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Moonan A, Hameed A, Nachiappan S, Das N, Pantos A, Valencia D, Kaikini R, Prashar A. A single institution experience of the Manta closure device in endovascular aortic repair. Vascular 2024:17085381241256191. [PMID: 38785381 DOI: 10.1177/17085381241256191] [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: 05/25/2024]
Abstract
BACKGROUND Majority of EVAR procedures are performed with percutaneous arterial access, unless there is severe steno-occlusive disease in the common femoral arteries (CFA). We present our experience of using MANTA closure device with a retrospective evaluation of its safety and efficacy, in the elective setting, and in the emergent setting for ruptured aortic aneurysm. DESIGN AND METHODS Between Feb 2021 and May 2023 a total of 75 EVAR procedures were closed with a Manta device. Data was collected prospectively and analysed retrospectively. In 75 patients, 128 CFAs were closed with a Manta closure device including 4 emergent ruptured aneurysms. RESULTS 67 male and 8 female patients with a median age of 77 years had percutaneous EVAR using Manta as a closure device. 128 CFAs were closed with Manta closure device. 3% (4/128) had deployment failures, with three requiring surgical cut down and closure. In one patient, a second Manta device deployment achieved satisfactory haemostasis. Three deployments were complicated by pseudoaneurysms of the CFA, all requiring no further interventions/treatment. No death related to severe haemorrhage from device failure. The pre- and post-procedure CFA puncture site AP diameter was recorded in a total of 106 cases with appropriate follow-up. 66% of these (70/106) had no reduction in CFA diameter post Manta closure. 34% (36/106) had some reduction of vessel AP size CFA post EVAR. No adverse features or further treatment was required due to reduction of vessel diameter in these cases (ongoing yearly surveillance). CONCLUSIONS Manta closure device is safe and easy to deploy with an overall success rate of 97%. There is a short learning curve. Ultrasound assessment and precise puncture at the healthy section of femoral artery are the key to achieve successful haemostasis with Manta closure device. Our findings suggest there is an association of non-clinically significant mild reduction in CFA vessel AP diameter post Manta closure device, which does not require further intervention.
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Affiliation(s)
- Ali Moonan
- Interventional Radiology, Kent and Canterbury Hospital, Canterbury, UK
| | - Aisha Hameed
- Interventional Radiology, Kent and Canterbury Hospital, Canterbury, UK
| | | | - Neelan Das
- Interventional Radiology, Kent and Canterbury Hospital, Canterbury, UK
| | - Athanasios Pantos
- Interventional Radiology, Kent and Canterbury Hospital, Canterbury, UK
| | - Dexter Valencia
- Interventional Radiology, Kent and Canterbury Hospital, Canterbury, UK
| | - Robert Kaikini
- Interventional Radiology, Kent and Canterbury Hospital, Canterbury, UK
| | - Akash Prashar
- Interventional Radiology, Kent and Canterbury Hospital, Canterbury, UK
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Benic C, Nicol PP, Hannachi S, Gilard M, Didier R, Nasr B. Vascular Complications Following Transcatheter Aortic Valve Implantation, Using MANTA (Collagen Plug-Based) versus PROSTAR (Suture-Based), from a French Single-Center Retrospective Registry. J Clin Med 2023; 12:6697. [PMID: 37892835 PMCID: PMC10607530 DOI: 10.3390/jcm12206697] [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: 08/30/2023] [Revised: 09/22/2023] [Accepted: 10/20/2023] [Indexed: 10/29/2023] Open
Abstract
TAVI requires a large-bore arteriotomy. Closure is usually performed by the suture system. Some studies report a vascular complication rate of up to 21%. MANTA is a recently developed percutaneous closure system dedicated to large caliber vessels based on an anchoring system. Early studies report a lower rate of vascular complications with MANTA devices. This single-center retrospective study included all patients who underwent femoral TAVI at the Brest University Hospital from 20 November 2019 to 31 March 2021. The primary endpoint is the rate of vascular complications (major and minor) pre and post-TAVI procedure. In total, 264 patients were included. There were no significant differences in vascular complications (major and minor) between the two groups (13.6% in the MANTA group versus 21.2% in the PROSTAR group; p = 0.105), although there was a tendency to have fewer minor vascular complications in the Manta group (12.1% versus 20.5%; p = 0.067). Manta was associated with a lower rate of bleeding complications (3.8% versus 15.2%; p = 0.002), predominantly minor complications with fewer closure failures (4.5% versus 13.6%; p = 0.01), less use of covered stents (4.5% versus 12.9%; p = 0.016), and with no difference in the need for vascular surgery compared to the Prostar group (1.5% versus 2.3%; p = 0.652). On the other hand, Manta was associated with a higher rate of femoral stenosis (4.5% versus 0%; p = 0.013) without clinical significance (1.5% versus 0%; p = 0.156). The Manta and Prostar devices are equivalent in terms of vascular complications. The Manta, compared to the Prostar, is associated with fewer bleeding complications.
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Affiliation(s)
- Clément Benic
- Department of Cardiology, University Hospital of Brest, 29200 Brest, France; (P.P.N.); (S.H.); (M.G.); (R.D.)
| | - Pierre Philippe Nicol
- Department of Cardiology, University Hospital of Brest, 29200 Brest, France; (P.P.N.); (S.H.); (M.G.); (R.D.)
| | - Sinda Hannachi
- Department of Cardiology, University Hospital of Brest, 29200 Brest, France; (P.P.N.); (S.H.); (M.G.); (R.D.)
| | - Martine Gilard
- Department of Cardiology, University Hospital of Brest, 29200 Brest, France; (P.P.N.); (S.H.); (M.G.); (R.D.)
| | - Romain Didier
- Department of Cardiology, University Hospital of Brest, 29200 Brest, France; (P.P.N.); (S.H.); (M.G.); (R.D.)
| | - Bahaa Nasr
- Department of Vascular Surgery, University Hospital of Brest, 29200 Brest, France;
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Wang Q, Wu J, Ma Y, Zhu Y, Song X, Xie S, Liang F, Gimzewska M, Li M, Yao L. Totally percutaneous versus surgical cut-down femoral artery access for elective bifurcated abdominal endovascular aneurysm repair. Cochrane Database Syst Rev 2023; 1:CD010185. [PMID: 36629152 PMCID: PMC9832535 DOI: 10.1002/14651858.cd010185.pub4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Abdominal aortic aneurysms (AAAs) are a vascular condition with significant risk attached, particularly if they rupture. Therefore, it is critical to identify and repair these as an elective procedure before they rupture and require emergency surgery. Repair has traditionally been an open surgical technique that required a large incision across the abdomen. Endovascular abdominal aortic aneurysm repairs (EVARs) are now a common alternative. In this procedure, the common femoral artery is exposed via a cut-down approach and a graft is introduced to the aneurysm in this way. This Cochrane Review examines a totally percutaneous approach to EVAR. This technique gives a minimally invasive approach to femoral artery access that may reduce groin wound complication rates and improve recovery time. However, the technique may be less applicable in people with, for example, groin scarring or arterial calcification. This is an update of the previous Cochrane Review published in 2017. OBJECTIVES To evaluate the benefits and harms of totally percutaneous access compared to cut-down femoral artery access in people undergoing elective bifurcated abdominal endovascular aneurysm repair (EVAR). SEARCH METHODS We used standard, extensive Cochrane search methods The latest search was 8 April 2022. SELECTION CRITERIA We included randomised controlled trials in people diagnosed with an AAA comparing totally percutaneous versus surgical cut-down access endovascular repair. We considered all device types. We only considered studies investigating elective repairs. We excluded studies reporting emergency surgery for ruptured AAAs and those reporting aorto-uni-iliac repairs. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcomes were 1. short-term mortality, 2. failure of aneurysm exclusion and 3. wound infection. Secondary outcomes were 4. major complications (30-day or in-hospital); 5. medium- to long-term (6 and 12 months) complications and mortality; 6. bleeding complications and haematoma; and 7. operating time, duration of intensive treatment unit (ITU) stay and hospital stay. We used GRADE to assess the certainty of evidence for the seven most clinically relevant primary and secondary outcomes. MAIN RESULTS Three studies with 318 participants met the inclusion criteria, 189 undergoing the percutaneous technique and 129 treated by cut-down femoral artery access. One study had a small sample size and did not adequately report the method of randomisation, allocation concealment or preselected outcomes. The other two larger studies had few sources of bias and good methodology; although one study had a high risk of bias in selective reporting. We observed no clear difference in short-term mortality between groups, with only one death occurring overall, in the totally percutaneous group (risk ratio (RR) 1.50, 95% confidence interval (CI) 0.06 to 36.18; 2 studies, 181 participants; low-certainty evidence). One study reported failure of aneurysm exclusion. There was one failure of aneurysm exclusion in the surgical cut-down femoral artery access group (RR 0.17, 95% CI 0.01 to 4.02; 1 study, 151 participants; moderate-certainty evidence). For wound infection, there was no clear difference between groups (RR 0.18, 95% CI 0.01 to 3.59; 3 studies, 318 participants; moderate-certainty evidence). There was no clear difference between percutaneous and cut-down femoral artery access groups in major complications (RR 1.21, 95% CI 0.61 to 2.41; 3 studies, 318 participants; moderate-certainty evidence), bleeding complications (RR 1.02, 95% CI 0.29 to 3.64; 2 studies, 181 participants; moderate-certainty evidence) or haematoma (RR 0.88, 95% CI 0.13 to 6.05; 2 studies, 288 participants). One study reported medium- to long-term complications at six months, with no clear differences between the percutaneous and cut-down femoral artery access groups (RR 0.82, 95% CI 0.25 to 2.65; 1 study, 135 participants; moderate-certainty evidence). We detected differences in operating time, with the percutaneous approach being faster than cut-down femoral artery access (mean difference (MD) -21.13 minutes, 95% CI -41.74 to -0.53 minutes; 3 studies, 318 participants; low-certainty evidence). One study reported the duration of ITU stay and hospital stay, with no clear difference between groups. AUTHORS' CONCLUSIONS Skin puncture may make little to no difference to short-term mortality. There is probably little or no difference in failure of aneurysm exclusion (failure to seal the aneurysms), wound infection, major complications within 30 days or while in hospital, medium- to long-term (six months) complications and bleeding complications between the two groups. Compared with exposing the femoral artery, skin puncture may reduce the operating time slightly. We downgraded the certainty of the evidence to moderate and low as a result of imprecision due to the small number of participants, low event rates and wide CIs, and inconsistency due to clinical heterogeneity. As the number of included studies was limited, further research into this technique would be beneficial.
