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Koziarz A, Kennedy SA, Awad El-Karim G, Tan KT, Oreopoulos GD, Kalra S, Etz CD, Rajan DK, Mafeld S. Vascular Closure Devices For Axillary Artery Access: A Systematic Review and Meta-Analysis. J Endovasc Ther 2023:15266028221147451. [PMID: 36625294 DOI: 10.1177/15266028221147451] [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: 01/11/2023]
Abstract
PURPOSE To evaluate the technical success and complication rates of vascular closure devices (VCDs) in the axillary artery. MATERIALS AND METHODS MEDLINE and Embase were searched independently by two reviewers to identify observational studies from inception through October 2021. The following outcomes were meta-analyzed: technical success, hematoma, dissection, pseudoaneurysm, infection, and local neurological complications. Complications were also graded as mild, moderate, and severe. A logistic regression evaluating the influence of sheath size for the outcome of technical success rate was performed using individual patient-level data. RESULTS Of 1496 unique records, 20 observational studies were included, totaling 915 unique arterial access sites. Pooled estimates were as follows: technical success 84.8% (95% confidence interval [CI]: 78%-89.7%, I2=60.4%), hematoma 7.9% (95% CI: 5.8%-10.6%, I2=0%), dissection 3.1% (95% CI: 1.3%-7.3%, I2=0%), pseudoaneurysm 2.7% (95% CI: 1.3%-5.7%, I2=0%), infection <1% (95% CI: 0%-5.7%, I2=20.5%), and local neurological complications 2.7% (95% CI: 1.7%-4.4%, I2=0%). There was a significant negative association between sheath size and technical success rate (odds ratio [OR]: 0.87 per 1 French (Fr) increase in sheath size, 95% CI: 0.80-0.94, p=0.0005). Larger sheath sizes were associated with a greater number of access-site complications (adjusted odds ratio [aOR]: 1.21 per 1 Fr increase sheath size, 95% CI: 1.04-1.40, p=0.013). CONCLUSIONS Off-label use of VCDs in the axillary artery provides an 85% successful closure rate and variable complication rate, depending on the primary procedure and sheath size. Larger sheaths were associated with a lower technical success and greater rate of access-related complications. CLINICAL IMPACT Safe arterial access is the foundation for arterial intervention. While the common femoral artery is a well established access site, alternative arterial access sites capable of larger sheath sizes are needed in the modern endovascular era. This article provides the largest synthesis to date on the use of vascular closure devices for percutaneous axillary artery access in endovascular intervention. It should serve clinicians with added confidence around this approach in terms of providing a reference for technical success and complications. Clinically, this data is relevant for patient consent purposes as well as for practice quality improvement in setting safety standards for this access site.
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Affiliation(s)
- Alex Koziarz
- Department of Radiology, McMaster University, Hamilton, ON, Canada
| | - Sean A Kennedy
- Division of Vascular and Interventional Radiology, Department of Medical Imaging, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
| | - Ghassan Awad El-Karim
- Division of Vascular and Interventional Radiology, Department of Medical Imaging, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
| | - Kong T Tan
- Division of Vascular and Interventional Radiology, Department of Medical Imaging, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
| | - George D Oreopoulos
- Division of Vascular and Interventional Radiology, Department of Medical Imaging, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
- Division of Vascular Surgery, University Health Network, Toronto, ON, Canada
| | - Sanjog Kalra
- Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Christian D Etz
- Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany
| | - Dheeraj K Rajan
- Division of Vascular and Interventional Radiology, Department of Medical Imaging, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
| | - Sebastian Mafeld
- Division of Vascular and Interventional Radiology, Department of Medical Imaging, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
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Koziarz A, Kennedy SA, El-Karim GA, Tan KT, Oreopoulos GD, Jaberi A, Rajan DK, Mafeld S. The Use of Vascular Closure Devices for Brachial Artery Access: A Systematic Review and Meta-Analysis. J Vasc Interv Radiol 2022; 34:677-684.e5. [PMID: 36526077 DOI: 10.1016/j.jvir.2022.12.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 11/28/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To estimate the rates of technical success and adverse events of vascular closure devices (VCDs) in the brachial artery and compare the rates of adverse events with manual compression. MATERIALS AND METHODS MEDLINE and Embase were searched for observational studies examining VCDs in the brachial artery. Meta-analyses were performed using random effects for the following outcomes: (a) technical success, (b) hematoma at the access site, (c) pseudoaneurysm, (d) local neurological adverse events, and (e) total number of adverse events. A pairwise meta-analysis compared VCD with manual compression for the outcomes of hematoma and the total number of adverse events. RESULTS Of 1,761 eligible records, 16 studies including 510 access sites were included. Primary procedures performed were peripheral arterial disease interventions, percutaneous coronary intervention, and endovascular thrombectomy for ischemic stroke. The technical success rate was 93% (95% CI, 87%-96%; I2 = 47%). Data on the following adverse events were obtained via meta-analysis: (a) hematoma, 9% (5%-15%; I2 = 54%); (b) stenosis or occlusion at access site, 3% (1%-14%; I2 = 51%); (c) infection, 0% (0%-5%; I2 = 0%); (d) pseudoaneurysm, 4% (1%-13%; I2 = 61%); (e) local neurological adverse events, 5% (2%-13%; I2 = 54%); and (f) total number of adverse events, 15% (10%-22%; I2 = 51%). Angio-Seal success rate was 96% (93%-98%; I2 = 0%), whereas the ExoSeal success rate was 93% (69%-99%; I2 = 61%). When comparing VCD and manual compression, there was no difference in hematoma formation (relative risk, 0.75; 95% CI, 0.35-1.63; I2 = 0%; P = .47) or the total number of adverse events (relative risk, 0.75; 95% CI, 0.35-1.58; I2 = 76%; P = .45). CONCLUSIONS Despite being off-label, studies suggest that VCDs in the brachial artery have a high technical success rate. There was no significant difference in adverse events between VCDs and manual compression in the brachial artery.
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Affiliation(s)
- Alex Koziarz
- Department of Radiology, McMaster University, Hamilton, Ontario, Canada
| | - Sean A Kennedy
- Division of Vascular and Interventional Radiology, Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Ghassan Awad El-Karim
- Division of Vascular and Interventional Radiology, Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Kong T Tan
- Division of Vascular and Interventional Radiology, Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - George D Oreopoulos
- Division of Vascular and Interventional Radiology, Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada; Division of Vascular Surgery, University Health Network, Toronto, Ontario, Canada
| | - Arash Jaberi
- Division of Vascular and Interventional Radiology, Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Dheeraj K Rajan
- Division of Vascular and Interventional Radiology, Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Sebastian Mafeld
- Division of Vascular and Interventional Radiology, Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada.
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Shiu WHL. Inadvertent cannulation of subclavian artery in central venous catheter insertion: A case report and review of prevention and management. J Clin Imaging Sci 2022; 12:34. [PMID: 35769095 PMCID: PMC9235425 DOI: 10.25259/jcis_50_2022] [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: 05/13/2022] [Accepted: 06/04/2022] [Indexed: 11/24/2022] Open
Abstract
Central venous catheter is a commonly performed procedure in which inadvertent arterial puncture is a known complication. Inadvertent arterial injury with a large-bore catheter is associated with significant morbidity and there are a few endovascular techniques to repair the injury, including the use of a percutaneous closure device and a covered stent placement. We report a case of a patient with complex medical history complicated by inadvertent right subclavian artery injury during central venous catheter insertion. The catheter was immediately removed. The right subclavian arterial injury was repaired with a stent-graft.
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Affiliation(s)
- Wai Hung Lester Shiu
- Department of Radiology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong
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Meucci F, Stolcova M, Caniato F, Sarraf M, Mattesini A, Di Mario C. The Essentials of Femoral Vascular Access and Closure. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Nanda C, Garg V, Singh A, Mehta Y. Inadvertent Insertion of Hemodialysis Catheter into Brachiocephalic Trunk During Cannulation of Internal Jugular Vein: Management Strategies. JOURNAL OF CARDIAC CRITICAL CARE TSS 2022. [DOI: 10.1055/s-0041-1739527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
AbstractCentral venous catheter insertion is a commonly performed procedure in the operating room and intensive care unit. It is associated with many complications, some of which may be life-threatening. We report here an accidental insertion of a hemodialysis catheter into the brachiocephalic trunk, which was successfully removed by an endovascular technique.
