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Bhogal S, Garg M, Meda NS, Merdler I, Wermers JP, Hashim HD, Ben-Dor I, Waksman R. Reasons for repeat urgent cardiac procedures within the same day. Catheter Cardiovasc Interv 2024; 103:691-694. [PMID: 38440925 DOI: 10.1002/ccd.31004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 02/25/2024] [Indexed: 03/06/2024]
Abstract
BACKGROUND With advances in technology and technique, the expectations are that patients undergoing procedures in the cardiac catheterization laboratory will not need to return for a repeat procedure within the same day. OBJECTIVES Report why subjects undergoing cardiac procedures return urgently to the catheterization laboratory for a repeat procedure during the same day. METHODS We retrospectively reviewed patients who were brought back to the cardiac catheterization laboratory within the same day for a repeat procedure. The reasons for index and repeat procedure were identified. Patients who were transferred from an outside center after an initial procedure at other centers were excluded. RESULTS Between November 2013 and January 2022, 55,942 catheterization procedures were performed at our institution, of which 140 entries were included in our analysis. Common reasons for the index procedure were diagnostic angiography (35.0%), percutaneous coronary intervention (PCI, 29.2%), and transcatheter aortic valve replacement (15.0%). The most common reason for bringing these patients back to the cardiac catheterization laboratory within the same day was vascular complications (24.2%), followed by repeat PCI (20.7%), need for hemodynamic support (15.0%), heart team discussion and PCI (10%), and pacemaker implantation (10%). Acute limb ischemia was the most commonly identified vascular complication (7.1%), followed by pseudoaneurysm (5%). CONCLUSION Our study demonstrates that a very small number of patients underwent repeat procedures within the same day. Special attention should be paid to vascular access and closure and assessment of recurrent chest pain postprocedure, as these are the main reasons for same-day repeat procedures.
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Affiliation(s)
- Sukhdeep Bhogal
- Section of Interventional Cardiology, Sovah Health, Martinsville, Virginia, USA
| | - Mohil Garg
- Department of Internal Medicine, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Namratha S Meda
- Department of Internal Medicine, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Ilan Merdler
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Jason P Wermers
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Hayder D Hashim
- 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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Johnsrud DO, Port SC. In 2023 invasive coronary angiography is preferred to PET myocardial perfusion imaging for the initial work-up of a symptomatic patient with a high coronary artery calcium score. J Nucl Cardiol 2023; 30:2269-2272. [PMID: 37845556 DOI: 10.1007/s12350-023-03385-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 09/06/2023] [Indexed: 10/18/2023]
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Dubosq M, Renard R, Jayet J, Mercier L, Javerliat I, Castier Y, Coggia M, Coscas R. Single Primary Retrograde Access to Treat Femoro-Popliteal Occlusive Lesions. J Endovasc Ther 2023:15266028231188868. [PMID: 37515490 DOI: 10.1177/15266028231188868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/31/2023]
Abstract
INTRODUCTION The retrograde puncture of a distal artery is considered a bailout procedure in case of anterograde approach failure for peripheral artery disease (PAD) treatment. A single primary retrograde access has been suggested as an efficient and safe option. As scant data are available, we present our results using this approach. MATERIAL AND METHODS Between August 2019 and October 2022, we performed this technique in selected patients with femoro-popliteal PAD. Chronic total occlusions (CTOs) were selected on the basis of the CTOP classification. An ultrasound-guided retrograde puncture of a tibial artery at the ankle level was performed, followed by the preferential use of 4F materials. Hemostasis of the puncture site was obtained using manual compression. Postoperative duplex scan examination systematically included an evaluation of the punctured artery. Demographics, intraoperative, and follow-up data were collected retrospectively. The results are expressed as means with standard deviations and numbers with percentages when appropriate. RESULTS In total, 55 procedures were performed in 46 patients (9 bilateral). Of these, 57% (N=26) were considered at risk for femoral puncture (obesity, history of groin surgery, challenging crossover approach) and 54% (N=25) presented with critical limb-threatening ischemia (CLTI). The TASC-II femoro-popliteal classification was generally B (60%) and also C (33%) or D (7%). Mean lesion length was 105.6±49.4 mm and 65% were CTOs. Most patients were operated in an outpatient setting (N=25; 54%) under potentialized local anesthesia (N=41, 89%). The punctured site was the posterior tibial artery in 73% (N=40). The procedure time was 65.1±25.7 minutes, and the fluoroscopy time was 10.7±8.5 minutes. The technical success rate was 100%. There were no intraoperative complications. All patients could walk the same day. One CLTI patient presented an erysipelas related to the puncture in postoperative period. At 30 days, the primary patency of the treated and the punctured arteries were 98% and 100%, respectively. CONCLUSION A single primary retrograde access can be used safely to treat femoro-popliteal PAD. It represents a valuable alternative to the femoral puncture and allows fast ambulation. Prospective and long-term studies on larger populations are necessary to confirm our results. CLINICAL IMPACT This study demonstrates that a single primary retrograde access can be used safely without damaging the punctured artery to treat femoro-popliteal lesions, especially in claudicant patients. Chronic total occlusions can be treated successfully using this technique. This approach represents a valuable alternative to the femoral puncture and allows fast ambulation without risk of major bleeding.
