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Tal MG, Covey A, Qaqish S, Livne R, Klass D. Prospective evaluation of efficacy and safety of distal radial and radial artery access using a novel articulating-tip guidewire. J Vasc Access 2023:11297298231212227. [PMID: 37997046 DOI: 10.1177/11297298231212227] [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: 11/25/2023] Open
Abstract
BACKGROUND Guidewire-facilitated access to peripheral vessels is commonplace in vascular access, but guidewire insertion into small vessels, such as the radial and distal radial arteries, can still be challenging. Failure to gain access on the first attempt may contribute to increased risks of procedural complications, such as vessel dissection, spasm, and occlusion. This research assessed the safety and efficacy of radial and distal radial artery access using a novel, FDA-cleared, small-core-diameter guidewire with an articulating tip, under ultrasound guidance. METHODS This was a prospective, single-arm, single-center trial. Patients in need of vascular access were screened for participation and enrolled in the study. Guidewire insertion was attempted by four physicians (three interventional radiologists and an interventional nephrologist) at 162 arterial sites-65 radial and 97 distal radial, having a mean diameter of 2.0 mm. RESULTS First-attempt successful placement of the guidewire in the artery occurred at 87.6% of access sites (142/162) and differences in the success rate between the radial and distal radial arteries or between vessels with diameter smaller or larger than 2 mm were not observed (62/68 and 67/77, respectively; p = 0.6). Four of the five reported adverse events were unrelated to the study device or procedure. Two of the three distal radial artery spasms occurred before the guidewire was used. The other two events were a radial artery spasm, and a distal radial artery site hematoma. All adverse events resolved spontaneously. CONCLUSIONS First-attempt placement of a novel articulating tip guidewire in the radial and distal radial arteries occurred at a high rate in our study and was not associated with safety concerns.
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Affiliation(s)
- Michael G Tal
- Division of Interventional Radiology, Hadassah Medical Center, Jerusalem, Israel
| | - Anne Covey
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | - Ron Livne
- Embrace Medical Ltd., Tel Aviv, Israel
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Tai WA, Wu CH, Ling K, Chen ST, Lin TM, Hwang HE, Luo CB, Guo WY, Chang FC. Iatrogenic retroperitoneal hematoma as an access-site complication of neurointervention. J Chin Med Assoc 2022; 85:774-781. [PMID: 35266918 DOI: 10.1097/jcma.0000000000000711] [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] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND To evaluate the clinical and imaging presentation, management, and outcome of iatrogenic retroperitoneal hematomas (IRPHs) during a series of neurointerventional procedures (NIPs). METHODS Six IRPH patients with complications, including five renal subcapsular hematomas (RSH) and one retroperitoneal hemorrhage, were observed among 2290 NIPs performed at our hospital from 2000 through 2020. The medical records, neurointerventional techniques, imaging data, and management of these six IRPH patients were retrospectively reviewed. All six patients received preprocedural dual antiplatelet medication and intraprocedural heparinization. RESULTS All patients underwent right femoral access. The guidewires were not handled under full course fluoroscopy monitoring. The most common symptom of IRPH was periprocedural flank/abdominal pain (6/6, 100%), including five on the left side (83.3%). Hypotension or shock was observed in three patients (50%). Two patients (33%) were diagnosed intraoperatively by sonogram and received on-site treatment, whereas the other four were diagnosed by postprocedural abdominal computed tomography. Active extravasation from a renal artery was diagnosed by angiogram in the five patients with RSH and was successfully treated with embolization. Multiple bleeders in the branches of the renal artery were noted in three RSH patients (60%). The patient with retroperitoneal hematoma was treated conservatively. CONCLUSION Unexplained periprocedural or postprocedural abdominal/flank pain, especially contralateral to the femoral access side of the NIPs, should raise the possibility of IRPH. To prevent IRPH, the authors suggest using full visual fluoroscopic monitoring for guidewire navigation during femoral catheterization of NIPs.