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Affiliation(s)
- Qi Wang
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Jing Wu
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China
| | - Yanfang Ma
- School of Chinese Medicine, Hong Kong Baptist University, Hong Kong, China
| | - Ying Zhu
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Xiaoyang Song
- Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shitong Xie
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China
| | - Fuxiang Liang
- Department of Cardiovascular Surgery, The First Hospital of Lanzhou University, Lanzhou, China
| | - Madelaine Gimzewska
- Academic Department of Vascular Surgery, Imperial College London, London, UK
| | - Meixuan Li
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
| | - Liang Yao
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
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4
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A 12-year experience of endovascular repair for ruptured Abdominal Aortic Aneurysms in all patients. J Vasc Surg 2022. [DOI: 10.1016/j.jvs.2022.10.032] [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]
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Mathisen SR, Nilsson KF, Larzon T. A Single Center Study of ProGlide Used for Closure of Large-Bore Puncture Holes After EVAR for AAA. Vasc Endovascular Surg 2021; 55:798-803. [PMID: 34105422 DOI: 10.1177/15385744211022654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE The objective of this study was to evaluate the primary and assisted secondary percutaneous and non-invasive technical success of the ProGlide device on all-comers in a consecutive case series of percutaneous endovascular aortic aneurysm repair (P-EVAR). METHOD A single-center consecutive case series where 434 elective and acute P-EVAR procedures were registered prospectively between May 2011 and July 2017. The mean age was 74.5 years ± SD 11.4 years. 82.3% of the patients were male. All patients were pre-planned from CT angiography. Percutaneous access punctures, performed in local anesthesia in the common femoral artery, with a final introducer size between 12-22 Fr OD were included and stratified in 2 groups, 12-16 Fr and 17-22 Fr. RESULTS By screening 868 access groins 22 groins were excluded. Of the remaining 846 groins, intended to be treated with ProGlide, 9 groins were excluded peri-procedurally and treated with the Fascia Suture Technique or surgical cutdown. The remaining 837 groins had access closure with ProGlide, with a mean value of 2.15 devices per groin with a slight significant difference between the 2 stratification groups. Primary ProGlide technical success was achieved in 68.1% of the groins. Secondary percutaneous or non-invasive technical success was achieved in 96.9%. Here there was no statistically significant difference between the 2 stratification groups. Thirty-one (3.7%) groin complications were registered during 30-day follow-up and 17 required additional treatment. Total mortality was 2.8%. None of these deaths were related to the access site. CONCLUSION ProGlide by itself has a significant failure rate in the closure of large-bore access holes on an unselected cohort of patients eligible for P-EVAR. However, together with adjunct percutaneous or non-invasive methods a success rate of 97% can be achieved. The access complication rate was lower than 4% at 30-day follow-up.
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Affiliation(s)
| | - Kristofer F Nilsson
- Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Thomas Larzon
- Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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6
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Armstrong EJ, Kokkinidis DG. Vascular Closure Devices for Large-Bore Mechanical Circulatory Support Devices: Becoming MANT(d)Atory? CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:879-881. [PMID: 32345537 DOI: 10.1016/j.carrev.2020.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 04/09/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Ehrin J Armstrong
- Division of Cardiology, Rocky Mountain Regional VA Medical Center, University of Colorado, Denver, CO, USA.
| | - Damianos G Kokkinidis
- Division of Cardiology, Rocky Mountain Regional VA Medical Center, University of Colorado, Denver, CO, USA
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7
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Baldino G, Rossi UG, Di Gregorio S, Gori A. Ultrasound-guided fascia closure as bailout technique for large-bore percutaneous femoral access failure: Report of two cases. J Vasc Access 2020; 21:769-772. [PMID: 32089061 DOI: 10.1177/1129729820906975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Percutaneous endovascular abdominal aortic aneurysm repair is nowadays considered a safe and effective procedure and has gained widespread globally acceptance. However, intraoperative persistent bleeding due to percutaneous access closure device failure can occur. Open conversion is first-line treatment to manage this complication. The fascia suture technique was introduced as an alternative to access closure device or as a solution to manage unsatisfactory hemostasis during percutaneous endovascular abdominal aortic aneurysm repair. In this article, we report a new simple minimally invasive ultrasound-guided fascia suture technique as a bailout method to manage persistent bleeding after percutaneous endovascular abdominal aortic aneurysm repair avoiding open conversion. This technique was successfully used in two cases at our center with satisfactory hemostasis and no further complications. Ultrasound-guided fascia suture technique can be proposed as a minimally invasive bailout technique for access closure device failure.
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Affiliation(s)
- Giuseppe Baldino
- Department of Vascular and Endovascular Surgery, Galliera Hospital, Genoa, Italy
| | - Umberto G Rossi
- Department of Radiological Area, Interventional Radiology Unit, Galliera Hospital, Genoa, Italy
| | - Sara Di Gregorio
- Department of Vascular and Endovascular Surgery, IRCCS San Martino Hospital, Genoa, Italy
| | - Amerigo Gori
- Department of Vascular and Endovascular Surgery, Galliera Hospital, Genoa, Italy
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8
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Reva VA, Petrov AN, Samokhvalov IM. First Russian experience with endovascular balloon occlusion of the aorta in a zone of combat operations. ANGIOLOGIIA I SOSUDISTAIA KHIRURGIIA = ANGIOLOGY AND VASCULAR SURGERY 2020; 26:61-75. [PMID: 32597886 DOI: 10.33529/angi02020204] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Resuscitative endovascular balloon occlusion of the aorta has increasingly been used all the world over for arresting ongoing intraabdominal and intrapelvic bleeding accompanied by unstable haemodynamics. However, the use of resuscitative endovascular balloon occlusion of the aorta in a zone of military operations has been limited to sporadic cases only. This article deals with 3 clinical case reports regarding rendering medical care for the wounded presenting with extremely unstable haemodynamics and/or a terminal state in a field hospital, where insertion of a balloon into the aorta made it possible to stabilize the condition, to perform the basic scope of diagnosis, and to finally control the continuing bleeding: in one case - intraabdominal (due to splenic rupture) and in 2 cases - intrapelvic (unstable fractures of pelvic bones). In two cases, despite low readings of blood pressure, puncture of the femoral artery was performed 'blindly' and in one case - in an open fashion. The balloons used were the 7 Fr Rescue Balloon (Japan) and 10 Fr balloons manufactured by the Limited Liability Company 'Minimally Invasive Technologies' (Russia). The balloons were positioned in the aorta also 'blindly' and only in one case we managed to perform an X-ray examination confirming the correct position of the balloon. The mean time of occlusion of the thoracic aorta in the survivors amounted to 20 minutes. The operations were accompanied by intensive therapy and massive haemotransfusion. The introducers were removed using the fascia suture technique (without closure of the arterial wall). Two of the three wounded were saved, to be evacuated to a central hospital and discharged 170 and 75 days thereafter, which was due to long-term treatment of severe concomitant fractures of pelvic bones and lower extremities. No complications on the background of resuscitative endovascular balloon occlusion of the aorta were revealed. Two years after surgery both men continue serving in the Armed Forces, with no significant functional impairments. Our third injured patient delivered in a condition of clinical death, despite restoration of the rhythm after inflation of the balloon unfortunately died. Our case reports demonstrate high efficacy of resuscitative endovascular balloon occlusion of the aorta in unstable haemodynamics induced by combat injury to the abdomen and pelvis. The technique of this method makes it possible not only to stabilize haemodynamics, to improve perfusion of the vital organs but also to staunch continuing haemorrhage, hence allowing additional time to carry out haemotransfusion. In future, resuscitative endovascular balloon occlusion of the aorta may become one of the methods of the extended protocol of prehospital care.
