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Li C, You H, Zhang H, Liu Y, Li W, Wang X, Zhang Y. Application of relay puncture technique in treating patients with complicated lower extremity arterial diseases. PeerJ 2019; 7:e6345. [PMID: 30783567 PMCID: PMC6377597 DOI: 10.7717/peerj.6345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 12/24/2018] [Indexed: 11/20/2022] Open
Abstract
Objective This study aimed to introduce and evaluate the safety and efficacy of the relay puncture technique in patients with complicated lower extremity arterial diseases. Methods A total of 21 patients (16 male and five female patients; median age: 68.5 years old), who had suffered from lower extremity arterial diseases between December 2014 and July 2017, were retrospectively collected. For all patients, the contralateral femoral artery was not available for puncture access, and the length of the devices was too short for the brachial artery approach. Therefore, the relay puncture technique, in which the first puncture was performed on the brachial artery, followed by an antegrade puncture on the femoral artery, was used to accomplish the endovascular therapy. Percutaneous transluminal angioplasty and/or percutaneous transluminal stenting were/was used to assess the efficacy of the relay puncture technique. The ankle–brachial index (ABI) and Rutherford clinical classification were used to evaluate the improvement of symptoms after treatment. Patients were followed up for 1, 3, 6, and 12 months, and annually (mean: 16.6 months) after discharge. Results The relay puncture treatment had a 100% technical success rate, and immediately decreased the ischemic symptoms of patients after the procedure. The ABI significantly increased from 0.33 ± 0.18 to 0.75 ± 0.21 at the 1-year follow-up time point (P < 0.05). No serious complications occurred during the follow-up period. The 1-year primary patency rate was 71.43%. Conclusion The relay puncture technique is a feasible technique in the hands of experienced and skilled equipment operators for the treatment of lower extremity arterial diseases, when the contralateral femoral artery is not available for puncture, and the length of the device is too short to treat the distal lesion of the femoral artery and popliteal artery through the brachial artery approach.
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Affiliation(s)
- Chengzhi Li
- Department of Interventional Radiology and Vascular Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Huimin You
- Department of Endocrinology, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.,Medical Imaging Center, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Hong Zhang
- Department of Interventional Radiology and Vascular Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Yulong Liu
- Department of Interventional Radiology and Vascular Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Wanghai Li
- Department of Interventional Radiology and Vascular Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Xiaobai Wang
- Department of Interventional Radiology and Vascular Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
| | - Yan Zhang
- Department of Interventional Radiology and Vascular Surgery, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, China
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Reich R, Rabelo-Silva ER, Santos SMD, Almeida MDA. Vascular access complications in patients undergoing percutaneous procedures in hemodynamics: a scoping review. Rev Gaucha Enferm 2018; 38:e68716. [PMID: 29933427 DOI: 10.1590/1983-1447.2017.04.68716] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 03/28/2017] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To map the production of knowledge on vascular access complications in patients undergoing percutaneous procedures in hemodynamic laboratories. METHODS Scoping review study. The search strategy was developed in three stages, considering the period from July 2005 to July 2015 in the PubMed, CINAHL, Scopus, and LILACS databases. The collected data were analyzed and summarized in a narrative form. RESULTS One-hundred twenty-eight publications that made it possible to map the contexts of study of complications, occurrence according to access routes, as well as an understanding of diagnosis and clinical management, were included. Three theme categories were identified: complications; predictive factors; and diagnosis/treatment. CONCLUSION Vascular access site complications range according to the access route used. Knowledge of factors that permeate the occurrence of these events may contribute to early detection, planning, and monitoring of the care implemented.
