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Roy AK, Garot P, Louvard Y, Neylon A, Spaziano M, Sawaya FJ, Fernandez L, Roux Y, Blanc R, Piotin M, Champagne S, Tavolaro O, Benamer H, Hovasse T, Chevalier B, Lefèvre T, Unterseeh T. Comparison of Transradial vs Transfemoral Access for Aortoiliac and Femoropopliteal Interventions. J Endovasc Ther 2016; 23:880-888. [DOI: 10.1177/1526602816665617] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: To compare the procedure and safety outcomes of the transradial approach (TRA) with the femoral approach (FA) for treating aortoiliac and femoropopliteal stenoses and occlusions. Methods: A single-center retrospective study was conducted involving 188 patients (mean age 66.4±10.8 years; 116 men) with lower limb claudication or critical limb ischemia who underwent aortoiliac (131, 62.4%) or femoropopliteal (79, 37.6%) interventions on 210 lesions over a 3-year period. Operator discretion determined TRA suitability; exclusions included Raynaud’s disease, upper limb occlusive disease, previous TRA difficulties, or planned hemodialysis. Lesion characteristics, clinical endpoints, and access site complications were compared. Results: FA was used primarily in 123 patients and the TRA (12 left and 53 right radial arteries) in 65 procedures. Eleven (16.9%) TRAs failed vs 9 (7.3%) FAs (p=0.42). Crossover to FA was due to occlusive lesions requiring alternative equipment in 9 cases and to tortuosity of the aortic arch vessels in 2 patients. The 134 FA interventions (balloon angioplasty, stents) were retrograde (112, 83.6%) or antegrade (22, 16.4%). There were significantly more TASC C/D lesions in the FA group (p=0.02). Sheath sizes (5-F to 8-F) did not differ between groups, and no significant differences were found between FA vs TRA in terms of procedure time (50.0±28.9 vs 46.8±25.1 minutes, p=0.50) or length of stay (2.2±0.6 vs 2.1±0.3 days, p=0.24). While there were no strokes, access site complications occurred in 6.0% of the FA patients vs 3.7% of the TRA patients (p=0.12). Conclusion: The transradial approach for aortoiliac and femoropopliteal interventions is safe and efficacious compared with the transfemoral approach for a range of lesion subtypes. Nevertheless, there remains a need for improvements in peripheral device and catheter technology to decrease transradial failure rates.
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Affiliation(s)
- Andrew K. Roy
- Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud, Hôpital Privé Jacques Cartier, Massy, France
- Hôpital Claude-Galien, Quincy Sous-Sénart, France
| | - Phillipe Garot
- Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud, Hôpital Privé Jacques Cartier, Massy, France
- Hôpital Claude-Galien, Quincy Sous-Sénart, France
| | - Yves Louvard
- Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud, Hôpital Privé Jacques Cartier, Massy, France
- Hôpital Claude-Galien, Quincy Sous-Sénart, France
| | - Antoinette Neylon
- Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud, Hôpital Privé Jacques Cartier, Massy, France
| | - Marco Spaziano
- Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud, Hôpital Privé Jacques Cartier, Massy, France
| | - Fadi J. Sawaya
- Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud, Hôpital Privé Jacques Cartier, Massy, France
| | - Leticia Fernandez
- Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud, Hôpital Privé Jacques Cartier, Massy, France
| | - Yann Roux
- Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud, Hôpital Privé Jacques Cartier, Massy, France
| | - Raphael Blanc
- Hôpital Claude-Galien, Quincy Sous-Sénart, France
- Department of Interventional Radiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud, Hôpital Privé Jacques Cartier, Massy, France
| | - Michel Piotin
- Hôpital Claude-Galien, Quincy Sous-Sénart, France
- Department of Interventional Radiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud, Hôpital Privé Jacques Cartier, Massy, France
| | | | - Oscar Tavolaro
- Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud, Hôpital Privé Jacques Cartier, Massy, France
- Hôpital Claude-Galien, Quincy Sous-Sénart, France
| | - Hakim Benamer
- Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud, Hôpital Privé Jacques Cartier, Massy, France
| | - Thomas Hovasse
- Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud, Hôpital Privé Jacques Cartier, Massy, France
- Hôpital Claude-Galien, Quincy Sous-Sénart, France
| | - Bernard Chevalier
- Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud, Hôpital Privé Jacques Cartier, Massy, France
- Hôpital Claude-Galien, Quincy Sous-Sénart, France
| | - Thierry Lefèvre
- Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud, Hôpital Privé Jacques Cartier, Massy, France
- Hôpital Claude-Galien, Quincy Sous-Sénart, France
| | - Thierry Unterseeh
- Department of Cardiology, Ramsay Générale de Santé, Institut Cardiovasculaire Paris-Sud, Hôpital Privé Jacques Cartier, Massy, France
- Hôpital Claude-Galien, Quincy Sous-Sénart, France
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Prasad A, Compton PA, Prasad A, Roesle M, Makke L, Rogers S, Banerjee S, Brilakis ES. Incidence and Treatment of Arterial Access Dissections Occurring during Cardiac Catheterization. J Interv Cardiol 2008; 21:61-6. [PMID: 18254788 DOI: 10.1111/j.1540-8183.2007.00309.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Arterial access dissections may complicate cardiac catheterization and can often be treated percutaneously. The goal of this study was to examine the incidence, consequences, and the treatment of arterial access dissections at a tertiary referral hospital with an active training program. METHODS Patients experiencing arterial access dissection during coronary angiography or intervention at our institution between October 1, 2004, and January 31, 2007, were identified and their records were retrospectively reviewed. RESULTS Thirteen of the 3,062 consecutive patients (0.42%) had arterial access dissection during the study period. The location of the dissection was in the common femoral artery (CFA) (n = 6), the external iliac artery (EIA) (n = 6), or in an aortobifemoral graft (n = 1). Three of the six patients with CFA dissection were diagnosed during coronary angiography, and because of significant comorbidities were treated with self-expanding stents. After a mean follow-up of 7 months, they experienced no stent fracture or other complication. Six patients had EIA dissections. In one such patient, the dissection was not flow limiting and was treated conservatively. The remaining five patients underwent successful implantation of self-expanding stents, and during a mean follow-up of 9.6 months, no patient had any symptoms or events related to lower extremity ischemia. Finally, one patient had an aortobifemoral graft dissection. Due to the patient's critical condition, secondary to sepsis, his family elected to withdraw care, and he subsequently expired. CONCLUSIONS Arterial access dissections occur infrequently during cardiac catheterization. Routine femoral artery angiography may help identify vascular access complications, often allowing simultaneous endovascular treatment, with excellent short-term outcomes.
