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Tilz RR, Feher M, Vogler J, Bode K, Duta AI, Ortolan A, Lopez LD, Küchler M, Mamaev R, Lyan E, Sommer P, Braun M, Sciacca V, Demming T, Maslova V, Kuck KH, Heeger CH, Eitel C, Popescu SS. Venous vascular closure system vs. figure-of-eight suture following atrial fibrillation ablation: the STYLE-AF Study. Europace 2024; 26:euae105. [PMID: 38647070 DOI: 10.1093/europace/euae105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 04/09/2024] [Indexed: 04/25/2024] Open
Abstract
AIMS Simplified ablation technologies for pulmonary vein isolation (PVI) are increasingly performed worldwide. One of the most common complications following PVI are vascular access-related complications. Lately, venous closure systems (VCSs) were introduced into clinical practice, aiming to reduce the time of bed rest, to increase the patients' comfort, and to reduce vascular access-related complications. The aim of the present study is to compare the safety and efficacy of using a VCS to achieve haemostasis following single-shot PVI to the actual standard of care [figure-of-eight suture and manual compression (MC)]. METHODS AND RESULTS This is a prospective, multicentre, randomized, controlled, open-label trial performed at three German centres. Patients were randomized 1:1 to undergo haemostasis either by means of VCS (VCS group) or of a figure-of-eight suture and MC (F8 group). The primary efficacy endpoint was the time to ambulation, while the primary safety endpoint was the incidence of major periprocedural adverse events until hospital discharge. A total of 125 patients were randomized. The baseline characteristics were similar between the groups. The VCS group showed a shorter time to ambulation [109.0 (82.0, 160.0) vs. 269.0 (243.8, 340.5) min; P < 0.001], shorter time to haemostasis [1 (1, 2) vs. 5 (2, 10) min; P < 0.001], and shorter time to discharge eligibility [270 (270, 270) vs. 340 (300, 458) min; P < 0.001]. No major vascular access-related complication was reported in either group. A trend towards a lower incidence of minor vascular access-related complications on the day of procedure was observed in the VCS group [7 (11.1%) vs. 15 (24.2%); P = 0.063] as compared to the control group. CONCLUSION Following AF ablation, the use of a VCS results in a significantly shorter time to ambulation, time to haemostasis, and time to discharge eligibility. No major vascular access-related complications were identified. The use of MC and a figure-of-eight suture showed a trend towards a higher incidence of minor vascular access-related complications.
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Affiliation(s)
- Roland Richard Tilz
- Department of Rhythmology, University Heart Center Lübeck, University Clinic Schleswig-Holstein, Ratzeburger Allee 160, D-23538 Luebeck, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Luebeck, Germany
| | - Marcel Feher
- Department of Rhythmology, University Heart Center Lübeck, University Clinic Schleswig-Holstein, Ratzeburger Allee 160, D-23538 Luebeck, Germany
| | - Julia Vogler
- Department of Rhythmology, University Heart Center Lübeck, University Clinic Schleswig-Holstein, Ratzeburger Allee 160, D-23538 Luebeck, Germany
| | - Kerstin Bode
- Department of Rhythmology, Heart Center of Leipzig, Leipzig, Germany
| | - Alexandru Ionut Duta
- Department of Rhythmology, University Heart Center Lübeck, University Clinic Schleswig-Holstein, Ratzeburger Allee 160, D-23538 Luebeck, Germany
| | - Angela Ortolan
- Department of Rhythmology, University Heart Center Lübeck, University Clinic Schleswig-Holstein, Ratzeburger Allee 160, D-23538 Luebeck, Germany
| | - Lisbeth Delgado Lopez
- Department of Rhythmology, University Heart Center Lübeck, University Clinic Schleswig-Holstein, Ratzeburger Allee 160, D-23538 Luebeck, Germany
| | - Mirco Küchler
- Department of Rhythmology, University Heart Center Lübeck, University Clinic Schleswig-Holstein, Ratzeburger Allee 160, D-23538 Luebeck, Germany
| | - Roman Mamaev
- Department of Rhythmology, University Heart Center Lübeck, University Clinic Schleswig-Holstein, Ratzeburger Allee 160, D-23538 Luebeck, Germany
| | - Evgeny Lyan
- Department of Internal Medicine III, University Medical Center of Schleswig-Holstein-Campus Kiel, Kiel, Germany
| | - Philipp Sommer
- Department of Electrophysiology and Rhythmology, Herz- und Diabeteszentrum NRW, Ruhr-Universitaet Bochum, Bad Oeynhausen, Germany
| | - Martin Braun
- Department of Electrophysiology and Rhythmology, Herz- und Diabeteszentrum NRW, Ruhr-Universitaet Bochum, Bad Oeynhausen, Germany
| | - Vanessa Sciacca
- Department of Electrophysiology and Rhythmology, Herz- und Diabeteszentrum NRW, Ruhr-Universitaet Bochum, Bad Oeynhausen, Germany
| | - Thomas Demming
- Department of Internal Medicine III, University Medical Center of Schleswig-Holstein-Campus Kiel, Kiel, Germany
| | - Vera Maslova
- Department of Internal Medicine III, University Medical Center of Schleswig-Holstein-Campus Kiel, Kiel, Germany
| | - Karl-Heinz Kuck
- Department of Rhythmology, University Heart Center Lübeck, University Clinic Schleswig-Holstein, Ratzeburger Allee 160, D-23538 Luebeck, Germany
| | - Christian-Hendrik Heeger
- Department of Rhythmology, University Heart Center Lübeck, University Clinic Schleswig-Holstein, Ratzeburger Allee 160, D-23538 Luebeck, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Luebeck, Germany
| | - Charlotte Eitel
- Department of Rhythmology, University Heart Center Lübeck, University Clinic Schleswig-Holstein, Ratzeburger Allee 160, D-23538 Luebeck, Germany
| | - Sorin Stefan Popescu
- Department of Rhythmology, University Heart Center Lübeck, University Clinic Schleswig-Holstein, Ratzeburger Allee 160, D-23538 Luebeck, Germany
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Unoki T, Konami Y, Nakayama T, Suzuyama H, Horio E, Taguchi E, Saku K, Sawamura T, Nakao K, Sakamoto T. Efficacy and safety of post-closure technique using Perclose ProGlide/ProStyle device for large-bore mechanical circulatory support access sites. Cardiovasc Revasc Med 2024; 62:60-65. [PMID: 38184452 DOI: 10.1016/j.carrev.2023.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 11/06/2023] [Accepted: 12/21/2023] [Indexed: 01/08/2024]
Abstract
PURPOSE Mechanical circulatory support (MCS) using a venoarterial extracorporeal membrane oxygenation (VA-ECMO) device or a catheter-type heart pump (Impella) is critical for the rescue of patients with severe cardiogenic shock. However, these MCS devices require large-bore cannula access (14-Fr and larger) at the femoral artery or vein, which often requires surgical decannulation. METHODS In this retrospective study, we evaluated post-closure method using a percutaneous suture-mediated vascular closure system, Perclose ProGlide/ProStyle (Abbott Vascular, Lake Bluff, IL, Perclose), as an alternative procedure for MCS decannulation. Closure of 83 Impella access sites and 68 VA-ECMO access sites performed using Perclose or surgical method between January 2018 and March 2023 were evaluated. RESULTS MCS decannulation using Perclose was successfully completed in all access sites without surgical hemostasis. The procedure time of ProGlide was shorter than surgical decannulation for both Impella and VA-ECMO (13 min vs. 50 min; p < 0.001, 21 min vs. 65 min; p < 0.001, respectively). There were no significant differences in the 30-day survival rate and major adverse events by decannulation including arterial dissection requiring endovascular treatment, hemorrhage requiring a large amount of red blood cell transfusion, and access site infection. CONCLUSION Our results suggest that the post-closure technique using the percutaneous suture-mediated closure system appears to be a safe and effective method for large-bore MCS decannulation.
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Affiliation(s)
- Takashi Unoki
- Intensive Care Unit, Saiseikai Kumamoto Hospital, Kumamoto, Japan; Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, Osaka, Japan.
| | - Yutaka Konami
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, Kumamoto, Japan
| | - Tomoko Nakayama
- Intensive Care Unit, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - Hiroto Suzuyama
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, Kumamoto, Japan
| | - Eiji Horio
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, Kumamoto, Japan
| | - Eiji Taguchi
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, Kumamoto, Japan
| | - Keita Saku
- Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Tadashi Sawamura
- Intensive Care Unit, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - Koichi Nakao
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, Kumamoto, Japan
| | - Tomohiro Sakamoto
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, Kumamoto, Japan
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Dahlbacka S, Nykänen AI, Juvonen T, Jormalainen M. Access site complications in thoracic endovascular aortic repair. J Vasc Surg 2024; 79:740-747.e2. [PMID: 38056701 DOI: 10.1016/j.jvs.2023.11.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 11/24/2023] [Accepted: 11/29/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND Percutaneous access and use of vascular closure devices facilitate thoracic endovascular aortic repair (TEVAR) procedures during local anesthesia and allow immediate detection of signs of spinal ischemia. However, the very large bore access (usually ≥22F sheath) associated with TEVAR increases the risk of vascular complications. In this study, we sought to define the safety and feasibility of two percutaneous femoral artery closure devices during TEVAR, in terms of access site vascular complications and major, life-threatening, or fatal bleeding (≥major) within 48 hours. Access site vascular complications were defined as technical failure of vascular closure or later formation of pseudoaneurysm. METHODS From March 2010 to December 2022, 199 transfemoral TEVAR were performed at Helsinki University Central Hospital, Finland. We retrospectively categorized these into three groups, based on surgeon preference for the access technique and femoral artery closure method: (1) surgical cut-down and vessel closure, n = 85 (42.7%), (2) percutaneous access and vascular closure with suture-based ProGlide, n = 56 (28.1%), or (3) percutaneous access and vascular closure with ultrasound-guided plug-based MANTA, n = 58 (29.1%). The primary outcome measure was technical success of vascular closure and access site vascular complications during index hospitalization. Secondary outcome measures were ≥major bleeding, early mortality, and hospital stay. RESULTS The technical success rate was 97.6% vs 91.1% vs 93.1% for surgical cut-down, ProGlide, and MANTA, respectively (P = .213). The rate of access site vascular complication was 3.5% vs 8.9% vs 10.3%, respectively (P = .290), with two pseudoaneurysms detected postoperatively and conservatively managed in the MANTA group. The vascular closure method was not associated with increased risk of ≥major bleeding, early mortality, or hospital stay on univariate analysis. Predictors for ≥major bleeding after TEVAR in multivariable analysis were urgent procedure (odds ratio: 2.8, 95% confidence interval: 1.4-5.5; P = .003) and simultaneous aortic branch revascularization (odds ratio: 2.7, 95% confidence interval: 1.3-5.4; P = .008). CONCLUSIONS In this study, the technical success rates of the percutaneous techniques demonstrated their feasibility during TEVAR. However, the number of access site complications for percutaneous techniques was higher compared with open approach, although the difference was not statistically significant. In the lack of evidence, the safety of the new MANTA plug-based vascular closure for TEVAR warrants further investigation.
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Affiliation(s)
- Sebastian Dahlbacka
- Department of Cardiac Surgery, Heart and Lung Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - Antti I Nykänen
- Department of Cardiac Surgery, Heart and Lung Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tatu Juvonen
- Department of Cardiac Surgery, Heart and Lung Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mikko Jormalainen
- Department of Cardiac Surgery, Heart and Lung Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Ross DS, Nogic J, Cong H, Nuzzi V, Thanikachalam P, Veenuraju S, Gruner-Hegge N, Anwar M, O'Sullivan M, Costopoulos C, Davies WR, Costanzo P. Ultrasound-guided deployment of ProGlide™ device in transfemoral transcatheter aortic valve implantation and risk reduction of vascular complications: A propensity-matched cohort study. Catheter Cardiovasc Interv 2024; 103:771-781. [PMID: 38451155 DOI: 10.1002/ccd.30999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 12/15/2023] [Accepted: 02/19/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND ProGlide is a percutaneous suture-mediated closure device used in arterial and venous closure following percutaneous intervention. Risk of vascular complications from use, particularly related to failure in hemostasis, or acute vessel closure, remains significant and often related to improper suture deployment. We describe a technique of ultrasound-guided ProGlide deployment in transfemoral transcatheter aortic valve implantation (TF-TAVI). AIMS The aim of this study is to assess vascular outcomes for ultrasound-guided deployment of ProGlide vascular closure devices in patients undergoing TF-TAVI. METHODS We collected relevant clinical data of patients undergoing TAVI in a large volume centre. PRIMARY OUTCOME main access Valve Academic Research Consortium 3 (VARC-3) major vascular complication. SECONDARY OUTCOME any major/minor VARC-3 vascular complication, its type (bleed or ischemia), and treatment required (medical, percutaneous, or surgical). We performed inverse weighting propensity score analysis to compare the population undergoing ultrasound-guided versus conventional ProGlide deployment for main TAVI access. Ultrasound technique for ProGlide insertion was performed as described below. RESULTS Five hundred and seventeen patients undergoing TF-TAVI were included. PRIMARY OUTCOME In 126 (ultrasound-guided) and 391 (conventional ProGlide insertion), 0% versus 1.8% (p < 0.001) had a major VARC-3 vascular complication, respectively. SECONDARY OUTCOME 0.8% (one minor VARC-3 bleed) vs 4.1% (13 bleeds and three occlusions) had any VARC-3 vascular complication (major and minor) (p < 0.001). Surgical treatment of vascular complication was required in 0.8% versus 1.3% (p = NS). CONCLUSIONS Ultrasound-guided deployment of ProGlide for vascular closure reduced the risk of major vascular complications in a large population undergoing TAVI.