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Affiliation(s)
- Maxime Dubosq
- Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Régis Renard
- Department of Vascular and Thoracic Surgery, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jérémie Jayet
- Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Lucie Mercier
- Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Isabelle Javerliat
- Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Yves Castier
- Department of Vascular and Thoracic Surgery, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Marc Coggia
- Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Raphael Coscas
- Department of Vascular Surgery, Ambroise Paré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
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Kumar AP, Valakkada J, Ayappan A, Kannath S. Management of Acute Complications during Endovascular Procedures in Peripheral Arterial Disease: A Review. JOURNAL OF CLINICAL INTERVENTIONAL RADIOLOGY ISVIR 2022. [DOI: 10.1055/s-0042-1760246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
AbstractEndovascular therapy, as opposed to surgical bypass, has become the mainstay for peripheral arterial disease even in long segment occlusions. Complications can occur during the arterial access, catheter manipulation, balloon dilation, and/or stent placement. Given the high prevalence of comorbidities such as diabetes, hypertension, renal dysfunction, and coronary artery disease in these patients, early identification of procedural complications and initiation of treatment are of paramount importance. This review aims to provide comprehensive data on the identification and management of commonly encountered endovascular complications during endovascular interventions in peripheral arterial disease.
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Affiliation(s)
- Ajay Pawan Kumar
- Department of Imaging Sciences and Interventional Radiology, Sreechitra Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Jineesh Valakkada
- Department of Imaging Sciences and Interventional Radiology, Sreechitra Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Anoop Ayappan
- Department of Imaging Sciences and Interventional Radiology, Sreechitra Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Santhosh Kannath
- Department of Imaging Sciences and Interventional Radiology, Sreechitra Institute of Medical Sciences and Technology, Trivandrum, Kerala, India
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Tai WA, Wu CH, Ling K, Chen ST, Lin TM, Hwang HE, Luo CB, Guo WY, Chang FC. Iatrogenic retroperitoneal hematoma as an access-site complication of neurointervention. J Chin Med Assoc 2022; 85:774-781. [PMID: 35266918 DOI: 10.1097/jcma.0000000000000711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND To evaluate the clinical and imaging presentation, management, and outcome of iatrogenic retroperitoneal hematomas (IRPHs) during a series of neurointerventional procedures (NIPs). METHODS Six IRPH patients with complications, including five renal subcapsular hematomas (RSH) and one retroperitoneal hemorrhage, were observed among 2290 NIPs performed at our hospital from 2000 through 2020. The medical records, neurointerventional techniques, imaging data, and management of these six IRPH patients were retrospectively reviewed. All six patients received preprocedural dual antiplatelet medication and intraprocedural heparinization. RESULTS All patients underwent right femoral access. The guidewires were not handled under full course fluoroscopy monitoring. The most common symptom of IRPH was periprocedural flank/abdominal pain (6/6, 100%), including five on the left side (83.3%). Hypotension or shock was observed in three patients (50%). Two patients (33%) were diagnosed intraoperatively by sonogram and received on-site treatment, whereas the other four were diagnosed by postprocedural abdominal computed tomography. Active extravasation from a renal artery was diagnosed by angiogram in the five patients with RSH and was successfully treated with embolization. Multiple bleeders in the branches of the renal artery were noted in three RSH patients (60%). The patient with retroperitoneal hematoma was treated conservatively. CONCLUSION Unexplained periprocedural or postprocedural abdominal/flank pain, especially contralateral to the femoral access side of the NIPs, should raise the possibility of IRPH. To prevent IRPH, the authors suggest using full visual fluoroscopic monitoring for guidewire navigation during femoral catheterization of NIPs.