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Affiliation(s)
- Chinmaya Nanda
- Department of Cardiac Anaesthesia, Institute of Critical Care and Anesthesiology, Medanta-The Medicity, Sector-38, Gurugram, Haryana, India
| | - Vinit Garg
- Department of Cardiac Anaesthesia, Institute of Critical Care and Anesthesiology, Medanta-The Medicity, Sector-38, Gurugram, Haryana, India
| | - Ajmer Singh
- Department of Cardiac Anaesthesia, Institute of Critical Care and Anesthesiology, Medanta-The Medicity, Sector-38, Gurugram, Haryana, India
| | - Yatin Mehta
- Department of Cardiac Anaesthesia, Institute of Critical Care and Anesthesiology, Medanta-The Medicity, Sector-38, Gurugram, Haryana, India
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Gonen KA, Hakyemez B, Erdogan C. Analysis of predictive and preventive factors for access complications associated with vascular closure devices in complicated endovascular procedures. Jpn J Radiol 2021; 39:1206-1212. [PMID: 34216347 DOI: 10.1007/s11604-021-01165-x] [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: 12/30/2020] [Accepted: 06/21/2021] [Indexed: 12/19/2022]
Abstract
PURPOSE The main goal is to evaluate the effectiveness of angioseal and starclose vascular closure devices (VCDs) in high-risk patients under intensive anticoagulation who require therapeutic angiographic procedures and to discuss which factors are important in complications associated with VCDs. MATERIALS AND METHODS Medical records of the patients who underwent therapeutic complex interventional vascular procedures were reviewed retrospectively. One hundred sixty-six patients were divided into two groups regarding VCDs used for access-site closure after the procedure: group 1, (angioseal); group 2, (starclose). Data including patients' demographics and comorbidity information, procedural characteristics, and complications were analyzed. RESULTS The device deployment success rate was 100%. For the procedural characteristics, there was no significant difference between the groups except access site (P = 0.016) and sheath size > 6F (P = 0.0001). No major complications had occurred in none of the patients. Minor complications including hematoma, access-site pain, and access-site infection, except prolonged hemostasis did not differ significantly between groups. The patients' demographic and periprocedural factors were not significantly correlated with the development of complications. CONCLUSION Contrary to published reports, our study showed that demographic and periprocedural factors may not be responsible for the vascular access-site complications associated with VCDs.
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Affiliation(s)
- Korcan Aysun Gonen
- Department of Radiology, School of Medicine, Tekirdag Namik Kemal University, Tekirdag, Turkey.
| | - Bahattin Hakyemez
- Department of Radiology, School of Medicine, Bursa Uludag University, Bursa, Turkey
| | - Cuneyt Erdogan
- Department of Radiology, School of Medicine, Bursa Uludag University, Bursa, Turkey
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Frenzel F, Fries P, Shayesteh-Kheslat R, Buecker A, Massmann A. Single Angio-Seal vascular closure device for transfemoral access exceeding 8F. J Cardiol 2020; 76:211-216. [PMID: 32402666 DOI: 10.1016/j.jjcc.2020.02.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 02/07/2020] [Accepted: 02/18/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND This was a retrospective single-center evaluation for off-label use of a single Angio-Seal-VIP 8F vascular closure device (VCD) (Terumo Interventional Systems, Somerset, NJ, USA) for retrograde transfemoral arterial access exceeding 8F. METHODS Between 2010 and 2018, in 32 consecutive patients (3 females; mean age 67±9; range 46-86 years) retrograde femoral access was performed in 48 groins for aortoiliac stent or stent graft implantations using 9-14F sheaths. For vascular closure, one single Angio-Seal™-VIP 8F was used. Procedural success, closure-related complications, and risk factors were retrospectively evaluated using patient characteristics, duplex-ultrasound, and contrast-enhanced computed tomography angiography (CTA). Receiver-operating-characteristics were used for statistical analysis. RESULTS Technical success for deployment of VCD was 100%. Visual inspection and duplex-ultrasound confirmed immediate hemostasis in 100%. Postinterventional CTA depicted major vascular access site complications in 6.3% (3/48 groins) requiring surgical treatment. A subgroup of 13 patients underwent surgical cut-down one day after VCD deployment as part of a two-staged complex endovascular aortic aneurysm repair procedure, allowing for visual assessment of prior used undersized Angio-SealTM. Patient's height (p=0.028) and severe access site calcifications (p=0.028) proved as predictors for one vessel occlusion and two pseudoaneurysms. Low body-mass-index (BMI) showed a non-significant trend. Sheath-size, common femoral artery depth, or body weight were not indicative for occurrence of complications. CONCLUSIONS In selected cases, without availability of appropriate VCDs, a single Angio-SealTM-VIP 8F served as a feasible option to achieve sufficient hemostasis of transfemoral access exceeding 8F without relevant bleeding complications. Very low BMI, tall body-height, and severe atherosclerosis were identified to predispose to access site complications.
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Affiliation(s)
- Felix Frenzel
- Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Peter Fries
- Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Roushanak Shayesteh-Kheslat
- Clinic for General, Abdominal and Vascular Surgery, Saarland University Medical Center, Homburg/Saar, Germany
| | - Arno Buecker
- Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Alexander Massmann
- Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg/Saar, Germany.
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Tagliaferro FB, Orgera G, Mascagni L, Laurino F, Tipaldi MA, Cariati M, Rossi M. FemoSeal ® vascular closure device for antegrade common femoral artery access: Safety and technical notes. J Vasc Access 2019; 21:79-85. [PMID: 31232151 DOI: 10.1177/1129729819854593] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
PURPOSE To retrospectively assess the efficacy and safety of FemoSeal® vascular closure device to achieve hemostasis following antegrade common femoral artery puncture after lower limb revascularization using vascular sheaths from 5 to 8 Fr. METHODS We reviewed the hemostatic outcome achieved with FemoSeal in 103 consecutive patients (mean age: 69 ± 8 years, 71 males) that undergone to 111 antegrade common femoral artery accesses for percutaneous lower limbs revascularization using 5- to 8-Fr vascular sheaths. We used FemoSeal in an unselected population, without exclusion criteria. The primary outcome was the technical success, meant as achieving complete hemostasis without immediate complications. RESULTS Hemostasis was achieved in all 111 puncture sites (100% technical success). We observed eight (7%) puncture site minor complications (hematomas), none of which affecting the patients' outcome or requiring further therapies or increasing the hospital stay. There were no statistically significant differences between the variables potentially related to the occurrence of complications (age, international normalized ratio, platelet count, partial thromboplastin time ratio, body mass index, and common femoral arteries calcification grade) in patients with and without complications. Complications group mean body mass index was 26.4 ± 2.8 kg/m2 versus non-complications group 26.6 ± 4.4 kg/m2, p = 0.92. Mean international normalized ratio and partial thromboplastin time ratio were 1.05 ± 0.01 and 1.05 ± 0.14 versus 1.13 ± 0.2 (p = 0.39) and 1.12 ± 0.23 (p = 0.53), respectively. Common femoral arteries calcification grade was the same (mean: 1, p = 1). Platelet count was 202 × 103/mL ± 66.7 versus 226 × 103/mL ± 91.2, p = 0.55. Mean age was 72.3 ± 10 years versus 72.8 ± 8 years, p = 0.86. CONCLUSION The low rate (7%) and grading of the adverse events, combined with the high technical success rate (100%), in an unselected group of patients treated in daily routine, suggest high safety and efficacy of FemoSeal vascular closure device in antegrade common femoral artery puncture site hemostasis when using vascular sheaths ranging from 5 to 8 Fr. Therefore, FemoSeal could be considered as a first-line hemostasis strategy in such cases.
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Affiliation(s)
| | - Gianluigi Orgera
- Unit of Interventional Radiology, Sant'Andrea University Hospital, La Sapienza University, Rome, Italy
| | - Luca Mascagni
- Unit of Interventional Radiology, Sant'Andrea University Hospital, La Sapienza University, Rome, Italy
| | - Florindo Laurino
- Unit of Interventional Radiology, Sant'Andrea University Hospital, La Sapienza University, Rome, Italy
| | - Marcello Andrea Tipaldi
- Unit of Interventional Radiology, Sant'Andrea University Hospital, La Sapienza University, Rome, Italy
| | - Maurizio Cariati
- Advanced Diagnostic-Therapeutic Technologies Department, ASST Santi Paolo e Carlo, Milano, Italy
| | - Michele Rossi
- Unit of Interventional Radiology, Sant'Andrea University Hospital, La Sapienza University, Rome, Italy
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Alimi Y, Hauguel A, Casbas L, Magnan PE, Pin JL, Sabatier J, Régnard O, Gouëffic Y. French Guidelines for the Management of Ambulatory Endovascular Procedures for Lower Extremity Peripheral Artery Disease. Ann Vasc Surg 2019; 59:248-258. [PMID: 31132446 DOI: 10.1016/j.avsg.2019.05.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 05/10/2019] [Accepted: 05/12/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Ambulatory hospitalization for endovascular repair of lower extremity peripheral arterial disease (PAD) could be a real opportunity to respond to the burden of PAD, to reduce costs, and to improve patients' empowerment. The French Society of Vascular and Endovascular Surgery (SCVE) established guidelines to facilitate the development of ambulatory hospitalization in France. METHODS In 2017, we used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and MEDLINE database to conduct a systematic review of available literature. A total of 448 relevant articles were found. Twelve articles, all published after the year 2000, were included and reviewed by two independent investigators. The SCVE mandated a scientific committee to collectively establish these guidelines. RESULTS Eligibility for ambulatory management shall be based on the assessment of the triad: (1) patient, (2) procedure, and (3) structure. Comprehensive information and a detailed procedural pathway should be provided for the patient. No age limit is recommended. American Society of Anesthesiologists I, II, and III stable patients are eligible for ambulatory intervention. Specific comorbidities such as severe obesity, sleep apnea, and/or chronic kidney failure should be assessed preoperatively. Critical limb ischemia and complex lesions have not been considered as exclusion criteria. Antiplatelet drug use (aspirin and/or clopidogrel) has not been considered as a contraindication. Femoral ultrasound-guided puncture is recommended. Manual compression or closure devices have been recommended for 7F sheath or less. A minimum of 4 hours of monitoring after percutaneous femoral access is required before discharge. CONCLUSIONS The SCVE guidelines aim to frame the practice of ambulatory endovascular procedures for lower extremity peripheral artery disease and to give vascular interventionalists help in their routine practice.