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Affiliation(s)
- Amit Prasad
- Department of Internal Medicine, University of Texas Southwestern Medical School, Dallas, TX, USA
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Creager MA, Goldstone J, Hirshfeld JW, Kazmers A, Kent KC, Lorell BH, Olin JW, Rainer Pauly R, Rosenfield K, Roubin GS, Sicard GA, White CJ, Creager MA, Winters WL, Hirshfeld JW, Lorell BH, Merli G, Rodgers GP, Tracy CM, Weitz HH. ACC/ACP/SCAI/SVMB/SVS clinical competence statement on vascular medicine and catheter-based peripheral vascular interventions: a report of the American College of Cardiology/American Heart Association/American College of Physician Task Force on Clinical Competence (ACC/ACP/SCAI/SVMB/SVS Writing Committee to develop a clinical competence statement on peripheral vascular disease). J Am Coll Cardiol 2004; 44:941-57. [PMID: 15312891 DOI: 10.1016/j.jacc.2003.10.012] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Lobato AC, Rodriguez-Lopez J, Diethrich EB. Learning curve for endovascular abdominal aortic aneurysm repair: evaluation of a 277-patient single-center experience. J Endovasc Ther 2002; 9:262-8. [PMID: 12096938 DOI: 10.1177/152660280200900302] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To determine the minimum number of stent-graft deployments that an interventional team with endovascular skills must do to be considered well trained in endovascular abdominal aortic aneurysm (AAA) exclusion. METHODS The records of 277 consecutive patients (236 men; median age 73 years, range 49-91) undergoing endovascular AAA repair at a single institution between 1994 and 1998 were reviewed. Information was collected on procedural success, conversion, time interval between procedures, operative complications, operative mortality, contrast volume, blood loss, intensive care unit (ICU) length of stay (LOS), and hospital LOS. A first-order differential equation was used to calculate a learning curve based on the success rate. Patients were subsequently divided into 5 sequential groups of 55 patients (the last group had 57 patients). RESULTS Analyzing the pattern of procedural success to failures, a sharp change in the slope was observed between 50 and 65 trials. The number 55 was arbitrarily chosen to represent the point after which the incremental change in the success rate never exceeded 0.01 (<1 failure per 100 attempts). In the intergroup comparisons, success rate (p<0.04), conversion rate (p<0.0001), and procedural frequency (p<0.0001) were statistically significant when the first 55-patient group was compared to the others. Operative complications (p=0.08) and operative mortality (p=0.16) were numerically but not significantly different. Contrast volume was significantly reduced for the last group (p<0.0001). A Cox regression model identified only procedural frequency (p=0.03) and procedural volume (p=0.04) as predictive of technical success. Performing endovascular AAA repairs at a < or =10-day interval was associated with a >80% success rate. CONCLUSIONS This study shows that not only is the number of procedures important to outcome, but also the frequency with which they are performed. Based on our team's performance data, 55 cases would appear to be the minimum volume and 1 case every 10 days the minimum frequency to obtain good operative results with aortic endografting.
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Affiliation(s)
- Armando C Lobato
- Department of Cardiovascular and Endovascular Surgery, Arizona Heart Institute and Hospital, 2632 N. 20th Street, Phoenix, AZ 85006, USA
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Abstract
The field of interventional nephrology is rapidly developing as an important new area of nephrology practice that holds great promise for improved patient care, outcomes, and cost control. This development is contingent on nephrologists acquiring the necessary knowledge and skills through suitable training and experience, and obtaining hospital privileges to perform these interventions. As more training programs are created, and credentialing criteria are established and accepted, it will become more practical for nephrologists to become interventionists. Reimbursement for interventional procedures can be complicated and confusing, with special problems applicable to a nephrology practice involved in the overall care of end-stage renal disease (ESRD) patients. It is essential to become familiar with applicable procedure codes, global periods, and code modifiers to correctly describe these procedures and receive correct reimbursement. Nephrologists work together with vascular access surgeons and interventional radiologists to provide care for dialysis patients. The role of each specialist in the management of vascular access depends on his or her level of interest, knowledge, and technical skill. These roles may vary considerably from one practice to another. There is potential for this area to become highly contentious, especially if one specialist feels threatened by the activities of another. Optimal patient care will be achieved only if all involved physicians take a serious intellectual interest in vascular access, develop superior clinical skills, and maintain cooperative, collegial, relationships.
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