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Affiliation(s)
- V A Reva
- Field Surgery Department, Military Medical Academy named after S.M. Kirov under the Ministry of Defence of the Russian Federation, Saint Petersburg, Russia
| | - A N Petrov
- Field Surgery Department, Military Medical Academy named after S.M. Kirov under the Ministry of Defence of the Russian Federation, Saint Petersburg, Russia
| | - I M Samokhvalov
- Field Surgery Department, Military Medical Academy named after S.M. Kirov under the Ministry of Defence of the Russian Federation, Saint Petersburg, Russia
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Wood DA, Krajcer Z, Sathananthan J, Strickman N, Metzger C, Fearon W, Aziz M, Satler LF, Waksman R, Eng M, Kapadia S, Greenbaum A, Szerlip M, Heimansohn D, Sampson A, Coady P, Rodriguez R, Krishnaswamy A, Lee JT, Ben-Dor I, Moainie S, Kodali S, Chhatriwalla AK, Yadav P, O’Neill B, Kozak M, Bacharach JM, Feldman T, Guerrero M, Nanjundappa A, Bersin R, Zhang M, Potluri S, Barker C, Bernardo N, Lumsden A, Barleben A, Campbell J, Cohen DJ, Dake M, Brown D, Maor N, Nardone S, Lauck S, O’Neill WW, Webb JG. Pivotal Clinical Study to Evaluate the Safety and Effectiveness of the MANTA Percutaneous Vascular Closure Device. Circ Cardiovasc Interv 2019; 12:e007258. [DOI: 10.1161/circinterventions.119.007258] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background:
Open surgical closure and small-bore suture-based preclosure devices have limitations when used for transcatheter aortic valve replacement, percutaneous endovascular abdominal aortic aneurysm repair, or percutaneous thoracic endovascular aortic aneurysm repair. The MANTA vascular closure device is a novel collagen-based technology designed to close large bore arteriotomies created by devices with an outer diameter ranging from 12F to 25F. In this study, we determined the safety and effectiveness of the MANTA vascular closure device.
Methods and Results:
A prospective, single arm, multicenter investigation in patients undergoing transcatheter aortic valve replacement, percutaneous endovascular abdominal aortic aneurysm repair, or thoracic endovascular aortic aneurysm repair at 20 sites in North America. The primary outcome was time to hemostasis. The primary safety outcomes were accessed site-related vascular injury or bleeding complications. A total of 341 patients, 78 roll-in, and 263 in the primary analysis cohort, were entered in the study between November 2016 and September 2017. For the primary analysis cohort, transcatheter aortic valve replacement was performed in 210 (79.8%), and percutaneous endovascular abdominal aortic aneurysm repair or thoracic endovascular aortic aneurysm repair was performed in 53 (20.2%). The 14F MANTA was used in 42 cases (16%), and the 18F was used in 221 cases(84%). The mean effective sheath outer diameter was 22F (7.3 mm). The mean time to hemostasis was 65±157 seconds with a median time to hemostasis of 24 seconds. Technical success was achieved in 257 (97.7%) patients, and a single device was deployed in 262 (99.6%) of cases. Valve Academic Research Consortium-2 major vascular complications occurred in 11 (4.2%) cases: 4 received a covered stent (1.5%), 3 had access site bleeding (1.1%), 2 underwent surgical repair (0.8%), and 2 underwent balloon inflation (0.8%).
Conclusions:
In a selected population, this study demonstrated that the MANTA percutaneous vascular closure device can safely and effectively close large bore arteriotomies created by current generation transcatheter aortic valve replacement, percutaneous endovascular abdominal aortic aneurysm repair, and thoracic endovascular aortic aneurysm repair devices.
Clinical Trial Registration:
URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT02908880.
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Affiliation(s)
- David A. Wood
- Center for Heart Valve Innovation, St Paul’s and Vancouver General Hospital, University of British Columbia, Vancouver, Canada (D.A.W., J.S., S.L., J.G.W.)
| | | | - Janarthanan Sathananthan
- Center for Heart Valve Innovation, St Paul’s and Vancouver General Hospital, University of British Columbia, Vancouver, Canada (D.A.W., J.S., S.L., J.G.W.)
| | | | | | - William Fearon
- Stanford University Medical Center, CA (W.F., J.T.L., M.D.)
| | - Mark Aziz
- Holston Valley Medical Center, TN (M.A.)
| | - Lowell F. Satler
- MedStar Washington Hospital Center, Washington DC (L.F.S., R.W., I.B.-D., N.B.)
| | - Ron Waksman
- MedStar Washington Hospital Center, Washington DC (L.F.S., R.W., I.B.-D., N.B.)
| | | | | | | | - Molly Szerlip
- The Heart Hospital Baylor Plano, TX (M.S., S.P., D.B.)
| | | | | | - Paul Coady
- Lankenau Medical Center, PA (P.C., R.R.)
| | | | | | - Jason T. Lee
- Stanford University Medical Center, CA (W.F., J.T.L., M.D.)
| | - Itsik Ben-Dor
- MedStar Washington Hospital Center, Washington DC (L.F.S., R.W., I.B.-D., N.B.)
| | | | | | | | - Pradeep Yadav
- Penn State Health/Hershey Medical Center, PA (P.Y., M.K.)
| | | | - Mark Kozak
- Penn State Health/Hershey Medical Center, PA (P.Y., M.K.)
| | | | | | | | | | | | - Ming Zhang
- Swedish Heart and Vascular, WA (R.B., M.Z.)
| | | | | | - Nelson Bernardo
- MedStar Washington Hospital Center, Washington DC (L.F.S., R.W., I.B.-D., N.B.)
| | | | | | | | - David J. Cohen
- Saint Luke’s Mid America Heart Institute, Kansas City (A.K.C., D.J.C.)
| | - Michael Dake
- Stanford University Medical Center, CA (W.F., J.T.L., M.D.)
| | - David Brown
- The Heart Hospital Baylor Plano, TX (M.S., S.P., D.B.)
| | | | | | - Sandra Lauck
- Center for Heart Valve Innovation, St Paul’s and Vancouver General Hospital, University of British Columbia, Vancouver, Canada (D.A.W., J.S., S.L., J.G.W.)
| | | | - John G. Webb
- Center for Heart Valve Innovation, St Paul’s and Vancouver General Hospital, University of British Columbia, Vancouver, Canada (D.A.W., J.S., S.L., J.G.W.)
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Fiorucci B, Kölbel T, Rohlffs F, Heidemann F, Carpenter SW, Debus ES, Tsilimparis N. The role of thoracic endovascular repair in elective, symptomatic and ruptured thoracic aortic diseases. Eur J Cardiothorac Surg 2019; 56:197-203. [DOI: 10.1093/ejcts/ezy482] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 12/18/2018] [Accepted: 12/21/2018] [Indexed: 11/13/2022] Open
Abstract
Abstract
OBJECTIVES
Thoracic endovascular aortic repair (TEVAR) has emerged as a safe procedure in the treatment of a wide spectrum of descending thoracic aortic pathologies, with satisfactory results both in elective and urgent settings. We investigated the results of our elective, urgent and emergency TEVAR interventions.
METHODS
A single-centre retrospective analysis of all consecutive patients undergoing TEVAR from 2010 to 2016 was performed. Primary end point of the study was early mortality, whereas the secondary end points included major complications according to the urgency of the procedure. The analysis was further conducted comparing symptomatic, asymptomatic and ruptured cases.
RESULTS
Two hundred and eight patients were treated with TEVAR between January 2010 and April 2016 (mean age 67 ± 12 years, 142 men, 68.3%). Patients undergoing TEVAR as a first-stage procedure for complex thoraco-abdominal repair were excluded. The indication for treatment was a dissection in most cases (n = 92, 44.2%; acute dissection in 40 cases, 19.2%), followed by thoracic aneurysms (n = 64, 30.8%), penetrating aortic ulcers (n = 37, 17.8%), intramural haematomas (n = 8, 3.8%), traumatic ruptures (n = 3, 1.4%) and other indications (n = 4, 1.8%). One hundred and eight procedures were performed electively and 100 urgently. Forty-three patients were treated on an emergency bas for aortic rupture, 44 urgently for thoracic pain and 13 for acute ischaemic complications of aortic dissection or other indications. Ischaemic complications of dissection included 1 case of mesenteric ischaemia, 3 cases of acute renal failure, 4 cases of limb ischaemia and multiple ischaemic complications in 4 cases. Other causes of urgent TEVAR included 1 patient bleeding from a bronchial artery treated with TEVAR after several embolization attempts. In-hospital mortality was 7.7%, significantly higher in the urgent setting (14% vs 1.9%, P = 0.001). Urgent procedures were also more frequently associated with major adverse clinical events (7.4% vs 26%, P = 0.0003) and specifically with paraplegia (2.8% vs 10%, P = 0.043). Perioperative mortality was significantly higher in the ruptured group compared to the symptomatic group (25.6% vs 2.3%, P = 0.002). When the analysis was conducted to compare the symptomatic and the asymptomatic patients, no differences in terms of perioperative mortality were detected.
CONCLUSIONS
TEVAR is an effective treatment strategy in thoracic aortic disease. Though emergency repair of the ruptured thoracic aorta still shows high rates of perioperative mortality and morbidity, symptomatic non-ruptured and asymptomatic patients have comparable early outcomes.