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Affiliation(s)
- Daniel S Ross
- Department of Cardiology, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
- Imperial College Healthcare NHS Trust, London, UK
| | - Jason Nogic
- Department of Cardiology, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Hey Cong
- Department of Cardiology, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Vincenzo Nuzzi
- Department of Cardiology, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
- Clinical Cardiology and Heart Failure Unit, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Palermo, Italy
| | - Prakash Thanikachalam
- Department of Cardiology, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Shree Veenuraju
- Department of Cardiology, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Nicolai Gruner-Hegge
- Department of Cardiology, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Majid Anwar
- Department of Cardiology, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Michael O'Sullivan
- Department of Cardiology, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Charis Costopoulos
- Department of Cardiology, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Willaim R Davies
- Department of Cardiology, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Pierluigi Costanzo
- Department of Cardiology, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
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Izawa D, Matsumoto H, Nishiyama H, Nakayama Y, Maeshima K. Factors related to insufficient hemostasis using the EXOSEAL vascular closure device with five-minutes compression for femoral artery punctures after neuro-endovascular therapy: A retrospective, single-center experience. Interv Neuroradiol 2024; 30:255-263. [PMID: 36357980 PMCID: PMC11095341 DOI: 10.1177/15910199221138367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 10/25/2022] [Indexed: 02/17/2024] Open
Abstract
OBJECTIVES The aim was to identify the factors related to inadequate hemostasis with five minutes of manual compression using the EXOSEAL vascular closure device (VCD), and to evaluate the optimal time to hemostasis (TTH). METHODS A total of 119 consecutive patients who underwent neuro-endovascular therapy via common femoral arterial puncture between February 2019 and August 2021 were included. These patients underwent hemostasis using an EXOSEAL with manual compression for five minutes. In this retrospective study, the 119 patients were divided into two groups: (1) achieved hemostasis with five minutes (n = 76); and (2) required more than five minutes to achieve hemostasis (n = 43, Add group). In both groups, patient's characteristics, endovascular procedures, and closure procedures were assessed. RESULTS On univariable analysis, activated clotting time (ACT), multiple antiplatelets, closure with an under-sized EXOSEAL VCD (U-VCD), endovascular procedure, and use of a 7Fr. VCD were significantly associated with additional compression (p < 0.05). On multivariate logistic regression analysis, the following three factors were found to be associated with additional compression: pre-closure ACT (adjusted OR, 0.136; 95% CI, 1.017-1.056; p < 0.001); multiple antithrombotics (adjusted OR, 12.843; 95% CI, 3.458-47.693; p < 0.001); and closure with a U-VCD (adjusted OR, 5.653; 95% CI, 1.751-18.151; p = 0.004). On the receiver-operating characteristic curve analysis for prediction of the need for additional compression, the cutoff point for pre-closure ACT was calculated to be 268 s. In the Add group, mean TTH was 9.8 ± 1.5 min. CONCLUSION Multiple antiplatelets and closure with a U-VCD may increase the risk of insufficient hemostasis with five-minutes compression using an EXOSEAL VCD for femoral puncture sites if the pre-closure ACT is greater than 268 s. In these patients, mean TTH was 9.8 ± 1.5 min.
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Affiliation(s)
- Daisuke Izawa
- Department of Neurological Surgery, Kishiwada Tokushukai Hospital, Osaka, Japan
| | - Hiroyuki Matsumoto
- Department of Neurological Surgery, Kishiwada Tokushukai Hospital, Osaka, Japan
| | - Hirokazu Nishiyama
- Department of Neurological Surgery, Kishiwada Tokushukai Hospital, Osaka, Japan
| | - Yukie Nakayama
- Department of Neurological Surgery, Kishiwada Tokushukai Hospital, Osaka, Japan
| | - Kazuhide Maeshima
- Department of Neurological Surgery, Kishiwada Tokushukai Hospital, Osaka, Japan
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Peeters M, Oosterveld R, Decraemer G, Wong C, Salemans P, Nouwens R, Bouwman L, Yazar O. Clinical outcomes of MANTA closure device in percutaneous endovascular aortic aneurysm repair. J Vasc Surg 2024; 79:569-576. [PMID: 37923021 DOI: 10.1016/j.jvs.2023.10.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 10/15/2023] [Accepted: 10/18/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE The MANTA device is a plug-based vascular closure device (VCD) designed for large bore femoral arterial access site closure. It showed promising results in transcatheter aortic valve replacement cases. In this study, we report our results and evaluate the MANTA VCD in percutaneous endovascular aortic aneurysm repair (pEVAR). METHODS All data of consecutive patients who underwent an elective pEVAR between October 2018 and December 2022 were retrospectively reviewed. In all patients at least one common femoral artery was intended to close with the MANTA VCD. Depending on the sheath size, the 14Fr or 18Fr MANTA VCD was used. On the preoperative computed tomography scan, the diameter of the common femoral artery (CFA) was measured and the amount of calcification based on the Peripheral Arterial Calcium Scoring System (PACSS) was scored. Primary outcome was procedural technical success. Procedural technical success was defined as placement of the MANTA closure device resulting in vascular closure with patent CFA, without requiring immediate open or endovascular surgery. The secondary outcomes were access site complications requiring reintervention and all-cause mortality at 30-day follow-up. RESULTS In total, 152 consecutive patients underwent pEVAR with 291 common femoral artery closure procedures with the Manta VCD. Mean age was 74.1 ± 6.4 years, with a mean body mass index of 27.7 ± 4.4 kg/m2. The mean diameter of the CFA was 10.5 ± 1.9 mm. In 52.6% of the cases, there were no calcification on the preoperative computed tomography scan. The 18Fr and 14Fr Manta VCD were used 169 and 122 times, respectively. The technical success rate was 96.6%. Major vascular complications were reported in 4.5% of the cases, without any death-related events. CONCLUSIONS This single-center retrospective cohort study analyzed the procedural technical success, major vascular complications and all-cause mortality at 30-day follow-up of the MANTA vascular closure device in 152 pEVAR patients with 291 common femoral artery closure procedures. The technical success rate was 96,6%. Major vascular complications were reported in 4.5% of the cases, without any death related events. We concluded that the MANTA device is a safe and feasible option with a high rate of technical success in patients undergoing pEVAR.
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Affiliation(s)
- Maxim Peeters
- Department of Surgery, Division of Vascular Surgery, Zuyderland Medical Centre, Heerlen, The Netherlands.
| | - Rens Oosterveld
- Department of Surgery, Division of Vascular Surgery, Zuyderland Medical Centre, Heerlen, The Netherlands; Faculty of Medicine, Maastricht University, Maastricht, The Netherlands
| | - Gilles Decraemer
- Department of Surgery, Division of Vascular Surgery, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - ChunYu Wong
- Department of Surgery, Division of Vascular Surgery, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - Pieter Salemans
- Department of Surgery, Division of Vascular Surgery, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - Ruben Nouwens
- Procurement Department, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - Lee Bouwman
- Department of Surgery, Division of Vascular Surgery, Zuyderland Medical Centre, Heerlen, The Netherlands; Faculty of Science and Engineering, Maastricht University, Maastricht, The Netherlands
| | - Ozan Yazar
- Department of Surgery, Division of Vascular Surgery, Zuyderland Medical Centre, Heerlen, The Netherlands
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Boussofara A, Godin M, Canville A, Baala B, Berland J, Koning R, Landolff Q. Assessment of the MANTA closure device in real-life transfemoral transcatheter aortic valve replacement: A single-centre observational study. Catheter Cardiovasc Interv 2024; 103:650-659. [PMID: 38407552 DOI: 10.1002/ccd.30969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 11/30/2023] [Accepted: 01/31/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND Vascular complications increase morbidity and mortality in transcatheter aortic valve replacement (TAVR). Data involving suture-based percutaneous vascular closure devices (VCDs) have been extensive. Although promising, data regarding the efficacy and safety of the MANTA VCD (Teleflex) are scarce. We sought to assess the safety and effectiveness of the MANTA device in a real-life unselected cohort of patients undergoing transfemoral-TAVR (TF-TAVR). METHODS This single-center retrospective observational study included a cohort of consecutive patients with severe aortic stenosis (AS) treated by our team using TAVR between January 2020 to December 2022. The primary outcome measure was access-related major and minor vascular complications according to the Valve Academic Research Consortium (VARC-3) definition criteria. RESULTS From January 2020 to December 2022, a total of 347 patients underwent TF-TAVR were treated using the MANTA 18 Fr VCD system for vascular closure. Mean age was 82.4 ± 6.1 years (56-98 years). There were no significant differences in preoperative and procedural characteristics between patients with and without VCD-related major vascular complications. Access site-related major and minor vascular complications occurred in 20 of 347 patients (5.7%). Overall, major vascular complications occurred in 5 patients (1.4%) and device failure was seen in 17 patients (4.9%). CONCLUSION This French real world evaluation of large-bore arteriotomy closure in TF-TAVR indicated that MANTA VCD is a feasible alternative with an acceptable low rate of access-site-related complications.
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Affiliation(s)
| | - Matthieu Godin
- Department of Cardiology, Clinique Saint Hilaire, Rouen, France
| | | | - Brahim Baala
- Department of Cardiology, Clinique Saint Hilaire, Rouen, France
| | - Jacques Berland
- Department of Cardiology, Clinique Saint Hilaire, Rouen, France
| | - René Koning
- Department of Cardiology, Clinique Saint Hilaire, Rouen, France
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Barbash IM, Wasserstrum Y, Erlebach M, Guetta V, Ziegelmüller J, Segev A, Fefer P, Maor E, Lange R, Ruge H. Comparison of MANTA versus Perclose Prostyle large-bore vascular closure devices during transcatheter aortic valve implantation. Catheter Cardiovasc Interv 2024; 103:160-168. [PMID: 38059295 DOI: 10.1002/ccd.30921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 09/28/2023] [Accepted: 11/12/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND New vascular closure devices (VCD) are being introduced for achieving hemostasis after transcatheter aortic valve implantation (TAVI). However, no safety or efficacy data have been published compared to other contemporary VCD. AIM To compare the safety and efficacy of suture-based Perclose Prostyle as compared to plug-based MANTA device. METHODS A total of 408 consecutive TAVI patients from two high volume TAVI centers were included in the present study. Patients were grouped according to VCD: Prostyle versus MANTA. Propensity score matching (PSM) and multivariable analysis were utilized to compare clinical endpoints between the two groups. The primary endpoint was any vascular complication (VC) according to VARC-3 criteria. RESULTS After PSM, a total of 264 patients were analyzed, of them 132 in each group. Overall baseline characteristics of the two groups were comparable. Primary end-point was similar between MANTA as compared to Prostyle (16.7% vs. 15.3% respectively, p = 0.888). The main driver for VC among MANTA group were minor vascular complications (15.2%). Conversely, minor and major VC contributed equally to the primary endpoint among Prostyle group (7.6%) (p = 0.013). No outcome predictors were identified in multivariate analysis. CONCLUSIONS VCD for transfemoral TAVI using the new-generation Prostyle device or the MANTA device achieved comparable VARC-3 VC rates.
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Affiliation(s)
- Israel M Barbash
- Interventional Cardiology Unit, Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yishay Wasserstrum
- Interventional Cardiology Unit, Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Magdalena Erlebach
- Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany
| | - Victor Guetta
- Interventional Cardiology Unit, Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Johannes Ziegelmüller
- Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany
| | - Amit Segev
- Interventional Cardiology Unit, Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Paul Fefer
- Interventional Cardiology Unit, Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Elad Maor
- Interventional Cardiology Unit, Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rüdiger Lange
- Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany
| | - Hendrik Ruge
- Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität München, Munich, Germany
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9
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Lodhi H, Shaukat S, Mathews A, Maini B, Khalili H. Comparison of Figure-of-Eight Suture and Perclose ProGlide Suture-Mediated Closure in Large Bore Venous Access Hemostasis: A Randomized Controlled Trial. Am J Cardiol 2023; 209:181-183. [PMID: 37863115 DOI: 10.1016/j.amjcard.2023.09.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 09/17/2023] [Accepted: 09/27/2023] [Indexed: 10/22/2023]
Abstract
Suture-mediated closure device and Figure-of-Eight suture are commonly used to achieve hemostasis after use of large bore venous access. Although both methods of closure are commonly used in clinical practice, a head-to-head comparison in a controlled setting has not been performed. Patients presenting to a single center for elective left atrial appendage occlusion or transcatheter edge-to-edge mitral valve repair were randomized to large bore venous closure using the Perclose ProGlide suture-based closure or a Figure-of-Eight suture closure. The patients were followed for 1 month after the procedure. Primary outcome, a composite of access site large ecchymosis, hematoma, infection, pain, need for unscheduled venous ultrasound and need for transfusion, was compared between the 2 arms. A total of 40 patients were randomized in a 1:1 fashion to the 2 venous closure strategies. Baseline characteristics were similar between the 2 groups. Perclose ProGlide arm required use of more devices for hemostasis (1.5 ± 0.5 vs 1 ± 0 respectively, p <0.0001), and there was a significant difference in the cost of closure device ($367.00 ± 122.00 vs $1.00 ± 0 respectively, p <0.001). At 1 month post-procedure, the primary outcome occurred in 4 patients (20%) in the Perclose arm and 7 (35%) patients in the Figure-of-Eight arm, a difference that was not statistically significant (p = 0.48). Time to hemostasis between Figure-of-Eight and Perclose arms did not reach statistical significance (2.5 ± 2.1 vs 3.7 ± 2.3, p = 0.09). In conclusion, both Perclose ProGlide suture-based device and Figure-of-Eight closure are equally feasible and safe for patients who underwent large bore venous access. Figure-of-Eight-based closure is more cost effective.
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Affiliation(s)
- Hamza Lodhi
- Florida Atlantic University, Boca Raton, Florida.
| | - Sana Shaukat
- Florida Atlantic University, Boca Raton, Florida
| | | | | | - Houman Khalili
- Florida Atlantic University, Boca Raton, Florida; Memorial Health Cardiovascular Institute, Hollywood, Florida
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10
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Kneizeh K, Milzi A, Vogt F, Witte KK, Marx N, Lehrke M, Schröder J. Plug-Based vs Suture-Based Vascular Closure Device After Transfemoral TAVR: A Randomized Controlled Trial. JACC Cardiovasc Interv 2023; 16:2692-2694. [PMID: 37855806 DOI: 10.1016/j.jcin.2023.08.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/18/2023] [Accepted: 08/22/2023] [Indexed: 10/20/2023]
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11
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Tuozzo KA, Morris R, Moskowitz N, McCauley K, Babaev A, Attubato M. Bed Rest Reduction Following Cardiac Catheterizations Using Vascular Closure Devices. Am J Crit Care 2023; 32:421-428. [PMID: 37907375 DOI: 10.4037/ajcc2023536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
BACKGROUND Bed rest duration following deployment of a vascular closure device after transfemoral left-sided cardiac catheterization is not standardized. Despite research supporting reduced bed rest, many hospitals require prolonged bed rest. Delayed ambulation is associated with back pain, urine retention, difficulty eating, and longer stay. OBJECTIVE To study length of stay, safety, and opportunity cost savings of reduced bed rest at a large urban hospital. METHODS A single-site 12-week study of 1-hour bed rest after transfemoral cardiac catheterizations using vascular closure devices. Results were compared with historical controls treated similarly. RESULTS The standard bed rest group included 295 patients (207 male, 88 female; mean [SD] age, 64.4 [8.6] years). The early ambulation group included 260 patients (188 male, 72 female; mean [SD] age, 64 [9.3] years). The groups had no significant difference in age (t634 = 1.18, P = .21) or sex (χ12=0.2, P = .64). Three patients in the standard bed rest group and 1 in the early ambulation group had hematomas (P = .36). The stay for diagnostic cardiac catheterizations was longer in the standard bed rest group (mean [SD], 220.7 [55.2] minutes) than in the early ambulation group (mean [SD], 182.1 [78.5] minutes; t196 = 4.06; P < .001). Stay for percutaneous coronary interventions was longer in the standard bed rest group (mean [SD], 400.2 [50.8] minutes) than in the early ambulation group (mean [SD], 381.6 [54.7] minutes; t262 = 2.86; P = .005). CONCLUSION Reduced bed rest was safe, shortened stays, and improved efficiency by creating opportunity cost savings.
