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van de Voort JC, Stark PW, van Dongen TT, Borger van der Burg BL, Hoencamp R. Ultrasound guided arterial access for combat medics: A blinded proof-of-concept study using echogenic needles. J Vasc Access 2024:11297298241256171. [PMID: 38825786 DOI: 10.1177/11297298241256171] [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: 06/04/2024] Open
Abstract
BACKGROUND Obtaining percutaneous vascular access in hemodynamically unstable patients with constricted vessels can be challenging. Training combat medics in this procedure is necessary for administration of fluid and blood products and introducing endovascular bleeding control tools in pre-hospital settings. Echogenic coated needles might provide better ultrasound visibility in invasive procedures and hereby lower complications. The primary aim was to evaluate the efficacy of a microteaching program for obtaining ultrasound-guided femoral artery access for ultrasound inexperienced combat medics. The secondary aim was to assess the additional value of innovative echogenic coated needles in ultrasound-guided vascular access. METHODS Combat medics participated in a four-step microteaching program. The program consisted of a theoretical and step-by-step practical part with three different models including live and dead tissue & a REBOA Access Task Trainer. During the final test, all participants had to obtain femoral artery access on a pressurized post-mortem human specimen model with both echogenic coated and conventional needles. Self-perceived and observed performance as well as procedure times were scored. RESULTS All nine participants succeeded in blood vessel visualization and obtaining vascular access in the two models within 3 minutes and were significantly faster during the second attempt on the pressurized post-mortem human specimen model. Scoring comparison and usability preference by ultrasound inexperienced personnel showed a significant difference in favor of the echogenic coated needles. CONCLUSION Microteaching may be an effective approach to train combat medics in obtaining ultrasound-guided percutaneous femoral artery access. The use of echogenic coatings on needles could be a valuable adjunct and provide advantage in obtaining vascular access. Future research should focus on realistic simulation of austere situations and further evaluation of the use of echogenic coated instruments for vascular access in these pre-hospital settings.
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Affiliation(s)
- Jan C van de Voort
- Department of Surgery, Alrijne Hospital, Leiderdorp, The Netherlands
- Trauma Research Unit, Department of Trauma Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Pieter W Stark
- Department of Surgery, Alrijne Hospital, Leiderdorp, The Netherlands
- Trauma Research Unit, Department of Trauma Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | | | - Rigo Hoencamp
- Department of Surgery, Alrijne Hospital, Leiderdorp, The Netherlands
- Trauma Research Unit, Department of Trauma Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
- Defense Healthcare Organisation, Ministry of Defense, Utrecht, The Netherlands
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Treffalls RN, Scheidt J, Lee C, Laverty RB, DuBose JJ, Scalea TM, Moore LJ, Podbielski JM, Inaba K, Piccinini A, Kauvar DS. Arterial Access Complications Following Percutaneous Femoral Access in 24-Hour Resuscitative Endovascular Balloon Occlusion of the Aorta Survivors. J Surg Res 2023; 290:203-208. [PMID: 37271068 DOI: 10.1016/j.jss.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 05/01/2023] [Accepted: 05/04/2023] [Indexed: 06/06/2023]
Abstract
INTRODUCTION With the use of resuscitative endovascular balloon occlusion of the aorta (REBOA) comes the potential for vascular access site complications (VASCs) and limb ischemic sequelae. We aimed to determine the prevalence of VASC and associated clinical and technical factors. METHODS A retrospective cohort analysis of 24-h survivors undergoing percutaneous REBOA via the femoral artery in the American Association for the Surgery of Trauma Aortic Occlusion for Resuscitation in Trauma and Acute care surgery registry between Oct 2013 and Sep 2021 was performed. The primary outcome was VASC, defined as at least one of the following: hematoma, pseudoaneurysm, arteriovenous fistula, arterial stenosis, or the use of patch angioplasty for arterial closure. Associated clinical and procedural variables were examined. Data were analyzed using Fisher exact test, Mann-Whitney-U