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Affiliation(s)
- Yves Alimi
- Université de la Méditerranée, CHU Nord, Service de chirurgie vasculaire, Marseille, France; Laboratoire de Biomécanique Appliquée, Faculté de Médecine Nord, UMRT24 IFSTTAR, Aix Marseille Université, Marseille, France
| | - Alexandra Hauguel
- CHU Nantes, l'institut du thorax, service de chirurgie vasculaire, Nantes, France
| | | | | | | | | | | | - Yann Gouëffic
- CHU Nantes, l'institut du thorax, service de chirurgie vasculaire, Nantes, France; Laboratoire de Physiopathologie de la Résorption Osseuse, Inserm-UN UMR-957, Nantes, France; Université de Nantes, Nantes, France.
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Ultrasound Evaluation of Puncture Sites After Deployment of Two Different Types of Vascular Closure Devices: A Prospective Comparative Study. Cardiovasc Intervent Radiol 2018; 41:1654-1663. [DOI: 10.1007/s00270-018-2056-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 08/07/2018] [Indexed: 12/19/2022]
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Owens JT, Bhatty S, Donovan RJ, Tordini A, Danyi P, Patel K, Wegelin JA, Jovin IS. Usefulness of a Nonsuture Closure Device in Patients Undergoing Diagnostic Coronary and Peripheral Angiography. Int J Angiol 2017; 26:228-233. [PMID: 29142488 DOI: 10.1055/s-0037-1607037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Vascular access site complications can follow diagnostic coronary and peripheral angiography. We compared the complication rates of the Catalyst vascular closure device, with the complication rates after manual compression in patients undergoing diagnostic angiographic procedures via femoral access. We studied 1,470 predominantly male patients undergoing diagnostic coronary and peripheral angiography. Catalyst closure devices were used in 436 (29.7%) patients and manual compression was used in 1,034 (70.3%) patients. The former were allowed to ambulate after 2 hours, while the latter were allowed to ambulate after 6 hours. Major complications occurred in 4 (0.9%) patients who had a Catalyst device and in 14 (1.4%) patients who had manual compression (odds ratio [OR]: 0.67, 95% confidence interval [CI]: 0.22-2.1, p = 0.49). Any complications occurred in 51 (11.7%) patients who had a Catalyst closure device and in 64 (6.2%) patients who had manual compression (OR: 2, CI: 1.4-3, p < 0.01). After adjustment for other variables and for a propensity score reflecting the probability to receive the closure device, the association of major complications with the use of the closure device remained not significant (OR: 0.54, 95% CI: 0.17-1.7, p = 0.29), while the association of any complications with the use of the Catalyst device remained significant (OR: 1.9, 95% CI: 1.3-2.9, p < 0.01). The Catalyst device was not associated with an increased risk of major groin complications but was associated with an increased risk of any complications compared with manual compression. Patients receiving the closure device ambulated sooner.
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Affiliation(s)
- John T Owens
- Department of Medicine, McGuire VA Medical Center, Virginia Commonwealth University, Richmond, Virginia
| | - Shaun Bhatty
- Department of Medicine, McGuire VA Medical Center, Virginia Commonwealth University, Richmond, Virginia
| | - Robert J Donovan
- Department of Medicine, McGuire VA Medical Center, Virginia Commonwealth University, Richmond, Virginia
| | - Andrea Tordini
- Department of Medicine, McGuire VA Medical Center, Virginia Commonwealth University, Richmond, Virginia
| | - Peter Danyi
- Department of Medicine, McGuire VA Medical Center, Virginia Commonwealth University, Richmond, Virginia
| | - Kalpesh Patel
- Department of Medicine, McGuire VA Medical Center, Virginia Commonwealth University, Richmond, Virginia
| | - Jacob A Wegelin
- Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia
| | - Ion S Jovin
- Department of Medicine, McGuire VA Medical Center, Virginia Commonwealth University, Richmond, Virginia
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Kim S, Kwon JH, Han YH, Kim JS. Usefulness and safety of the "God's Hand" pneumatic compression device for hemostasis in femoral catheterization. Diagn Interv Radiol 2016; 23:49-54. [PMID: 27856404 DOI: 10.5152/dir.2016.15451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE We aimed to assess the usefulness and safety of the God's Hand pneumatic compression device for hemostasis in patients undergoing percutaneous endovascular procedures via femoral artery. METHODS Two hundred thirty-seven patients in whom hemostasis of femoral catheterization was achieved using a God's Hand pneumatic compression device were enrolled. The patients were divided into group A, those in whom the device was applied for four hours, and group B, those in whom the device was applied for two hours, with an additional two hours of bed rest in both groups. Groups A and B were regrouped to groups A' and B' using the propensity score matching method (n=65, for both). Chi-squared test and logistic regression models were used to analyze the relationship between the complication rate and patient characteristics and procedure-related factors. RESULTS Clinical success was achieved in 216 of 237 patients (91.1%): 63 in group A (84%) and 153 in group B (94.4%); in propensity score matched groups, clinical success was seen in 47 patients in group A' (81.5%) and 62 patients in group B' (95.4%). Group B' showed a higher clinical success rate than group A' (P = 0.028). There were no major complications. In logistic regression models, a negative association was noted between the complication rate and the duration of God's Hand application; however, this association was not statistically significant. CONCLUSION The God's Hand pneumatic compression device is effective and safe for the hemostasis of femoral catheterization, and four hours of bed rest is sufficient for hemostasis in selected patients.
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Affiliation(s)
- Sungwon Kim
- Department of Radiology, Dongguk University Graduate School of Medicine, Ilsan Hospital, Goyang, Korea.
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Feldman T, Sarraf M. The Essentials of Femoral Vascular Access and Closure. Interv Cardiol 2016. [DOI: 10.1002/9781118983652.ch2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Ted Feldman
- NorthShore University HealthSystem; Evanston IL USA
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Kabelitz L, Nonn A, Nolte KW, Nikoubashman O, Othman A, Heringer S, Kramer M, Wiesmann M, Brockmann MA. Long Term Outcome after Application of the Angio-Seal Vascular Closure Device in Minipigs. PLoS One 2016; 11:e0163878. [PMID: 27682594 PMCID: PMC5040263 DOI: 10.1371/journal.pone.0163878] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 09/15/2016] [Indexed: 11/19/2022] Open
Abstract
Minipigs are frequently used in (neuro-)interventional research. Longitudinal experiments may require repeated vessel access via the femoral artery. Anticoagulation and incompliance of the animals necessitates the use of a vascular closure device (VCD). The effects of the Angio-Seal VCD in minipigs were longitudinally assessed. Minipig (42±8.4 kg body weight) femoral arteries were sealed using the 8F (n = 6) or 6F (n = 7) Angio-Seal VCD. The pre-interventional femoral artery diameter was 5.1±0.4 mm (4.3–5.8 mm). Sealed puncture sites were analysed angiographically as well as by computed tomography angiography (CTA) for a mean period of 14.1±8.0 weeks (1–22 weeks). All animals were constantly treated with acetylsalicylic acid (ASS) (450 mg/d (n = 7) or 100 mg/d (n = 1)) and clopidogrel (75 mg/d (n = 8)). Non-instrumented (n = 2) and arteries sealed using the VCD (n = 2) were examined histologically. No postoperative hemorrhagic complications were observed. Three arteries were occluded after VCD placement (1 animal diagnosed after 4 weeks (8F), 2 animals after 1 week (6F)) and remained so until the end of the experiments after 22, 12 and 4 weeks, respectively. In one artery a 50% stenosis 8 weeks after application of a 6F Angio-Seal was detected. In 69.2% (n = 9) the VCD was applied without complications. Histopathological analysis of the sealed arterial segments showed subtotal obliteration of the vessel lumen, formation of collagenous tissue and partial damage of the internal elastic lamina. The Angio-Seal VCD prevents relevant hemorrhagic complications in minipigs treated with dual platelet inhibition, but is associated with increased vessel occlusion rates.