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Affiliation(s)
- Rejane Reich
- Hospital de Clínicas de Porto Alegre (HCPA). Porto Alegre, Rio Grande do Sul, Brasil.,Universidade Federal do Rio Grande do Sul (UFRGS), Escola de Enfermagem, Programa de Pós-graduação em Enfermagem. Porto Alegre, Rio Grande do Sul, Brasil
| | - Eneida Rejane Rabelo-Silva
- Hospital de Clínicas de Porto Alegre (HCPA). Porto Alegre, Rio Grande do Sul, Brasil.,Universidade Federal do Rio Grande do Sul (UFRGS), Escola de Enfermagem, Programa de Pós-graduação em Enfermagem. Porto Alegre, Rio Grande do Sul, Brasil.,Universidade Federal do Rio Grande do Sul (UFRGS), Escola de Enfermagem. Departamento de Enfermagem Médico-Cirúrgica. Porto Alegre, Rio Grande do Sul, Brasil
| | - Simone Marques Dos Santos
- Hospital de Clínicas de Porto Alegre (HCPA). Porto Alegre, Rio Grande do Sul, Brasil.,Universidade Federal do Rio Grande do Sul (UFRGS), Escola de Enfermagem, Programa de Pós-graduação em Enfermagem. Porto Alegre, Rio Grande do Sul, Brasil
| | - Miriam de Abreu Almeida
- Hospital de Clínicas de Porto Alegre (HCPA). Porto Alegre, Rio Grande do Sul, Brasil.,Universidade Federal do Rio Grande do Sul (UFRGS), Escola de Enfermagem, Programa de Pós-graduação em Enfermagem. Porto Alegre, Rio Grande do Sul, Brasil.,Universidade Federal do Rio Grande do Sul (UFRGS), Escola de Enfermagem. Departamento de Enfermagem Médico-Cirúrgica. Porto Alegre, Rio Grande do Sul, Brasil
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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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Hackl G, Gary T, Belaj K, Hafner F, Eller P, Brodmann M. Risk Factors for Puncture Site Complications After Endovascular Procedures in Patients With Peripheral Arterial Disease. Vasc Endovascular Surg 2015; 49:160-5. [PMID: 26429973 DOI: 10.1177/1538574415608268] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To compare femoral access site closure techniques and to highlight risk factors for puncture site complications after lower extremity endovascular procedures. METHODS This retrospective study included 787 patients. Procedures were performed according to a standardized protocol. Puncture site complications within 24 hours were regarded as study end points. RESULTS Ninety (11.5%) puncture site complications were registered. Conventional manual compression (n = 87, 11.1%) was significantly associated with puncture site complications (odds ratio [OR] 2.08, P = .03). Body mass index > 25 kg/m(2) (OR 0.54, P = .01) and prothrombin time > 70% (OR 0.38, P = .04) were protective. All bleeding occurred in procedures >45 minutes. Blood pressure >200 mm Hg and below the knee (BTK) procedures were strong predictors for access site complications (OR 4.21, P = .01 and OR 3.33, P = .02). CONCLUSIONS We observed an inferiority of conventional manual compression. Age, procedure duration > 45 minutes, BTK procedures, uncontrolled hypertension, and impaired coagulation were risk factors.
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Affiliation(s)
- Gerald Hackl
- Division of Angiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Thomas Gary
- Division of Angiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Klara Belaj
- Division of Angiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Franz Hafner
- Division of Angiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Philipp Eller
- Division of Angiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Marianne Brodmann
- Division of Angiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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Grandhi R, Zhang X, Panczykowski D, Choi P, Hunnicutt CT, Jadhav AP, Ducruet AF, Jovin T, Jankowitz B. Incidence of delayed angiographic femoral artery complications using the EXOSEAL vascular closure device. Interv Neuroradiol 2015; 21:401-6. [PMID: 26015532 DOI: 10.1177/1591019915581776] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND PURPOSE Femoral artery injuries are known complications of percutaneous vascular closure devices (VCDs). We studied the incidence of delayed femoral artery angiographic irregularities after neurointerventional procedures in which the EXOSEAL extravascular closure device was used for femoral arterial puncture closure. METHODS Adult patients who underwent femoral arterial puncture closures with an EXOSEAL VCD and had a follow-up femoral artery angiogram from June 2012 through August 2013 were reviewed. A blinded radiologist compared pre-deployment and follow-up femoral arteriograms for the presence of femoral artery stenosis, dissection, pseudoaneurysm, or development of an arteriovenous fistula. Hospital records were reviewed for major or minor complications of the groin site or femoral artery. RESULTS The EXOSEAL VCD achieved hemostasis, without evidence of a groin hematoma or requiring subsequent prolonged manual compression, in 400 of 441 closures following transfemoral arterial access, representing a device success rate of 90.7%. A total of 98 patients underwent 102 repeat angiograms following closure with the EXOSEAL VCD. The average time to the repeat angiogram was 73.5 days (range 0-488, median 28). Follow-up femoral arteriography demonstrated an irregularity in seven cases, all of which were vessel stenoses of <50%. There were no dissections, pseudoaneurysms, infections, or ischemic events in the study population. CONCLUSIONS Angiographic irregularities were seen in 6.86% of cases after closure with the EXOSEAL VCD. There were no clinically significant vascular complications. Thus, femoral artery closure with EXOSEAL carries a low risk of clinically significant delayed angiographic findings.