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Affiliation(s)
- Beatrice Fiorucci
- Department of Vascular Medicine, German Aortic Center, Hamburg, Germany
- Unit of Vascular Surgery, Ospedale S. Maria della Misericordia, University of Perugia, Perugia, Italy
- Department of Vascular Surgery, University Aortic Center of the Ludwig-Maximilian University Munich, Munich, Germany
| | - Tilo Kölbel
- Department of Vascular Medicine, German Aortic Center, Hamburg, Germany
| | - Fiona Rohlffs
- Department of Vascular Medicine, German Aortic Center, Hamburg, Germany
| | | | | | | | - Nikolaos Tsilimparis
- Department of Vascular Surgery, University Aortic Center of the Ludwig-Maximilian University Munich, Munich, Germany
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Majid K, Anwar MA, Shepherd A, Malina M, Hussain T. Effectiveness of fascial closure technique following percutaneous endovascular aneurysm repair. Ann R Coll Surg Engl 2018; 101:14-16. [PMID: 30482052 DOI: 10.1308/rcsann.2018.0200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Percutaneous access and closure is commonly performed for patients undergoing endovascular aneurysm repair (EVAR). It has proven to be a safe and successful method of closure associated with fewer complications when compared with the traditional open technique. Fascial closure is an alternative technique that can be used for closure reducing the risks associated with the open technique. The aim of this study was to assess the safety and durability of fascial closure for failed percutaneous closure device following EVAR. MATERIALS AND METHODS Over a 12-month period, 49 patients who had undergone EVAR were identified via our EVAR register. Retrospective analysis of the clinical records was undertaken. We identified all the patients who had fascial closure of the groins following a failed percutaneous closure device. Patients had a computed tomography angiogram one month postoperatively, with duplex imaging and clinic follow-up three months later. RESULTS Fascial closure was performed in 14 groins. It failed in three groins and these patients had traditional open repair. Fascial closure was successful in 11 groins (7 patients). Of these seven patients, one was female (6%). The mean age was 80 years (range 68-92 years). Two patients died and one was lost to follow-up. One pseudoaneurysms were seen on computed tomography angiogram, which was managed conservatively and had resolved on follow-up imaging. CONCLUSIONS Fascial closure is a very good alternative to open repair after failure of the closure device.
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Affiliation(s)
- K Majid
- Northwick Park Hospital , London , UK
| | - M A Anwar
- Northwick Park Hospital , London , UK
| | | | - M Malina
- Northwick Park Hospital , London , UK
| | - T Hussain
- Northwick Park Hospital , London , UK
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12
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Rees P. Response to: ‘REBOA at Role 2 Afloat: resuscitative endovascular balloon occlusion of the aorta as a bridge to damage control surgery in the military maritime setting’ by Rees et al. J ROY ARMY MED CORPS 2018; 165:213-214. [DOI: 10.1136/jramc-2018-001016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 07/10/2018] [Indexed: 11/04/2022]
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Fascial suture technique versus open femoral access for thoracic endovascular aortic repair. J Vasc Surg 2018; 69:34-39. [PMID: 29960794 DOI: 10.1016/j.jvs.2018.04.057] [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: 01/25/2018] [Accepted: 04/21/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Fascial suture technique (FST) has proved to be a safe and effective access closure technique after endovascular repair of the abdominal aorta. FST has not yet been investigated for closure of large-bore access after thoracic endovascular aortic repair (TEVAR). The aim of this study was to compare FST with open femoral access in terms of access safety, hemostasis efficacy, and reintervention rate after TEVAR. METHODS A retrospective study including consecutive patients undergoing TEVAR with either FST or open femoral access between January 2010 and April 2016 was undertaken. Exclusion criteria included the use of closure devices. The composite primary end point was defined as any access-related complication (bleeding, femoral artery stenosis or occlusion, pseudoaneurysm, and wound infection) during 30 postoperative days. Preoperative and procedural variables were examined in a multiple logistic regression model as potential associated factors with access morbidity. All access vessels were postoperatively examined by clinical examination and computed tomography angiography before discharge as well as during the follow-up period. In case of suspected pseudoaneurysm, additional duplex ultrasound and computed tomography angiography confirmed the diagnosis. RESULTS From a total of 206 patients undergoing TEVAR, 109 (53%) had FST, whereas 93 (45%) had an open femoral access. Four patients were excluded: closure device was used in one; one had primary conversion after percutaneous puncture without FST; and in two, no data were available about the femoral access. The access complication rate was higher in FST (FST, 14 [13%]; open access, 3 [3%]; P = .01). Five (4.6%) patients needed early reintervention, two for bleeding and three for vessel occlusion. Seven (6.4%) pseudoaneurysms were detected during the 30-day period in the FST group; three had successful exclusion with thrombin injection, one was treated with manual compression, one was treated with open repair, and two were managed conservatively. Four (3.6%) patients in the FST group and three (3%) patients in the open access group had wound complications. After multiple logistic regression, FST was the only independent factor for any access complication (odds ratio, 5.176; 95% confidence interval, 1.402-19.114; P = .014). During follow-up, neither new pseudoaneurysm nor stenosis or occlusion was detected. CONCLUSIONS FST for large-hole closure had higher risk for any access complication compared with open access in TEVAR during the 30-day postoperative period. No other complications during 12 months of follow-up were observed in FST patients.
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Karaolanis G, Kostakis ID, Moris D, Palla VV, Moulakakis KG. Fascia Suture Technique and Suture-mediated Closure Devices: Systematic Review. Int J Angiol 2018; 27:13-22. [PMID: 29483761 DOI: 10.1055/s-0037-1620241] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background The aim of the present study is to review the available data on suture-mediated closure devices (SMCDs) and fascia suture technique (FST), which are alternatives for minimizing the invasiveness of percutaneous endovascular aortic aneurysm repair (p-EVAR) and reduce the complications related to groin dissections. Methods The Medline, ClinicalTrials.gov, and Cochrane library - Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched for publications regarding SMCD and FST between January 1999 and December 2016. Results We review 37 original articles, 30 referring to SMCDs (Prostar XL and Proglide), which included 3,992 patients, and 6 articles referring to FST, which include 426 patients. The two techniques are compared only in one article (100 patients). The two types of SMCDs were Prostar and Proglide. In most studies on SMCDs, the reported technical success rates were between 89 and 100%, but the complication rates varied greatly between 0 and 25%. Concerning FST, the technical success rates were also high, ranging between 87 and 99%. However, intraoperative complication rates ranged between 1.2 and 13%, whereas postoperative complication rates varied from 0.9 to 6.2% for the short-term and from 1.9 to 13.6% for the long-term. Conclusions SMCDs and FST seem to be effective and simple methods for closing common femoral artery (CFA) punctures after p-EVAR. FST can reduce the access closure time and the procedural costs with a quite short learning curve, whereas it can work as a bailout procedure for failed SMCDs suture. The few failures of the SMCDs and FST that may occur due to bleeding or occlusion can easily be managed.
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Affiliation(s)
- Georgios Karaolanis
- Vascular Unit, First Department of Surgery, National and Kapodistrian University of Athens, "Laiko" General Hospital, Athens, Greece
| | - Ioannis D Kostakis
- Second Department of Propedeutic Surgery, National and Kapodistrian University of Athens, "Laiko" General Hospital, Athens, Greece
| | - Demetrios Moris
- Vascular Unit, First Department of Surgery, National and Kapodistrian University of Athens, "Laiko" General Hospital, Athens, Greece
| | - Viktoria-Varvara Palla
- Vascular Unit, First Department of Surgery, National and Kapodistrian University of Athens, "Laiko" General Hospital, Athens, Greece
| | - Konstantinos G Moulakakis
- Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece
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Rees P, Waller B, Buckley AM, Doran C, Bland S, Scott T, Matthews J. REBOA at Role 2 Afloat: resuscitative endovascular balloon occlusion of the aorta as a bridge to damage control surgery in the military maritime setting. J ROY ARMY MED CORPS 2017; 164:72-76. [PMID: 29269480 DOI: 10.1136/jramc-2017-000874] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 11/18/2017] [Accepted: 11/20/2017] [Indexed: 11/04/2022]
Abstract
Role 2 Afloat provides a damage control resuscitation and surgery facility in support of maritime, littoral and aviation operations. Resuscitative endovascular balloon occlusion of the aorta (REBOA) offers a rapid, effective solution to exsanguinating haemorrhage from pelvic and non-compressible torso haemorrhage. It should be considered when the patient presents in a peri-arrest state, if surgery is likely to be delayed, or where the single operating table is occupied by another case. This paper will outline the data in support of endovascular haemorrhage control, describe the technique and explore how REBOA could be delivered using equipment currently available in the Royal Navy Role 2 Afloat equipment module. Also discussed are potential future directions in endovascular resuscitation.
