intraoperative complications, p = 0.86; 2/22, 9.1% postoperative complications, p = 0.13). CONCLUSION The application of the ProGlide closure system is a safe and efficient method to achieve hemostasis during percutaneous endovascular aortic repair. Complex aortic pathologies, which often require a staged approach with re-puncture, can also be successfully treated with this closure system.
Collapse
Affiliation(s)
- Kyriakos Oikonomou
- Department of Vascular and Endovascular Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
- Department of Vascular and Endovascular Surgery, Cardiovascular Surgery Clinic, University Hospital Frankfurt, Johann Wolfgang Goethe University Frankfurt, 60596 Frankfurt, Germany
- Correspondence: ; Tel.: +49-069-6301-4136
| | - Akaki Kvataia
- Department of Vascular and Endovascular Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
- Department of Vascular and Endovascular Surgery, Cardiovascular Surgery Clinic, University Hospital Frankfurt, Johann Wolfgang Goethe University Frankfurt, 60596 Frankfurt, Germany
| | - Karin Pfister
- Department of Vascular and Endovascular Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Evgenia Zygouridou
- Department of Vascular and Endovascular Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Thomas Betz
- Department of Vascular and Endovascular Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Wilma Schierling
- Department of Vascular and Endovascular Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Georgios Sachsamanis
- Department of Vascular and Endovascular Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| |
Collapse
|
2
|
Mathisen SR, Nilsson KF, Larzon T. A Single Center Study of ProGlide Used for Closure of Large-Bore Puncture Holes After EVAR for AAA. Vasc Endovascular Surg 2021; 55:798-803. [PMID: 34105422 DOI: 10.1177/15385744211022654] [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] [Indexed: 12/14/2022]
Abstract
PURPOSE The objective of this study was to evaluate the primary and assisted secondary percutaneous and non-invasive technical success of the ProGlide device on all-comers in a consecutive case series of percutaneous endovascular aortic aneurysm repair (P-EVAR). METHOD A single-center consecutive case series where 434 elective and acute P-EVAR procedures were registered prospectively between May 2011 and July 2017. The mean age was 74.5 years ± SD 11.4 years. 82.3% of the patients were male. All patients were pre-planned from CT angiography. Percutaneous access punctures, performed in local anesthesia in the common femoral artery, with a final introducer size between 12-22 Fr OD were included and stratified in 2 groups, 12-16 Fr and 17-22 Fr. RESULTS By screening 868 access groins 22 groins were excluded. Of the remaining 846 groins, intended to be treated with ProGlide, 9 groins were excluded peri-procedurally and treated with the Fascia Suture Technique or surgical cutdown. The remaining 837 groins had access closure with ProGlide, with a mean value of 2.15 devices per groin with a slight significant difference between the 2 stratification groups. Primary ProGlide technical success was achieved in 68.1% of the groins. Secondary percutaneous or non-invasive technical success was achieved in 96.9%. Here there was no statistically significant difference between the 2 stratification groups. Thirty-one (3.7%) groin complications were registered during 30-day follow-up and 17 required additional treatment. Total mortality was 2.8%. None of these deaths were related to the access site. CONCLUSION ProGlide by itself has a significant failure rate in the closure of large-bore access holes on an unselected cohort of patients eligible for P-EVAR. However, together with adjunct percutaneous or non-invasive methods a success rate of 97% can be achieved. The access complication rate was lower than 4% at 30-day follow-up.