tests, and linear regression. RESULTS There were 34 (7%) cases with VASC among 485 meeting inclusion criteria. Hematoma (40%) was the most common, followed by pseudoaneurysm (26%) and patch angioplasty (21%). No differences in demographics or injury/shock severity were noted between cases with and without VASC. The use of ultrasound (US) was protective (VASC, 35% versus no VASC, 51%; P = 0.05). The VASC rate in US cases was 12/242 (5%) versus 22/240 (9.2%) without US. Arterial sheath size >7 Fr was not associated with VASC. US use increased over time (R2 = 0.94, P < 0.001) with a stable rate of VASC (R2 = 0.78, P = 0.61). VASC were associated with limb ischemia (VASC, 15% versus no VASC, 4%; P = 0.006) and arterial bypass procedures (VASC 3% versus no VASC 0%; P < 0.001) but amputation was uncommon (VASC, 3% versus no VASC, 0.4%; P = 0.07). CONCLUSIONS Percutaneous femoral REBOA had a 7% VASC rate which was stable over time. VASC are associated with limb ischemia but need for surgical intervention and/or amputation is rare. The use of US-guided access appears to be protective against VASC and is recommended for use in all percutaneous femoral REBOA procedures.
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Affiliation(s)
| | - Justin Scheidt
- Department of Surgery, Brooke Army Medical Center, Texas
| | - Christina Lee
- Department of Surgery, Brooke Army Medical Center, Texas
| | | | | | - Thomas M Scalea
- R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, Maryland
| | - Laura J Moore
- University of Texas Health Sciences Center - Houston, Houston, Texas
| | | | - Kenji Inaba
- Los Angeles County + University of Southern California Hospital, Los Angeles, California
| | - Alice Piccinini
- Los Angeles County + University of Southern California Hospital, Los Angeles, California
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Foley MP, Walsh SR, Doolan N, Vulliamy P, McMonagle M, Aylwin C. Editor's Choice - Systematic Review and Meta-Analysis of Lower Extremity Vascular Complications after Arterial Access for Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA): An Inevitable Concern? Eur J Vasc Endovasc Surg 2023; 66:103-118. [PMID: 36796674 DOI: 10.1016/j.ejvs.2023.02.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 01/24/2023] [Accepted: 02/10/2023] [Indexed: 02/16/2023]
Abstract
OBJECTIVE Resuscitative endovascular balloon occlusion of the aorta (REBOA) is used to temporise non-compressible torso haemorrhage. Recent data have suggested that vascular access complications secondary to REBOA placement are higher than initially anticipated. This updated systematic review and meta-analysis aimed to determine the pooled incidence rate of lower extremity arterial complications after REBOA. DATA SOURCES PubMed, Scopus, Embase, conference abstract listings, and clinical trial registries. REVIEW METHODS Studies including more than five adults undergoing emergency REBOA for exsanguinating haemorrhage that reported access site complications were eligible for inclusion. A pooled meta-analysis of vascular complications was performed using the DerSimonian-Laird weights for the random effects model, presented as a Forest plot. Further meta-analyses compared the relative risk of access complications between different sheath sizes, percutaneous access techniques, and indications for REBOA. Risk of bias was assessed using the Methodological Index for Non-Randomised Studies (MINORS) tool. RESULTS No randomised controlled trials were identified, and the overall study quality was poor. Twenty-eight studies including 887 adults were identified. REBOA was performed for trauma in 713 cases. The pooled proportion rate of vascular access complications was 8.6% (95% confidence interval 4.97 - 12.97), with substantial heterogeneity (I2 = 67.6%). There was no significant difference in the relative risk of access complications between 7 and > 10 F sheaths (p = .54), or between ultrasound guided and landmark guided access (p = .081). However, traumatic haemorrhage was associated with a significantly higher risk of complications compared with non-traumatic haemorrhage (p = .034). CONCLUSION This updated meta-analysis aimed to be as comprehensive as possible considering the poor quality of source data and high risk of bias. It suggested that lower extremity vascular complications were higher than originally suspected after REBOA. While the technical aspects did not appear to impact the safety profile, a cautious association could be drawn between REBOA use for traumatic haemorrhage and a higher risk of arterial complications.