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Affiliation(s)
- Paul Rees
- Academic Department of Military Medicine, London, UK.,University of St Andrews School of Medicine, St Andrews, UK
| | - B Waller
- Shackleton Department of Anaesthetics, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - A M Buckley
- Academic Department of Military Medicine, London, UK
| | - C Doran
- Department of Surgery, Royal Centre for Defence Medicine, Birmingham, UK
| | - S Bland
- Department of Emergency Medicine, Queen Alexandra Hospital, Portsmouth, UK
| | - T Scott
- Department of Anaesthesia and Critical Care, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - J Matthews
- Department of Orthopaedics and Trauma Surgery, Royal Cornwall Hospitals NHS Trust, Truro, UK.,Clinical Director Role 2 Afloat, National Command Headquarters, Portsmouth, UK
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A Retrospective Analysis of Surgical Femoral Artery Closure Techniques: Conventional versus Purse Suture Technique. Ann Vasc Surg 2017; 44:103-112. [PMID: 28483631 DOI: 10.1016/j.avsg.2017.04.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 04/13/2017] [Accepted: 04/14/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Different techniques have been reported for the exploration and repair of femoral artery (FA) in patients who undergo minimally invasive cardiac surgery (MICS) and endovascular aortic surgery. We used a modified approach alternative to the conventional technique (group CT) since May 2013, which specifies a shorter groin incision and diamond-shaped hemostatic purse sutures for arteriotomy closure without the requirement of cross-clamping (group PT [purse suture technique]) and evaluated early outcomes and the complication profiles of the 2 techniques for femoral access. METHODS In our clinic, between May 2011 and December 2015, 503 FA cannulations were performed on 345 patients who underwent MICS (n = 109, mean age 64.1 ± 17.6 years, female/male ratio 71/38), endovascular abdominal aneurysm repair (n = 158, mean age 71.3 ± 10.2 years, female/male ratio 63/95), thoracal endovascular aneurysm repair (n = 50, mean age 65.0 ± 15.3 years, female/male ratio 15/35), and transaortic valve implantation (n = 28, mean age 80.8 ± 5.9 years, female/male ratio 13/15). A total of 295 FAs were exposed via mini incision and were repaired with the PT. We compared the duration of femoral closure (FC), wound infection, and vascular complications including bleeding hematoma, thromboembolic and ischemic events, pseudoaneurysm, seroma, surgical reintervention rates, delayed hospital stay for groin complications, and existence of postoperative local luminal narrowing (LLN) at the intervention site over 25% for both groups. RESULTS FC time (CT 14.9 ± 3.16 min, PT 6.5 ± 1.12 min, P < 0.0001), bleeding hematoma frequency (CT 6.2%, PT 1.7%, P = 0.01), and prolonged hospital stay for groin complications (CT 14.9%, PT 3.4%, P < 0.0001) were significantly lower in the PT group. Rate of technical success (CT 80.3%, PT 87.4%, P = 0.03) and event-free patient (CT 66.1%, PT 77.5%, P = 0.03) were significantly better in the PT group. There were no differences between groups in terms of ischemic events, wound infection rates, development of pseudoaneurysm and seroma, surgical reintervention rates, and LLN of FA over 25% at 6-month duplex evaluation. CONCLUSIONS The comparison of the 2 approaches revealed the advantages of the PT in terms of bleeding hematoma and shortening in FC time and the length of hospital stay. We suggest performing a smaller skin incision for FA access and utilizing purse sutures, which allows completing the procedure without cross-clamping, thus providing a favorable approach and excellent comfort for the surgeon.
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Gimzewska M, Jackson AIR, Yeoh SE, Clarke M. Totally percutaneous versus surgical cut-down femoral artery access for elective bifurcated abdominal endovascular aneurysm repair. Cochrane Database Syst Rev 2017; 2:CD010185. [PMID: 28221665 PMCID: PMC6464496 DOI: 10.1002/14651858.cd010185.pub3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Abdominal aortic aneurysms (AAAs) are a vascular condition with significant risk attached, particularly if they rupture. It is, therefore, critical to identify and repair these as an elective procedure before they rupture and require emergency surgery. Repair has traditionally been an open surgical technique that required a large incision across the abdomen. Endovascular abdominal aortic aneurysm repairs (EVARs) are now a common alternative. In this procedure, the common femoral artery is exposed via a cut-down approach and a graft introduced to the aneurysm in this way. This review examines a totally percutaneous approach to EVAR. This technique gives a minimally invasive approach to femoral artery access that may reduce groin wound complication rates and improve recovery time. The technique may, however, be less applicable in people with, for example, groin scarring or arterial calcification. This is an update of the review first published in 2014. OBJECTIVES This review aims to compare the clinical outcomes of percutaneous access with surgical cut-down femoral artery access in elective bifurcated abdominal endovascular aneurysm repair (EVAR). SEARCH METHODS For this update the Cochrane Vascular Information Specialist (CIS) searched their Specialised Register (last searched October 2016) and CENTRAL (2016, Issue 9). We also searched clinical trials registries and checked the reference lists of relevant retrieved articles. SELECTION CRITERIA We considered only randomised controlled trials. The primary intervention was a totally percutaneous endovascular repair. We considered all device types. We compared this against surgical cut-down femoral artery access endovascular repair. We only considered studies investigating elective repairs. We excluded studies reporting emergency surgery for a ruptured abdominal aortic aneurysm and those reporting aorto-uni-iliac repairs. DATA COLLECTION AND ANALYSIS Two review authors independently collected all data. Owing to the small number of trials identified we did not conduct any formal sensitivity analysis. Heterogeneity was not significant for any outcome. MAIN RESULTS Two studies with a total of 181 participants met the inclusion criteria, 116 undergoing the percutaneous technique and 65 treated by cut-down femoral artery access. One study had a small sample size and did not adequately report method of randomisation, allocation concealment or pre-selected outcomes. The second study was a larger study with few sources of bias and good methodology.We observed no significant difference in mortality between groups, with only one mortality occurring overall, in the totally percutaneous group (risk ratio (RR) 1.50; 95% confidence interval (CI) 0.06 to 36.18; 181 participants; moderate-quality evidence). Only one study reported aneurysm exclusion. In this study we observed only one failure of aneurysm exclusion in the surgical cut-down femoral artery access group (RR 0.17, 95% CI 0.01 to 4.02; 151 participants; moderate-quality evidence). No wound infections occurred in the cut-down femoral artery access group or the percutaneous group across either study (moderate-quality evidence).There was no difference in major complication rate between cut-down femoral artery access and percutaneous groups (RR 0.91, 95% CI 0.20 to 1.68; 181 participants; moderate-quality evidence); or in bleeding complications and haematoma (RR 0.94, 95% CI 0.31 to 2.82; 181 participants; high-quality evidence).Only one study reported long-term complication rates at six months, with no differences between the percutaneous and cut-down femoral artery access group (RR 1.03, 95% CI 0.34 to 3.15; 134 participants; moderate-quality evidence).We detected differences in surgery time, with percutaneous approach being significantly faster than cut-down femoral artery access (mean difference (MD) -31.46 minutes; 95% CI -47.51 minutes to -15.42 minutes; 181 participants; moderate-quality evidence). Only one study reported duration of ITU (intensive treatment unit) and hospital stay, with no difference found between groups. AUTHORS' CONCLUSIONS This review shows moderate-quality evidence of no difference between the percutaneous approach compared with cut-down femoral artery access group for short-term mortality, aneurysm exclusion, major complications, wound infection and long-term (six month) complications, and high-quality evidence for no difference in bleeding complications and haematoma. There was a difference in operating time, with moderate-quality evidence showing that the percutaneous approach was faster than the cut-down femoral artery access technique. We downgraded the quality of the evidence to moderate as a result of the limited number of studies, low event numbers and imprecision. As the number of included studies were limited, further research into this technique would be beneficial. The search identified one ongoing study, which may provide an improved evidence base in the future.
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Affiliation(s)
- Madelaine Gimzewska
- Usher Institute of Population Health Sciences and Informatics, The University of EdinburghCochrane VascularTeviot PlaceEdinburghUKEH8 9AG
| | - Alexander IR Jackson
- University Hospital Southampton NHS Foundation TrustSouthampton General HospitalTremona RoadSouthamptonUKS016 6YD
- University of SouthamptonClinical and Experimental Sciences Academic UnitSouth Academic Block, Mailpoint 801Southampton General Hospital, Tremona RoadSouthamptonUKS016 6YD
| | - Su Ern Yeoh
- The University of EdinburghCollege of Medicine and Veterinary MedicineEdinburghUKEH16 4TJ
| | - Mike Clarke
- Freeman HospitalNorthern Vascular CentreFreeman RoadNewcastle upon TyneUKNE7 7DN
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Bilos L, Pirouzram A, Toivola A, Vidlund M, Cha SO, Hörer T. EndoVascular and Hybrid Trauma Management (EVTM) for Blunt Innominate Artery Injury with Ongoing Extravasation. Cardiovasc Intervent Radiol 2016; 40:130-134. [PMID: 27796532 DOI: 10.1007/s00270-016-1440-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Accepted: 07/29/2016] [Indexed: 10/20/2022]
Abstract
Innominate artery (IA) traumatic injuries are rare but life-threatening, with high mortality and morbidity. Open surgical repair is the treatment of choice but is technically demanding. We describe a case of blunt trauma to the IA with ongoing bleeding, treated successfully by combined (hybrid) endovascular and open surgery. The case demonstrates the immediate usage of modern endovascular and surgical tools as part of endovascular and hybrid trauma management.