Collapse
Affiliation(s)
| | - Kristofer F Nilsson
- Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Thomas Larzon
- Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| |
Collapse
|
3
|
Kim CH, Ju MH, Lim MH, Lee CH, Je HG. Control of Femoral Cannulation with a ProGlide Pre-Closure Device during Cardiac Surgery: Is It Reliable? J Chest Surg 2021; 54:179-185. [PMID: 33911051 PMCID: PMC8181693 DOI: 10.5090/jcs.21.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/13/2021] [Accepted: 03/17/2021] [Indexed: 11/16/2022] Open
Abstract
Background The use of ProGlide as a percutaneous vascular closure device in cardiac surgery remains inconclusive. This study investigated the clinical outcomes of using Pro- Glide in the percutaneous cannulation of femoral vessels in adult cardiac surgery. Methods From September 2017 to July 2018, 131 consecutive patients underwent femoral vessel cannulation during cardiac surgery. The ProGlide (Abbott Vascular Inc., Santa Clara, CA, USA) with percutaneous cannulation was used in 118 patients (mean age, 55.7±15.5 years). The accessibility of femoral cannulation was evaluated through preoperative computed tomography. For cannulation, sonography was routinely used. The postoperative ankle-brachial index (ABI) was used to evaluate femoral artery stenosis. Results Of the 118 patients, 112 (94.9%) and 6 (5.1%) underwent minimally invasive cardiac surgery and median sternotomy, respectively. Most femoral cannulations were performed on the right side (98.3%) using 15F to 19F arterial cannulas. The technical success rate of cannulation with ProGlide was 99.2%, with no delayed bleeding or cannulation site-related complications during hospitalization. During follow-up, only 1 patient showed femoral artery stenosis with claudication and was treated with interventional balloon angioplasty. The postoperative ABI revealed no significant difference in functional stenosis between the cannulation and non-cannulation sides (n=86; cannulation vs. non-cannulation, 1.2±0.1 vs. 1.1±0). Conclusion Percutaneous femoral cannulation with ProGlide was safe and feasible in adult cardiac surgery. This technique may be a good alternative option in patients requiring femoral vessel cannulation for cardiac surgery.
Collapse
Affiliation(s)
- Chang Hun Kim
- Department of Thoracic and Cardiovascular Surgery, Pusan National University Yangsan Hospital, Medical Research Institute, Pusan National University School of Medicine, Yangsan, Korea
| | - Min Ho Ju
- Department of Thoracic and Cardiovascular Surgery, Pusan National University Yangsan Hospital, Medical Research Institute, Pusan National University School of Medicine, Yangsan, Korea
| | - Mi Hee Lim
- Department of Thoracic and Cardiovascular Surgery, Pusan National University Yangsan Hospital, Medical Research Institute, Pusan National University School of Medicine, Yangsan, Korea
| | - Chee-Hoon Lee
- Department of Thoracic and Cardiovascular Surgery, Pusan National University Yangsan Hospital, Medical Research Institute, Pusan National University School of Medicine, Yangsan, Korea
| | - Hyung Gon Je
- Department of Thoracic and Cardiovascular Surgery, Pusan National University Yangsan Hospital, Medical Research Institute, Pusan National University School of Medicine, Yangsan, Korea
| |
Collapse
|
4
|
Theivacumar NS, Qureshi MI, Glasgow S, Najem M. Pledget reinforcement and traction compression as adjunctive techniques for suture-based closure of arterial cannulation sites in percutaneous endovascular aneurysm repair—initial experience. J Vasc Surg Cases Innov Tech 2021; 7:183-187. [PMID: 33748559 PMCID: PMC7973132 DOI: 10.1016/j.jvscit.2020.12.014] [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: 11/07/2020] [Accepted: 12/21/2020] [Indexed: 11/16/2022] Open
Abstract
Suture-based vascular closure devices are used in percutaneous endovascular procedures. However, failures are not uncommon. We have described our initial experience with two adjunct techniques to reinforce the suture-based vascular closure device (ProGlide; Abbot Vascular, Santa Clara, Calif) after percutaneous endovascular aneurysm repair. The threads of the ProGlide device (Abbot Vascular) were passed through a pledget with the help of a needle, which was secured to the puncture site to allow for traction compression. The use of the techniques can be helpful if the suture-based vascular closure devices fail to achieve immediate and complete hemostasis. The use of these adjuncts could reduce the incidence of closure-related complications after percutaneous endovascular procedures.