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Affiliation(s)
- Megan Power Foley
- Department of Vascular Surgery, University College Hospital Galway, Galway, Ireland; Blizard Institute for Trauma Sciences, Queen Mary University of London, London, UK.
| | - Stewart R Walsh
- Lambe Institution for Translational Research, National University of Ireland Galway, Galway, Ireland; National Surgical Research Support Centre, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Nathalie Doolan
- Department of Vascular Surgery, University College Hospital Galway, Galway, Ireland
| | - Paul Vulliamy
- Blizard Institute for Trauma Sciences, Queen Mary University of London, London, UK
| | | | - Christopher Aylwin
- Blizard Institute for Trauma Sciences, Queen Mary University of London, London, UK; Department of Trauma Surgery, Imperial College London, London, UK
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Minici R, Serra R, Maglia C, Guzzardi G, Spinetta M, Fontana F, Venturini M, Laganà D. Efficacy and Safety of Axiostat ® Hemostatic Dressing in Aiding Manual Compression Closure of the Femoral Arterial Access Site in Patients Undergoing Endovascular Treatments: A Preliminary Clinical Experience in Two Centers. J Pers Med 2023; 13:812. [PMID: 37240982 PMCID: PMC10220903 DOI: 10.3390/jpm13050812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/10/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Hemostasis of the femoral arterial access site by manual compression or a vascular closure device is critical to the safe completion of any endovascular procedure. Previous investigations evaluated the hemostatic efficacy at the radial access site of some chitosan-based hemostatic pads. This study aims to assess the efficacy and safety of a new chitosan-based hemostatic dressing, namely Axiostat®, in aiding manual compression closure of the femoral arterial access site in patients undergoing endovascular treatments. Furthermore, the outcomes were compared with evidence on manual compression alone and vascular closure devices. METHODS This investigation is a two-center retrospective analysis of 120 consecutive patients who had undergone, from July 2022 to February 2023, manual compression closure of the femoral arterial access site aided by the Axiostat® hemostatic dressing. Endovascular procedures performed with introducer sheaths ranging from 4 Fr to 8 Fr were evaluated. RESULTS Primary technical success was achieved in 110 (91.7%) patients, with adequate hemostasis obtained in all cases of prolonged manual compression requirements. The mean time-to-hemostasis and time-to-ambulation were 8.9 (±3.9) and 462 (±199) minutes, respectively. Clinical success was achieved in 113 (94.2%) patients, with bleeding-related complications noted in 7 (5.8%) patients. CONCLUSIONS Manual compression aided by the Axiostat® hemostatic dressing is effective and safe in achieving hemostasis of the femoral arterial access site in patients undergoing endovascular treatment with a 4-8 Fr introducer sheath.
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Affiliation(s)
- Roberto Minici
- Radiology Unit, Dulbecco University Hospital, 88100 Catanzaro, Italy; (R.M.); (C.M.)
| | - Raffaele Serra
- Vascular Surgery Unit, Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Dulbecco University Hospital, 88100 Catanzaro, Italy;
| | - Claudio Maglia
- Radiology Unit, Dulbecco University Hospital, 88100 Catanzaro, Italy; (R.M.); (C.M.)
| | - Giuseppe Guzzardi
- Radiology Unit, Maggiore della Carità University Hospital, 28100 Novara, Italy; (G.G.); (M.S.)
| | - Marco Spinetta
- Radiology Unit, Maggiore della Carità University Hospital, 28100 Novara, Italy; (G.G.); (M.S.)
| | - Federico Fontana
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Insubria University, 21100 Varese, Italy; (F.F.); (M.V.)
| | - Massimo Venturini
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Insubria University, 21100 Varese, Italy; (F.F.); (M.V.)
| | - Domenico Laganà
- Radiology Unit, Dulbecco University Hospital, 88100 Catanzaro, Italy; (R.M.); (C.M.)
- Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy
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Lee SH, Yu DU, Kim TK, Jeon JC, Jin SC, Choi WI, Lee JH. Analysis of the Common Femoral Artery and Vein: Anatomical Morphology, Vessel Relationship, and Factors Affecting Vessel Size. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:325. [PMID: 35208648 PMCID: PMC8876717 DOI: 10.3390/medicina58020325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/17/2022] [Accepted: 02/18/2022] [Indexed: 11/22/2022]
Abstract
Background and Objectives: We aimed to analyze the morphology of the common femoral artery (CFA) and common femoral vein (CFV) and the anatomical relationship between the two blood vessels, and to investigate the factors that influence the size of these blood vessels. Materials and Methods: This retrospective study included 584 patients who underwent abdominal and pelvic computed tomography from 1 February to 28 February 2021. We measured the vessels at three regions on both lower extremities (inguinal ligament, distal vessel bifurcation, midpoint) and analyzed and classified the degree of overlap between the CFA and CFV into three types, as well as the factors affecting vessel size. Results: After comparing the femoral vessels according to location, it was confirmed that the CFA and CFV were larger distally than proximally on both sides (p < 0.001). The degree of overlap increased distally (p < 0.001) but was less at the middle (p < 0.001) and distal (p = 0.011) regions on the right side. It was found that the size of CFA and CFV were related to age, sex, and body mass index (BMI) and that malignancy also affects the CFA size. Conclusions: The morphology of the CFA and CFV was conical and increased distally. The degree of overlap between the two blood vessels also increased distally but was less on the right than on the left. Age, sex, and BMI are significant factors affecting the sizes of the CFA and CFV, and malignancy is associated with the CFA size.
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Affiliation(s)
- Sang-hun Lee
- Department of Emergency Medicine, Dongsan Medical Center, Keimyung University School of Medicine, 1035, Dalgubeol-daero Dalseo-gu, Daegu 42601, Korea; (D.u.Y.); (T.k.K.); (J.-c.J.); (S.c.J.); (W.i.C.)
| | - Dong uk Yu
- Department of Emergency Medicine, Dongsan Medical Center, Keimyung University School of Medicine, 1035, Dalgubeol-daero Dalseo-gu, Daegu 42601, Korea; (D.u.Y.); (T.k.K.); (J.-c.J.); (S.c.J.); (W.i.C.)
| | - Tae kwon Kim
- Department of Emergency Medicine, Dongsan Medical Center, Keimyung University School of Medicine, 1035, Dalgubeol-daero Dalseo-gu, Daegu 42601, Korea; (D.u.Y.); (T.k.K.); (J.-c.J.); (S.c.J.); (W.i.C.)
| | - Jae-cheon Jeon
- Department of Emergency Medicine, Dongsan Medical Center, Keimyung University School of Medicine, 1035, Dalgubeol-daero Dalseo-gu, Daegu 42601, Korea; (D.u.Y.); (T.k.K.); (J.-c.J.); (S.c.J.); (W.i.C.)
| | - Sang chan Jin
- Department of Emergency Medicine, Dongsan Medical Center, Keimyung University School of Medicine, 1035, Dalgubeol-daero Dalseo-gu, Daegu 42601, Korea; (D.u.Y.); (T.k.K.); (J.-c.J.); (S.c.J.); (W.i.C.)
| | - Woo ik Choi
- Department of Emergency Medicine, Dongsan Medical Center, Keimyung University School of Medicine, 1035, Dalgubeol-daero Dalseo-gu, Daegu 42601, Korea; (D.u.Y.); (T.k.K.); (J.-c.J.); (S.c.J.); (W.i.C.)
| | - Jae ho Lee
- Department of Anatomy, Keimyung University School of Medicine, 1035, Dalgubeol-daero Dalseo-gu, Daegu 42601, Korea;
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