Predictors of Complications Associated With Closure Devices After Transfemoral Percutaneous Coronary Procedures

Safety profile of an 8F femoral arteriotomy closure using the Angio-Seal device in thrombolysed acute stroke patients undergoing thrombectomy

Background The relationship between bridging thrombolysis and femoral access site complications after mechanical thrombectomy remains contested. Use of a closure device could minimise bleeding complications. This study aimed to elucidate the rate of access site complications in a cohort of patients treated using an 8F groin sheath with subsequent closure using the Angio-Seal to assess safety and the impact of bridging thrombolysis on access site complication rate. Methods All patients with large vessel occlusive stroke treated between 2014 and 2017 with thrombectomy with or without bridging thrombolysis were reviewed. A prospectively acquired departmental database was used to obtain baseline data, and the radiology information and haematology reporting systems were used to record imaging or transfusion relating to subsequent access site complications. Results Seventy-five patients treated with thrombectomy alone were compared to 70 patients treated with prior intravenous thrombolysis. All had an 8F femoral sheath placed for arterial access, and all underwent attempted haemostasis with an 8F Angio-Seal. Two patients (1.14%) suffered Angio-Seal device failure necessitating manual pressure. One patient (0.6%) suffered a small femoral pseudo-aneurysm. No retroperitoneal haemorrhage, haematoma requiring transfusion, ipsilateral deep-vein thrombosis or ipsilateral acute limb ischaemia was encountered. There was no significant difference in the rate of haemorrhagic, ischaemic or infective complications between those treated with bridging thrombolysis or thrombectomy alone. Conclusion Use of the Angio-Seal closure device for 8F femoral access is safe in acute stroke patients. Intravenous thrombolysis prior to endovascular thrombectomy does not significantly alter femoral access site complication rate if this approach is used.

Interventional procedures: best practice to avoid complications

Technological advances have allowed treatment of patients using interventional radiological imaging including the performance of multiple procedures in almost any vessel, eg, angioplasty, stenting, embolization, and coilings. Patients undergoing any procedure are at risk for complications because of contrast media, radiation exposure, vessel injury, and prolonged time in one position during the procedure. Diagnostic-only procedures minimize use of contrast medium and radiation time, and generally take about one hour to complete. On the other hand, interventional procedures can take several hours and require larger volumes of contrast medium and radiation, as well as increased time lying supine on a procedure table. This article will discuss several potential and known risks associated with interventional procedures, how to monitor for these risks, and evidence-based measures to prevent or minimize their occurrence.

Peripheral arterial sheath removal program: a performance improvement initiative

The increasing number of endovascular procedures by both cardiologists and vascular surgeons strain available resources, such as recovery space, creating delays in the throughput of patients. The use of alternative settings, personnel, and approaches to postprocedural care has been proposed to maximize the number of procedures that can be done with existing procedure rooms. However, a key question remains about whether this can be done safely and achieve good patient outcomes. A performance improvement project was conducted to evaluate the safety and effectiveness of shifting postprocedural care and removal of intraarterial sheaths by the staff in the cardiac catheterization laboratory to specially trained acute care nurses on an inpatient vascular surgical unit. The purpose of this project was to develop a performance improvement project that included administrative, educational, and clinical components and to evaluate effects on key patient outcomes, prospectively, over 15 months.