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Affiliation(s)
- Kristin A Tuozzo
- Kristin A. Tuozzo is a senior nurse clinician at New York University (NYU) Langone Health, New York
| | - Reena Morris
- Reena Morris is a senior nurse clinician at NYU Langone Health
| | - Nicole Moskowitz
- Nicole Moskowitz is a clinical resource nurse at NYU Langone Health
| | - Kathleen McCauley
- Kathleen McCauley is a professor of cardiovascular nursing at NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia
| | - Anvar Babaev
- Anvar Babaev is a clinical professor of medicine, NYU Grossman School of Medicine, New York, and director of endovascular interventions, cardiac catheterization laboratories, NYU Langone Medical Center
| | - Michael Attubato
- Michael Attubato is an associate professor of medicine, NYU Grossman School of Medicine, and director of complex coronary intervention, cardiac catheterization laboratories, NYU Langone Health
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12
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Xu C, Zhang ZX, Gu YM, Yu JF, Fang CW, Xu GX, Jin YQ. Dual Suture Versus Suture and Plug Closure Devices for Large Bore Access Haemostasis During Percutaneous Access Endovascular Aneurysm Repair. Cardiovasc Intervent Radiol 2023; 46:1553-1561. [PMID: 37828234 DOI: 10.1007/s00270-023-03570-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 09/19/2023] [Indexed: 10/14/2023]
Abstract
PURPOSE This study aimed to compare a dual Proglide strategy versus a combination of one Proglide and dual Exoseal for large-bore access closure during percutaneous access endovascular aneurysm repair (pEVAR). MATERIALS AND METHODS We retrospectively analyzed 97 patients who underwent pEVAR at our center between January 2021 and February 2023. The patients were divided into two groups: dual Proglide (P + P) and one Proglide with dual Exoseal (P + E). The primary outcome measures were technical success and access-related vascular complications. Technical success was defined as achieving complete hemostasis without a bailout strategy. Postprocedural follow-up for access-related vascular complications was evaluated at 30 and 60 days using computed tomography angiography and ultrasonography. Severity was graded according to the Cardiovascular Interventional Radiological Society of Europe (CIRSE) Classification. RESULTS Overall, a dual Proglide strategy was used in 46 patients (47.4%) with 65 groins (46.4%), and a combination of one Proglide and dual Exoseal was used in 51 patients (52.6%) with 75 groins (53.6%). The baseline characteristics were similar between the groups. The total technical success rate was 96.4%, and no significant differences were observed (95.4% vs. 97.3%; p = 0.870). Minor bleeding treatable through compression occurred significantly more often in the P group (CIRSE 1, 10.8% vs. 1.3%, p = 0.042). Hemostasis time, procedural time, length of stay in the hospital, closure device failure, and incidence of unplanned intervention did not differ significantly between the groups. CONCLUSIONS A combined Proglide and Exoseal strategy is safe and effective for large-bore access closure during pEVAR and can be considered an alternative. However, it should be supported by larger prospective studies.
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Affiliation(s)
- Chen Xu
- Department of Vascular Surgery and Intervention, The Affiliated Suzhou Hospital of Nanjing Medical University, 242 Guangji Road, Gusu District, Suzhou, 215000, China
| | - Zhi-Xuan Zhang
- Department of Vascular Surgery and Intervention, The Affiliated Suzhou Hospital of Nanjing Medical University, 242 Guangji Road, Gusu District, Suzhou, 215000, China
| | - Yi-Ming Gu
- Department of Vascular Surgery and Intervention, The Affiliated Suzhou Hospital of Nanjing Medical University, 242 Guangji Road, Gusu District, Suzhou, 215000, China
| | - Jin-Fan Yu
- Department of Vascular Surgery and Intervention, The Affiliated Suzhou Hospital of Nanjing Medical University, 242 Guangji Road, Gusu District, Suzhou, 215000, China
| | - Chang-Wen Fang
- Department of Vascular Surgery and Intervention, The Affiliated Suzhou Hospital of Nanjing Medical University, 242 Guangji Road, Gusu District, Suzhou, 215000, China
| | - Guo-Xiong Xu
- Department of Vascular Surgery and Intervention, The Affiliated Suzhou Hospital of Nanjing Medical University, 242 Guangji Road, Gusu District, Suzhou, 215000, China.
| | - Yi-Qi Jin
- Department of Vascular Surgery and Intervention, The Affiliated Suzhou Hospital of Nanjing Medical University, 242 Guangji Road, Gusu District, Suzhou, 215000, China
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13
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Mejia E, Cummer E, Morgan GJ, Buckvold S, Mitchell M, Leahy RA, Zablah JE. Percutaneous VA-ECMO from Cannulation to Decannulation: Novel Use of a Vascular Closure Device in Pediatrics. Pediatr Cardiol 2023; 44:1623-1628. [PMID: 37418147 DOI: 10.1007/s00246-023-03222-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 06/26/2023] [Indexed: 07/08/2023]
Abstract
VA-ECMO can be lifesaving in cardiogenic shock in children. While surgical vascular repair is the current standard of care for decannulation, it comes with notable risks. We present a series of eight patients who underwent decannulation with a collagen plug-based vascular closure device (MANTA) for the common femoral artery. Seven of the patients were successfully decannulated without access site-related vascular complications. One required conversion to surgical cut-down with arterial repair due to device failure. This series demonstrates the successful use of the MANTA device in percutaneous VA-ECMO decannulation in the pediatric population, while highlighting potential technical challenges for success.
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Affiliation(s)
- Ernesto Mejia
- The Heart Center, Children's Hospital Colorado, University of Colorado, 13123 E 16th Ave, B100, Aurora, CO, 80045, USA
| | - Elaina Cummer
- The Heart Center, Children's Hospital Colorado, University of Colorado, 13123 E 16th Ave, B100, Aurora, CO, 80045, USA
| | - Gareth J Morgan
- The Heart Center, Children's Hospital Colorado, University of Colorado, 13123 E 16th Ave, B100, Aurora, CO, 80045, USA
| | - Shannon Buckvold
- The Heart Center, Children's Hospital Colorado, University of Colorado, 13123 E 16th Ave, B100, Aurora, CO, 80045, USA
| | - Max Mitchell
- The Heart Center, Children's Hospital Colorado, University of Colorado, 13123 E 16th Ave, B100, Aurora, CO, 80045, USA
| | - Ryan A Leahy
- The Heart Center, Children's Hospital Colorado, University of Colorado, 13123 E 16th Ave, B100, Aurora, CO, 80045, USA
| | - Jenny E Zablah
- The Heart Center, Children's Hospital Colorado, University of Colorado, 13123 E 16th Ave, B100, Aurora, CO, 80045, USA.
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14
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Yoshioka N, Morita Y, Tokuda T, Yamada T, Morishima I. Removal of Migrated Vascular Closure Device Plug Material From the Popliteal Artery Using the Bi-Directional Approach "Push Balloon Into Vessel and Close Embolus From Retrograde Site (PINCER)" Technique: A Case Report. Vasc Endovascular Surg 2023; 57:795-800. [PMID: 37097033 DOI: 10.1177/15385744231173200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
Vascular closure devices (VCDs) are widely used to achieve rapid hemostasis after percutaneous intervention via the common femoral artery (CFA), with well-established efficacy and safety. Although VCD-related artery occlusion is rare, it can be critical. A 72-year-old female underwent endovascular therapy (EVT) for stent occlusion in the left superficial femoral artery through a 7-Fr guiding sheath from the right CFA. After the procedure, an acute right popliteal artery (POP-A) occlusion, associated with the EXOSEAL VCD plug, occurred. The plug material was successfully removed using a bidirectional approach. The migration plug was blocked to prevent distal vessel migration and pushed gently to close the antegrade system, using an over-the-wire balloon from the retrograde site. We named this the "Push balloon INto vessel and Close Embolus from Retrograde site" (PINCER) technique. Finally, the plug was successfully removed using biopsy forceps. Acute limb ischemia (ALI) caused by EXOSEAL is a rare condition. Removal of the emboli by EVT is clinically significant because it is minimally invasive. However, it is sometimes difficult to remove the embolus using only antegrade approach; thus, the bidirectional approach using the PINCER technique can be effective in these situations.
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Affiliation(s)
- Naoki Yoshioka
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Yasuhiro Morita
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Takahiro Tokuda
- Department of Cardiology, Nagoya Heart Center, Nagoya, Japan
| | - Takehiro Yamada
- Department of Cardiology, Central Japan International Medical Center, Minokamo, Japan
| | - Itsuro Morishima
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
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15
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Picone F, Contro A, Nguyen HQ, Gasparini C, Mansueto G. Management of Percutaneous Access to Portal Vein: A Initial Experience of Hemostasis by Vascular Closure Device (AngioSeal). Cardiovasc Intervent Radiol 2023; 46:1422-1424. [PMID: 37550588 DOI: 10.1007/s00270-023-03522-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 07/21/2023] [Indexed: 08/09/2023]
Affiliation(s)
- Federico Picone
- Institute of Radiology, University Hospital G.B. Rossi A.O.U.I. Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy.
| | - Alberto Contro
- Institute of Radiology, University Hospital G.B. Rossi A.O.U.I. Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy
| | - Hoang Quyen Nguyen
- Institute of Radiology, University Hospital G.B. Rossi A.O.U.I. Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy
| | - Clizia Gasparini
- Institute of Radiology, University Hospital G.B. Rossi A.O.U.I. Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy
| | - Giancarlo Mansueto
- Institute of Radiology, University Hospital G.B. Rossi A.O.U.I. Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy
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16
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Kim E, Sebastiao BG, Lee A, Ande S, Shankar J. Safety and effectiveness of vascular closure devices in interventional radiological procedures. Interv Neuroradiol 2023; 29:525-531. [PMID: 35538887 PMCID: PMC10549703 DOI: 10.1177/15910199221100628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 04/26/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Although it is well known that vascular closure devices (VCD) are commonly used in therapeutic interventional radiological procedures, standard use in diagnostic procedures is not as well studied. PURPOSE The aim of this study was to determine the real-world safety and effectiveness of the VCD in both diagnostic and therapeutic interventional radiological procedures. MATERIALS AND METHODS A retrospective, single center study included all patients where VCDs were used for either a diagnostic or therapeutic interventional procedure. Various demographic and clinical risk factors were recorded and examined for any significant association with successful deployment and complications. RESULTS A total of 2072 patients were included. VCDs were successfully deployed in 95.2% of the patients with 4.8% of perioperative complications, which included minor oozing from the puncture site, small hematoma less than or equal to 5 cm, large hematoma greater than 5 cm, pain, and loss of vascular access. Therapeutic (vascular interventional radiology (VIR) and neuro-interventional radiology (NIR)) procedures (OR 3.03, 95% CI 1.51-6.09, p = 0.002), use of Angioseal (OR 5.26, 95% CI 3.13-8.33), p < 0.001), and no use of antiplatelet medications (OR 0.47, 95% CI 0.22-0.97, p = 0.041) were independently associated with successful deployment of VCDs when controlled for other risk factors. Smoking (OR 3.50, 95% CI 2.00-6.05, p = <0.001), use of antiplatelet (OR 2.01, 95% CI 1.04-3.87, p = 0.037) and use of heparin (OR 1.78, 95% CI 1.10-2.86, p = 0.018) were independently associated with higher complication rates. CONCLUSION VCD's were successfully deployed in 95.2% of the patients with 4.8% of perioperative minor complications.
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Affiliation(s)
- Esther Kim
- Department of Radiology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Bruno Goncalves Sebastiao
- Department of Radiology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Amy Lee
- Department of Radiology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sudharshan Ande
- Department of Radiology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jai Shankar
- Department of Radiology, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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17
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Burgos Revilla FJ, Artiles Medina A, Domínguez Gutiérrez A, Muriel García A, Figueiredo A, Gómez Dos Santos V. Vascular closure devices in living-donor nephrectomy: a much-needed systematic review and meta-analysis focusing on safety. BJU Int 2023; 132:239-251. [PMID: 37017627 DOI: 10.1111/bju.16025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Abstract
OBJECTIVE To assess the safety of vascular closure devices in living-donor nephrectomy (LDN), as staplers and non-transfixion techniques (polymer locking and metal clips) are the methods employed to secure the renal vessels during laparoscopic and robotic LDN, but the use of clips has come into question since the United States Food and Drug Administration and manufacturers issued a contraindication. METHODS A systematic review and meta-analysis were conducted to assess the safety of vascular closure devices (International Prospective Register of Systematic Reviews [PROSPERO] registration: CRD42022364349). The PubMed, Scopus, the Excerpta Medica dataBASE (EMBASE), and the Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) databases were searched in September 2022. For comparative and non-comparative studies, incidence estimates and odds ratios (ORs), respectively, for the main variables regarding safety of vascular closure devices were pooled by using random effects meta-analyses. Quality assessment of the included comparative studies was conducted using the Risk Of Bias In Non-randomised Studies of Interventions (ROBINS-I) tool. RESULTS Of the 863 articles obtained, data were retrieved from 44 studies, which included 42 902 patients. In non-comparative studies, the pooled estimate rates for device failure, severe haemorrhage rate, conversion to open surgery, and mortality were similar for both clips and staplers. Regarding the meta-analyses for comparative studies (three studies), there were no significant differences between the two groups for the severe haemorrhage rate (OR 0.57, 95% confidence interval [CI] 0.18-1.75; P = 0.33), conversion to open surgery (OR 0.35, 95% CI 0.08-1.54; P = 0.16), or death rate (OR 3.64, 95% CI 0.47-28.45; P = 0.22). Based on weak evidence, device failure was lower in the polymer clip group (OR 0.41, 95% CI 0.23-0.75; P = 0.00). CONCLUSIONS This study has confirmed that there is no evidence for the superiority of any vascular closure device in terms of safety in LDN. Standardised recommendations for vascular control in this context should be carefully designed and prospectively evaluated.