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Affiliation(s)
- Wei-An Tai
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Chia-Hung Wu
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Kan Ling
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Shu-Ting Chen
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Te-Ming Lin
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Hsuen-En Hwang
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Chao-Bao Luo
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Biomedical Engineering, Yuanpei University of Medical Technology, Hsinchu, Taiwan, ROC
| | - Wan-Yuo Guo
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Feng-Chi Chang
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
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Qu XL, Hu HY. A Case of Renal Subcapsular Hematoma Caused by an Accident Injection from Renal Capsular Artery. Chin Med J (Engl) 2015; 128:708. [PMID: 25698212 PMCID: PMC4834791 DOI: 10.4103/0366-6999.151704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Haller C, Keim M. Current issues in the diagnosis and management of patients with renal artery stenosis: a cardiologic perspective. Prog Cardiovasc Dis 2003; 46:271-86. [PMID: 14685944 DOI: 10.1016/s0033-0620(03)00074-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Renal artery stenosis most often is caused by atherosclerosis. Although patients with renal artery stenosis can be managed conservatively, renal revascularization may be indicated, particularly in patients with refractory hypertension on a multidrug regimen and patients with declining renal function. Duplex ultrasonography of the renal arteries and magnetic resonance angiography are currently the most efficient noninvasive methods for the evaluation of renal artery stenosis. Selective digital subtraction renal arteriography remains the gold standard for the definitive diagnosis. In selected patients undergoing coronary studies and angiography immediately after the coronary procedure can be efficient. Atherosclerotic renal artery lesions, which commonly affect the renal artery ostium, can be treated safely and effectively with balloon-expandable stents. Successful angioplasty commonly results in improved control of hypertension, but an overall benefit on renal function and/or patient survival has not been shown. Generally the risk/benefit ratio of renal artery stenting seems favorable, but further randomized studies are needed for evidence-based decision making. All patients with atherosclerotic renal artery stenosis should receive rigorous secondary prevention measures including platelet inhibitors, statins, and beta-blockers.
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Affiliation(s)
- Christlieb Haller
- Department of Medicine I, Hegau-Klinikum, Singen, Germany. haller@hegau-klinikum,de
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5
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Pentecost MJ, Criqui MH, Dorros G, Goldstone J, Johnston KW, Martin EC, Ring EJ, Spies JB. Guidelines for Peripheral Percutaneous Transluminal Angioplasty of the Abdominal Aorta and Lower Extremity Vessels. J Vasc Interv Radiol 2003; 14:S495-515. [PMID: 14514865 DOI: 10.1016/s1051-0443(07)61267-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
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Stoeteknuel-Friedli S, Do DD, von Briel C, Triller J, Mahler F, Baumgartner I. Endovascular Brachytherapy for Prevention of Recurrent Renal In-Stent Restenosis. J Endovasc Ther 2002. [DOI: 10.1583/1545-1550(2002)009<0350:ebfpor>2.0.co;2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Butterfield JS, Fitzgerald JB, Razzaq R, Willard CJ, Ashleigh RJ, England RE, Chalmers N, Andrew HM. Early mobilization following angioplasty. Clin Radiol 2000; 55:874-7. [PMID: 11069744 DOI: 10.1053/crad.2000.0595] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIM To assess the incidence of puncture site complications in in-patients undergoing early mobilization following angioplasty with a view to performing day case angioplasty. MATERIALS AND METHODS One hundred and twenty-eight patients undergoing peripheral and renal angioplasty using a sheath size of up to 6 French were recruited prospectively. The mobilization protocol consisted of supine bed rest for 2 h, followed by gradual mobilization, so that the patient was ambulant 4 h after the procedure. Mobilization was delayed if clinically appropriate. Puncture sites were scored for discomfort, paraesthesia, visible bruising and palpable haematoma after groin compression and the following morning. RESULTS One hundred and forty-four puncture sites were studied. There were 44 haematomas in total, of which 37 (26%) were less than 2.5 cm and seven (4.9%) were between 2.5 cm and 7.5 cm. Four patients (2.8%) had visible bruising greater than 7.5 cm. No patient assessed discomfort higher than moderate at any stage. Mobilization was delayed in 15 patients. In 11 this was due to puncture site oozing, haematoma in one, two were hypertensive and one required surgery for limb ischaemia. All complications occurred within 4 h of angioplasty. No patient required surgery or transfusion for haemorrhagic complications. CONCLUSION Mobilization at 4 h was successful in 90% of cases but 10% require more prolonged bed rest. No delayed complications occurred. These results suggest that day case angioplasty is feasible in most cases.Butterfield, J. S. (2000). Clinical Radiology55, 874-877
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Affiliation(s)
- J S Butterfield
- South Manchester University Hospitals, N.H.S. Trust, Nell Lane, West Didsbury, Machester, UK
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8
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Matsi PJ, Manninen HI. Complications of lower-limb percutaneous transluminal angioplasty: a prospective analysis of 410 procedures on 295 consecutive patients. Cardiovasc Intervent Radiol 1998; 21:361-6. [PMID: 9853140 DOI: 10.1007/s002709900281] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate complications and their predictors in percutaneous transluminal angioplasty (PTA) of lower-limb arteries. METHODS Complications in 410 angioplasty procedures in 295 consecutive patients (192 claudicants and 103 suffering from chronic critical ischemia) were prospectively analyzed. RESULTS The total complication rate was 10.5% (43/410). There were 21 major complications (5%), eight of which required surgical treatment, including four hematomas, two arteriovenous fistulae, and two pseudoaneurysms at the puncture site, two retroperitoneal hematomas, and 11 thrombotic/thromboembolic complications. There were significantly more complications with treatment of occlusions compared with stenoses (18% vs 7%, p = 0.002). Women had significantly more bleeding complications than men (15% vs 6%, p = 0.032). The 30-day mortality rate in patients with critical ischemia was 10%. CONCLUSION In lower-limb PTA a few target lesion- and patient-related determinants of complications could be identified. In patients with critical ischemia, the 30-day mortality was rather high and mainly due to associated coronary and cerebrovascular diseases.
