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Samy M, Landt M, Mankerious N, Kurniadi A, Alotaibi S, Toelg R, Abdel-Wahab M, Nef H, Allali A, Richardt G, Elbasha K. ProGlide-AngioSeal versus ProGlide-FemoSeal for vascular access hemostasis posttranscatheter aortic valve implantation. Catheter Cardiovasc Interv 2024. [PMID: 39378384 DOI: 10.1002/ccd.31259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 07/24/2024] [Accepted: 09/29/2024] [Indexed: 10/10/2024]
Abstract
BACKGROUND The hybrid strategy combining plug-based and suture-based vascular closure devices (VCD) was introduced as a promising technique for vascular access hemostasis after transcatheter aortic valve implantation (TAVI) with satisfactory outcomes. However, data comparing two plug-based VCDs each in the combination with a suture-based VCD, namely ProGlide/AngioSeal (P/AS) with ProGlide/FemoSeal (P/FS) VCDs, is still lacking. AIMS To compare the 30-day outcome of the hybrid strategy using P/AS versus P/FS for vascular access site closure after TAVI. METHODS A retrospective single-center observational study included 608 patients recruited from a prospective TAVI registry between 2016 and 2022. The composite endpoint was defined as any VCD-related major vascular complications and/or bleeding more than type 1 according to Valve Academic Research Consortium criteria. RESULTS The current study reported a significantly higher rate of composite endpoint in P/AS group, which was driven by a higher rate of major bleeding (5.4% vs. 1.4%, p = 0.036). We also found a higher rate of VCD-related minor bleeding in P/AS group (16.3% vs. 8.1%, p = 0.013). Successful access site hemostasis was achieved in 71.7% of P/AS group versus 83.1% in P/FS group (p = 0.006). The presence of anterior wall calcification at the access site was significantly associated with the composite endpoint (adj odds ratio 2.49; 95% confidence interval (1.08-5.75), p = 0.032). CONCLUSION The hybrid strategy for large bore vascular access closure using P/FS showed a potentially better 30-day outcomes compared with P/AS. The presence of anterior calcification at the access site carries a significant risk of VCD-related complications.
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Affiliation(s)
- Mohamed Samy
- Cardiology Department, Heart Center Segeberger Kliniken GmbH, Bad Segeberg, Germany
- Cardiology Department, Zagazig University, Sharkia, Egypt
| | - Martin Landt
- Cardiology Department, Heart Center Segeberger Kliniken GmbH, Bad Segeberg, Germany
| | - Nader Mankerious
- Cardiology Department, Heart Center Segeberger Kliniken GmbH, Bad Segeberg, Germany
- Cardiology Department, Zagazig University, Sharkia, Egypt
| | - Arief Kurniadi
- Cardiology Department, Heart Center Segeberger Kliniken GmbH, Bad Segeberg, Germany
| | - Sultan Alotaibi
- Cardiology Department, Heart Center Segeberger Kliniken GmbH, Bad Segeberg, Germany
- Cardiology Department, Cardiac Centre, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Ralph Toelg
- Cardiology Department, Heart Center Segeberger Kliniken GmbH, Bad Segeberg, Germany
- Cardiology Department, Medical Faculty of the Christian-Albrechts-University of Kiel, Kiel, Germany
- Cardiology Department, Center for Cardiovascular and Diabetes Medicine, Asklepios Clinic Bad Oldesloe, Bad Oldesloe, Germany
| | - Mohamed Abdel-Wahab
- Cardiology Department, Heart Centre Leipzig at the University of Leipzig, Leipzig, Germany
| | - Holger Nef
- Cardiology Department, Heart Center Segeberger Kliniken GmbH, Bad Segeberg, Germany
| | - Abdelhakim Allali
- Cardiology Department, Heart Center Segeberger Kliniken GmbH, Bad Segeberg, Germany
- Cardiology Department, Medical Clinic II, University Heart Centre Lübeck, Lübeck, Germany
| | - Gert Richardt
- Cardiology Department, Heart Center Segeberger Kliniken GmbH, Bad Segeberg, Germany
- Cardiology Department, Center for Cardiovascular and Diabetes Medicine, Asklepios Clinic Bad Oldesloe, Bad Oldesloe, Germany
| | - Karim Elbasha
- Cardiology Department, Heart Center Segeberger Kliniken GmbH, Bad Segeberg, Germany
- Cardiology Department, Zagazig University, Sharkia, Egypt
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Antegrade common femoral artery closure device use is associated with decreased complications. J Vasc Surg 2020; 72:1610-1617.e1. [PMID: 32165058 DOI: 10.1016/j.jvs.2020.01.052] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 01/15/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Antegrade femoral artery access is often used for ipsilateral infrainguinal peripheral vascular intervention. However, the use of closure devices (CD) for antegrade access (AA) is still considered outside the instructions for use for most devices. We hypothesized that CD use for antegrade femoral access would not be associated with an increased odds of access site complications. METHODS The Vascular Quality Initiative was queried from 2010 to 2019 for infrainguinal peripheral vascular interventions performed via femoral AA. Patients who had a cutdown or multiple access sites were excluded. Cases were then stratified into whether a CD was used or not. Hierarchical multivariable logistic regressions controlling for hospital-level variation were used to examine the independent association between CD use and access site complications. A sensitivity analysis using coarsened exact matching was performed using factors different between treatment groups to reduce imbalance between the groups. RESULTS Overall, 11,562 cases were identified and 5693 (49.2%) used a CD. Patients treated with a CD were less likely