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Affiliation(s)
- Lisa Kabelitz
- Department of Diagnostic and Interventional Neuroradiology, RWTH Aachen University Hospital, Aachen, Germany
| | - Andrea Nonn
- Department of Diagnostic and Interventional Neuroradiology, RWTH Aachen University Hospital, Aachen, Germany
| | - Kay W. Nolte
- Institute of Neuropathology, RWTH Aachen University Hospital, Aachen, Germany
| | - Omid Nikoubashman
- Department of Diagnostic and Interventional Neuroradiology, RWTH Aachen University Hospital, Aachen, Germany
| | - Ahmed Othman
- Department of Diagnostic and Interventional Neuroradiology, RWTH Aachen University Hospital, Aachen, Germany
- Department of Radiology, University Hospital Tübingen, Tübingen, Germany
| | - Sarah Heringer
- Department of Diagnostic and Interventional Neuroradiology, RWTH Aachen University Hospital, Aachen, Germany
| | - Martin Kramer
- Department of Veterinary Clinical Sciences, Small Animal Clinic, Justus-Liebig-University, Giessen, Germany
| | - Martin Wiesmann
- Department of Diagnostic and Interventional Neuroradiology, RWTH Aachen University Hospital, Aachen, Germany
| | - Marc A. Brockmann
- Department of Diagnostic and Interventional Neuroradiology, RWTH Aachen University Hospital, Aachen, Germany
- Department of Neuroradiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
- * E-mail:
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15
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Sauer A, Dierks A, Wolfschmidt F, Hassold N, Bley TA, Kickuth R. Hemostatic Wound Dressing for Postinterventional Hemostasis in Large Femoral Artery Access Sites. J Endovasc Ther 2016; 23:744-50. [DOI: 10.1177/1526602816658029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Purpose: To present the results of a prospective single-center study that evaluated the safety and efficacy of a hemostatic dressing following femoral artery access. Methods: Within a 9-month period, 80 patients (mean age 68±14 years; 55 men) were treated with a hemostatic dressing patch (Hematrix Active Patch) containing aminocaproic acid, calcium chloride, and thrombin after endovascular procedures via a 6- to 8-F femoral artery access. After removing the sheath, the wound dressing was placed on the puncture site followed by constant manual compression adapted to the sheath size (specified pressure times: 8 minutes for 6-F, 9 minutes for 7-F, and 10 minutes for 8-F). Patients were treated with an additional pressure bandage for 24 hours. Hemostasis was checked clinically and with duplex ultrasound after patch removal and at 24 hours. Patient characteristics [platelets, systolic blood pressure, international normalized ratio (INR), and partial thromboplastin time (PTT)], sheath sizes, and approach direction were compared among patients with successful hemostasis (within specified pressure times) vs those with prolonged compression. Results: A total of 39 6-F, 19 7-F, and 22 8-F sheaths were employed. In 73 (91.2%) of 80 patients, hemostasis was reached within the prespecified pressure times (mean 8.8±0.8 minutes). In 7 patients (4 6-F, 1 7-F, 2 8-F) a longer compression time was necessary (mean 34±30 minutes). No serious major complication occurred. Twelve (15.0%) minor and 5 (6.3%) moderate subcutaneous hematomas were observed. Two (2.5%) false aneurysms were treated successfully. Ambulation and discharge was possible within 24 hours in 79 (98.7%) cases. Patients with initial hemostasis and those with prolonged compression did not differ substantially (p>0.05) according to sheath size, approach direction, INR (1.09±0.3 vs 1.11±0.3), platelets (234±47×103/µL vs 249±93×103/µL), systolic blood pressure (150±26 vs 152±17 mm Hg), or PTT (31±7.9 vs 34.8±10.0 seconds). Conclusion: The evaluated wound dressing seems to be safe and effective in reducing time to hemostasis in large arterial access sites. However, a randomized trial with a larger population and an active control group is necessary to confirm these preliminary data. Moreover, additional focus on shortening the time to ambulation is required in future studies.
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Affiliation(s)
- Alexander Sauer
- Department for Diagnostic and Interventional Radiology, University Hospital Wuerzburg, Germany
| | - Alexander Dierks
- Department for Diagnostic and Interventional Radiology, University Hospital Wuerzburg, Germany
| | - Franziska Wolfschmidt
- Department for Diagnostic and Interventional Radiology, University Hospital Wuerzburg, Germany
| | - Nicole Hassold
- Department for Diagnostic and Interventional Radiology, University Hospital Wuerzburg, Germany
| | - Thorsten A. Bley
- Department for Diagnostic and Interventional Radiology, University Hospital Wuerzburg, Germany
| | - Ralph Kickuth
- Department for Diagnostic and Interventional Radiology, University Hospital Wuerzburg, Germany
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16
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Fokkema TM, Minnee RC, Kock GAH, Blomjous JGAM, Vahl AC, Leijdekkers VJ. Comparison of a collagen plug arterial closure device with manual compression after endovascular interventions for peripheral artery disease. J Vasc Surg 2016; 64:104-108.e1. [PMID: 27038835 DOI: 10.1016/j.jvs.2016.02.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 02/02/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Arterial closure devices (ACDs) seem to be safe and effective to obtain hemostasis for cardiac interventions and diagnostic vascular procedures. However, only limited evidence is presented on therapeutic interventions in patients with peripheral atherosclerotic disease. We compared ischemic and hemorrhagic complications of an ACD vs manual compression (MC) after puncture of the femoral artery for endovascular lower extremity procedures. METHODS The records of all subsequent endovascular interventions for peripheral artery disease performed in a large teaching hospital, from January 2012 to April 2014, were retrospectively reviewed. The primary outcome was an ischemic complication requiring reintervention. Secondary outcomes were hematoma (needing conservative or invasive intervention) and infection (needing intervention or antibiotics). Multivariate analysis was performed to identify predictors for any complication. RESULTS The Angio-Seal (St. Jude Medical, Minnetonka, Minn) closure device was used in 244 of 463 endovascular interventions (54%). Five patients (2%) who received an ACD needed emergency surgery for ischemic complications vs none in the MC group (P = .06). Hematomas occurred in 22 patients (9%) after ACD vs in six (3%) after MC (adjusted odds ratio [OR], 3.4; 95% confidence interval [CI], 1.4-8.9; P = .015). There were no infections in either group. ACD (OR, 3.8; 95% CI, 1.5-9.7) and current smoking (OR, 2.6; 95% CI, 1.01-6.7) were independent predictors for any complication. CONCLUSIONS This study demonstrates that ACD use in patients with peripheral artery disease can lead to serious adverse events resulting in increased morbidity. Therefore, the potential benefits of an ACD over MC should be carefully weighed.
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Affiliation(s)
- Talje M Fokkema
- Department of Vascular Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
| | - Robert C Minnee
- Department of Vascular Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Gert-Aldert H Kock
- Department of Interventional Radiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Joost G A M Blomjous
- Department of Interventional Radiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Anco C Vahl
- Department of Vascular Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Vanessa J Leijdekkers
- Department of Vascular Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
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Patient Satisfaction After Femoral Arterial Access Site Closure Using the ExoSeal® Vascular Closure Device Compared to Manual Compression: A Prospective Intra-individual Comparative Study. Cardiovasc Intervent Radiol 2015; 39:21-7. [DOI: 10.1007/s00270-015-1204-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 08/16/2015] [Indexed: 01/13/2023]
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18
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Suri S, Nagarsheth KH, Goraya S, Singh K. A novel technique to retrieve a maldeployed vascular closure device. J Endovasc Ther 2015; 22:71-3. [PMID: 25775683 DOI: 10.1177/1526602814565773] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To report a novel technique for endovascular retrieval of a maldeployed vascular closure device, obviating the need for a femoral cutdown. TECHNIQUE To remove a 6-F Angio-Seal device that embolized to the superficial femoral artery, the contralateral common femoral artery was accessed, and an 8-F, 65-cm-long sheath was inserted just proximal to the embolus. A second semistiff 0.035-inch buddy wire was advanced past the lesion along the sheath. A 0.014-inch wire was advanced past the embolus, and a SpiderFX embolic protection device was deployed 1 cm past the embolized Angio-Seal device. The sheath was advanced so as to push the embolus into the filter. The sheath and the filter containing the Angio-Seal device were then removed. CONCLUSION Endovascular retrieval of an embolized Angio-Seal device can be done using an embolic filter device, restoring arterial flow to the limb.
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Affiliation(s)
- Simrat Suri
- Staten Island University Hospital, Staten Island, NY, USA
| | | | - Sumeet Goraya
- Staten Island University Hospital, Staten Island, NY, USA
| | - Kuldeep Singh
- Staten Island University Hospital, Staten Island, NY, USA
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Barbetta I, van den Berg JC. Access and hemostasis: femoral and popliteal approaches and closure devices-why, what, when, and how? Semin Intervent Radiol 2014; 31:353-60. [PMID: 25435661 DOI: 10.1055/s-0034-1393972] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This article reviews the arterial access sites used in the treatment of peripheral arterial disease, including common femoral, superficial femoral, and popliteal arterial puncture. The optimal approach and techniques for arterial puncture will be described and technical tips and tricks will be discussed. An overview of the currently available vascular closure devices will also be presented. Indications, contraindications, and complications will be discussed. Results of the use of vascular closure devices compared with manual compression will be presented.
