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Bergh EP, Mann LK, Won JH, Nobles A, Johnson A, Papanna R. Anchoring device to prevent membrane detachment and preterm prelabor rupture of membranes after fetal intervention. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2024; 64:374-380. [PMID: 38514967 DOI: 10.1002/uog.27646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 03/07/2024] [Accepted: 03/12/2024] [Indexed: 03/23/2024]
Abstract
OBJECTIVE To assess the feasibility of using a novel device designed for minimally invasive suturing to anchor fetal membranes to the uterine wall and to close surgical defects after fetoscopy. METHODS We tested the WestStitch™ suturing device both ex vivo and in vivo. In the ex-vivo studies, 12-Fr trocar defects were created with a fetoscope in five specimens of human uterine tissue with fetal membranes attached. Specimens were examined for integrity of the anchoring stitch. For the in-vivo studies, trocar defects were created in the two uterine horns of three pregnant ewes, each carrying twins at approximately 79-90 days' gestation. One trocar defect in each ewe was repaired using the suture device, and the other was left unrepaired as a control. The repair sites were examined for membrane-anchoring integrity when the defect was created and at delivery. RESULTS Fetal membranes were anchored successfully to the uterine myometrium using the suture-delivery device in all five experiments performed ex vivo. The in-vivo experiments also revealed successful membrane anchoring compared with controls, both at the time of device deployment and 1-9 weeks after the procedure. CONCLUSIONS We successfully anchored amniotic membranes to the underlying myometrium using a suturing device, both ex vivo and in vivo. Further studies are needed to evaluate the efficacy of the device and to determine whether it can successfully anchor fetal membranes percutaneously in human patients. © 2024 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- E P Bergh
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, UTHealth The University of Texas McGovern Medical School and the Fetal Center at Children's Memorial Hermann Hospital, Houston, TX, USA
| | - L K Mann
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, UTHealth The University of Texas McGovern Medical School and the Fetal Center at Children's Memorial Hermann Hospital, Houston, TX, USA
| | - J H Won
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, UTHealth The University of Texas McGovern Medical School and the Fetal Center at Children's Memorial Hermann Hospital, Houston, TX, USA
| | - A Nobles
- HeartStitch Inc., Fountain Valley, CA, USA
| | - A Johnson
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, UTHealth The University of Texas McGovern Medical School and the Fetal Center at Children's Memorial Hermann Hospital, Houston, TX, USA
| | - R Papanna
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Sciences, UTHealth The University of Texas McGovern Medical School and the Fetal Center at Children's Memorial Hermann Hospital, Houston, TX, USA
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Sheth RA, Walker TG, Saad WE, Dariushnia SR, Ganguli S, Hogan MJ, Hohenwalter EJ, Kalva SP, Rajan DK, Stokes LS, Zuckerman DA, Nikolic B. Quality improvement guidelines for vascular access and closure device use. J Vasc Interv Radiol 2013; 25:73-84. [PMID: 24209907 DOI: 10.1016/j.jvir.2013.08.011] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 08/15/2013] [Accepted: 08/16/2013] [Indexed: 12/17/2022] Open
Affiliation(s)
- Rahul A Sheth
- Division of Vascular Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit St., Gray 290, Boston, MA 02114
| | - T Gregory Walker
- Division of Vascular Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit St., Gray 290, Boston, MA 02114
| | - Wael E Saad
- Department of Radiology, University of Michigan Medical Center, Ann Arbor, Michigan.
| | - Sean R Dariushnia
- Department of Interventional Radiology and Image-guided Medicine, Emory University, Atlanta, Georgia
| | - Suvranu Ganguli
- Division of Vascular Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit St., Gray 290, Boston, MA 02114
| | - Mark J Hogan
- Section of Vascular and Interventional Radiology, Department of Radiology, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio
| | - Eric J Hohenwalter
- Department of Radiology, Medical College of Wisconsin, Froedtert Memorial Lutheran Hospital, Milwaukee, Wisconsin
| | - Sanjeeva P Kalva
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Dheeraj K Rajan
- Department of Medical Imaging, University of Toronto, University Health Network, Toronto, Ontario, Canada
| | - Leann S Stokes
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Darryl A Zuckerman
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Boris Nikolic
- Department of Radiology, Stratton Medical Center, Albany, New York
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Georg Y, Thaveau F, Lejay A, Bajcz C, Bakassa S, Chakfe N, Kretz JG. Arterial thrombosis after using Angio-Seal. Ann Vasc Surg 2012; 25:1078-93. [PMID: 22023942 DOI: 10.1016/j.avsg.2010.11.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2010] [Revised: 10/04/2010] [Accepted: 11/09/2010] [Indexed: 12/17/2022]
Abstract
Percutaneous closure systems of arterial puncture sites are being used more and more in modern endovascular practice. In this article, we report five cases of thrombotic complications following Angio-Seal deployment which required to be treated in our department between June 2004 and January 2006. We carried out a computerized literature review using "vascular closure" as a keyword and elected 106 articles published between 1992 and 2007. The analysis of this literature review showed that the rate of percutaneous closure complications was similar to the rate of manual compression complications, which is still the reference method. The complications associated with the use of these systems were more complex and more often required surgical repair. The severity and frequency of these complications differ based on the type of closure systems. The vascular surgeon in charge must have a good knowledge of these systems and of the complications each of them entails to be able to treat them in the most appropriate way.