to be white (74.1% vs 75.2%), have coronary artery disease (29.7% vs 33.4%), use aspirin (68.7% vs 72.4%), and have heparin reversal with protamine (15.5% vs 25.6%; all P < .05). CD patients were more likely to be obese (31.6% vs 27.0%), have an elective operation (82.6% vs 80.1%), ultrasound-guided access (75.5% vs 60.6%), and a larger access sheath (6.0 ± 1.0 F vs 5.5 ± 1.0 F; P < .05 for all). CD cases were less likely to develop any access site hematoma (2.55% vs 3.53%; P < .01) or a hematoma requiring reintervention (0.63% vs 1.26%; P < .01) and had no difference in access site stenosis or occlusion (0.30% vs 0.22%; P = .47) compared with no CD. On multivariable analysis, CD cases had significantly decreased odds of developing any access site hematoma (odds ratio, 0.75; 95% confidence interval, 0.59-0.95) and a hematoma requiring intervention (odds ratio, 0.56; 95% confidence interval, 0.38-0.81). A sensitivity analysis after coarsened exact matching confirmed these findings. CONCLUSIONS In this nationally representative sample, CD use for AA was associated with a lower odds of hematoma in selected patients. Extending the instructions for use indications for CDs to include femoral AA may decrease the incidence of access site complications, patient exposure to reintervention, and costs to the health care system.
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Chatzigeorgiadis P, Hellwig K, Almasi-Sperling V, Meyer A, Lang W, Rother U. Major vascular complications after transfemoral arterial closure system implantation: a single-center study. INT ANGIOL 2020; 39:139-144. [DOI: 10.23736/s0392-9590.19.04253-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Cha NH, Sok S. Effects of position change on lumbar pain and discomfort of Korean patients after invasive percutaneous coronary intervention: a RCT study. J Phys Ther Sci 2016; 28:2742-2747. [PMID: 27821926 PMCID: PMC5088117 DOI: 10.1589/jpts.28.2742] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 06/09/2016] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study sought to examine the effects of position change on lumbar pain and
discomfort of Korean patients after invasive percutaneous coronary intervention. [Subjects
and Methods] The participants consisted of 48 patients (experimental: n=24, control: n=24)
who underwent invasive coronary intervention (Percutaneous Coronary Intervention) in K
hospital, Seoul, Korea. A randomized controlled trial design was used. Position changes as
the experimental treatment were sequenced as follows: supine position for one hour after
removal of the catheter; 30-degree bed-elevated lateral position for one hour; 30-degree
bed elevation for one hour; and finally 30-degree bed-elevated lateral position for one
hour. The thirty degree bed-elevated lateral position was intended to press on the
surgical site. Measures used were the general characteristics form, Visual Analogue Scale
for lumbar pain, and discomfort scale. [Results] There were significant differences on
lumbar pain and discomfort of Korean patients after invasive coronary intervention between
the experimental and control groups. [Conclusion] Position change was an effective
intervention for decreasing lumbar pain and discomfort of Korean patients after invasive
coronary intervention. Health professionals need to consider an array of methods including
position change for patients after invasive coronary intervention.
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Affiliation(s)
- Nam Hyun Cha
- Department of Nursing, Andong National University, Republic of Korea
| | - Sohyune Sok
- College of Nursing Science, Kyung Hee University, Republic of Korea
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Safety and Effectiveness of Closure Devices Applied to a Stented Common Femoral Artery: A Retrospective Analysis. Int J Angiol 2016; 25:165-7. [PMID: 27574383 DOI: 10.1055/s-0036-1572524] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Bailout stenting of the common femoral artery (CFA) may become necessary with failed balloon angioplasty or atherectomy or in case of bleeding requiring a covered stent over the arteriotomy site. Reaccessing the CFA through a previously placed stent may occur during angiography. The safety and effectiveness of applying a closure device, or manual compression to achieve hemostasis through an accessed stented CFA are unknown. All patients in our practice that underwent CFA stenting were identified using billing records for 3 years (January 1, 2010-February 28, 2013). Patients were included if there has been documentation of access through the stented CFA segment on angiography. In-hospital and up to 2 weeks postdischarge major adverse events were recorded from medical records. A total of 48 patients were included in the study. The mean age was 65.9 ± 10.9 years, males 60.4%. Perclose (Abbott Vascular, Santa Clara, CA) was used in 85.7%, AngioSeal (St. Jude Medical, St. Paul, MN) in 8.3%, Mynx (Access Closure, Santa Clara, CA) in 2%, and manual compression in 4% of the patients. Major adverse events consisted of in-hospital mortality in two patients: one probably related to index access-site thrombosis complicated by subsequent acute renal failure following reintervention; the other mortality was related to major bleeding possibly related to the index access site. The remaining patients had no adverse events and there were no reported problems at 2 weeks follow-up. Accessing and applying closure device in stented CFA can be accomplished successfully in approximately 96% of the patients with low major adverse events.