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Affiliation(s)
- Iacopo Barbetta
- Service of Interventional Radiology, Ospedale Regionale di Lugano, Lugano, Switzerland
| | - Jos C van den Berg
- Service of Interventional Radiology, Ospedale Regionale di Lugano, Lugano, Switzerland
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20
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Boschewitz JM, Pieper CC, Andersson M, Nadal J, Schild HH, Meyer C. Efficacy and time-to-hemostasis of antegrade femoral access closure using the ExoSeal vascular closure device: a retrospective single-center study. Eur J Vasc Endovasc Surg 2014; 48:585-91. [PMID: 25201516 DOI: 10.1016/j.ejvs.2014.08.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 08/01/2014] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To retrospectively evaluate the efficacy and time-to-hemostasis of antegrade femoral access closure using the ExoSeal vascular closure device (VCD). DESIGN Retrospective, single-center analysis. MATERIALS AND METHODS Between September 2010 and February 2013, 148 ExoSeal VCD closures (5-7F) of antegrade femoral accesses were performed in 119 patients (70 males, mean age 71.6 years, range 40-97 years). In all cases initial diagnostic angiography was performed via an 18G/3.8F retrograde femoral access, which was left in place during intervention (in-house standard) and was used to obtain control angiography after successful closure of the antegrade access to determine hemostasis. Technical device success was defined as ExoSeal closure without major VCD-related complications; procedural success as hemostasis within 5 minutes. Statistical analysis was performed using a logistic regression model and correlation analyses. RESULTS 145/148 (98.0%) ExoSeal closures were technically successful (5F: n = 76; 6F: n = 65; 7F: n = 7). Angiographic control showed closure after 2 minutes in 130/145 cases. In a further 14 cases hemostasis was achieved after an additional 3 minutes MC, so that closure was successful within 5 minutes in 144/148 cases (97.3%). No major complication occurred. One minor complication was recorded in a 6F access case. Pre-interventional activated partial thromboplastin time (aPTT) was the only statistically significant predictor of necessary manual compression (MC) > 2 minutes (p = .01), but with an odds-ratio of only 1.038. The INR showed an odds-ratio of 2.455 for need for 5 minutes MC (NS). Significant correlations were found between the need for 5 minutes MC and medication with acetylsalicylic acid (p = .01), clopidogrel (p < .01), and abciximab (p < .001). CONCLUSION ExoSeal vascular closure of antegrade femoral punctures is safe and effective with a low complication rate. Two minutes of MC are sufficient to achieve hemostasis in the majority of cases. However, in patients on antiplatelet therapy, especially after abciximab, the authors advocate prolonging MC to 5 minutes.
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Affiliation(s)
- J M Boschewitz
- Department of Radiology, University of Bonn, Bonn, Germany
| | - C C Pieper
- Department of Radiology, University of Bonn, Bonn, Germany
| | - M Andersson
- Department of Radiology, University of Bonn, Bonn, Germany
| | - J Nadal
- Institute for Medical Biometry, Informatics and Epidemiology, University of Bonn, Bonn, Germany
| | - H H Schild
- Department of Radiology, University of Bonn, Bonn, Germany
| | - C Meyer
- Department of Radiology, University of Bonn, Bonn, Germany.
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21
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Vascular closure devices after endovascular procedures in swine: a reliable method? ScientificWorldJournal 2014; 2014:514942. [PMID: 24737976 PMCID: PMC3967389 DOI: 10.1155/2014/514942] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 01/21/2014] [Indexed: 11/18/2022] Open
Abstract
Purpose. To investigate the safety and feasibility of the use of a vascular closure device (VCD) after endovascular procedures in swine. Material and Methods. In a study on endovascular therapy, VCD (StarClose, Abbott Vascular, Il, USA) was used in 20 female swines to achieve immediate hemostasis after percutaneous right femoral artery (FA) access. 10 animals were sacrificed immediately after the study and 10 animals were sacrificed 28 days after the initial study. To ensure complete hemostasis and patency of the femoral artery, a CT-angiography of the puncture site was performed on day 1 (acute and chronic group) and day 28 (chronic group). After the sacrifice, the femoral artery was explanted and examined macroscopically for signs of VCD dysfunction. Results. Technical success rate was 100% with immediate hemostasis being achieved in all animals. No animals showed evidence of hematoma. During explantation, only small traces of coagulated blood were found in the acute group, while there were no signs of hematoma in the chronic group. CT-angiography immediately after VCD application as well as before sacrifice (chronic group) showed patency of the FA in all cases. Conclusion. The use of VCD to achieve hemostasis after endovascular studies in swine is feasible and safe.
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22
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Feasibility of vascular access closure in arteries other than the common femoral artery using the ExoSeal vascular closure device. Cardiovasc Intervent Radiol 2014; 37:1352-7. [PMID: 24525965 DOI: 10.1007/s00270-014-0853-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Accepted: 01/21/2014] [Indexed: 01/27/2023]
Abstract
PURPOSE To describe the feasibility of vascular access closure in arteries other than the common femoral artery (CFA) using the ExoSeal vascular closure device (VCD). MATERIALS AND METHODS Between December 2011 and August 2013, 8 patients (4 males, 4 females, mean age 64 years [range 42-81]) underwent 13 extrafemoral access site closure using the ExoSeal VCD (brachial artery n = 7, venous femoropopliteal bypass n = 3, femoropopliteal segment n = 2, proximal superficial femoral artery n = 1). Patient history, procedural characteristics, and complications were recorded. RESULTS Technical success was achieved in 12 of 13 VCD procedures. In 1 case of brachial puncture, safe plug-deployment was not possible, so manual compression was applied. In this case, angiographic and clinical control showed residual bleeding 5 min after the procedure. After additional manual compression for 5 min, the haemorrhage stopped, but a hematoma <3 cm was detectable (procedural success rate 12 of 13 closures). Overall no major complications were observed. Heparin, 5,000 IU, was administered in all cases. Six ExoSeal closures were performed under additional acetylsalicylic acid (ASS) and clopidogrel, three under additional ASS, and the remaining four under heparin only. International normalized ratio and thrombocytes were within normal values in all patients. CONCLUSION Successful vascular access closure using the ExoSeal VCD in puncture sites other than the CFA is feasible with a low complication rate. These applications, however, remain an "off-label" use in selected patients.
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23
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Boschewitz JM, Andersson M, Naehle CP, Schild HH, Wilhelm K, Meyer C. Retrospective evaluation of safety and effectiveness of the EXOSEAL vascular closure device for single vascular closure and closure after repeat puncture in diagnostic and interventional radiology: single-center experience. J Vasc Interv Radiol 2013; 24:698-702. [PMID: 23622041 DOI: 10.1016/j.jvir.2013.02.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Revised: 02/12/2013] [Accepted: 02/12/2013] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To retrospectively evaluate the safety and effectiveness of the EXOSEAL vascular closure device (VCD) for first or repeated closure after retrograde percutaneous femoral arterial access. MATERIALS AND METHODS A retrospective analysis of 417 patients (271 men; mean age, 64.1 y±12.8; age range, 22-94 y) who had undergone arterial closure with the EXOSEAL VCD was performed. Procedures with retrograde femoral access and closure with the 5-F, 6-F, or 7-F EXOSEAL VCD according to the manufacturer's instructions were included. The clinical indications included the full procedural portfolio of a radiologic department with a focus on transarterial hepatic procedures. After EXOSEAL VCD closure, patients were restricted to bed rest for 4 hours. RESULTS From August 2010 to March 2012, a total of 682 EXOSEAL VCDs (5-F, n = 276; 6-F, n = 394; 7-F, n = 12) were used in 659 procedures with a total of 404 repeated closures. The EXOSEAL VCD was used successfully in 676 of 682 procedures (99.1%). Hemostasis was achieved in 651 of 682 procedures (95.5%). No major complications were encountered. There were eight cases (1.17%) of minor complications despite a successful vascular closure procedure, none requiring further therapy. There were no complications in any of the 404 cases of repeated vascular closure. CONCLUSIONS The results of this study suggest that the EXOSEAL VCD is safe and effective in single and repeated closure of retrograde percutaneous femoral arterial access in interventional radiology cases.