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Affiliation(s)
- Wei-An Tai
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Chia-Hung Wu
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Kan Ling
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Shu-Ting Chen
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Te-Ming Lin
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Hsuen-En Hwang
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Chao-Bao Luo
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Biomedical Engineering, Yuanpei University of Medical Technology, Hsinchu, Taiwan, ROC
| | - Wan-Yuo Guo
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Feng-Chi Chang
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
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Abstract
PURPOSE OF REVIEW Vascular access and closure is a key part of endovascular procedures, and access site-related complications are an independent predictor of adverse procedural outcomes. The purpose of this review is to discuss the methods of vascular closure including manual compression, vascular closure devices (VCDs) for both arterial and venous arteriotomies, their mechanisms, and access site-related complications. RECENT FINDINGS Various VCDs have been approved over the last three decades. These devices have different mechanisms to achieve hemostasis and are generally categorized into active and passive approximators. Studies have largely found that they are non-inferior to manual compression. Uncomplicated vascular closure is pertinent to avoid adverse procedure-related outcomes. The emergence of VCDs has reduced time to hemostasis, facilitating early ambulation and discharge and reducing hospitalization cost with comparable complication rate to manual compression. Nonetheless, they should be used in favorable vascular anatomy and are not intended to reduce complications.
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Affiliation(s)
- Sukhdeep Bhogal
- Section of Interventional Cardiology, MedStar Washington Hospital Center, 110 Irving St.Suite 4B-1, Washington, NWDC, 20010, USA
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, 110 Irving St.Suite 4B-1, Washington, NWDC, 20010, USA.
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Cambruzzi M, Borgeat K, MacFarlane P. Anaesthetic management of a dog with severe pulmonary stenosis and R2A right coronary artery anomaly undergoing placement of a hybrid transventricular pulmonary stent. VETERINARY RECORD CASE REPORTS 2022. [DOI: 10.1002/vrc2.322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Martina Cambruzzi
- Small Animal Hospital Langford Vets University of Bristol Langford UK
| | - Kieran Borgeat
- Small Animal Hospital Langford Vets University of Bristol Langford UK
| | - Paul MacFarlane
- Small Animal Hospital Langford Vets University of Bristol Langford UK
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Carmo PBD, Magliano CADS, Rey HCV, Camargo GC, Trocado LFL, Gottlieb I. Análise da Custo-Efetividade da Angiotomografia Coronariana no SUS, em Comparação com Outros Métodos Não Invasivos na Suspeita de DAC Estável. Arq Bras Cardiol 2021; 118:578-585. [PMID: 35137778 PMCID: PMC8959029 DOI: 10.36660/abc.20201050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 03/24/2021] [Indexed: 11/18/2022] Open
Abstract
Fundamento Objetivos Métodos Resultados Conclusão
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9
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Strassle Rojas S, Collins GC, Tridandapani S, Lindsey BD. Ultrasound-gated computed tomography coronary angiography: Development of ultrasound transducers with improved computed tomography compatibility. Med Phys 2021; 48:4191-4204. [PMID: 34087004 DOI: 10.1002/mp.15023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 05/06/2021] [Accepted: 05/26/2021] [Indexed: 11/06/2022] Open
Abstract
PURPOSE Cardiovascular disease (CVD) is a leading cause of death worldwide, with coronary artery disease (CAD) accounting for nearly half of all CVD deaths. The current gold standard for CAD diagnosis is catheter coronary angiography (CCA), an invasive, expensive procedure. Computed tomography coronary angiography (CTCA) represents an attractive non-invasive alternative to CCA, however, CTCA requires gated acquisition of CT data during periods of minimal cardiac motion (quiescent periods) to avoid non-diagnostic scans. Current gating methods either expose patients to high levels of radiation (retrospective gating) or lead to high rates of non-diagnostic scans (prospective gating) due to the