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Kara K, Mahabadi AA, Rothe H, Müller P, Krüger J, Neubauer H, Klein-Wiele O, Mügge A, Kahlert P, Erbel R. Safety and effectiveness of a novel vascular closure device: a prospective study of the ExoSeal compared to the Angio-Seal and ProGlide. J Endovasc Ther 2015; 21:822-8. [PMID: 25453885 DOI: 10.1583/14-4744mr.1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE To prospectively assess the safety and efficacy of a novel absorbable vascular closure device (ExoSeal) in patients undergoing cardiac catheterization with femoral access compared to the established collagen-based (Angio-Seal) and suture-mediated (ProGlide) closure devices. METHODS This prospective, observational, dual-center, non-randomized, non-blinded study enrolled 1013 patients (65.1 ± 11.8 years) undergoing cardiac catheterization via a common femoral artery access in which hemostasis was achieved using a vascular closure device (255 Angio-Seal, 258 ProGlide, and 500 ExoSeal). In hospital complications (bleeding, hematoma, pseudoaneurysm, vessel occlusion, dissection, and arteriovenous fistula) of the puncture site and device failures (persistent bleeding) were recorded and compared for ExoSeal vs. the established devices (Angio-Seal + ProGlide). RESULTS There were more complications after utilization of ExoSeal compared to established devices (3.6% vs. 1.2%, p=0.012). No significant difference was observed in the device success rate between the established vascular closure devices (96.3%) and the novel device (94.8%, p=0.28). Considering each closure system, Angio-Seal had the lowest complication rate (0.4%) and the highest efficacy (99.2%); the latter differed significantly from ExoSeal (94.8%, p=0.001). Logistic regression analysis revealed a >3-fold odds of complications when using ExoSeal, which remained unchanged in multivariate analysis. CONCLUSION Utilization of the novel vascular closure device is associated with a higher complication rate and a similar device failure rate compared to collagen-based and suture-mediated devices, with Angio-Seal having the lowest complication and device failure rates.
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Affiliation(s)
- Kaffer Kara
- 1 Cardiovascular Center, St. Josef Hospital, Ruhr-University Bochum, Germany
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Alshehri AM, Elsharawy M. Comparison of Angioseal and Manual Compression in Patients Undergoing Transfemoral Coronary and Peripheral Vascular Interventional Procedures. Int J Angiol 2015; 24:133-6. [PMID: 26060385 DOI: 10.1055/s-0035-1547449] [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: 10/23/2022] Open
Abstract
Vascular closure devices (VCDs) were introduced in the early 1990s with the goal of limiting the time, labor, bed rest, and patient discomfort associated with manual compression (MC) for hemostasis after cardiovascular interventions. However, its advantage over MC has not been extensively studied after interventional procedures. The aim of this study was to do prospective, randomized study comparing the safety and efficacy of the Angio-Seal (AS) to that of MC in patients undergoing transfemoral coronary and peripheral vascular interventional procedure. A prospective, randomized trial was undertaken on consecutive series of patients admitted to King Fahd Hospital of the University for transfemoral coronary and peripheral vascular interventional procedures over 1 year. The study was designed to compare the hemostasis time in minutes and the incidence of vascular complications in patients receiving AS with those undergoing MC. All patients were on antiplatelets and received heparin during the procedure. During the study period, 160 patients were included, 80 in each group. There was a significant difference in mean time to hemostasis in minutes (15.83 ± 1.63 minutes for MC and 0.42 ± 0.04 minutes for the AS; p < 0.001), time to ambulation in minutes (280 ± 15 for MC and 120 for AS; p = 0.04) and in minor complications (33.8% in MC vs. AS 5%; p < 0.001). However, the major complication rate did not significantly differ between the two groups (0% in AS vs. 2.5% in MC; p = 0.15). AS was found to achieve rapid closure of the femoral access site safely in patients undergoing coronary and peripheral vascular interventional procedures under antiplatelets and systemic heparinization.
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Affiliation(s)
- Abdullah M Alshehri
- Division of Cardiology, Department of Internal Medicine, University of Dammam, Saudi Arabia
| | - Mohamed Elsharawy
- Division of Vascular Surgery, Department of General Surgery, University of Dammam, Saudi Arabia
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Krishnasamy VP, Hagar MJ, Scher DJ, Sanogo ML, Gabriel GE, Sarin SN. Vascular Closure Devices: Technical Tips, Complications, and Management. Tech Vasc Interv Radiol 2015; 18:100-12. [DOI: 10.1053/j.tvir.2015.04.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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