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Affiliation(s)
- Jack M Boschewitz
- Department of Radiology, University of Bonn, Sigmund-Freud-Strasse 25, D-53105 Bonn, Germany
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Gouicem D, Palcau L, Le Hello C, Cameliere L, Dufranc J, Coffin O, Berger L. Feasibility of ambulatory percutaneous femoral access without the use of arterial closure systems. Ann Vasc Surg 2013; 28:132-6. [PMID: 24183456 DOI: 10.1016/j.avsg.2013.06.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Revised: 06/11/2013] [Accepted: 06/12/2013] [Indexed: 11/20/2022]
Abstract
BACKGROUND To evaluate the feasibility of early ambulation in patients treated for peripheral occlusive lesions by femoral percutaneous access, without the use of closure systems and the application to ambulatory practice. METHODS This single-center observational exploratory study was undertaken among 99 consecutive patients between August 1-December 31, 2011 (mean age: 72 years; 72 men) who were treated by percutaneous femoral route for peripheral arterial lesions. All the patients had a manual compression then pressure bandage. A clinical evaluation was carried out after 4 hours, seeking a local or a general complication and checking the procedure. Rising and walking in the unit of hospitalization were authorized in the absence of complication as of 4 hours postoperatively. All patients remained in hospital for at least 1 night, with a clinical revaluation before discharge. All patients were contacted by telephone at postoperative day 7 in order to verify the absence of local complications. All the individual factors and those related to the procedure were analyzed. RESULTS With criteria of complications related to the gesture, 72 patients (72.7%) were considered ready to be discharged as of postoperative hour 4. Among the 27 patients who were not able to leave, 7 presented with an early local complication without reoperation, and 20 could not walk because of a necrotic lesion (n = 8), their advanced age (n = 4), morbid obesity (n = 2), or a choice of the surgeon in charge (n = 6). Twenty-five patients could, however, stroll after 12 hours. The mean duration of hospitalization was 1.3 days (range: 0-10 days). Two patients required distal amputation during the same hospitalization, and 1 underwent a femoropopliteal bypass after failure of a femoropopliteal recanalization. With univariate analysis, the treatment by anticoagulants and the duration of the hospitalization were the only factors significantly related to the impossibility of early ambulation. The occurrence of complications was linked with the experience of the surgeon, the age of the patient, and the female sex. Three patients, including 2 regarded as ready to walk by postoperative hour 4, were rehospitalized after 1 week for reoperation because of 1 major hematoma and 2 femoral false aneurysms. CONCLUSION Percutaneous endovascular surgery by the femoral route without using an arterial closure system is feasible in an ambulatory practice in nearly 75% of cases. Particular monitoring must be done in the oldest patients, women, and those treated with anticoagulants.
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Affiliation(s)
- Djelloul Gouicem
- Service de Chirurgie Vasculaire, Centre Hospitalier Universitaire de Caen, Caen, France
| | - Laura Palcau
- Service de Chirurgie Vasculaire, Centre Hospitalier Universitaire de Caen, Caen, France
| | - Claire Le Hello
- Service de Chirurgie Vasculaire, Centre Hospitalier Universitaire de Caen, Caen, France
| | - Lucie Cameliere
- Service de Chirurgie Vasculaire, Centre Hospitalier Universitaire de Caen, Caen, France
| | - Julie Dufranc
- Service de Chirurgie Vasculaire, Centre Hospitalier Universitaire de Caen, Caen, France
| | - Olivier Coffin
- Service de Chirurgie Vasculaire, Centre Hospitalier Universitaire de Caen, Caen, France
| | - Ludovic Berger
- Service de Chirurgie Vasculaire, Centre Hospitalier Universitaire de Caen, Caen, France.
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Sheth RA, Walker TG, Saad WE, Dariushnia SR, Ganguli S, Hogan MJ, Hohenwalter EJ, Kalva SP, Rajan DK, Stokes LS, Zuckerman DA, Nikolic B. Quality improvement guidelines for vascular access and closure device use. J Vasc Interv Radiol 2013; 25:73-84. [PMID: 24209907 DOI: 10.1016/j.jvir.2013.08.011] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 08/15/2013] [Accepted: 08/16/2013] [Indexed: 12/17/2022] Open
Affiliation(s)
- Rahul A Sheth
- Division of Vascular Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit St., Gray 290, Boston, MA 02114
| | - T Gregory Walker
- Division of Vascular Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit St., Gray 290, Boston, MA 02114
| | - Wael E Saad
- Department of Radiology, University of Michigan Medical Center, Ann Arbor, Michigan.
| | - Sean R Dariushnia
- Department of Interventional Radiology and Image-guided Medicine, Emory University, Atlanta, Georgia
| | - Suvranu Ganguli
- Division of Vascular Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit St., Gray 290, Boston, MA 02114
| | - Mark J Hogan
- Section of Vascular and Interventional Radiology, Department of Radiology, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio
| | - Eric J Hohenwalter
- Department of Radiology, Medical College of Wisconsin, Froedtert Memorial Lutheran Hospital, Milwaukee, Wisconsin
| | - Sanjeeva P Kalva
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Dheeraj K Rajan
- Department of Medical Imaging, University of Toronto, University Health Network, Toronto, Ontario, Canada
| | - Leann S Stokes
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Darryl A Zuckerman
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Boris Nikolic
- Department of Radiology, Stratton Medical Center, Albany, New York
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Prajapati HJ, Rafi S, Edalat F, Kooby DA, Kim HS. Safety and Efficacy of a Circumferential Clip-Based Vascular Closure Device in Cirrhotic and Coagulopathic Patients with Hepatocellular Carcinoma After Doxorubicin Drug-eluting Beads Transarterial Chemoembolization. Cardiovasc Intervent Radiol 2013; 37:664-70. [DOI: 10.1007/s00270-013-0709-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Accepted: 07/12/2013] [Indexed: 12/22/2022]
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Isfort P, Urban U, Mahnken AH, Penzkofer T, Bruners P, Pfeffer J, Steinseifer U, Günther RW, Schmitz-Rode T. Animal experimental evaluation of a new sealing device for indwelling arterial catheters. Acta Radiol 2013; 54:521-5. [PMID: 23474769 DOI: 10.1177/0284185113476022] [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]
Abstract
BACKGROUND Hematoma is a common complication following arterial puncture. To date no device that allows sealing of an arterial puncture site with in-situ catheter has been developed. PURPOSE To evaluate a newly developed arterial sealing device for endovascular catheters in an in-vivo experimental setting. MATERIAL AND METHODS A peelable collagen-based vascular sealing device for endovascular catheters was tested in acute (follow-up: 4 h; n = 2) and chronic (follow-up: 1 week; n = 4) settings in the femoral artery (FA) of sheep. After implantation correct position of the device as well as patency of the FA were verified angiographically. In the chronic group, hematoma was excluded and patency of FA was assured using color Doppler ultrasound 1 and 3 days after the procedure. After 1 week a final ultrasound and an angiography were performed for final evaluation. Thereafter, the animals were sacrificed and the puncture site was dissected and analyzed macroscopically. RESULTS Sufficient sealing of the puncture site could be observed in all animals. In acute and chronic experiments, neither a hematoma at the puncture site nor other complications were observed after positioning the sealing device. Follow-up color Doppler ultrasounds (CDUS) and final angiography revealed patent FAs in all animals. Macroscopic evaluation of dissection material proved collagen plug and catheter being in place. CONCLUSION Our preliminary in-vivo results demonstrate a safe and convenient vascular sealing system for endovascular catheters. No acute or chronic complications were observed.
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Affiliation(s)
- Peter Isfort
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen
| | - Ute Urban
- Department of Cardiovascular Engineering (CVE), Institute of Applied Medical Engineering (AME) – Helmholtz Institute, RWTH Aachen University, Aachen, Germany
| | - Andreas Horst Mahnken
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen
| | - Tobias Penzkofer
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen
| | - Philipp Bruners
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen
| | - Joachim Pfeffer
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen
| | - Ulrich Steinseifer
- Department of Cardiovascular Engineering (CVE), Institute of Applied Medical Engineering (AME) – Helmholtz Institute, RWTH Aachen University, Aachen, Germany
| | - Rolf Wilhelm Günther
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen
| | - Thomas Schmitz-Rode
- Department of Cardiovascular Engineering (CVE), Institute of Applied Medical Engineering (AME) – Helmholtz Institute, RWTH Aachen University, Aachen, Germany
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Prabhu SJ, Padia SA, Valji K, McNeeley MF, Vaidya S, Vo NJ. Arterial closure device to achieve hemostasis in children following percutaneous femoral arterial puncture. Pediatr Radiol 2013; 43:703-8. [PMID: 23321700 DOI: 10.1007/s00247-012-2606-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2012] [Revised: 11/06/2012] [Accepted: 11/15/2012] [Indexed: 11/24/2022]
Abstract
BACKGROUND Percutaneous arterial closure devices have increasingly entered clinical practice to assist in achieving femoral arterial access site hemostasis. Prior studies have demonstrated the safety and efficacy of several arterial closure devices in adults. OBJECTIVE To evaluate the efficacy of using an arterial closure device in children. MATERIALS AND METHODS A retrospective review of all children (defined as younger than 18 years) undergoing device-assisted closure of their percutaneous femoral arterial access site was conducted. Patient demographics, the clinical indications for use of the arterial closure device and pre-procedural laboratory parameters were noted. The accessed common femoral artery diameter and largest procedural sheath size were recorded. The technical success rate for device deployment and rates of immediate and delayed complications including hemorrhage, access site or retroperitoneal hematoma, access site infection, arterial thromboembolism, pseudoaneurysm or arteriovenous fistulae were documented. RESULTS Between June 2009 and June 2011, an arterial closure device was deployed with intent to achieve hemostasis in percutaneous femoral arterial access punctures in 38 consecutive children. The mean common femoral artery diameter was 0.70 ± 0.13 cm. Device deployment was technically successful in 37/38 (97.4%) procedures. There was a single complication (2.6%), a small access site hematoma. No other immediate or delayed complications occurred. CONCLUSION The use of a percutaneous arterial closure device can be an efficacious method for achieving immediate femoral arterial access site hemostasis with few complications in children who have undergone percutaneous femoral arterial access procedures.