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Affiliation(s)
- Linda Bilos
- Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University Hospital and Örebro University, 701 85, Örebro, Sweden.
| | - Artai Pirouzram
- Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University Hospital and Örebro University, 701 85, Örebro, Sweden
| | - Asko Toivola
- Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University Hospital and Örebro University, 701 85, Örebro, Sweden
| | - Mårten Vidlund
- Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University Hospital and Örebro University, 701 85, Örebro, Sweden
| | - Soon Ok Cha
- Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University Hospital and Örebro University, 701 85, Örebro, Sweden
| | - Tal Hörer
- Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University Hospital and Örebro University, 701 85, Örebro, Sweden
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Single Centre Results of Total Endovascular Repair of Complex Aortic Aneurysms with Custom Made Anaconda Fenestrated Stent Grafts. Eur J Vasc Endovasc Surg 2016; 52:500-508. [DOI: 10.1016/j.ejvs.2016.07.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 07/04/2016] [Indexed: 11/23/2022]
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Dosluoglu HH, Cherr GS, Harris LM, Dryjski ML. Total Percutaneous Endovascular Repair of Abdominal Aortic Aneurysms Using Perclose ProGlide Closure Devices. J Endovasc Ther 2016; 14:184-8. [PMID: 17484534 DOI: 10.1177/152660280701400210] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Purpose: To describe a technique for access site closure in percutaneous abdominal aortic aneurysm (AAA) repair using double Perclose ProGlide devices to overcome the problems associated with the bulky delivery system and braided suture of the antecedent (Prostar) device. Technique: After obtaining guidewire access, 2 Perclose ProGlide sutures are deployed at 90° to each other. The appropriate sheaths are placed over the stiff guidewires. After the stent-graft procedure is completed, an assistant holds pressure while the knots are tightened with the stiff guidewire still in the artery. Once the second knot is tightened with the knot pusher and after confirming adequate hemostasis, the wire is removed, pressure is applied, and heparin reversed. This method has been used in 17 consecutive patients (age range 65–85 years) undergoing endovascular AAA repair. One patient needed patch angioplasty and 2 required small incisions for additional suture placements (81% primary success rate for total percutaneous repair, 90% success rate for all sites). Conclusion: We have found the double Perclose ProGlide technique to be easy to use, safe, and feasible for total percutaneous AAA repair. More experience with longer follow-up is needed to assess its potential to replace the Perclose Prostar closure device for total percutaneous AAA repairs.
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Affiliation(s)
- Hasan H Dosluoglu
- Division of Vascular Surgery, VA Western NY Healthcare System, State University of New York at Buffalo, New York 14215, USA.
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Re-interventions after endovascular aortic repair for infrarenal abdominal aneurysms: a retrospective cohort study. BMC Cardiovasc Disord 2016; 16:124. [PMID: 27267131 PMCID: PMC4895810 DOI: 10.1186/s12872-016-0309-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 05/30/2016] [Indexed: 11/18/2022] Open
Abstract
Background Early morbidity and mortality are generally lower after endovascular aortic repair (EVAR), than after open repair but re-interventions and late complications are more common. The aim of the present study was to make a detailed description of re-interventions after EVAR-including incidence, indications, procedures, and outcome-with special reference to non-access-related re-interventions. Methods This is a retrospective single-center cohort study of re-interventions after standard EVAR with special reference to non-access-related re-interventions. Consecutive patients (n = 405) treated with standard EVAR for non-ruptured (n = 337) or ruptured (n = 68) infrarenal aneurysms between 2005 and 2013 were analysed. Median follow-up was 29 months (range 0–108). Results Eighty-nine patients (22 %) underwent 113 re-interventions during follow-up. Twenty-seven patients (7 %) had 28 access related re-intervention, 65 patients (16 %) had 85 non-access related reinterventions. Non-access related re-interventions were more common in ruptured aneurysms than in unruptured aneurysms (22 vs. 15 %, p = 0.002). The most frequent indications were endoleak type I (n = 19), type II (n = 21), or type III (n = 5); stent graft migration (n = 9); and thrombosis (n = 14). The most frequent procedures were embolization of endoleak type II (n = 21), additional iliac stent graft (n = 19), proximal extension (n = 12), thrombolysis (n = 8), iliac limb bare-metal stenting (n = 6), and stent graft relining (n = 7). Endovascular technique was used in 83 % of re-interventions. Thirty-day mortality after non-access-related re-interventions was 15 % when initiated from symptoms (rupture or infection) and 0 % when initiated from follow-up findings (p = 0.014). Cumulative survival five years after EVAR was 72 % in patients with a re-intervention and 59 % in patients without (p = 0.21). Conclusions Non-access-related re-intervention rates are still considerable after EVAR and more frequent after ruptured aneurysms. Endoleak embolization is the most frequent procedure, followed by additional iliac stent grafts. Outcomes after re-interventions are generally good, except when initiated by rupture or infection.
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Hörer TM, Hebron D, Swaid F, Korin A, Galili O, Alfici R, Kessel B. Aorta Balloon Occlusion in Trauma: Three Cases Demonstrating Multidisciplinary Approach Already on Patient's Arrival to the Emergency Room. Cardiovasc Intervent Radiol 2015; 39:284-9. [PMID: 26452781 DOI: 10.1007/s00270-015-1212-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 08/29/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE To describe the usage of aortic balloon occlusion (ABO), based on a multidisciplinary approach in severe trauma patients, emphasizing the role of the interventional radiologist in primary trauma care. METHODS We briefly discuss the relevant literature, the technical aspects of ABO in trauma, and a multidisciplinary approach to the bleeding trauma patient. We describe three severely injured trauma patients for whom ABO was part of initial trauma management. RESULTS Three severely injured multi-trauma patients were treated by ABO as a bridge to surgery and embolization. The procedures were performed by an interventional radiologist in the early stages of trauma management. CONCLUSIONS The interventional radiologist and the multidisciplinary team approach can be activated already on severe trauma patient arrival. ABO usage and other endovascular methods are becoming more widely spread, and can be used early in trauma management, without delay, thus justifying the early activation of this multidisciplinary approach.
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Affiliation(s)
- Tal M Hörer
- Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro University, 701 85, Örebro, Sweden.
| | - Dan Hebron
- Department of Radiology, Hillel Yaffe Medical Center, Hadera, Israel
| | - Forat Swaid
- Department of General Surgery, Bnai-Zion Medical Center, Haifa, Israel
| | | | - Offer Galili
- Department of Vascular Surgery, Hillel Yaffe Medical Center, Hadera, Israel
| | - Ricardo Alfici
- Surgical Division, Hillel Yaffe Medical Center, Hadera, Israel
| | - Boris Kessel
- Trauma Unit, Hillel Yaffe Medical Center, Hadera, Israel
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F-EVAR does not Impair Renal Function more than Open Surgery for Juxtarenal Aortic Aneurysms: Single Centre Results. Eur J Vasc Endovasc Surg 2015; 50:432-41. [DOI: 10.1016/j.ejvs.2015.04.028] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 04/25/2015] [Indexed: 12/29/2022]
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A small case series of aortic balloon occlusion in trauma: lessons learned from its use in ruptured abdominal aortic aneurysms and a brief review. Eur J Trauma Emerg Surg 2015; 42:585-592. [PMID: 26416402 DOI: 10.1007/s00068-015-0574-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 09/03/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND EndoVascular and Hybrid Trauma Management (EVTM) is an emerging concept for the early treatment of trauma patients using aortic balloon occlusion (ABO), embolization agents and stent grafts to stop ongoing traumatic bleeding. These techniques have previously been implemented successfully in the treatment of ruptured aortic aneurysm. AIMS We describe our very recent experience of EVTM using ABO in bleeding patients and lessons learned over the last 20 years from the endovascular treatment of ruptured abdominal aortic aneurysms (rAAA). We also briefly describe current knowledge of ABO usage in trauma. METHODS A small series of educational cases in our hospital is described, where endovascular techniques were used to gain temporary hemorrhage control. The methods used for rAAA and their applicability to EVTM with a multidisciplinary approach are presented. RESULTS Establishing femoral arterial access immediately on arrival at the emergency room and use of an angiography table in the surgical suite may facilitate EVTM at an early stage. ABO may be an effective method for the temporary stabilization of severely hemodynamically unstable patients with hemorrhagic shock, and may be useful as a bridge to definitive treatment of the bleeding patients. CONCLUSION EVTM, including the usage of ABO, can be initiated on patient arrival and is feasible. Further data need to be collected to investigate proper indications for ABO, best clinical usage, results and potential complications. Accordingly, the ABOTrauma Registry has recently been set up. Existing experiences of EVTM and lessons from the endovascular treatment of rAAA may be useful in trauma management.
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McGraw CJ, Gandhi RT, Vatakencherry G, Baumann F, Benenati JF. Percutaneous Large Arterial Access Closure Techniques. Tech Vasc Interv Radiol 2015; 18:122-6. [PMID: 26070624 DOI: 10.1053/j.tvir.2015.04.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Endovascular repair has replaced open surgical repair as the standard of care for treatment of abdominal and thoracic aortic aneurysms in appropriately selected patients owing to its decreased morbidity and length of stay and excellent clinical outcomes. Similarly, there is a progressive trend toward total percutaneous repair of the femoral artery using percutaneous suture-mediated closure devices over open surgical repair due to decreased complications and procedure time. This article describes the techniques of closure for large-bore vascular access most commonly used in endovascular treatment of abdominal and thoracic aortic aneurysms, but could similarly be applied to any procedure requiring large-bore arterial access, such as transcatheter aortic valve replacement.