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Affiliation(s)
- Francisco Javier Burgos Revilla
- Department of Urology, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), University of Alcalá, Madrid, Spain
- Board of the EAU Section of Transplantation Urology (ESTU), Coimbra, Portugal
| | - Alberto Artiles Medina
- Department of Urology, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), University of Alcalá, Madrid, Spain
| | - Ana Domínguez Gutiérrez
- Department of Urology, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), University of Alcalá, Madrid, Spain
| | - Alfonso Muriel García
- Clinical Biostatistics Unit, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), CIBERESP, University of Alcalá, Madrid, Spain
| | - Arnaldo Figueiredo
- Board of the EAU Section of Transplantation Urology (ESTU), Coimbra, Portugal
- Department of Urology and Kidney Transplantation, Centro Hospitalar e Universitário de Coimbra (CHUC), Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Victoria Gómez Dos Santos
- Department of Urology, Hospital Universitario Ramón y Cajal, Madrid, Spain
- Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), University of Alcalá, Madrid, Spain
- Board of the EAU Section of Transplantation Urology (ESTU), Coimbra, Portugal
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18
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Ierardi AM, Coppola A, Renzulli M, Piacentino F, Fontana F, Paladini A, Guzzardi G, Semeraro V, Di Stasi C, Giurazza F, Niola R, Stefanini M, Contegiacomo A, Carrubba C, Discalzi A, Ciferri F, Carriero S, Lanza C, Biondetti P, Coniglio G, Fonio P, Venturini M, Carrafiello G, Del Giudice C. Effectiveness and Safety of Different Vascular Closure Devices: Multicentre Prospective Observational study. Cardiovasc Intervent Radiol 2023; 46:827-834. [PMID: 37225968 PMCID: PMC10208551 DOI: 10.1007/s00270-023-03463-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 04/29/2023] [Indexed: 05/26/2023]
Abstract
AIM The aim of this prospective, multicentre, observational study was to compare the efficacy and safety of balloon-based and non-balloon-based vascular closure devices (VCDs). MATERIALS AND METHODS From March 2021 to May 2022, 2373 participants from 10 different centres were enrolled. Among them, 1672 patients with 5-7 Fr accesses were selected. Successful haemostasis, failure and safety were evaluated. Successful haemostasis was defined as the possibility to obtain complete haemostasis with the use of VCDs, without any complication. Failure management was defined as the need of manual compression. Safety was defined as the rate of complications. Cases of haematomas/pseudoaneurysms (PSA) and artero-venous fistula (AVF) were collected. RESULTS VCDs mechanism of action is statistically significant associated with the outcome. Non-balloon-based VCDs demonstrated a statistically significant better outcome: successful haemostasis was obtained in 96.5% vs. 85.9%, of cases when compared to balloon occluders (p < 0.001). The incidence of AVF was statistically more frequent using non-balloon occluders devices (1.57% vs 0%, p: 0.007). No significant statistical difference was found in comparing haematoma and PSA occurrence. Thrombocytopenia, coagulation deficit, BMI, diabetes mellitus and anti-coagulation were demonstrated to be independent predictors of failure management. CONCLUSION Our study suggests a better outcome with the same complication rate, except that for AVF incidence for non-balloon collagen plug device if compared to balloon occluders vascular closure devices.
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Affiliation(s)
- Anna Maria Ierardi
- UOC Radiologia, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy.
| | - Andrea Coppola
- UOC Radiologia Diagnostica ed Interventistica, ASST Settelaghi, Insubria University, Varese, Italy
| | - Matteo Renzulli
- Department of Radiology, IRCSS Azienda Ospedaliero-Universitaria di Bologna, 40138, Bologna, Italy
| | - Filippo Piacentino
- UOC Radiologia Diagnostica ed Interventistica, ASST Settelaghi, Insubria University, Varese, Italy
| | - Federico Fontana
- UOC Radiologia Diagnostica ed Interventistica, ASST Settelaghi, Insubria University, Varese, Italy
| | - Andrea Paladini
- U.O. Radiologia Interventistica-AOU "Maggiore della Carità", Università del Piemonte Orientale, Vercelli, Italy
| | - Giuseppe Guzzardi
- U.O. Radiologia Interventistica-AOU "Maggiore della Carità", Università del Piemonte Orientale, Vercelli, Italy
| | - Vittorio Semeraro
- SSD Radiologia Interventistica, POC SS Annunziata, ASL Taranto, Taranto, Italy
| | - Carmine Di Stasi
- SSD Radiologia Interventistica, POC SS Annunziata, ASL Taranto, Taranto, Italy
| | - Francesco Giurazza
- Vascular and Interventional Radiology Department, Cardarelli Hospital, Via Antonio Cardarelli 9, 80131, Naples, Italy
| | - Raffaella Niola
- Vascular and Interventional Radiology Department, Cardarelli Hospital, Via Antonio Cardarelli 9, 80131, Naples, Italy
| | - Matteo Stefanini
- UO Diagnostica per Immagini e Radiologia Interventistica, Policlinico Casilino, Rome, Italy
| | - Andrea Contegiacomo
- UOSA Radiologia d'Urgenza, Fondazione Policlinico Universitario "A Gemelli", IRCCS, Rome, Italy
| | - Claudio Carrubba
- UOSA Radiologia d'Urgenza, Fondazione Policlinico Universitario "A Gemelli", IRCCS, Rome, Italy
| | - Andrea Discalzi
- Department of Surgical Sciences; Radiology Unit, University of Torino, Via Genova 3, 10126, Turin, Italy
| | - Fernanda Ciferri
- Department of Surgical Sciences; Radiology Unit, University of Torino, Via Genova 3, 10126, Turin, Italy
| | - Serena Carriero
- Post-graduate School of Radiology, Università degli Studi di Milano, Milan, Italy
| | - Carolina Lanza
- Post-graduate School of Radiology, Università degli Studi di Milano, Milan, Italy
| | - Pierpaolo Biondetti
- UOC Radiologia, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy
| | - Giovanni Coniglio
- Radiologia diagnostica ed Interventistica, Azienda Ospedaliera per l'emergenza Cannizzaro-Catania, Catania, Italy
| | - Paolo Fonio
- Department of Surgical Sciences; Radiology Unit, University of Torino, Via Genova 3, 10126, Turin, Italy
| | - Massimo Venturini
- UOC Radiologia Diagnostica ed Interventistica, ASST Settelaghi, Insubria University, Varese, Italy
| | - Gianpaolo Carrafiello
- UOC Radiologia, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy
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19
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Merdler I, Bernardo NL, Ben-Dor I, Waksman R. Cutting balloon for femoral arterial and venus obstructions due to suture-based closure devices: Case series. Catheter Cardiovasc Interv 2023; 101:1235-1238. [PMID: 37061866 DOI: 10.1002/ccd.30668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 03/14/2023] [Accepted: 04/07/2023] [Indexed: 04/17/2023]
Abstract
Suture-based vascular closure devices have been shown to be effective in hemostasis for procedures with vascular access. However, iatrogenic vascular occlusion may occur. The cutting balloon (CB) is a noncompliant balloon wrapped with 3-4 microsurgical blades that are intended to modify vascular lesions, but it may also be utilized to cut and release endovascular sutures. We report two cases in which the CB was employed as a bailout strategy to alleviate suture-related vascular occlusion after transcatheter aortic valve replacement. The CB can be effectively utilized to resolve suture-related vascular occlusion.
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Affiliation(s)
- Ilan Merdler
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Nelson L Bernardo
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Itsik Ben-Dor
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
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20
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Dauerman H, Gupta T. A UNIVERSAL call for the optimisation of vascular closure devices. EUROINTERVENTION 2023; 19:15-17. [PMID: 37170565 PMCID: PMC10173750 DOI: 10.4244/eij-e-23-00016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Affiliation(s)
- Harold Dauerman
- Division of Cardiology, Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Tanush Gupta
- Division of Cardiology, Larner College of Medicine, University of Vermont, Burlington, VT, USA
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21
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Ma K, Kastengren M, Svenarud P, Green R, Dalén M. Routine use of percutaneous femoral cannulation in minimally invasive cardiac surgery. Eur J Cardiothorac Surg 2023; 63:7000339. [PMID: 36692172 DOI: 10.1093/ejcts/ezad020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 12/28/2022] [Accepted: 01/23/2023] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES Large series of percutaneous femoral access for extracorporeal circulation in minimally invasive cardiac surgery (MICS) are scarcely reported. METHODS This is a single-centre study describing the use of percutaneous femoral access in patients undergoing MICS via minithoracotomy. Femoral artery closure was performed with a plug-based closure device. To reduce the risk for vascular complications, intraoperative ultrasound assessment of correct deployment of the arterial closure device was done during the later period of the study. RESULTS During a 5-year period, 650 patients underwent percutaneous femoral cannulation and decannulation with device closure of the femoral artery puncture. Two hundred and seven patients (31.8%) were operated in the early phase of the experience (August 2017-August 2019), without the use of intraoperative ultrasound assessment of closure device deployment. During the later period of our experience (August 2019-September 2022), 443 patients (68.2%) were operated, of whom all underwent intraoperative ultrasound assessment of closure device deployment. Of the patients operated without intraoperative ultrasound assessment, 6 patients (2.9%) experienced vascular complications compared with none of the patients in whom intraoperative ultrasound-assessment was used (P < 0.001). In total, 15 patients (2.3%) underwent conversion to surgical cutdown owing to incomplete haemostasis or femoral artery stenosis/occlusion and the mechanism was intravascular deployment of the closure device in all 15 cases. CONCLUSIONS Percutaneous femoral access in MICS is safe and the need for surgical cutdown was infrequent. The risk for vascular complications is minimized with the use of intraoperative ultrasound assessment of the correct positioning of the vascular closure device. CLINICAL TRIAL REGISTRATION NUMBER http://www.clinicaltrials.gov; Unique identifier: NCT05462769.
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Affiliation(s)
- Kristina Ma
- Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Mikael Kastengren
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Peter Svenarud
- Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Ram Green
- Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Magnus Dalén
- Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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22
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Wu W, Chen H, Chen T. Evaluation of Cardiac Function Characteristics after Patent Ductus Arteriosus Closure in Children and Adults by Echocardiographic Data. Comput Math Methods Med 2022; 2022:1310841. [PMID: 35126616 PMCID: PMC8816572 DOI: 10.1155/2022/1310841] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 12/19/2021] [Accepted: 12/31/2021] [Indexed: 11/17/2022]
Abstract
This study was to investigate the value of echocardiographic data in assessing changes in cardiac function before and after transcatheter closure in children and adult patients with patent ductus arteriosus (PDA). In this study, 150 patients with isolated PDA treated by cardiac catheterization and transcatheter closure were selected as the study sample. Real-time color Doppler echocardiography was used both after and after operation. The results showed that the left ventricle returned to normal in 75 patients one day after operation, with an average age of 10.95 ± 3.27 years; the left ventricle did not return to normal in 10 patients 360 days after operation, with an average age of 64.31 ± 7.05 years. Left ventricular end diastolic volume index (LVEDVI) and left ventricular end systolic volume index (LVESVI) of patients decreased significantly one day after operation and remained at 51.95 ± 9.55 mL/m2 and 20.36 ± 8.11 mL/m-2, respectively. In summary, echocardiographic data have a high reference value in assessing cardiac function characteristics in children and adult patients with PDA and are worthy of further promotion.
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Affiliation(s)
- Wenhai Wu
- Cardiac Color Doppler Ultrasound Room, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, 362000 Fujian, China
| | - Hongwei Chen
- Cardiac Surgery, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, 362000 Fujian, China
| | - Tianbao Chen
- Department of Internal Medicine-Cardiovascular, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou, 362000 Fujian, China
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23
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Tewari S. Randomized Trial Suggests Potential Benefits of Polymer Over Suture-Based Vascular Closure. Cardiovasc Intervent Radiol 2021; 44:1893-1894. [PMID: 34647151 DOI: 10.1007/s00270-021-02979-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 09/16/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Sanjit Tewari
- Division of Diagnostic Imaging - Department of Nuclear Medicine, The University of Texas MD Anderson Cancer Center, TX, Houston, USA.
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24
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Mayer K, Gewalt S, Morath T, Emmer C, Hilz R, Linhardt M, Hoppe K, Schmidt R, Bott-Flügel L, Laugwitz KL, Schunkert H, Kastrati A, Schüpke S, Sarafoff N. Comparison of Vascular Closure Devices vs Manual Compression After Femoral Artery Puncture in Patients on Oral Anticoagulation - Post Hoc Analysis of the ISAR-CLOSURE Trial. J Invasive Cardiol 2021; 33:E709-E715. [PMID: 34170841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVES To compare vascular closure devices (VCD) with manual compression (MC) in patients on chronic oral anticoagulation (OAC) who undergo diagnostic coronary angiography in terms of vascular access-site complications. METHODS This is a subanalysis of 604 patients that had undergone transfemoral diagnostic coronary angiography and were randomly assigned to arteriotomy closure with either VCDs (intravascular FemoSeal VCD or extravascular EXOSEAL VCD) or MC within the large scale, randomized ISAR-CLOSURE trial. Primary endpoint was the composite of access-site-related vascular complications at 30 days. Secondary endpoints were time to hemostasis and repeat MC. RESULTS Vascular access-site complications were similar in patients assigned to VCDs compared to MC (8.2% vs 10.6%; P=.33). There was no interaction of treatment effect and OAC (P interaction = 0.59). Rates of pseudoaneurysms were lower with VCDs (0.8% vs 3.2%; P=.02). Time to hemostasis was significantly shortened with VCDs compared to MC (1 [IQR 0.5-2.0] min vs 12 [IQR 10-15] min; P<.001). There was no difference regarding repeat MC in both groups (VCD 1.5% vs MC 0.5%; P=.23). Time to hemostasis (0.5 [0.2-1.0] min, vs 2.0 [1.75-2.0] min; P<.001) and closure device failure (3.7% vs 17.2%; P<.001) were lower with the intravascular VCD, compared with the extravascular VCD. CONCLUSIONS In patients on chronic OAC undergoing transfemoral diagnostic coronary angiography, the use of VCDs was comparable to MC regarding the primary combined endpoint of vascular access-site related complications. VCDs reduced the occurrence of pseudoaneurysms and time to hemostasis.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Nikolaus Sarafoff
- Klinik fuer Herz- und Kreislauferkrankungen, Deutsches Herzzentrum Muenchen, Lazarettstr. 36, 80363 Muenchen, Germany.