Collapse
Affiliation(s)
- Nadarajah Selva Theivacumar
- Correspondence: Nadarajah Selva Theivacumar, MBBS, MD, FRCS, West London Vascular and Interventional Centre, Northwick Park Hospital, Watford Rd, Harrow HA1 3UJ, United Kingdom
| | | | | | | |
Collapse
|
5
|
Najem M, Martin G, Patrone L, Malina M, Theivacumar NS. Pledget Reinforcement and Tractional Compression as Adjunctive Techniques for Suture-Mediated Closure (SMC) in Percutaneous Endovascular Aneurysm Repair (pEVAR): A Retrospective Observational Cohort Study. Ann Vasc Surg 2021; 73:369-374. [PMID: 33444773 DOI: 10.1016/j.avsg.2020.11.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 11/08/2020] [Accepted: 11/11/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Percutaneous endovascular aneurysm repair (pEVAR) is commonly utilized and requires the use of suture-mediated closure (SMC) devices to ensure adequate femoral artery hemostasis. Despite the use of such devices, puncture-related complications remain relatively common. We introduced two new adjuncts (pledget reinforcement and tractional compression) along with SMC to reduce such puncture-related complications. The aim of the study was to assess the efficacy and safety of the new adjunct techniques. METHODS This retrospective observational cohort study examines the impact of two adjunctive techniques on puncture-related complications compared with the previous year data before this new introduction of adjunct techniques. RESULTS Sixty-one percutaneous femoral punctures (in 31 patients) utilizing adjunct techniques for closure (the adjunct group) were retrospectively compared with 89 punctures (in 46 patients) closed with standard SMC technique (the standard group). The use of adjunctive techniques led to a significant reduction in overall puncture-related complications (3/61 (4.9%) vs. 20/89 (22.5%), P = 0.0106) and the need for emergent surgical repair after failed hemostasis (2/61 (3.3%) vs. 13/89 (14.6%), P = 0.037). CONCLUSIONS These novel adjunctive techniques (pledget reinforcement and tractional compression) of SMC for pEVAR reduce puncture-related complications and increase the confidence to offer percutaneous techniques for more patients.
Collapse
Affiliation(s)
- Mojahid Najem
- West London Vascular & Interventional Centre (WeLVIC), Northwick Park Hospital, Harrow, UK
| | - Guy Martin
- West London Vascular & Interventional Centre (WeLVIC), Northwick Park Hospital, Harrow, UK
| | - Lorenzo Patrone
- West London Vascular & Interventional Centre (WeLVIC), Northwick Park Hospital, Harrow, UK
| | - Martin Malina
- West London Vascular & Interventional Centre (WeLVIC), Northwick Park Hospital, Harrow, UK
| | - Nada Selva Theivacumar
- West London Vascular & Interventional Centre (WeLVIC), Northwick Park Hospital, Harrow, UK
| |
Collapse
|
6
|
Baldino G, Rossi UG, Di Gregorio S, Gori A. Ultrasound-guided fascia closure as bailout technique for large-bore percutaneous femoral access failure: Report of two cases. J Vasc Access 2020; 21:769-772. [PMID: 32089061 DOI: 10.1177/1129729820906975] [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: 11/16/2022] Open
Abstract
Percutaneous endovascular abdominal aortic aneurysm repair is nowadays considered a safe and effective procedure and has gained widespread globally acceptance. However, intraoperative persistent bleeding due to percutaneous access closure device failure can occur. Open conversion is first-line treatment to manage this complication. The fascia suture technique was introduced as an alternative to access closure device or as a solution to manage unsatisfactory hemostasis during percutaneous endovascular abdominal aortic aneurysm repair. In this article, we report a new simple minimally invasive ultrasound-guided fascia suture technique as a bailout method to manage persistent bleeding after percutaneous endovascular abdominal aortic aneurysm repair avoiding open conversion. This technique was successfully used in two cases at our center with satisfactory hemostasis and no further complications. Ultrasound-guided fascia suture technique can be proposed as a minimally invasive bailout technique for access closure device failure.
Collapse
Affiliation(s)
- Giuseppe Baldino
- Department of Vascular and Endovascular Surgery, Galliera Hospital, Genoa, Italy
| | - Umberto G Rossi
- Department of Radiological Area, Interventional Radiology Unit, Galliera Hospital, Genoa, Italy
| | - Sara Di Gregorio
- Department of Vascular and Endovascular Surgery, IRCCS San Martino Hospital, Genoa, Italy
| | - Amerigo Gori
- Department of Vascular and Endovascular Surgery, Galliera Hospital, Genoa, Italy
| |
Collapse
|