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Affiliation(s)
- Yannick Georg
- Service de Chirurgie Vasculaire, Nouvel Hôpital Civil, Strasbourg, France
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Klocker J, Gratl A, Chemelli A, Moes N, Goebel G, Pachinger O, Jaschke W, Fraedrich G. Incidence and treatment of local stenosis or occlusion at the vascular access site leading to limb ischemia and new-onset intermittent claudication after percutaneous interventions: Implications of Vascular Closure Devices. Catheter Cardiovasc Interv 2011; 79:938-43. [DOI: 10.1002/ccd.23151] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2011] [Accepted: 03/19/2011] [Indexed: 01/02/2023]
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5
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Endovascular Treatment of Complications of Femoral Arterial Access. Cardiovasc Intervent Radiol 2010; 33:457-68. [PMID: 20162284 DOI: 10.1007/s00270-010-9820-3] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2009] [Accepted: 01/19/2010] [Indexed: 10/19/2022]
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Hon L, Ganeshan A, Thomas S, Warakaulle D, Jagdish J, Uberoi R. An overview of vascular closure devices: What every radiologist should know. Eur J Radiol 2010; 73:181-90. [DOI: 10.1016/j.ejrad.2008.09.023] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2008] [Revised: 09/21/2008] [Accepted: 09/23/2008] [Indexed: 11/28/2022]
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Affiliation(s)
- Wallace J. Hamel
- Wallace J. Hamel is an advanced practice registered nurse for the Connecticut Multispeciality Group’s division of cardiology at Hartford Hospital in Hartford, Connecticut
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Kahlert P, Eggebrecht H, Erbel R, Sack S. A modified "preclosure" technique after percutaneous aortic valve replacement. Catheter Cardiovasc Interv 2009; 72:877-84. [PMID: 19006257 DOI: 10.1002/ccd.21711] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To evaluate the feasibility, safety and efficacy of suture-mediated closure devices using a modified "preclosure" technique for access site management after percutaneous aortic valve replacement (PAVR). BACKGROUND PAVR using a retrograde transfemoral approach has recently evolved to an endovascular alternative to open surgery in high-risk patients. However, large-bore femoral artery access is required, commonly demanding surgical closure and general anesthesia. A truly percutaneous intervention would be desirable to reduce procedural complexity and diminish the need of vascular surgery and general anaesthesia. METHODS After direct puncture of the common femoral artery, three conventional suture-mediated closure devices (6F Perclose) were deployed. The preloaded sutures were tied at the end of the procedure. If no immediate hemostasis was achieved, an additional device was deployed thereafter. RESULTS PAVR with percutaneous access site closure was attempted in 15 consecutive patients and could successfully be achieved in all patients allowing conscious sedation in all but three cases. Following complications occurred: one retroperitoneal bleeding caused by removal of the valve delivery sheath requiring surgical repair, as well as two cases of femoral and iliac artery dissection caused by delivery sheath introduction and treated by stenting and vascular surgery, respectively. Vascular surgery became only necessary due to total vessel occlusion after suture closure and remains the only closure-related complication. However, treatment led to recovery in all patients. CONCLUSIONS The modified "preclosure" technique is a feasible and safe method for hemostasis after PAVR improving procedural management and diminishing the need for general anesthesia.
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Affiliation(s)
- Philipp Kahlert
- West German Heart Center Essen, Department of Cardiology, University Duisburg-Essen, Germany.