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Affiliation(s)
- Ramesh Grandhi
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Xiaoran Zhang
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - David Panczykowski
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Phillip Choi
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - Ashutosh P Jadhav
- UPMC Stroke Institute, Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Andrew F Ducruet
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Tudor Jovin
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA UPMC Stroke Institute, Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Brian Jankowitz
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Vascular Closure Devices in Interventional Radiology Practice. Cardiovasc Intervent Radiol 2015; 38:781-93. [DOI: 10.1007/s00270-015-1116-1] [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: 06/22/2014] [Accepted: 04/09/2015] [Indexed: 12/17/2022]
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Grandhi R, Zhang X, Jadhav AP, Horowitz MB, Ducruet AF, Jankowitz BT, Jovin TG. Femoral arteriotomy closure using the Mynx vascular closure device: a profile of device efficacy and complications. Interv Cardiol 2014. [DOI: 10.2217/ica.14.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Comparison of a 21G Micropuncture Needle and a Regular 19G Access Needle for Antegrade Arterial Access into the Superficial Femoral Artery. Cardiovasc Intervent Radiol 2013; 37:343-7. [DOI: 10.1007/s00270-013-0669-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2013] [Accepted: 05/03/2013] [Indexed: 10/26/2022]
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Gutzeit A, van Schie B, Schoch E, Hergan K, Graf N, Binkert CA. Feasibility and Safety of Vascular Closure Devices in an Antegrade Approach to Either the Common Femoral Artery or the Superficial Femoral Artery. Cardiovasc Intervent Radiol 2012; 35:1036-40. [DOI: 10.1007/s00270-012-0454-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Accepted: 07/12/2012] [Indexed: 10/28/2022]
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Rapid hemostasis at the femoral venous access site using a novel hemostatic pad containing kaolin after atrial fibrillation ablation. J Interv Card Electrophysiol 2011; 31:157-64. [DOI: 10.1007/s10840-011-9552-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Accepted: 01/28/2011] [Indexed: 10/18/2022]
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Ultrasound-guided antegrade femoral access: comparison between the common femoral artery and the superficial femoral artery. Eur Radiol 2010; 21:1323-8. [DOI: 10.1007/s00330-010-2032-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2010] [Revised: 11/10/2010] [Accepted: 12/03/2010] [Indexed: 10/18/2022]
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Gutzeit A, Schoch E, Sautter T, Jenelten R, Graf N, Binkert CA. Antegrade Access to the Superficial Femoral Artery with Ultrasound Guidance: Feasibility and Safety. J Vasc Interv Radiol 2010; 21:1495-500. [DOI: 10.1016/j.jvir.2010.03.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2009] [Revised: 11/22/2009] [Accepted: 03/12/2010] [Indexed: 10/19/2022] Open
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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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Hoke M, Koppensteiner R, Schillinger M, Haumer M, Minar E, Wiesbauer F, Huber CD, Mlekusch W. D-dimer testing in the diagnosis of transfemoral pseudoaneurysm after percutaneous transluminal procedures. J Vasc Surg 2010; 52:383-7. [PMID: 20488641 DOI: 10.1016/j.jvs.2010.02.275] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2009] [Revised: 02/18/2010] [Accepted: 02/23/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Pseudoaneurysms are characterized by extravascular circulation and therefore may lead to an activation of the coagulation cascade. We investigated d-dimer levels in patients with and without postcatheterization femoral pseudoaneurysms and hypothesized that d-dimer levels correlate with the presence of pseudoaneurysms at the vascular access site. METHODS Patients with clinical suspected groin pseudoaneurysms after transluminal procedures were eligible. We compared prospectively-collected laboratory values of quantitative d-dimer testing in patients with and without pseudoaneurysms as assessed by color-coded duplex sonography. Furthermore, we measured the peak systolic velocity at the arterial fistula of each pseudoaneurysm. RESULTS In 48 (40%) of 120 consecutive patients, a pseudoaneurysm was found. The level of d-dimer values was significantly higher in patients with postcatheterization femoral pseudoaneurysms compared with controls (1.9 microg/mL [interquartile range (IQR), 1.34-2.78 microg/mL] vs 0.8 microg/mL [IQR, 0.53-1.14 microg/mL]; P < .001). Values of d-dimer below 0.67 microg/mL have been calculated with a sensitivity of 94% (87%-100%), a specificity of 38% (27%-50%), a positive predictive value of 50% (40%-60%), a negative predictive value of 90% (82%-99%), and a likelihood ratio of 1.52 (1.25-1.85) with regard to the presence of pseudoaneurysms. We also found a significant correlation of the peak systolic velocity at the arterial fistula and increasing d-dimer levels (r = 0.98, P < .0001). CONCLUSION We found a significantly higher level of d-dimer values in patients with femoral pseudoaneurysms at the vascular access site. Therefore, d-dimer levels could be a potential serological marker in the diagnosis of pseudoaneurysms. A confirmation is warranted in a larger patient sample.
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Affiliation(s)
- Matthias Hoke
- Department of Angiology, Medical University, Vienna, Austria.
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