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25
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Kuno T, Claessen BE, Guedeney P, Serruys PW, Sabik JF, Simonton CA, Kandzari DE, Morice MC, Zhang Z, Dressler O, Mehran R, Ben-Yehuda O, Kappetein AP, Stone GW. Outcomes of Vascular Closure Device Use After Transfemoral Coronary Intervention: Insights From the EXCEL Trial. J Invasive Cardiol 2021; 33:E619-E627. [PMID: 34170842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVES To assess the safety and efficacy of using vascular closure devices (VCDs) in percutaneous coronary intervention (PCI) for left main coronary artery disease (LM-CAD). BACKGROUND VCDs provide rapid hemostasis for patients undergoing PCI with transfemoral access (TFA); however, the safety and efficacy of VCDs continues to be debated. METHODS We analyzed data from the EXCEL trial in patients with LM-CAD in whom PCI was performed via TFA with vs without VCD. The primary endpoint was a composite of death, myocardial infarction (MI), or stroke. Bleeding Academic Research Consortium (BARC) type 2-5 bleeding at 30 days was also assessed. Propensity-score matching analysis was used. RESULTS Among 694 patients with LM-CAD undergoing TFA-PCI, 423 (61.0%) received VCDs (collagen plug, 320 [75.7%]; suture mediated, 55 [13.0%]; others, 48 [11.3%]). Patients with and without VCD use had similar 30-day rates of BARC type 2-5 bleeding (5.0% vs 6.7%, respectively; P=.30) and BARC type 3-5 bleeding (2.1% vs 3.7%, respectively; P=.20). There were no significant differences in the rates of death, MI, or stroke in patients with and without VCD use at 30 days (4.7% vs 4.1%, respectively; P=.74) or at 5 years (20.3% vs 24.2%, respectively; P=.16). These results were similar after adjustment. CONCLUSION In the EXCEL trial, LM-CAD PCI via TFA using VCD was associated with similar 30-day rates of bleeding and comparable early and late major adverse cardiovascular events compared with manual compression.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Gregg W Stone
- Mount Sinai Medical Center, Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, NY 10019 USA.
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26
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Junquera L, Urena M, Muñoz-Garcia A, Nombela-Franco L, Faurie B, Veiga-Fernandez G, Alperi A, Serra V, Fischer Q, Himbert D, Muñoz-García E, Vera-Urquiza R, Jiménez-Quevedo P, de la Torre Hernandez JM, Pascual I, Garcia Del Blanco B, Mohammadi S, Faroux L, Couture T, Côté M, Rodés-Cabau J. Secondary Femoral Access Hemostasis During Transcatheter Aortic Valve Replacement: Impact of Vascular Closure Devices. J Invasive Cardiol 2021; 33:E604-E613. [PMID: 34338651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Vascular and bleeding complications related to secondary femoral access site are frequent in patients undergoing transcatheter aortic valve replacement (TAVR), and their occurrence is associated to poorer outcomes. We aimed to evaluate the clinical impact of vascular closure devices (VCDs) for secondary femoral access hemostasis in TAVR procedures. METHODS This was a multicenter study including 4031 patients who underwent TAVR (mean age, 81 ± 8 years; mean Society of Thoracic Surgeons [STS] score, 4.9 [interquartile range, 3.3-7.6]), and had a secondary femoral access. The 30-day clinical outcomes were analyzed according to femoral access-site hemostasis (manual compression vs VCD), and according to the type of VCD (Perclose [Abbott Cardiovascular] vs Angio-Seal [Terumo Interventional Systems]) using a propensity-matched, multivariable, logistic regression model. RESULTS Manual compression was used in 941 patients (23.3%) and VCDs were used in 3090 patients (76.7%; Perclose in 1549 patients [38.4%] and Angio-Seal in 1541 patients [38.2%]) for secondary femoral access hemostasis. Vascular complications related to secondary access site occurred in 162 patients (4%), and were more frequent in patients who underwent manual compression (7.2%) compared with VCD hemostasis (3%; adjusted P<.001). In the VCD group, the use of Angio-Seal (vs Perclose) was associated with a higher rate of vascular complications (3.7% vs 2.4%, respectively; adjusted P=.02), femoral artery pseudoaneurysm (1.3% vs 0.4%, respectively; adjusted P<.01), invasive treatment requirement for treating vascular complications (surgery: 0.8% vs 0.3%, respectively [adjusted P=.03]; and thrombin injection: 0.9% vs 0%, respectively [adjusted P<.001]). CONCLUSION VCDs represented a safer and more effective alternative compared with manual compression for secondary femoral access-site hemostasis in patients undergoing TAVR procedures, and the Perclose VCD was associated with the lowest risk of vascular complications. Future randomized studies are warranted.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Josep Rodés-Cabau
- Quebec Heart and Lung Institute, Laval University, 2725 Ch Ste-Foy, Québec, QC G1V 4G5, Canada.
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27
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Lichaa H, Wollmuth J, Tayal R. Dry Field Closure of Large-Bore Access With Iliac Artery Angioplasty Through the Ipsilateral Sheath: The Single-Access Dry-Closure Technique. J Invasive Cardiol 2021; 33:E516-E521. [PMID: 34224380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The use of large-bore sheaths has risen exponentially in the last decade partly due to the growth of structural heart interventions and various mechanical circulatory support options. Meanwhile, the interventional community has gradually shifted from an open surgical to endovascular closure. However, vascular access complications and bleeding still remain a significant risk. Various techniques involving an additional access site have been described to allow for endovascular bailout of potential complications. However, these by themselves create an additional burden to procedural morbidity. Furthermore, the weight of additional procedural time, contrast, radiation and the need for advanced peripheral endovascular skills constitute considerable downsides to the "second arterial access" strategy. For that reason, we propose an alternative strategy, the "single-access dry-closure" technique, which provides vascular access control without the additional burden and risk of a second arterial access. This involves the use of low-pressure iliac artery occlusive angioplasty, delivered through the ipsilateral sheath during the endovascular closure. We hereby describe the steps, advantages and disadvantages of this novel technique. We also include the description of multiple technical variations depending on the use of one or two preclosed Proglide devices. This novel approach seems to be a safe, effective, simple, fast and economical technique that has the potential to decrease procedural morbidity by avoiding an additional arterial access. It also lowers contrast volume and radiation exposure while improving the overall set-up and operator ergonomics.
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Affiliation(s)
| | | | - Rajiv Tayal
- New York Medical College, 1200 East Ridgewood Avenue, West Wing, Suite 301, Ridgewood, NJ 07450 USA.
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28
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Megaly M, Sedhom R, Abdelmaseeh P, ElBebawy B, Goel SS, Karam J, Pershad A, Brilakis ES, Garcia S. Complications of the MANTA closure device. Insights from MAUDE database. Cardiovasc Revasc Med 2021; 34:75-79. [PMID: 33612411 DOI: 10.1016/j.carrev.2021.02.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 02/06/2021] [Accepted: 02/10/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND The collagen-based MANTA device (Teleflex, PA, USA) is used for closure of large-bore vascular access. There is a paucity of data on complications associated with its use in a real-life setting. METHODS We queried the "Manufacturer and User Facility Device Experience" MAUDE database between February 2019 and December 2020 for reports on MANTA device. RESULTS We identified 250 reports in the MAUDE database from February 2019 through December 2020. The most common failure complication of MANTA is persistent bleeding (48.8%) and vessel occlusion or stenosis (29.6%). Most complications were managed successfully with an endovascular approach (48.4%), but a high number of patients required surgical intervention (40.4%). The most commonly reported failure mechanism was the failure of deployment (22%) followed by subcutaneous deployment (7.6%), intraluminal deployment (4.8%) amd detachment of collagen (2.8%). Access site infection was rare (1.2%). The 18 Fr. MANTA was associated with a lower risk of failure of deployment compared with the 14 Fr. device but was associated with a higher risk of vessel occlusion or stenosis (32.4% vs. 16.3%, p = 0.04) and thrombosis (11.6% vs 0%, p = 0.03). CONCLUSIONS The most common complication of the MANTA device reported to the MAUDE registry was persistent bleeding (48.8% of reports) followed by vessel occlusion (29.6%). These complications were managed successfully using an endovascular approach in 48.4% of the reports.
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Affiliation(s)
- Michael Megaly
- Division of Cardiology, Banner University Medical Center, University of Arizona, Phoenix, AZ, USA
| | - Ramy Sedhom
- Department of Medicine, Albert Einstein Medical Center, Philadelphia, PA, USA
| | - Peter Abdelmaseeh
- Department of Medicine, Albert Einstein Medical Center, Philadelphia, PA, USA
| | - Bishoy ElBebawy
- Division of Cardiology, Arnot Ogden Medical Center- Lake Erie College of Medicine, Elmira, NY, USA
| | - Sachin S Goel
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Joseph Karam
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Ashish Pershad
- Division of Cardiology, Banner University Medical Center, University of Arizona, Phoenix, AZ, USA
| | | | - Santiago Garcia
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA.
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29
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Sinclair N, Mordhorst A, Yang GK, MacDonald PS, Sidhu R, Reid JDS. Vascular Access Complications and Clinical Outcomes of Vascular Surgical Repairs Following Transcatheter Aortic Valve Implantation (TAVI). Ann Vasc Surg 2021; 74:258-263. [PMID: 33549772 DOI: 10.1016/j.avsg.2020.12.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 12/08/2020] [Accepted: 12/12/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) procedures have revolutionized the treatment of aortic stenosis. However, due to large sheaths, improperly deployed closure devices, and the comorbidities and challenges innate to this population, vascular access complications can be devastating. The objective of this study is to evaluate vascular access complications in one of the largest TAVI sites in North America. METHODS This was a retrospective single center review between January 2014 and December 2018 of vascular access complications necessitating operative intervention by vascular surgery. Patient demographics and preoperative comorbidities were collected. Type of vascular access complication, types of repair, closure device used, and postoperative outcomes were analyzed. RESULTS A total of 37 cases out of a total of 985 TAVI procedures were identified. TAVI was carried out in the operating suite (70%) or the catheterization lab (30%). Consults to vascular surgery were requested intraoperatively (60%), immediately postoperative (14%), later in the day of the TAVI (20%), and on postoperative day 1 (6%). The location of injury included common femoral artery (49%), superficial femoral artery (11%) and external iliac artery (41%), with some cases injuring multiple vessels. Closure devices were found in the subcutaneous tissue (26%), anterior wall (37%), posterior wall (11%), intra-arterial (11%), closing the anterior to the posterior wall (16%), and in the inguinal ligament (5%). Injuries included tears (11%), dissections (38%), and vessel rupture (19%). The majority of repairs were done primarily (64%), with patch (28%) and bypass (8%) less frequently. Four patients died perioperatively (11%), 2 from hemorrhage, 1 from cardiac arrest, and 1 from progressive respiratory disease. CONCLUSIONS Access complications during TAVI procedures predispose complex patients to increased risk of morbidity and mortality. Careful patient selection, proper access techniques, and performing high risk patients in the operating suite with vascular surgery are fundamental in minimizing complications.
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Affiliation(s)
- Nicholas Sinclair
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Alexa Mordhorst
- Division of Vascular Surgery, University of British Columbia, Vancouver, BC, Canada.
| | - Gary K Yang
- Division of Vascular Surgery, University of British Columbia, Vancouver, BC, Canada
| | - P Shaun MacDonald
- Division of Vascular Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Ravi Sidhu
- Division of Vascular Surgery, University of British Columbia, Vancouver, BC, Canada
| | - John D S Reid
- Division of Vascular Surgery, University of British Columbia, Vancouver, BC, Canada
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30
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Reifart J, Liebetrau C, Weferling M, Dörr O, Renker M, Bhumimuang K, Liakopoulos O, Choi YH, Nef H, Hamm CW, Kim WK. Single versus double use of a suture-based closure device for transfemoral aortic valve implantation. Int J Cardiol 2021; 331:183-188. [PMID: 33529662 DOI: 10.1016/j.ijcard.2021.01.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 01/11/2021] [Accepted: 01/22/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND The most common method of percutaneous closure in transfemoral transcatheter aortic valve implantation (TAVI) employs two obtusely oriented ProGlide devices. The aim of this study was to assess the feasibility and safety of using a single ProGlide system for primary access site closure in comparison with the double ProGlide approach in an all-comers TAVI population. METHODS Between March 2016 and December 2018, a total of 1105 patients underwent transfemoral TAVI for severe aortic stenosis at our center. Application of two ProGlide systems was standard until April 2017 (n = 432), whereas thereafter a single ProGlide system was used (n = 663). A 1:1 propensity score matching was performed to adjust for baseline differences between the two groups, resulting in 327 matched cases. Primary outcomes of interest were main access site-related vascular complications. RESULTS The mean number of ProGlide devices used per patient was 1.03 (SD 0.2) in the single-ProGlide group versus 2.01 (SD 0.14) in the double-ProGlide group. An additional vascular closure device was required to obtain full hemostasis in 23.2% versus 9.5% of patients (p < 0.001) in the two groups, respectively. Technical success of ProGlide usage was similar (94.3% versus 92.1%, p = 0.163). In the matched cohorts, the rates of main access site-related major vascular complications were similar (4.0% vs. 6.4%, p = 0.217). CONCLUSION The single-ProGlide technique is feasible, with rates of technical success similar to those of the double-ProGlide technique. Use of this method did not lead to more frequent access site-related complications but was more cost effective than the double-ProGlide approach.
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Affiliation(s)
- Joerg Reifart
- Kerckhoff Heart Center, Department of Cardiology, Bad Nauheim, Germany; DZHK (German Center for Cardiovascular Research), Partner Site RheinMain, Frankfurt am Main, Germany.
| | - Christoph Liebetrau
- Kerckhoff Heart Center, Department of Cardiology, Bad Nauheim, Germany; DZHK (German Center for Cardiovascular Research), Partner Site RheinMain, Frankfurt am Main, Germany
| | - Maren Weferling
- Kerckhoff Heart Center, Department of Cardiology, Bad Nauheim, Germany; DZHK (German Center for Cardiovascular Research), Partner Site RheinMain, Frankfurt am Main, Germany
| | - Oliver Dörr
- Justus-Liebig University of Giessen, Department of Cardiology, Giessen, Germany
| | - Matthias Renker
- Kerckhoff Heart Center, Department of Cardiology, Bad Nauheim, Germany; DZHK (German Center for Cardiovascular Research), Partner Site RheinMain, Frankfurt am Main, Germany
| | - Kid Bhumimuang
- Kerckhoff Heart Center, Department of Cardiology, Bad Nauheim, Germany
| | - Oliver Liakopoulos
- Kerckhoff Heart Center, Department of Cardiac Surgery, Bad Nauheim, Germany
| | - Yeong-Hoon Choi
- Kerckhoff Heart Center, Department of Cardiac Surgery, Bad Nauheim, Germany
| | - Holger Nef
- Justus-Liebig University of Giessen, Department of Cardiology, Giessen, Germany
| | - Christian W Hamm
- Kerckhoff Heart Center, Department of Cardiology, Bad Nauheim, Germany; DZHK (German Center for Cardiovascular Research), Partner Site RheinMain, Frankfurt am Main, Germany; Justus-Liebig University of Giessen, Department of Cardiology, Giessen, Germany
| | - Won-Keun Kim
- Kerckhoff Heart Center, Department of Cardiology, Bad Nauheim, Germany; DZHK (German Center for Cardiovascular Research), Partner Site RheinMain, Frankfurt am Main, Germany; Kerckhoff Heart Center, Department of Cardiac Surgery, Bad Nauheim, Germany; Justus-Liebig University of Giessen, Department of Cardiology, Giessen, Germany
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31
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Halna du Fretay X, Aubry P, Cavillon A, Moisei R. [Vascular access-site infections in percutaneous cardiac interventions: A significant risk?]. Ann Cardiol Angeiol (Paris) 2020; 69:380-384. [PMID: 33069382 DOI: 10.1016/j.ancard.2020.09.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 09/23/2020] [Indexed: 06/11/2023]
Abstract
Vascular access site infections are infrequent and rarely reported as a potential complication of percutaneous cardiac intervention. A case of access site infection is reported with a literature review. Femoral access is mainly concerned in some circumstances: delayed sheath withdrawal, vascular complications (hematoma, false-aneurysm, arteriovenous fistula), or use of hemostatic closure device. These infectious complications are always serious requiring medical and surgical treatment and potentially associated with life-threatening complications. Preventive measures should be applied in order to reduce the risks: optimisation of femoral punctures with the support of echography guidance, avoid a new puncture in a area with hematoma, femoral angiographic evaluation and strict aseptic precautions with vascular closure devices, and obviously preferential choice of radial access.