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Hon LQ, Ganeshan A, Thomas SM, Warakaulle D, Jagdish J, Uberoi R. Vascular Closure Devices: A Comparative Overview. Curr Probl Diagn Radiol 2009; 38:33-43. [DOI: 10.1067/j.cpradiol.2008.02.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Kälsch HIM, Eggebrecht H, Mayringer S, Konorza T, Sievers B, Sack S, Erbel R, Kroeger K. Randomized comparison of effects of suture-based and collagen-based vascular closure devices on post-procedural leg perfusion. Clin Res Cardiol 2007; 97:43-8. [PMID: 17874036 DOI: 10.1007/s00392-007-0575-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2007] [Accepted: 07/18/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Vascular closure devices (VCD) are well established to facilitate hemostasis after cardiac catheterization procedures. However, impairment of flow due to the reduction of femoral artery diameter remains a major concern. The present study aims to evaluate leg perfusion before and after application of collagen- and suture-based vascular closure devices. METHODS A total of 366 patients (age: 64.3 years+/-10.7, male: 71.3%) were randomized to receive femoral access site closure with either a collagen-based closure device (group A) (n=214) or a suture-mediated device (group B) (n=152), immediately following coronary catheterization procedures. In all patients, the ankle-brachial-index (ABI) was measured before and the day after closure device application. RESULTS In group A, mean ABI at baseline was 1.09+/-0.2, in group B 1.11+/-0.2. In both groups, there was a significant, albeit clinically not relevant, reduction in post-procedural ABI (group A: 1.04+/-0.2, p<0.01 vs baseline, group B: 1.06+/-0.2, p<0.01 vs baseline). DeltaABI was not different between both VCD groups (p=0.55). In patients with peripheral vascular disease (PVD), neither the Angioseal device (mean ABI at baseline 0.76+/-0.1) nor the Perclose-device (mean ABI at baseline 0.79+/-0.1) induced a remarkable impairment of leg perfusion (Angioseal: 0.77+/-0.1, p=0.9 vs baseline, Perclose: 0.78+/-0.1, p=1.0 vs baseline). Clinically, no aggravation of claudication was observed in the PVD patient group. CONCLUSION Both vascular closure devices are not associated with clinically relevant reduction in ABI. There was no difference between the two groups with respect to the level of flow impairment. Both devices may be safely used in patients with reduced ABI.
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Affiliation(s)
- H I M Kälsch
- Department of Cardiology, West-German Heart Center, Hufelandstr. 55, 45122, Essen, Germany.
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Kälsch H, Konorza T, Erbel R. Occlusion of the femoral artery after using the percutaneous suture-mediated closure system perclose. Clin Res Cardiol 2006; 95:617-9. [PMID: 16941083 DOI: 10.1007/s00392-006-0435-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2006] [Accepted: 07/24/2006] [Indexed: 11/24/2022]
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Ramondo A, Napodano M, Tarantini G, Calzolari D, Nalli C, Cacciavillani L, Iliceto S. High-risk percutaneous coronary intervention using the intracardiac microaxial pump ‘Impella Recover’. J Cardiovasc Med (Hagerstown) 2006; 7:149-52. [PMID: 16645377 DOI: 10.2459/01.jcm.0000203856.05515.cf] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Patients with multivessel coronary artery disease and severe left ventricular dysfunction are considered to be at high risk for percutaneous coronary intervention, and often are poor surgical candidates because of severe comorbidity. We report a case of high-risk percutaneous coronary intervention in a 67-year-old man with a severe left ventricular dysfunction and three-vessel coronary artery disease using a novel left ventricular assist device.
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Affiliation(s)
- Angelo Ramondo
- Department of Cardiac Thoracic and Vascular Sciences, University of Padova, Padova, Italy
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Hatfield MK, Zaleski GX, Kozlov D, Woo T, Gentile E, Sinnen J. Angio-Seal Device Used for Hemostasis in the Descending Aorta. AJR Am J Roentgenol 2004; 183:612-4. [PMID: 15333344 DOI: 10.2214/ajr.183.3.1830612] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Malcolm K Hatfield
- Department of Radiology, St. Mary's Medical Center, 3801 Spring St., Racine, WI 53405, USA
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14
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Abstract
Both sealing and suturing closure devices have been shown to shorten hemostasis time, reduce the discomfort of manual or mechanical compression, and allow for earlier ambulation after cardiac catheterization and percutaneous coronary interventions without increasing vascular complications compared with conventional compression techniques. Several studies now report a reduction in vascular complications for percutaneous coronary intervention patients treated with closure devices compared with manual compression with pronounced benefit seen in patients receiving glycoprotein IIb/IIIa receptor inhibitors. Adoption of a simple predeployment femoral angiogram is now standard practice for use of a closure device. In an attempt to develop devices that are safer and more "user friendly," considerable modifications and improvements have been made in newer generation devices. Ultimately, the acceptance of femoral closure devices will depend on which device provides a simple approach with reliable hemostasis and a cost that can justify their incorporation into routine practice.
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Affiliation(s)
- Timothy A Sanborn
- Division of Cardiology, Evanston Northwestern Healthcare, Evanston, IL 60201, USA.
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