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Affiliation(s)
- Somnath J Prabhu
- Department of Radiology, Division of Interventional Radiology, University of Washington, Seattle, WA, USA
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Funke C, Pfiffner R, Husmann M, Pfammatter T. The Use of the “Preclosure” Technique for Antegrade Aspiration Thrombectomy with Large Catheters in Acute Limb Ischemia. Cardiovasc Intervent Radiol 2012; 36:377-84. [DOI: 10.1007/s00270-012-0455-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2012] [Accepted: 07/15/2012] [Indexed: 12/17/2022]
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Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Nallamothu BK, Ting HH. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. Catheter Cardiovasc Interv 2012; 79:453-95. [PMID: 22328235 DOI: 10.1002/ccd.23438] [Citation(s) in RCA: 125] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Safety and Efficacy of StarClose SE Vascular Closure System in High-Risk Liver Interventional Oncology Patients. J Vasc Access 2012; 13:415-20. [DOI: 10.5301/jva.5000068] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2012] [Indexed: 11/20/2022] Open
Abstract
Purpose To assess the safety and efficacy of the StarClose SE Vascular Closure System (Abbott Vascular, Abbott Park IL, USA) in high-risk thrombocytopenic and coagulopathic interventional oncology (IO) patients. Methods In this single institution retrospective study, 63 high-risk thrombocytopenic or coagulopathic IO patients (M:F=51:12, mean age 58 years, range 31–88 years) who underwent 83 common femoral arteriotomy closures using the StarClose device were identified among all IO patients (n=131) undergoing StarClose closure (n=177) between 2008–2011. High-risk thrombocytopenia and coagulopathy were defined as platelet count ≤100 103/mL and international normalized ratio (INR) ≥1.5. Procedures included chemoembolization (n=67), radioembolization (n=8), and hepatic arterial mapping with technetium-99m macroaggrated albumin administration (n=8) for treatment of hepatocellular carcinoma (n=79) or liver metastases (n=4). Measured outcomes included technical success of arterial closure and closure-related adverse events, graded according to the Society of Interventional Radiology classification. Results In all cases, 5 French common femoral arterial access was used. Platelet count was ≤100 103/mL in 80/83 (96.4%) cases and INR was ≥1.5 in 35/83 (42.2%) cases. Mean pre-procedure platelet count was 71 (range 26–347) 103/mL and mean INR was 1.4 (range 1.0–2.1). The StarClose device effectively sealed the arteriotomy in 83/83 (100%) cases, 60/83 (72.3%) cases were first-time closures, and 20/83 (24.1%) cases were repeat closures. Small groin hematomas, graded as class A minor complications, developed in 3/83 (3.6%) cases. No other complications were encountered. Conclusions The StarClose SE Vascular Closure System confers high technical success and safety in common femoral arteriotomy closure in high-risk IO patients.
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Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Nallamothu BK, Ting HH. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: Executive Summary. J Am Coll Cardiol 2011. [DOI: 10.1016/j.jacc.2011.08.006] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Nallamothu BK, Ting HH. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. Circulation 2011; 124:2574-609. [PMID: 22064598 DOI: 10.1161/cir.0b013e31823a5596] [Citation(s) in RCA: 381] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. J Am Coll Cardiol 2011; 58:e44-122. [PMID: 22070834 DOI: 10.1016/j.jacc.2011.08.007] [Citation(s) in RCA: 1719] [Impact Index Per Article: 132.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Nallamothu BK, Ting HH, Ting HH. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. Circulation 2011; 124:e574-651. [PMID: 22064601 DOI: 10.1161/cir.0b013e31823ba622] [Citation(s) in RCA: 896] [Impact Index Per Article: 68.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Nallamothu BK, Ting HH, Jacobs AK, Anderson JL, Albert N, Creager MA, Ettinger SM, Guyton RA, Halperin JL, Hochman JS, Kushner FG, Ohman EM, Stevenson W, Yancy CW. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention. Catheter Cardiovasc Interv 2011; 82:E266-355. [DOI: 10.1002/ccd.23390] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Spiliopoulos S, Katsanos K, Karnabatidis D, Diamantopoulos A, Nikolaos C, Siablis D. Safety and efficacy of the StarClose vascular closure device in more than 1000 consecutive peripheral angioplasty procedures. J Endovasc Ther 2011; 18:435-43. [PMID: 21679086 DOI: 10.1583/10-3277.1] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE To present a large single-center retrospective study investigating the safety and efficacy of the StarClose extravascular closure device in achieving hemostasis after antegrade or retrograde femoral artery catheterization during peripheral angioplasty procedures. METHODS Between January 2004 and October 2009, 1213 StarClose devices were implanted in 850 consecutive patients (598 men; mean age 65.8 ± 12.2 years) who underwent peripheral endovascular procedures. Femoral artery punctures included 625 (51.5%) retrograde and 588 (48.5%) antegrade accesses. The primary endpoints were hemostasis success, device failure, and major and minor complication rates up to 30 days. RESULTS A 6-F vascular sheath was used in the majority of cases [39 (3.2%) 7-F and 9 (0.7%) 8-F]. The device was applied more than once in the same femoral artery of 124 (10.2%) limbs during different angioplasty sessions. Overall hemostasis success was achieved in 1139 (93.9%) cases. In 237 (20.8%) of those, additional manual compression for <5 minutes was necessary due to immediate vessel oozing. The remaining 74 (6.1%) cases required prolonged standard manual compression because of hemostasis failure, including 13 (1.1%) failures to deliver the clip. Overall major and minor complication rates were 0.3% (4/1213) and 5.3% (64/1213), respectively. CONCLUSION The StarClose vascular closure device is safe and effective in achieving hemostasis during antegrade and retrograde peripheral angioplasty procedures.
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Affiliation(s)
- Stavros Spiliopoulos
- Department of Interventional Radiology, Patras University Hospital, School of Medicine, Rion, Greece.
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Chung J, Lee DW, Kwon OS, Kim BS, Shin YS. Angio-Seal™ Evolution™ versus Manual Compression for Common Femoral Artery Puncture in Neurovascular Diagnostic Angiography : A Prospective, Non-Randomized Study. J Korean Neurosurg Soc 2011; 49:153-6. [PMID: 21556234 DOI: 10.3340/jkns.2011.49.3.153] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2010] [Revised: 02/21/2011] [Accepted: 03/03/2011] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE This prospective, non-randomized study compared the safety and efficacy of the Angio-Seal™ Evolution™ to that of manual compression for common femoral artery punctures in neurovascular diagnostic angiography. METHODS From June 2009 to September 2009, we performed 169 diagnostic trans-femoral cerebral angiographies, using either the Angio-Seal™ Evolution™ or manual compression to achieve hemostasis. We included 60 patients in this study, 30 in each group. We defined minor complications as those requiring no further treatment such as hematoma size less than 6 cm and bruise size less than 25 cm. Major complications were those requiring surgery of the femoral artery pseudoaneurysm and/or the second line increase of hospital stay even without further treatment. RESULTS Mean time to hemostasis was 0.42±0.04 minutes for the angioseal and 15.83±1.63 minutes for manual compression (p<0.001). Overall complication rate did not differ between the 2 groups. After the patients were fully mobile, at 24 hours, the rate of onset of new complication differed significantly between the 2 groups (p=0.032). In the angioseal group, 5 (16.7%) of the 30 patients experienced the onset of a new complication after 24 hours, including 3 (60.0%) of the 5 who experienced major complications. CONCLUSION The Angio-Seal™ Evolution™ is effective at decreasing mean time to hemostasis, like other closing devices. However, it may not be effective at producing early ambulation and discharge, compared to manual compression, because delayed complications may occur significantly after 24 hours.