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Affiliation(s)
- X Halna du Fretay
- Cardioreliance, pole Santé Oreliance, 559, avenue Jacqueline-Auriol 45770 Saran, France.
| | - P Aubry
- Service de cardiologie, centre hospitalier de Gonesse, 95500 Gonesse, France
| | - A Cavillon
- Chirurgie vasculaire, pole Santé Oreliance, 45700 Saran, France
| | - R Moisei
- Cardioreliance, pole Santé Oreliance, 559, avenue Jacqueline-Auriol 45770 Saran, France
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32
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Mohanty S, Trivedi C, Beheiry S, Al-Ahmad A, Horton R, Della Rocca DG, Gianni C, Gasperetti A, Abdul-Moheeth M, Turakhia M, Natale A. Venous access-site closure with vascular closure device vs. manual compression in patients undergoing catheter ablation or left atrial appendage occlusion under uninterrupted anticoagulation: a multicentre experience on efficacy and complications. Europace 2020; 21:1048-1054. [PMID: 30726903 DOI: 10.1093/europace/euz004] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 01/14/2019] [Indexed: 12/25/2022] Open
Abstract
AIMS Manual compression (MC), widely used to achieve venous access haemostasis, needs prolonged immobilization and extended time-to-haemostasis. Vascular closure devices (VCD) have been reported to have significantly shorter time to haemostasis and ambulation in arterial access-site management. The current study aimed to evaluate the safety and efficacy as well as rate of urinary tract complications in patients receiving MC vs. VCD for venous access-site closure. METHODS AND RESULTS A total of 803 consecutive patients undergoing catheter ablation or left atrial appendage closure were classified into the VCD (n = 304) and the MC (n = 499) group, based on the methods used for haemostasis at the venous access site. Foley catheter was used for bladder-emptying in all MC cases and 15 VCD patients. At one site, VCD group patients with experience of MC in prior ablations were asked to describe their overall satisfaction level after comparing the past experience with the present. Haemostasis was achieved effectively in both populations. No VCD cases required >2 h bed rest, whereas 7 (1.4%) patients in the MC group needed prolonged immobilization (P = 0.04). Significantly higher incidence of access-site haematoma (P = 0.004) and urinary complications (P < 0.05) were observed in the MC group. Majority of VCD patients (68%) with prior experience of MC for haemostasis expressed satisfaction over the early ambulation and ability to void urine without bladder catheterization. CONCLUSION Vascular closure devices provided effective haemostasis, while reducing the access-site complications, ambulation time, and urinary complications.
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Affiliation(s)
- Sanghamitra Mohanty
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. I-35, Suite 720, Austin, TX, USA
- Department of Internal Medicine, Dell Medical School, University of Texas, Austin, TX, USA
| | - Chintan Trivedi
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. I-35, Suite 720, Austin, TX, USA
| | - Salwa Beheiry
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. I-35, Suite 720, Austin, TX, USA
| | - Amin Al-Ahmad
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. I-35, Suite 720, Austin, TX, USA
| | - Rodney Horton
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. I-35, Suite 720, Austin, TX, USA
| | - Domenico G Della Rocca
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. I-35, Suite 720, Austin, TX, USA
| | - Carola Gianni
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. I-35, Suite 720, Austin, TX, USA
| | | | | | - Mintu Turakhia
- Division of Cardiology, Stanford University, Palo Alto, CA, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, 3000 N. I-35, Suite 720, Austin, TX, USA
- Department of Internal Medicine, Dell Medical School, University of Texas, Austin, TX, USA
- Division of Cardiology, Stanford University, Palo Alto, CA, USA
- Case Western Reserve University, Cleveland, OH, USA
- Interventional Electrophysiology, Scripps Clinic, San Diego, CA, USA
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33
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Nakamura T. Unexpected EXOSEAL deployment into the vascular wall. Cardiovasc Interv Ther 2020; 36:547-548. [PMID: 33119837 DOI: 10.1007/s12928-020-00721-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 10/12/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Takuji Nakamura
- Department of Cardiology, Horikawa Hospital, 865 Kitafunahashi-Cho, Kamigyo-Ku, Kyoto, 602-0056, Japan.
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34
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Beraldo de Andrade P, de Ribamar Costa J, Rinaldi FS, de Castro Bienert IR, Barbosa RA, Esteves V, Tebet M, Zukowski C, Maia F, Piva E Mattos LA, Labrunie A, Abizaid A, Sousa AR. Vascular Closure Devices Attenuate Femoral Access Complications of Primary Percutaneous Coronary Intervention. J Invasive Cardiol 2020; 32:364-370. [PMID: 32999089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To compare severe complications related to radial access and those related to femoral access using vascular closure devices for patients undergoing primary percutaneous coronary intervention (PCI). BACKGROUND Femoral artery access is still used for acute myocardial infarction management; studies comparing state-of-the-art radial and femoral techniques are required to minimize bias regarding the outcomes associated with operator preferences. METHODS We performed a randomized study comparing radial access with a compression device and anatomic landmark-guided femoral access with a hemostatic vascular closure device. The severe complication rates related to the access site were assessed until hospital discharge. A meta- analysis including studies with comparable populations reporting severe bleeding and major adverse cardiovascular event rates was performed. RESULTS A total of 250 patients were included who underwent PCI between January 2016 and February 2019. Mean age was 61.5 ± 12.2 years, 73.2% were men, and 28.4% had diabetes. There were no differences between groups or in vascular access-related severe complication rates (8.0% for femoral group vs 5.6% for radial group; P=.45). Although radial access was associated with decreased vascular complications related to the access site when compared with the femoral approach (relative risk [RR], 0.64; 95% confidence interval [CI], 0.43-0.95), the meta-analysis did not show an impact on severe bleeding (RR, 0.74; 95% CI, 0.37-1.46) or severe cardiovascular adverse events (RR, 0.69; 95% CI, 0.30-1.58). CONCLUSIONS Compliance with femoral artery puncture techniques and routine use of a vascular closure device promoted low severe complication rates.
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35
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Ginn-Hedman A, Jessen SL, Friedemann MC, Nichols RM, Maitland DJ, Clubb FJ. Correlation of light microscopic findings with transmission electron microscopy within a vascular occlusion device. Cardiovasc Pathol 2020; 50:107288. [PMID: 32931920 DOI: 10.1016/j.carpath.2020.107288] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 09/08/2020] [Accepted: 09/09/2020] [Indexed: 11/30/2022] Open
Abstract
Host response to an implanted biomaterial is a complex process involving microscopic changes in extracellular matrix (ECM) composition. Reliable pathology analysis is imperative for accurate assessment of the tissue response to an implanted device. Plastic histology is commonly used for histology evaluation of medical devices to assess the device-tissue interface; however, this technique is prone to variable staining that can confound histology interpretation. Appropriately, we propose using transmission electron microscopy (TEM) to confirm histologic ECM findings in order to provide sufficient host-response data. Tissue response to an absorbable shape memory polymer intravascular occlusion device with a nitinol wire backbone was evaluated. Representative plastic-embedded, micro-ground sections from 30-day, 60-day, and 90-day timepoints were analyzed. ECM regions were selected, and ultrathin sections were created for TEM evaluation. Histological changes in ECM composition were compared for light microscopy (LM) and TEM findings; specifically, TEM fibrillary patterns for collagen and fibrin were used to confirm LM results. Throughout this study, LM reveals inconsistent staining in plastic-embedded sections. TEM, on the other hand, provides clear insight into the tissue response by morphologically discerning distinct fibrillary patterns within ECM structures; loose to dense collagen surrounds the implant as fibrin degrades, demonstrating progression of postimplant ECM maturation. Moreover, TEM serves as a definitive method for confirming tissue substrate morphology when LM findings prove ambiguous.
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Affiliation(s)
- A Ginn-Hedman
- Department of Biomedical Engineering, Texas A&M University, College Station, TX, United States
| | - S L Jessen
- Department of Biomedical Engineering, Texas A&M University, College Station, TX, United States; Department of Veterinary Pathobiology, Texas A&M University, College Station, TX, United States
| | - M C Friedemann
- Department of Veterinary Pathobiology, Texas A&M University, College Station, TX, United States
| | - R M Nichols
- Cardiovascular Pathology Laboratory, Texas Heart Institute, Houston, TX, United States
| | - D J Maitland
- Department of Biomedical Engineering, Texas A&M University, College Station, TX, United States; Shape Memory Medical Inc., Santa Clara, CA, United States
| | - F J Clubb
- Department of Biomedical Engineering, Texas A&M University, College Station, TX, United States; Department of Veterinary Pathobiology, Texas A&M University, College Station, TX, United States.
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36
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Çelik Ö, Şahin AA, Güner A, Demir AR, Uzun N, Ertürk M. Clinical efficacy and safety of the PRO-glide device as a sUture-mediated ClosurE in Thoracic EndoVascular Aortic Repair in patients with previous groin intervention (from the PRODUCE-TEVAR Trial). Vascular 2020; 29:237-243. [PMID: 32829695 DOI: 10.1177/1708538120949669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND While the percutaneous approach is increasingly preferred, suture-mediated closure devices have been put into clinical practice to close the femoral artery during procedures requiring a large-sized introducer. However, scar in the groin is considered a contraindication or an exclusion criterion for percutaneous procedures. The aim of our study was to investigate the outcomes and safety of Pro-Glide device as suture-mediated closure device in patients who underwent thoracic endovascular aortic repair with percutaneous femoral access ≥22 F who had previous groin intervention. METHODS A total of 73 patients who underwent endovascular repair with percutaneous femoral access were retrospectively included in the study. Previous groin intervention was defined as history of open surgical access or large sheath insertion (>18 F) to femoral artery because of endovascular or valvular intervention. Patients were divided into two groups as who had previous groin intervention PGI (+) and had not PGI (-). RESULTS A total of 73 patients [60 male (82.2%)] were included in the study. Seventeen patients had PGI, and 56 did not. When groups were compared in terms of sheath sizes, a significantly higher sheath sizes were used in PGI (+) patients (24.5 ± 1.1 F vs. 23.8 ± 0.9 F, p = 0.005). The overall success rate in the femoral approach with pre-close technique was statistically insignificant between two groups (94.1% vs. 96.4%, p = 0.55). One patient in PGI (+) group and two patients in PGI (-) had technical failure for percutaneous femoral approach. One patient (5.9%) in PGI (+) group and one patient (1.8%) in PGI (-) group had femoral complications after the procedures; however, there was no significant difference between the groups in terms of complications (5.9% vs. 1.8%, p = 0.13). CONCLUSION Pro-Glide device may be a safe and less invasive method for femoral access in patients with PGI and might not be considered as a contraindication for patients with history of PGI.
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Affiliation(s)
- Ömer Çelik
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Anıl Şahin
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Güner
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ali Rıza Demir
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Nedim Uzun
- Department of Emergency Medicine, Gaziosmanpasa Taksim Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Ertürk
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
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37
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Nagarajarao HS, Ojha CP, Kedar A, Mukherjee D. Patent Foramen Ovale, the Role of Antiplatelet Therapy Alone or Anticoagulant Therapy Alone Versus Device Closure for Cryptogenic Stroke: A Review of the Literature and Current Recommendations. Cardiovasc Hematol Agents Med Chem 2020; 18:135-150. [PMID: 32013839 DOI: 10.2174/1871525718666200203111641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 11/22/2019] [Accepted: 01/16/2020] [Indexed: 06/10/2023]
Abstract
Cryptogenic stroke and its relation to the Patent Foramen Ovale (PFO) is a long-debated topic. Recent clinical trials have unequivocally established the relationship between cryptogenic strokes and paradoxical embolism across the PFO. This slit-like communication exists in everyone before birth, but most often closes shortly after birth. PFO may persist as a narrow channel of communication between the right and left atria in approximately 25-27% of adults. In this review, we examine the clinical relevance of the PFO with analysis of the latest trials evaluating catheter-based closure of PFO's for cryptogenic stroke. We also review the current evidence examining the use of antiplatelet medications versus anticoagulants for stroke prevention in those patients with PFO who do not qualify for closure per current guidelines.