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Affiliation(s)
- P J Matsi
- Department of Clinical Radiology, Kuopio University Hospital, Finland
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Bajwa TK, Shalev YA, Gupta A, Khalid MA. Peripheral vascular disease, Part 2. Curr Probl Cardiol 1998; 23:305-48. [PMID: 9640544 DOI: 10.1016/s0146-2806(98)80013-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- T K Bajwa
- Department of Medicine, University of Wisconsin Medical School, Milwaukee Heart Institute, Sinai Samaritan Medical Center, USA
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LYON ROSST, MARIN MICHAELL, VEITH FRANKJ. Balloon Angioplasty and Endoluminal Stenting of Clinically Significant Human Carotid Artery Occlusive Lesions: A New Model for Ex Vivo Morphological Analysis. J Interv Cardiol 1996. [DOI: 10.1111/j.1540-8183.1996.tb00619.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Pentecost MJ, Criqui MH, Dorros G, Goldstone J, Johnston KW, Martin EC, Ring EJ, Spies JB. Guidelines for peripheral percutaneous transluminal angioplasty of the abdominal aorta and lower extremity vessels. A statement for health professionals from a special writing group of the Councils on Cardiovascular Radiology, Arteriosclerosis, Cardio-Thoracic and Vascular Surgery, Clinical Cardiology, and Epidemiology and Prevention, the American Heart Association. Circulation 1994; 89:511-31. [PMID: 8281692 DOI: 10.1161/01.cir.89.1.511] [Citation(s) in RCA: 227] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- M J Pentecost
- Office of Scientific Affairs, American Heart Association, Dallas, TX 75231-4596
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12
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Die Anwendung von Laserenergie zur schonenden Venenklappenablatio beim Ex-situ- und In-situ-Venenbypass. Eur Surg 1993. [DOI: 10.1007/bf02602208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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13
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Weibull H, Bergqvist D, Jendteg S, Lindgren B, Persson U, Jonsson K, Bergentz SE. Clinical outcome and health care costs in renal revascularization--percutaneous transluminal renal angioplasty versus reconstructive surgery. Br J Surg 1991; 78:620-4. [PMID: 1829388 DOI: 10.1002/bjs.1800780531] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Clinical outcome and health care costs related to investigation, treatment with either percutaneous transluminal renal angioplasty (PTRA) or reconstructive surgery, and follow-up of patients with renovascular hypertension with or without uraemia were analysed in 21 PTRA-treated and 16 operated patients. Most renal artery stenoses were atherosclerotic. Nineteen PTRAs were successful or partly successful and two failed; the patients were operated on without delay. All surgical reconstructions were successful. In the PTRA group six restenoses occurred after 4-24 months. Four were treated with re-PTRA and two were operated on. No recurrence occurred in the operated group. At the end of follow-up (median 48, range 9-84 months) primary patency in the PTRA group was 69 per cent and in the operated group 100 per cent. Secondary patency in the PTRA group was 100 per cent. With regard to hypertension, including primary and secondary results, 19 out of 21 (90 per cent) patients were improved in the PTRA group and 13 out of 16 (81 per cent) in the operated group. The diagnostic and preprocedure costs were the same in both groups, whereas the procedure and postprocedure costs were lower in the PTRA group. However, the follow-up costs were considerably higher because of recurrences and their treatment in the PTRA group. The total median cost of reconstructive surgery was 12 per cent higher than for PTRA, a non-significant difference.
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Affiliation(s)
- H Weibull
- Department of Surgery, Malmö General Hospital, Lund University, Sweden
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Kim D, Porter DH, Siegel JB, Shapiro ME, Strom TB, Glotzer DJ. Use of a reperfusion catheter after angioplasty dissection for salvage of ischemic renal allograft: case report. Cardiovasc Intervent Radiol 1991; 14:179-82. [PMID: 1831690 DOI: 10.1007/bf02577725] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Percutaneous transluminal angioplasty was performed on a right common iliac artery stenosis presumed to be causing renovascular hypertension in a patient with a renal allograft anastomosis to the right external iliac artery. This was complicated by an obstructive dissection resulting in acute threatening renal allograft ischemia. Renal blood flow was restored by means of a transluminal reperfusion catheter until corrective surgery could be performed. This case is reported because such catheters can be acutely helpful to the interventionalist, and they have not been described in the radiology literature.
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Affiliation(s)
- D Kim
- Department of Radiology, Beth Israel Hospital, Boston, Massachusetts 02215
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