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Affiliation(s)
- Joonho Chung
- Department of Neurosurgery, Inha University School of Medicine, Incheon, Korea
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Feldman T, Yong G. The Essentials of Vascular Access and Closure. Interv Cardiol 2011. [DOI: 10.1002/9781444319446.ch3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Plaza Martínez Á, Carrera Díaz S, Alonso Álvarez M, Escudero J, Vaquero Puerta C, Cairols Castellote M, Riambau V, Lojo Rocamonde I, Gutiérrez Alonso V. Tratamiento endovascular de la patología obstructiva aortoiliaca. ANGIOLOGIA 2011. [DOI: 10.1016/j.angio.2011.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Distal embolism of percutaneous arterial closure device resulting in critical limb ischemia. J Vasc Interv Radiol 2011; 21:1487-8. [PMID: 20801676 DOI: 10.1016/j.jvir.2010.06.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Revised: 06/10/2010] [Accepted: 06/18/2010] [Indexed: 11/22/2022] Open
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Bechara CF, Annambhotla S, Lin PH. Access site management with vascular closure devices for percutaneous transarterial procedures. J Vasc Surg 2010; 52:1682-96. [DOI: 10.1016/j.jvs.2010.04.079] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2010] [Revised: 04/23/2010] [Accepted: 04/30/2010] [Indexed: 11/27/2022]
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Lombardo A, van den Berg JC. Preventing vascular access site complications during interventional procedures. Interv Cardiol 2010. [DOI: 10.2217/ica.10.82] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Das R, Ahmed K, Athanasiou T, Morgan RA, Belli AM. Arterial Closure Devices Versus Manual Compression for Femoral Haemostasis in Interventional Radiological Procedures: A Systematic Review and Meta-Analysis. Cardiovasc Intervent Radiol 2010; 34:723-38. [DOI: 10.1007/s00270-010-9981-0] [Citation(s) in RCA: 107] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2010] [Accepted: 07/27/2010] [Indexed: 11/28/2022]
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Hemostatic efficacy of chitosan-based bandage for closure of percutaneous arterial access sites: An experimental study in heparinized sheep model. Radiol Oncol 2010; 44:86-91. [PMID: 22933896 PMCID: PMC3423686 DOI: 10.2478/v10019-010-0021-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2010] [Accepted: 03/22/2010] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Most of the presently used percutaneous arterial closure devices (PACD) for hemostasis after interventional vascular procedures are effective, but carry risk of complications by deposition of a foreign body. A new promising externally applied PACD - chitosan-based HemCon Bandage (HCB) was explored in sheep. The HCB hemostatic efficacy and complications occurring with its use were compared to those with the standard manual compression (SMC). MATERIAL AND METHODS Both superficial femoral arteries (SFA) of 9 heparinized sheep were catheterized with an 8F sheath for 5 minutes. After the sheath withdrawal, hemostasis with the HCB was compared with hemostasis achieved with SMC in the contralateral SFA. Iliac angiograms performed by carotid artery approach determined the hemostasis time. RESULTS The HCB use shortened time to hemostasis with a mean time of 6.9 ± 3.9 minutes versus 10.8 ± 2.8 minutes for the SMC (P-value 0.019). Seven SFAs in the HCB group and only 1 SFA in the SMC group exhibited hemostasis in 5 minutes. All nine SFAs using the HCB showed femoral artery patency and demonstrated less hematoma (2/9) than in the SMC group (8/9). No complications developed in the HCB group, one SFA occlusion was seen in the SMC group. CONCLUSIONS The externally applied HCB in heparinized sheep was safe and effective. It significantly shortened time to hemostasis at the SFA access sites following 8F sheath removal. Proper application of the HCB was necessary to shorten hemostasis and prevent hematoma formation. The HCB should be tested in a clinically controlled study to evaluate its efficacy in humans.
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Endovascular management of inadvertent subclavian artery catheterization during subclavian vein cannulation. J Vasc Interv Radiol 2010; 21:470-6. [PMID: 20171903 DOI: 10.1016/j.jvir.2009.12.392] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2009] [Revised: 11/23/2009] [Accepted: 12/23/2009] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To retrospectively review a 9-year experience with endovascular management of inadvertent subclavian artery catheterization during subclavian vein cannulation. MATERIALS AND METHODS From June 2000 through July 2009 (109 months), 13 patients underwent endovascular management of inadvertent subclavian artery catheterization. All catheters were still in situ, including one 7-F catheter, six 8-F catheters, and six large-bore 10-11-F catheters. Treatment was performed with an Angio-Seal device (n = 6) or balloon catheters (n = 7) and by additional stent-graft placement (n = 4). RESULTS Mean follow-up was 27.3 months (range, 0.4-78 months). The 30-day mortality rate was 7.7% and the late mortality rate was 46.1%. Primary technical success was achieved in nine patients (69.2%), in four with the use of a compliant balloon catheter and in the other five with an Angio-Seal device. Complications required additional stent-graft placement in four patients (30.8%), one because of stenosis after Angio-Seal device deployment and three as a result of insufficient closure of the puncture site by balloon tamponade. Stent-graft repair was successful in all four patients, for a primary assisted technical success rate of 100%. CONCLUSIONS Endovascular techniques offer a less invasive alternative to surgery. The present limited experience shows that the use of the Angio-Seal device is not without risks, whereas balloon tamponade is not always reliable in closing the puncture site. Stent-graft placement may be required in patients in whom balloon tamponade fails or in whom the use of the Angio-Seal device is contraindicated.
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Hon L, Ganeshan A, Thomas S, Warakaulle D, Jagdish J, Uberoi R. An overview of vascular closure devices: What every radiologist should know. Eur J Radiol 2010; 73:181-90. [DOI: 10.1016/j.ejrad.2008.09.023] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2008] [Revised: 09/21/2008] [Accepted: 09/23/2008] [Indexed: 11/28/2022]
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Karmy-Jones R, Teso D, Jackson N, Ferigno L, Bloch R. Endovascular approach to acute aortic trauma. World J Radiol 2009; 1:50-62. [PMID: 21160721 PMCID: PMC2998886 DOI: 10.4329/wjr.v1.i1.50] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2009] [Revised: 12/18/2009] [Accepted: 12/21/2009] [Indexed: 02/06/2023] Open
Abstract
Traumatic thoracic aortic injury remains a major cause of death following motor vehicle accidents. Endovascular approaches have begun to supersede open repair, offering the hope of reduced morbidity and mortality. The available endovascular technology is associated with specific anatomic considerations and complications. This paper will review the current status of endovascular management of traumatic thoracic aortic injuries.
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Roadmap Guidance for the Safer Deployment of an Arterial Closure Device. J Vasc Interv Radiol 2009; 20:1244-7. [DOI: 10.1016/j.jvir.2009.05.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2008] [Revised: 05/09/2009] [Accepted: 05/27/2009] [Indexed: 11/22/2022] Open
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Kim YH, Pavcnik D, Kakizawa H, Uchida BT, Burke A, Loriaux M, Keller FS, Rosch J. Thrombus formation after percutaneous catheterization and manual compression of the femoral artery in heparinized sheep. Cardiovasc Intervent Radiol 2009; 33:321-9. [PMID: 19705199 DOI: 10.1007/s00270-009-9688-2] [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] [Received: 05/13/2009] [Revised: 07/07/2009] [Accepted: 07/28/2009] [Indexed: 10/20/2022]
Abstract
The purpose of this study was to evaluate the angiographic and histopathologic changes in the superficial femoral artery (SFA) in heparinized sheep shortly after catheterization with an 8-Fr sheath and manual compression hemostasis either with standard manual compression (SMC) or with the use of a procoagulant chitosan-based HemCon Bandage. The evaluation was done in 38 SFAs of 19 heparinized (100 mg/kg) sheep. After a 5-min catheterization with an 8-Fr sheath, a 5-min compression was applied. Follow-up angiograms to evaluate hemostasis were done immediately after release of compression and then at 2.5-min intervals until no extravasation was present. Compression was reapplied between angiograms. Final angiograms were performed approximately 30 min after hemostasis and after 3 min of passive flexion and extension of sheep hind limbs. Sheep were then euthanized and SFA specimens with surrounding tissues excised for histopathologic evaluation. Both types of compression caused similar changes in the catheterized SFAs. Follow-up angiograms showed mild arterial narrowing in 14 SFAs and intraluminal clots in 9 SFAs. Histology revealed periarterial hematoma in all 38 specimens. Intraluminal thrombi consisting predominantly of platelets and fibrin were present in 32 SFAs. Their size varied from superficial elevations (8 arteries) to medium-sized, 1- to 2-mm, polypoid protrusions (15 arteries) to large polypoid clots, 3-4 mm long (9 arteries). In six SFAs, the arterial access sites were not included in the obtained specimens. In conclusion, hemostasis with manual compression is achieved in the acute phase by formation of a predominantly platelet-fibrin thrombus occluding the arterial wall access site and often extending significantly into the arterial lumen. The healing process of arterial access sites should be explored several days after catheterization.
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Affiliation(s)
- Young Hwan Kim
- Dotter Interventional Institute, Oregon Health Sciences University, 3181 SW Sam Jackson Park Road, L-342, Portland, OR 97239-3098, USA
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