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Affiliation(s)
- Harsha S Nagarajarao
- Department of Medicine, Texas Tech University of Health Sciences, El Paso, TX, United States
| | - Chandra P Ojha
- Department of Medicine, Texas Tech University of Health Sciences, El Paso, TX, United States
| | - Archana Kedar
- Department of Medicine, Clinical Instructor, University of Louisville, Kentucky, Louisville, Kentucky, United States
| | - Debabrata Mukherjee
- Department of Medicine, Texas Tech University of Health Sciences, El Paso, TX, United States
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38
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Giordano A, Corcione N, Ferraro P, Morello A, Conte S, Testa L, Iadanza A, Sardella G, Mancone M, Berti S, Petronio AS, Romagnoli E, Pepe M, Frati G, Biondi-Zoccai G. Comparison of ProGlide vs. Prostar in patients undergoing transcatheter aortic valve implantation. Minerva Cardioangiol 2019; 67:443-449. [PMID: 31670491 DOI: 10.23736/s0026-4725.19.05071-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Arturo Giordano
- Unit of Cardiovascular Interventional Medicine, Pineta Grande Hospital, Castel Volturno, Caserta, Italy
| | - Nicola Corcione
- Unit of Cardiovascular Interventional Medicine, Pineta Grande Hospital, Castel Volturno, Caserta, Italy
| | - Paolo Ferraro
- Unit of Hemodynamics, Santa Lucia Hospital, San Giuseppe Vesuviano, Naples, Italy
| | - Alberto Morello
- Unit of Cardiovascular Interventional Medicine, Pineta Grande Hospital, Castel Volturno, Caserta, Italy
| | - Sirio Conte
- Unit of Hemodynamics, Santa Lucia Hospital, San Giuseppe Vesuviano, Naples, Italy
| | - Luca Testa
- Department of Cardiology, San Donato Polyclinic IRCCS, San Donato Milanese, Milan, Italy
| | - Alessandro Iadanza
- Unit of Hemodynamics, Department of Cardiac, Thoracic and Vascular Sciences, Santa Maria alle Scotte Polyclinic, Siena, Italy
| | - Gennaro Sardella
- Department of Cardiovascular, Respiratory, Nephrological, Anaesthetic and Geriatric Sciences, Umberto I Polyclinic, Sapienza University, Rome, Italy
| | - Massimo Mancone
- Department of Cardiovascular, Respiratory, Nephrological, Anaesthetic and Geriatric Sciences, Umberto I Polyclinic, Sapienza University, Rome, Italy
| | - Sergio Berti
- G. Monasterio C.N.R. Foundation, Ospedale del Cuore, Massa, Italy
| | - Anna S Petronio
- Department of Cardiology, AOUP Cisanello, University Hospital of Pisa, Pisa, Italy
| | - Enrico Romagnoli
- Institute of Cardiology, A. Gemelli University Polyclinic, IRCCS and Foundation, Sacred Heart Catholic University, Rome, Italy
| | - Martino Pepe
- Division of Cardiology, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Giacomo Frati
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy
- IRCCS NEUROMED, Pozzili, Isernia, Italy
| | - Giuseppe Biondi-Zoccai
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy -
- Mediterranea Cardiocentro, Naples, Italy
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39
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Bates KM, Chaudhuri A. Retrograde Femoral Arterial Endoprosthesis Insertion for Access Site Haemorrhage After Percutaneous Endovascular Aneurysm Repair. Eur J Vasc Endovasc Surg 2019; 58:689. [PMID: 31631007 DOI: 10.1016/j.ejvs.2019.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 09/01/2019] [Accepted: 09/05/2019] [Indexed: 11/18/2022]
Affiliation(s)
- Kersten Morgan Bates
- Bedfordshire-Milton Keynes Vascular Centre, Bedford Hospital NHS Trust, Bedford, UK.
| | - Arindam Chaudhuri
- Bedfordshire-Milton Keynes Vascular Centre, Bedford Hospital NHS Trust, Bedford, UK
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40
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Wei X, Han T, Sun Y, Sun X, Wu Y, Wang S, Zhou J, Zhao Z, Jing Z. A Retrospective Study Comparing the Effectiveness and Safety of EXOSEAL Vascular Closure Device to Manual Compression in Patients Undergoing Percutaneous Transbrachial Procedures. Ann Vasc Surg 2019; 62:310-317. [PMID: 31449959 DOI: 10.1016/j.avsg.2019.06.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 06/10/2019] [Accepted: 06/16/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND This study aimed to assess the safety and efficacy of EXOSEAL vascular closure device (EVCD) insertion by comparing its performance with manual compression (MC) in achieving hemostasis at the brachial artery puncture site. METHODS A retrospective study of brachial artery access by using either MC or EVCD for achieving hemostasis from March 2016 to October 2017 was conducted. Patients with Stanford type B aortic dissection (TBAD) undergoing percutaneous transbrachial procedures were included. Time to hemostasis (TTH) was the primary efficacy end point. Seven-day incidence of major access site-related complications was the primary safety end point. TTH and major and minor complications associated with treatment of these 2 groups were also evaluated. RESULTS A total of 157 patients with TBAD undergoing percutaneous transbrachial procedures entered the analysis. Of these, 107 patients underwent EVCD insertion and 50 patients underwent MC. The baseline characteristics of the 2 groups were similar. TTH was significantly shorter for EVCD over MC (P < 0.05). The TTH ≥10 min in the MC group was 100.0% (n = 50), but in the EVCD group, it was ≤2 min, 87.9% (n = 107); 2-5 min, 7.5% (n = 107); and ≥10 min, 4.7% (n = 107). The EVCD group had several major complications, while the MC group had none. Two patients (1.9%, n = 107) required vascular repair, one patient (0.6%, n = 107) required blood transfusion, and 1 patient (0.6%, n = 107) developed upper limb numbness and weakness after EVCD deployment. Minor complication such as the occurrence of hematoma (≤5 cm) in the MC group was 4 (8.0%) but was also 4 (3.7%) in the EVCD group, showing statistically significant difference (P = 0.030). The incidence of ecchymosis was 8 (7.5%) in the EVCD group when compared with 13 (26.0%) in the MC group, which showed statistically significant difference (P = 0.001). Other major and minor complications showed no significant differences between these 2 groups. CONCLUSIONS After invasive procedures by 6F percutaneous access via the brachial artery in preprocedurally fully anticoagulated patients, TTH was significantly reduced in patients who underwent EVCD when compared with patients who underwent MC. MC is a safer and more convenient way to achieve hemostasis but has higher incidence of minor complications.
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Affiliation(s)
- Xiaolong Wei
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Tonglei Han
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Yudong Sun
- Department of General Surgery, Nanjing General Hospital of Eastern Theater Command, Nanjing, China
| | - Xiuli Sun
- Department of ophthalmology, Jinan Aier Eye hospital, Jinan, China
| | - Yani Wu
- Department of Breast and Thyroid Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Shiying Wang
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Jian Zhou
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China.
| | - Zhiqing Zhao
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China.
| | - Zaiping Jing
- Department of Vascular Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China.
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41
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De Palma R, Settergren M, Saleh N. Ray of potential with Manta. Int J Cardiol 2019; 288:64. [PMID: 31101234 DOI: 10.1016/j.ijcard.2019.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 01/02/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Rodney De Palma
- Heart and Vascular theme, Karolinska University Hospital and department of Medicine, Karolinska Institutet, Karolinska vägen, 171 76 Stockholm, Sweden.
| | - Magnus Settergren
- Heart and Vascular theme, Karolinska University Hospital and department of Medicine, Karolinska Institutet, Karolinska vägen, 171 76 Stockholm, Sweden
| | - Nawzad Saleh
- Heart and Vascular theme, Karolinska University Hospital and department of Medicine, Karolinska Institutet, Karolinska vägen, 171 76 Stockholm, Sweden.
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42
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Andò G, Cimmino M. Prolonged Benefit of Radial Access Beyond 30 Days: Fact or Fiction? Am J Cardiol 2019; 123:1736-1737. [PMID: 30902344 DOI: 10.1016/j.amjcard.2019.02.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 02/26/2019] [Indexed: 11/18/2022]
Affiliation(s)
- Giuseppe Andò
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.
| | - Michele Cimmino
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
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43
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Kim SH, Behnes M, Baron S, Shchetynska-Marinova T, Tekinsoy M, Mashayekhi K, Hoffmann U, Borggrefe M, Akin I. Differences of bleedings after percutaneous coronary intervention using femoral closure and radial compression devices. Medicine (Baltimore) 2019; 98:e15501. [PMID: 31096450 PMCID: PMC6531194 DOI: 10.1097/md.0000000000015501] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Bleedings represent most relevant complications being correlated with significant rates of adverse clinical outcomes in patients undergoing percutaneous coronary intervention (PCI). To reduce bleeding and improve prognosis various types of vascular closure devices (VCD) are frequently applied. This study aims to compare directly one specific femoral closure (FC) to one specific radial compression (RC) device in patients after PCI focusing on overall and access-site bleedings as well as major adverse cardiac events (MACE).This single-center, prospective, and observational study included consecutive patients either treated by the FC (StarClose SE) or RC (TR Band) device following PCI. The primary outcome was bleeding; the secondary outcomes were MACE at 30 days of follow-up.Two hundred patients in each group were enrolled following PCI. Access-site bleeding was significantly higher in the FC (43%) compared to the RC (30%) group (P = .001). Most common type of access-site bleeding consisted of hematomas. Of these, small and large hematomas were significantly higher in the FC group (P < .05). No significant differences of MACE were observed in both groups. In multivariable logistic regression models no consistent significant association of any risk factor with bleeding complications was identified.Despite the use of VCD, transfemoral arterial access is still associated with a higher rates of access site bleeding consisting mostly of hematomas compared to trans-radial access, whereas no differences of MACE were observed between FC and RC patients at 30 days follow-up.
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Affiliation(s)
- Seung-Hyun Kim
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Michael Behnes
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Sebastian Baron
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Tetyana Shchetynska-Marinova
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Melike Tekinsoy
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Kambis Mashayekhi
- Division of Cardiology and Angiology II, University Heart Center Freiburg - Bad Krozingen, Bad Krozingen, Germany
| | - Ursula Hoffmann
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Martin Borggrefe
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Ibrahim Akin
- First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, European Center for AngioScience (ECAS), and DZHK (German Center for Cardiovascular Research) partner site Heidelberg/Mannheim, Mannheim, Germany
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Schaefer A, Schirmer J, Schofer N, Schneeberger Y, Deuschl F, Blankenberg S, Reichenspurner H, Conradi L, Schäfer U. Transaxillary transcatheter aortic valve implantation utilizing a novel vascular closure device with resorbable collagen material: a feasibility study. Clin Res Cardiol 2018; 108:779-786. [PMID: 30560381 DOI: 10.1007/s00392-018-1407-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 12/13/2018] [Indexed: 12/19/2022]
Abstract
OBJECTIVES We herein aimed to evaluate technical feasibility of transaxillary (Tax) transcatheter aortic valve implantation (TAVI) utilizing a novel vascular closure device with a resorbable collagen plug and absence of suture material. METHODS Between 05/2018 and 8/2018, eight patients (76.0 ± 5.9 years, 62.5% male, logEuroSCORE I 23.6 ± 4.7) received Tax-TAVI using the MANTA™ vascular closure device. Implanted transcatheter heart valves consisted of Edwards Sapien 3, NVT Allegra, Medtronic CoreValve EvolutR and SJM Portico. RESULTS Puncture location depth was variable (3.5-7.5 cm). The left subclavian artery was used in five cases, the right subclavian artery in three cases. Low-pressure balloon-angioplasty for vessel closure was performed in 5/8 patients. VARC-2 defined device success was met in all patients. Major access site complication occurred in one patient with aneurysma spurium of the subclavian artery and consecutive stent implantation on postoperative day 5. CONCLUSION The MANTA™ device is applicable in Tax-TAVI, with potential particular advantages regarding easiness of use and marked access for subsequent interventions in case of vascular complications. Before conclusions regarding clinical efficacy and safety can be made, the device has to be evaluated in larger patient cohorts.
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Affiliation(s)
- Andreas Schaefer
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Martinistrasse 52, 20246, Hamburg, Germany.
| | - Johannes Schirmer
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Martinistrasse 52, 20246, Hamburg, Germany
| | - Niklas Schofer
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Martinistrasse 52, 20246, Hamburg, Germany
| | - Yvonne Schneeberger
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Martinistrasse 52, 20246, Hamburg, Germany
| | - Florian Deuschl
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Martinistrasse 52, 20246, Hamburg, Germany
| | - Stefan Blankenberg
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Martinistrasse 52, 20246, Hamburg, Germany
| | - Hermann Reichenspurner
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Martinistrasse 52, 20246, Hamburg, Germany
| | - Lenard Conradi
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Martinistrasse 52, 20246, Hamburg, Germany
| | - Ulrich Schäfer
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Martinistrasse 52, 20246, Hamburg, Germany
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45
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Avrahami I, Raz D, Bash O. Biomechanical Aspects of Closing Approaches in Postcarotid Endarterectomy. Comput Math Methods Med 2018; 2018:4517652. [PMID: 30510592 PMCID: PMC6230422 DOI: 10.1155/2018/4517652] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Revised: 08/25/2018] [Accepted: 09/17/2018] [Indexed: 11/30/2022]
Abstract
The carotid bifurcation tends to develop atherosclerotic stenoses which might interfere with cerebral blood supply. In cases of arterial blockage, the common clinical solution is to remove the plaque via carotid endarterectomy (CEA) surgery. Artery closure after surgery using primary closures along the cutting edge might lead to artery narrowing and restrict blood flow. An alternative approach is patch angioplasty which takes longer time and leads to more during-surgery complications. The present study uses numerical methods with fluid-structure interaction (FSI) to explore and compare the two solutions in terms of hemodynamics and stress and strain fields developed in the artery wall.
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Affiliation(s)
- Idit Avrahami
- Department of Mechanical Engineering and Mechatronics, Ariel University, Ariel, Israel
| | - Dafna Raz
- Department of Mechanical Engineering and Mechatronics, Ariel University, Ariel, Israel
| | - Oranit Bash
- Department of Mechanical Engineering and Mechatronics, Ariel University, Ariel, Israel
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Linti C, Doser M, Planck H, Oberhoffner S, Mueller E, Renardy M, Biesinger J, Neumann B, Stang K, Greiner TO, Schlensak C, Krajewski S, Wendel HP. Development, preclinical evaluation and validation of a novel quick vascular closure device for transluminal, cardiac and radiological arterial catheterization. J Mater Sci Mater Med 2018; 29:83. [PMID: 29892952 DOI: 10.1007/s10856-018-6092-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 05/26/2018] [Indexed: 06/08/2023]
Abstract
Following percutaneous coronary intervention, vascular closure devices (VCDs) are increasingly used to reduce time to ambulation, enhance patient comfort, and reduce potential complications compared with traditional manual compression. Newer techniques include complicated, more or less automated suture devices, local application of pads or the use of metal clips and staples. These techniques often have the disadvantage of being time consuming, expensive or not efficient enough. The VCD failure rate in association with vascular complications of 2.0-9.5%, depending on the type of VCD, is still not acceptable. Therefore, the aim of this study is to develop a self-expanding quick vascular closure device (QVCD) made from a bioabsorbable elastic polymer that can be easily applied through the placed introducer sheath. Bioabsorbable block-co-polymers were synthesized and the chemical and mechanical degradation were determined by in vitro tests. The best fitting polymer was selected for further investigation and for microinjection moulding. After comprehensive haemocompatibility analyses in vitro, QVCDs were implanted in arterial vessels following arteriotomy for different time points in sheep to investigate the healing process. The in vivo tests proved that the new QVCD can be safely placed in the arteriotomy hole through the existing sheath instantly sealing the vessel. The degradation time of 14 days found in vitro was sufficient for vessel healing. After 4 weeks, the remaining QVCD material was covered by neointima. Overall, our experiments showed the safety and feasibility of applying this novel QVCD through an existing arterial sheath and hence encourage future work with larger calibers.