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Affiliation(s)
- Charles J McGraw
- Department of Vascular and Interventional Radiology, Miami Cardiac and Vascular Institute, Baptist Hospital, Miami, FL
| | - Ripal T Gandhi
- Department of Vascular and Interventional Radiology, Miami Cardiac and Vascular Institute, Baptist Hospital, Miami, FL.
| | - Geogy Vatakencherry
- Department of Vascular and Interventional Radiology, Kaiser Permanente, Los Angeles, CA
| | - Frederic Baumann
- Department of Vascular and Interventional Radiology, Miami Cardiac and Vascular Institute, Baptist Hospital, Miami, FL
| | - James F Benenati
- Department of Vascular and Interventional Radiology, Miami Cardiac and Vascular Institute, Baptist Hospital, Miami, FL
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Barbier CE, Lundin E, Melki V, James S, Nyman R. Percutaneous Closure in Transfemoral Aortic Valve Implantation: A Single-Centre Experience. Cardiovasc Intervent Radiol 2015; 38:1438-43. [DOI: 10.1007/s00270-015-1117-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 04/12/2015] [Indexed: 12/17/2022]
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Preoperative methylprednisolone enhances recovery after endovascular aortic repair: a randomized, double-blind, placebo-controlled clinical trial. Ann Surg 2015; 260:540-8; discussion 548-9. [PMID: 25115430 DOI: 10.1097/sla.0000000000000895] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To evaluate effects of preoperative high-dose glucocorticoid on the inflammatory response and recovery after endovascular aortic aneurysm repair (EVAR). BACKGROUND The postimplantation syndrome after EVAR may delay recovery due to the release of proinflammatory mediators. Glucocorticoids may reduce postoperative inflammatory responses and enhance recovery, but with limited information on EVAR. METHODS A single-center, randomized, double-blind, placebo-controlled trial of 153 patients undergoing elective EVAR between November 2009 and January 2013. Patients received 30 mg/kg of methylprednisolone (MP) (n = 77) or placebo (n = 76) preoperatively. Primary outcome was a modified version of the systemic inflammatory response syndrome. Secondary outcome measures were the effect on inflammatory biomarkers, morbidity, and time to meet discharge criteria. RESULTS Of 153 randomized patients, 150 (98%) were evaluated for the primary outcome. MP reduced systemic inflammatory response syndrome from 92% to 27% (P < 0.0001) (number needed to treat = 1.5), maximal plasma interleukin 6 from 186 pg/mL [interquartile range (IQR) = 113-261 pg/mL] to 20 pg/mL (IQR = 11-28 pg/mL) (P < 0.001) and fulfillment of discharge criteria was shorter [2 days (IQR = 2-4 days) vs 3 days (IQR = 3-4 days)] (P < 0.001). C-reactive protein, temperature, interleukin 8, and soluble tumor necrosis factor receptor were also reduced (P < 0.001) by MP. Myeloperoxidase, D-dimer, and matrix metalloproteinase 9 were not modified. No differences in 30-day medical (23% vs 36%) (P = 0.1) or surgical (20% vs 21%) morbidity were found in the active group versus the placebo group. CONCLUSIONS Preoperative MP attenuates the inflammatory response with a faster recovery after EVAR for abdominal aortic aneurysms. Further safety and dose-response studies are required to allow recommendations for general practice. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00989729.
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Larzon T, Roos H, Gruber G, Henrikson O, Magnuson A, Falkenberg M, Lönn L, Norgren L. Editor's Choice - A Randomized Controlled Trial of the Fascia Suture Technique Compared with a Suture-mediated Closure Device for Femoral Arterial Closure after Endovascular Aortic Repair. Eur J Vasc Endovasc Surg 2015; 49:166-73. [DOI: 10.1016/j.ejvs.2014.10.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Accepted: 10/03/2014] [Indexed: 12/17/2022]
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Rückert RI, Hanack U, Aronés-Gomez S, Yousefi S. [Aneurysms of the abdominal aorta and iliac arteries: paradigm shift - operative therapy, if possible endovascular?]. Chirurg 2014; 85:782-90. [PMID: 25200628 DOI: 10.1007/s00104-014-2718-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Therapy of abdominal aortic aneurysms (AAA) is currently based on a high level of evidence. This is not true in the same manner for iliac artery aneurysms (IAA) which are frequently associated with AAAs and occur only rarely as isolated lesions. The therapeutic principles apply in the same way to both aneurysm locations. OBJECTIVES New findings, improved perioperative care and the rapid development of minimally invasive techniques require a constant update which is the aim of this article concerning the therapy of AAAs and IAAs. MATERIAL AND METHODS A systematic literature review was performed in PubMed and Medline and priority was given to recent publications with a high level of evidence. RESULTS Endovascular aneurysm repair (EVAR) and open aneurysm repair (OAR) result in a similar long-term survival. The perioperative survival advantage with EVAR persists only during medium-term postoperative courses. The reintervention rate after EVAR is substantially higher compared to OAR. For older patients and those who are considered unfit for OAR the expected benefits from EVAR has not been proven to date. Aneurysmal ruptures after EVAR demonstrate that a life-long surveillance of these patients is necessary. CONCLUSION Therapy of AAAs and IAAs is increasingly being performed by EVAR. Even the majority of complex aneurysms are amenable to minimally invasive treatment. Nevertheless, indications for OAR continue to exist. Screening for AAAs results in a decrease of aneurysmal ruptures for which EVAR is also gaining importance.
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Affiliation(s)
- R I Rückert
- Klinik für Gefäß- und endovaskuläre Chirurgie, Allgemein- und Viszeralchirurgie Franziskus-Krankenhaus, Akademisches Lehrkrankenhaus der Charité, Universitätsmedizin Berlin, Budapester Str. 15-19, 10787, Berlin, Deutschland,
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Unipuncture double-access method in emergent endovascular procedures. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2014; 8:245-7. [PMID: 23989822 DOI: 10.1097/imi.0b013e31828d9c23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We describe a technique to gain an additional endovascular access in acute situations in which a large-bore introducer is already inserted or in situations in which multiple accesses are impaired because of other reasons. Using an existing percutaneous femoral artery access, a second guide wire is inserted into the introducer, which is later withdrawn and applied onto one of the two guide wires. A double-wire access is then achieved. This access can be used, for example, for angiography or embolization catheters. This method might be useful in situations in which a quick and unplanned extra access is needed. It is, for example, applicable in hemodynamically unstable patients in whom percutaneous access can be difficult to obtain or in aortic endovascular procedures when an unplanned access is needed to insert an additional catheter for angiography and embolization.
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New surgical modification of fascial closure following endovascular aortic pathology repair. Wideochir Inne Tech Maloinwazyjne 2014; 9:89-92. [PMID: 24729815 PMCID: PMC3983539 DOI: 10.5114/wiitm.2011.35795] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2013] [Revised: 03/25/2013] [Accepted: 04/04/2013] [Indexed: 12/19/2022] Open
Abstract
Introduction There are clear benefits of percutaneous versus open femoral access for endovascular aortic pathology repair. All closing devices commercially available are expensive. Surgical closure of the femoral artery risks potential prolonged wound healing and as a consequence longer hospital stay. Fascial closure is a technique that remains an interesting option. Aim To evaluate the efficacy of the surgical modification of hemostasis control after endovascular repair of aortic pathology. Material and methods One hundred sixteen common femoral arteries in a group of 58 patients underwent a minimally invasive procedure. Patients suffering from abdominal, thoracic aorta aneurysms, acute thoracic aorta type B dissections and traumatic aortic injury were treated. Results A 1-year period of experience in fascial closure of 116 common femoral arteries was presented in the group of 58 patients undergoing endovascular interventions. Five intraoperative complications were observed and one late. Three primary failures were due to hemorrhage in three arteries, one required open repair and two additional compression after the procedure. Two cases of limb ischemia required surgical correction of artery closure. One limb ischemia was detected 4 weeks later, and was treated conservatively. At 1 year, 92 fascial closures (80%) were in the follow-up and 24 (20%) were lost to follow-up. Conclusions This new modification of fascial closure is a safe and cheap method of arterial closure following endovascular repair of selected aortic pathologies. The usage of two suture lines makes this procedure easy and quick. Fascial closure technique is comparable to other techniques in terms of success and complication rates.