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Affiliation(s)
- C Linti
- German Institutes of Textile and Fiber Research (DITF), Denkendorf, Germany
| | - M Doser
- German Institutes of Textile and Fiber Research (DITF), Denkendorf, Germany
| | - H Planck
- German Institutes of Textile and Fiber Research (DITF), Denkendorf, Germany
| | - S Oberhoffner
- German Institutes of Textile and Fiber Research (DITF), Denkendorf, Germany
| | - E Mueller
- ITV Denkendorf Produktservice GmbH, Denkendorf, Germany
| | - M Renardy
- ITV Denkendorf Produktservice GmbH, Denkendorf, Germany
| | - J Biesinger
- Department of Thoracic, Cardiac and Vascular Surgery, Clinical Research Laboratory, University Hospital Tuebingen, Tuebingen, Germany
| | - B Neumann
- Department of Thoracic, Cardiac and Vascular Surgery, Clinical Research Laboratory, University Hospital Tuebingen, Tuebingen, Germany
| | - K Stang
- Department of Thoracic, Cardiac and Vascular Surgery, Clinical Research Laboratory, University Hospital Tuebingen, Tuebingen, Germany
| | - T O Greiner
- Department of General, Visceral and Transplant Surgery, University Hospital of Tuebingen, Tuebingen, Germany
| | - C Schlensak
- Department of Thoracic, Cardiac and Vascular Surgery, Clinical Research Laboratory, University Hospital Tuebingen, Tuebingen, Germany
| | - S Krajewski
- Department of Thoracic, Cardiac and Vascular Surgery, Clinical Research Laboratory, University Hospital Tuebingen, Tuebingen, Germany
| | - H P Wendel
- Department of Thoracic, Cardiac and Vascular Surgery, Clinical Research Laboratory, University Hospital Tuebingen, Tuebingen, Germany.
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Brenner C, Margreitter J, Gratl A, Klocker J, Kirchmair R, Marschang P, Friedrich G, Metzler B, Moes N. Femoral access site closure without prior femoral angiography : A retrospective analysis. Wien Klin Wochenschr 2018; 130:197-203. [PMID: 29368241 PMCID: PMC5978917 DOI: 10.1007/s00508-018-1314-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Accepted: 01/06/2018] [Indexed: 11/26/2022]
Abstract
AIMS AND BACKGROUND Although guideline recommendations have shifted towards a transradial route, femoral puncture is still an established vascular access, especially for complex coronary interventions. The FemoSeal™ vascular closure device (FVCD) helps to reduce femoral compression time and access site complications after removal of the catheter sheath. To ensure safe use, an angiography of the femoral artery prior to FVCD deployment is recommended by the manufacturer. We postulate that omitting this angiography does not relevantly increase the risk for vascular complications. METHODS AND RESULTS In this retrospective analysis of an all-comers population (n = 1923) including patients receiving a percutaneous coronary intervention (PCI), we could show that combined vascular complication rates without femoral angiography were low (primary endpoint 4.6%) and comparable to a randomized clinical trial that did perform angiography of the vascular access site in a cohort of patients receiving diagnostic coronary angiography only. In addition to this analysis, we could demonstrate that patients with an acute coronary syndrome, receiving periprocedural anticoagulation or anti-platelet therapy had an increased risk for the formation of arterial pseudoaneurysms; however, we did not observe any ischemic vascular event after FVCD deployment. CONCLUSION Closure of the femoral access site after coronary angiography using the FVCD can be safely performed without femoral angiography; however, due to an increased risk for the formation of pseudoaneurysms we recommend the transradial access in situations with increased bleeding risk.
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Affiliation(s)
- Christoph Brenner
- Department of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria.
| | - Julian Margreitter
- Department of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Alexandra Gratl
- Department of Vascular Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Josef Klocker
- Department of Vascular Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Rudolf Kirchmair
- Department of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Peter Marschang
- Department of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Guy Friedrich
- Department of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Bernhard Metzler
- Department of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
| | - Nicolas Moes
- Department of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstr. 35, 6020, Innsbruck, Austria
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Fastner C, Behnes M, Sartorius B, Wenke A, Lang S, Yücel G, Sattler K, Rusnak J, Saleh A, Barth C, Mashayekhi K, Hoffmann U, Borggrefe M, Akin I. Interventional Left Atrial Appendage Closure Affects the Metabolism of Acylcarnitines. Int J Mol Sci 2018; 19:ijms19020500. [PMID: 29414920 PMCID: PMC5855722 DOI: 10.3390/ijms19020500] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Revised: 01/29/2018] [Accepted: 01/30/2018] [Indexed: 12/21/2022] Open
Abstract
Background: Left atrial appendage closure (LAAC) represents the interventional alternative to oral anticoagulation for stroke prevention in atrial fibrillation (AF). The metabolism of acylcarnitines was shown to affect cardiovascular diseases. This study evaluates the influence of successful LAAC on the metabolism of acylcarnitines. Methods: Patients undergoing successful LAAC were enrolled prospectively. Peripheral blood samples for metabolomics measurements were collected immediately before (i.e., index) and six months after LAAC (i.e., mid-term). A targeted metabolomics analysis based on electrospray ionization–liquid chromatography–mass spectrometry (ESI–LC–MS/MS) and MS/MS measurements was performed. Results: 44 patients with non-valvular AF (median CHA2DS2-VASc score 4, median HAS-BLED score 4) and successful LAAC were included. Significant changes in acylcarnitine levels were found in the total cohort, which were mainly attributed to patients with impaired left ventricular and renal function, elevated amino-terminal pro-brain natriuretic peptide (NT-proBNP) and diabetes mellitus. Adjusted multivariable regression models revealed significant changes of five metabolites over mid-term follow-up: C2, C14:1, C16, and C18:1 decreased significantly (each p < 0.05); short-chain C5 acylcarnitine plasma levels increased significantly (p < 0.05). Conclusion: This study demonstrates that successful LAAC affects the metabolism of acylcarnitines at mid-term follow-up. Clinical Trial Registration: ClinicalTrials.gov Identifier: NCT02985463.
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Affiliation(s)
- Christian Fastner
- First Department of Medicine, University Medical Center Mannheim, Faculty of Medicine Mannheim, University of Heidelberg, 68167 Mannheim, Germany.
| | - Michael Behnes
- First Department of Medicine, University Medical Center Mannheim, Faculty of Medicine Mannheim, University of Heidelberg, 68167 Mannheim, Germany.
| | - Benjamin Sartorius
- First Department of Medicine, University Medical Center Mannheim, Faculty of Medicine Mannheim, University of Heidelberg, 68167 Mannheim, Germany.
| | - Annika Wenke
- First Department of Medicine, University Medical Center Mannheim, Faculty of Medicine Mannheim, University of Heidelberg, 68167 Mannheim, Germany.
| | - Siegfried Lang
- First Department of Medicine, University Medical Center Mannheim, Faculty of Medicine Mannheim, University of Heidelberg, 68167 Mannheim, Germany.
| | - Gökhan Yücel
- First Department of Medicine, University Medical Center Mannheim, Faculty of Medicine Mannheim, University of Heidelberg, 68167 Mannheim, Germany.
| | - Katherine Sattler
- First Department of Medicine, University Medical Center Mannheim, Faculty of Medicine Mannheim, University of Heidelberg, 68167 Mannheim, Germany.
| | - Jonas Rusnak
- First Department of Medicine, University Medical Center Mannheim, Faculty of Medicine Mannheim, University of Heidelberg, 68167 Mannheim, Germany.
| | - Ahmad Saleh
- First Department of Medicine, University Medical Center Mannheim, Faculty of Medicine Mannheim, University of Heidelberg, 68167 Mannheim, Germany.
| | - Christian Barth
- First Department of Medicine, University Medical Center Mannheim, Faculty of Medicine Mannheim, University of Heidelberg, 68167 Mannheim, Germany.
| | - Kambis Mashayekhi
- Division of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, 79189 Bad Krozingen, Germany.
| | - Ursula Hoffmann
- First Department of Medicine, University Medical Center Mannheim, Faculty of Medicine Mannheim, University of Heidelberg, 68167 Mannheim, Germany.
| | - Martin Borggrefe
- First Department of Medicine, University Medical Center Mannheim, Faculty of Medicine Mannheim, University of Heidelberg, 68167 Mannheim, Germany.
| | - Ibrahim Akin
- First Department of Medicine, University Medical Center Mannheim, Faculty of Medicine Mannheim, University of Heidelberg, 68167 Mannheim, Germany.
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Benham E, Deloose K, Callaert J, Bosiers M, Cox T, Lincourt A, Heniford BT. AbsorbaSeal™ Vascular Closure Device: A Novel Device for Hemostasis Following Interventional Peripheral Vascular Procedures. Surg Technol Int 2017; 31:93-99. [PMID: 29020709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Vascular closure devices (VCDs) are designed to achieve rapid hemostasis during percutaneous coronary and peripheral vascular procedures. Studies demonstrate that VCDs improve time to hemostasis (TTH) and time to ambulation (TTA) in comparison to standard manual compression. The available products, however, typically have 13-17 steps in their application, often require hemostatic collagen or other agents as part of the process, and can result in significant scarring at the puncture site that can impact future access. The aim of this study was to investigate the performance of a three-step, novel VCD for access site TTH, short-term and long-term histology, and a first-in-man clinical study. MATERIALS AND METHODS This study evaluated AbsorbaSeal™ (CyndRx, LLC, Brentwood, Tennessee), a simple, three-step, VCD with bio-absorbable components. Following an institutional review board (IRB) approval, a 6-F sheath was placed directly into the porcine aorta, AbsorbaSeal™ was used to seal the puncture site, and a measure of total time of deployment (TTD) and TTH was performed, as well as histologic evaluation at 30, 60, and 180 days. A complement activation test was performed to determine the potential for activation of the complement system as a mediator of inflammation. The test was performed by directly incubating the VCDs AbsorbaSeal™ and Angio-Seal™ (Terumo Interventional Systems, Tokyo, Japan) in human serum. Serum samples were removed after 30, 60, and 90 minutes and tested for the presence and amount of complement protein SC5b-9. In the first in-man trial, the device was deployed in anticoagulated patients undergoing interventional vascular procedures. The TTH, estimated blood loss, patient pain scores, and procedural and follow-up complications were recorded. RESULTS In the acute and chronic porcine studies, TTD averaged 25 seconds (17-29 seconds). Vascular control was immediate, yielding a TTH of effectively zero seconds. Histologic evaluation demonstrated complete endothelial coverage of the device by 30 days without evidence of bleeding, clotting, or inflammation. At 60 days, the significant mass of the device had dissolved and normal appearing collagen surrounded the devices with essentially no inflammatory response. By six months, all but one microscopic segment of one of the devices had been absorbed with normal appearing vascular endothelium, and no, or minimal, scarring appreciated. The complement test demonstrated that the AbsorbaSeal™ had similar, or lower, complement concentrations than the negative controls and significantly less than Angio-Seal™. This supported the histologic findings of minimal to no inflammation. The VCD was deployed in 20 patients undergoing interventional vascular procedures. The mean TTH was 2.3 ± 1.5 minutes. Estimated blood loss was 11.7 mL ± 3.5 mL, and no significant hematoma was noted. Post-procedure pain scores were low, with a mean of 1.4 ± 0.8 on a 0-10 pain rating scale. There were no perioperative complications and no adverse events at follow-up. CONCLUSIONS The AbsorbaSeal™ is safe and simple to use for vascular closure after interventional vascular procedures with favorable outcomes including a short TTH, minimal procedural blood loss, low postoperative pain scores, and no perioperative complications or adverse effects. Histologic evaluation reveals rapid device absorption and little scar formation both short- and long-term. A direct study of complement activation supports that AbsorbaSeal™ evokes a minimal inflammatory response that is significantly less than Angioseal.
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Affiliation(s)
- Emily Benham
- Surgery Care Division, Carolinas HealthCare System, Charlotte, North Carolina
| | | | - Joren Callaert
- Vascular Surgery Department, AZ Sint-Blasius Hospital, Dendermonde, Belgium
| | - Marc Bosiers
- Vascular Surgery Department, AZ Sint-Blasius Hospital, Dendermonde, Belgium
| | - Tiffany Cox
- Surgery Care Division, Carolinas HealthCare System, Charlotte, North Carolina
| | - Amy Lincourt
- Surgery Care Division, Carolinas HealthCare System, Charlotte, North Carolina
| | - B Todd Heniford
- Division of Gastrointestinal and Minimally Invasive Surgery, Surgery Care Division, Carolinas HealthCare System, Charlotte, North Carolina
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50
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Walter J, Vogl M, Holderried M, Becker C, Brandes A, Sinner MF, Rogowski W, Maschmann J. Manual Compression versus Vascular Closing Device for Closing Access Puncture Site in Femoral Left-Heart Catheterization and Percutaneous Coronary Interventions: A Retrospective Cross-Sectional Comparison of Costs and Effects in Inpatient Care. Value Health 2017; 20:769-776. [PMID: 28577694 DOI: 10.1016/j.jval.2016.05.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 04/13/2016] [Accepted: 05/12/2016] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To compare complication rates, length of hospital stay, and resulting costs between the use of manual compression and a vascular closing device (VCD) in both diagnostic and interventional catheterization in a German university hospital setting. METHODS A stratified analysis according to risk profiles was used to compare the risk of complications in a retrospective cross-sectional single-center study. Differences in costs and length of hospital stay were calculated using the recycled predictions method, based on regression coefficients from generalized linear models with gamma distribution. All models were adjusted for propensity score and possible confounders, such as age, sex, and comorbidities. The analysis was performed separately for diagnostic and interventional catheterization. RESULTS The unadjusted relative risk (RR) of complications was not significantly different in diagnostic catheterization when a VCD was used (RR = 0.70; 95% confidence interval [CI] 0.22-2.16) but significantly lower in interventional catheterization (RR = 0.44; 95% CI 0.21-0.93). Costs were on average €275 lower in the diagnostic group (95% CI -€478.0 to -€64.9; P = 0.006) and around €373 lower in the interventional group (95% CI -€630.0 to -€104.2; P = 0.014) when a VCD was used. The adjusted estimated average length of stay did not differ significantly between the use of a VCD and manual compression in both types of catheterization. CONCLUSIONS In interventional catheterization, VCDs significantly reduced unadjusted complication rates, as well as costs. A significant reduction in costs also supports their usage in diagnostic catheterization on a larger scale.
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Affiliation(s)
- Julia Walter
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.
| | - Matthias Vogl
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany; Munich School of Management, Institute of Health Economics and Health Care Management & Munich Center of Health Sciences, Ludwig-Maximilians-Universität München, Munich, Germany
| | | | - Christian Becker
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany; Munich School of Management, Institute of Health Economics and Health Care Management & Munich Center of Health Sciences, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Alina Brandes
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Moritz F Sinner
- Department of Medicine I, University Hospital Munich, Munich, Germany
| | - Wolf Rogowski
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany; University of Bremen, Health Sciences, Institute of Public Health and Nursing Research, Department of Health Care Management, Bremen, Germany
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