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Ambulatory percutaneous endovascular abdominal aortic aneurysm repair. J Vasc Surg 2014; 59:58-64. [DOI: 10.1016/j.jvs.2013.06.076] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 06/24/2013] [Accepted: 06/26/2013] [Indexed: 12/17/2022]
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Percutaneous Closure of Large Femoral Artery Access with Prostar XL in Thoracic Endovascular Aortic Repair. Eur J Vasc Endovasc Surg 2013; 46:558-63. [DOI: 10.1016/j.ejvs.2013.08.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 08/18/2013] [Indexed: 12/17/2022]
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Du Cailar C, Gandet T, Du Cailar M, Albat B. A simple sheath removal after open trans-femoral catheterization procedure: the ZIP technique. Eur J Cardiothorac Surg 2013; 45:746-8. [DOI: 10.1093/ejcts/ezt384] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Hörer TM, Hammo S, Lönn L, Skoog P, Larzon T. Unipuncture Double-Access Method in Emergent Endovascular Procedures. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2013. [DOI: 10.1177/155698451300800314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Tal M. Hörer
- Department of Cardio-Thoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden
| | - Sari Hammo
- Department of Cardio-Thoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden
| | - Lars Lönn
- Department of Vascular Surgery and Cardiovascular Radiology, National Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Per Skoog
- Department of Cardio-Thoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden
| | - Thomas Larzon
- Department of Cardio-Thoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden
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Hörer TM, Skoog P, Norgren L, Magnuson A, Berggren L, Jansson K, Larzon T. Intra-peritoneal microdialysis and intra-abdominal pressure after endovascular repair of ruptured aortic aneurysms. Eur J Vasc Endovasc Surg 2013; 45:596-606. [PMID: 23540804 DOI: 10.1016/j.ejvs.2013.03.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Accepted: 03/02/2013] [Indexed: 02/07/2023]
Abstract
OBJECTIVES This study aims to evaluate intra-peritoneal (ip) microdialysis after endovascular aortic repair (EVAR) of ruptured abdominal aortic aneurysm (rAAA) in patients developing intra-abdominal hypertension (IAH), requiring abdominal decompression. DESIGN Prospective study. MATERIAL AND METHODS A total of 16 patients with rAAA treated with an emergency EVAR were followed up hourly for intra-abdominal pressure (IAP), urine production and ip lactate, pyruvate, glycerol and glucose by microdialysis, analysed only at the end of the study. Abdominal decompression was performed on clinical criteria, and decompressed (D) and non-decompressed (ND) patients were compared. RESULTS The ip lactate/pyruvate (l/p) ratio was higher in the D group than in the ND group during the first five postoperative hours (mean 20 vs. 12), p = 0.005 and at 1 h prior to decompression compared to the fifth hour in the ND group (24 vs. 13), p = 0.016. Glycerol levels were higher in the D group during the first postoperative hours (mean 274.6 vs. 121.7 μM), p = 0.022. The IAP was higher only at 1 h prior to decompression in the D group compared to the ND group at the fifth hour (mean 19 vs. 14 mmHg). CONCLUSIONS Ip l/p ratio and glycerol levels are elevated immediately postoperatively in patients developing IAH leading to organ failure and subsequent abdominal decompression.
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Affiliation(s)
- T M Hörer
- Department of Cardio-Thoracic and Vascular Surgery, Örebro University Hospital and Örebro University, Örebro, Sweden.
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Minion DJ, Davenport DL. Access Techniques for EVAR: Percutaneous Techniques and Working with Small Arteries. Semin Vasc Surg 2012. [PMID: 23206568 DOI: 10.1053/j.semvascsurg.2012.09.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Fisher RK. Commentary: the fascia suture technique: this late bloomer could become a winner. J Endovasc Ther 2012; 19:397-9. [PMID: 22788894 DOI: 10.1583/11-3702c.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Mathisen SR, Zimmermann E, Markström U, Mattsson K, Larzon T. Complication Rate of the Fascia Closure Technique in Endovascular Aneurysm Repair. J Endovasc Ther 2012; 19:392-6. [DOI: 10.1583/jevt-11-3702r.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Montán C, Lehti L, Holst J, Björses K, Resch TA. Short- and Midterm Results of the Fascia Suture Technique for Closure of Femoral Artery Access Sites After Endovascular Aneurysm Repair. J Endovasc Ther 2011; 18:789-96. [DOI: 10.1583/11-3621.1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Harrison G, Thavarajan D, Brennan J, Vallabhaneni S, McWilliams R, Fisher R. Fascial Closure Following Percutaneous Endovascular Aneurysm Repair. Eur J Vasc Endovasc Surg 2011; 41:346-9. [PMID: 21145265 DOI: 10.1016/j.ejvs.2010.11.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2010] [Accepted: 11/18/2010] [Indexed: 12/17/2022]
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Comments regarding 'fascial closure following percutaneous endovascular aneurysm repair'. Eur J Vasc Endovasc Surg 2011; 41:350. [PMID: 21194986 DOI: 10.1016/j.ejvs.2010.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2010] [Accepted: 11/24/2010] [Indexed: 11/21/2022]
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Malkawi A, Hinchliffe R, Holt P, Loftus I, Thompson M. Percutaneous Access for Endovascular Aneurysm Repair: A Systematic Review. Eur J Vasc Endovasc Surg 2010; 39:676-82. [DOI: 10.1016/j.ejvs.2010.02.001] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2009] [Accepted: 02/01/2010] [Indexed: 12/17/2022]
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Hingorani AP, Ascher E, Marks N, Shiferson A, Patel N, Gopal K, Jacob T. Iatrogenic injuries of the common femoral artery (CFA) and external iliac artery (EIA) during endograft placement: An underdiagnosed entity. J Vasc Surg 2009; 50:505-9; discussion 509. [DOI: 10.1016/j.jvs.2009.03.050] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2009] [Revised: 03/25/2009] [Accepted: 03/28/2009] [Indexed: 10/20/2022]
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Holst J, Resch T, Ivancev K, Björses K, Dias N, Lindblad B, Mathiessen S, Sonesson B, Malina M. Early and Intermediate Outcome of Emergency Endovascular Aneurysm Repair of Ruptured Infrarenal Aortic Aneurysm: A Single-Centre Experience of 90 Consecutive Patients. Eur J Vasc Endovasc Surg 2009; 37:413-9. [PMID: 19211279 DOI: 10.1016/j.ejvs.2008.12.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2008] [Accepted: 12/21/2008] [Indexed: 10/21/2022]
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Jonsson T, Larzon T, Jansson K, Arfvidsson B, Norgren L. Limb Ischemia After EVAR:An Effect of the Obstructing Introducer? J Endovasc Ther 2008; 15:695-701. [DOI: 10.1583/08-2476.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
It is now more than 20 years since the first report of stent graft insertion in the human arterial system was published. The first "homemade" devices proved that the technique was possible but could not show any durability. Using these devices, it was possible to get a good seal but not a good anchorage. Not even the first generation of commercially available stent grafts proved to be durable. First after gaining knowledge about the forces acting on the stent graft, it was realized that attachment was important for the durability and the hooks and barbs or a longitudinal stability are needed to minimise the risk for distal migration. Not much of a difference in the overall performance is noticed between the ePTFE graft or the polyester graft or when comparing stainless steel stents with those made out of nitinol. The systems are made much more flexible and hydrophilic leading to a better performance and a greater chance of percutaneous approach. The optimal stent graft is not out on the market yet, but hopefully will come with further development.
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Affiliation(s)
- J Brunkwall
- Department of Vascular Surgery, University Clinics, Cologne, Germany.
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Dias NV, Resch TA, Sonesson B, Ivancev K, Malina M. EVAR of aortoiliac aneurysms with branched stent-grafts. Eur J Vasc Endovasc Surg 2008; 35:677-84. [PMID: 18378472 DOI: 10.1016/j.ejvs.2007.10.022] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2007] [Accepted: 10/24/2007] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Branched iliac stent-grafts (bSG) have recently been developed in order to preserve internal iliac artery (IIA) flow in patients with aneurysmal or short common iliac arteries. The aim of this study is to evaluate a single-center experience with bSG for the IIA. METHODS Twenty-two male patients (70 (IQR 65-79) years old) underwent EVAR with 23 bSG (1 bilateral repair) between September 2002 and August 2007. Median AAA diameter was 52 (37-60) mm while common iliac diameter on the side of the bSG was 34 (27-41) mm. Two in-house modified Zenith SG and subsequently 21 commercially available bSG (18 Zenith Iliac Side and 3 Helical Branches) were used. Follow-up (FU) included CT at one month and yearly thereafter. Data was prospectively entered in a database. RESULTS Primary technical success was 91% (21 bSG). Median FU duration was 20 (8-31) months. One patient (5 %) died after discharge from acute myocardial infarction on day 13. Another patient died 30 months after EVAR of an unrelated cause. The overall bSG patency was 74% due to 6 branch occlusions (2 intraoperative and 4 late). All patients with patent bSG were asymptomatic. Three occlusions were asymptomatic findings on CT, while the other three developed claudication (two patients with contralateral IIA occlusion and one with simultaneous occlusion of the external iliac). One patient (5%) developed an asymptomatic type III endoleak at 1 month and was successfully treated with a bridging SG. Overall, four patients (18%) required reinterventions (1 bilateral stenting of the external iliac arteries, 1 external and 1 internal SG extensions and 1 femoro-femoral cross-over bypass). Nine out of 16 patients (56%) with CT-FU>/=1 year had shrinking aneurysms. There were no postoperative aneurysm expansions. CONCLUSIONS EVAR of aortoiliac aneurysms with IIA bSG is a good alternative to occlusion of the IIA in patients with challenging distal anatomy.
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Affiliation(s)
- N V Dias
- Vascular Centre Malmö-Lund, Malmö University Hospital, Malmö, Sweden.
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Jean-Baptiste E, Hassen-Khodja R, Haudebourg P, Bouillanne PJ, Declemy S, Batt M. Percutaneous Closure Devices for Endovascular Repair of Infrarenal Abdominal Aortic Aneurysms: A Prospective, Non-randomized Comparative Study. Eur J Vasc Endovasc Surg 2008; 35:422-8. [DOI: 10.1016/j.ejvs.2007.10.021] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2007] [Accepted: 10/26/2007] [Indexed: 12/17/2022]
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Dosluoglu HH, Cherr GS, Harris LM, Dryjski ML. Total Percutaneous Endovascular Repair of Abdominal Aortic Aneurysms Using Perclose ProGlide Closure Devices. J Endovasc Ther 2007. [DOI: 10.1583/1545-1550(2007)14[184:tperoa]2.0.co;2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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