challenge of predicting cardiac quiescence based on ECG alone. Alternatively, ultrasound (US) imaging has been demonstrated as an effective indicator of cardiac quiescence, however, ultrasound transducers produce prominent streak artifacts that disrupt CTCA scans. In this study, a proof-of-concept array transducer with improved CT-compatibility was developed for utilization in an integrated US-CTCA system. METHODS Alternative materials were tested radiographically and acoustically to replace the radiopaque acoustic backings utilized in low frequency (1-4 MHz) cardiac US transducers. The results of this testing were used to develop alternative acoustic backings consisting of varying concentrations of aluminum oxide in an epoxy matrix via simulations. On the basis of these simulations, single element test transducers designed to operate at 2.5 MHz were fabricated, and the performance of these devices was characterized via acoustic and radiographic testing with micro-computed tomography (micro-CT). Finally, a first proof-of-concept cardiac phased array transducer was developed and its US imaging performance was evaluated. Micro-CT images of the developed US array with improved CT-compatibility were compared with those of a conventional array. RESULTS Materials testing with micro-CT identified an acoustic backing with a measured radiopacity of 1008 HU, more than an order of magnitude lower than that of the acoustic backing (24,000 HU) typically used in cardiac transducers operating in the 1-4 MHz range. When utilized in a simulated transducer design, this acoustic backing yielded a -6-dB fractional bandwidth of 57%, similar to the 54% bandwidth of the transducer with the radiopaque acoustic backing. The developed 2.5 MHz, single element transducer based on these simulations exhibited a fractional bandwidth of 51% and signal-to-noise ratio (SNR) of 14.7 dB. Finally, the array transducer developed with the acoustic backing having decreased radiopacity exhibited a 56% fractional bandwidth and 10.4 dB single channel SNR, with penetration depth >10 cm in phantom and in vivo imaging using the full array. CONCLUSIONS The first attempt at developing a CT-compatible ultrasound transducer is described. The developed CT-compatible transducer exhibits improved radiographic compatibility relative to conventional cardiac array transducers with similar SNR, bandwidth, and penetration depth for US imaging, according to phantom and in vivo cardiac imaging. A CT-compatible US transducer might be used to identify cardiac quiescence and prospectively gate CTCA acquisition, reducing challenges associated with current gating approaches, specifically relatively high rates of non-diagnostic scans for prospective ECG gating and high radiation dose for retrospective gating.
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Affiliation(s)
- Stephan Strassle Rojas
- Department of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Graham C Collins
- Wallace H Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Srini Tridandapani
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Brooks D Lindsey
- Department of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA, USA.,Wallace H Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
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Ybarra LF, Rinfret S. Access Selection for Chronic Total Occlusion Percutaneous Coronary Intervention and Complication Management. Interv Cardiol Clin 2020; 10:109-120. [PMID: 33223100 DOI: 10.1016/j.iccl.2020.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Dual access for chronic total occlusion percutaneous coronary intervention is considered best practice by many experts. There are 2 access sites: radial and femoral. Both accesses have important advantages and disadvantages. Determining the ratio risk/benefit-efficacy/safety of each access for each patient in a specific procedure should be based on procedural and clinical variables. Given the safety benefit and the minimal procedural disadvantages, radial access should be the standard approach, especially in procedures of low complexity and in patients at high risk of vascular complications. Nonetheless, mastering both approaches is important because they are needed in multiple occasions.
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Affiliation(s)
- Luiz F Ybarra
- London Health Sciences Centre, Schulich School of Medicine & Dentistry, Western University, 339 Windermere Road, Room B6-127, London, Ontario N6A 5A5, Canada. https://twitter.com/YbarraLuiz
| | - Stéphane Rinfret
- Division of Cardiology, Department of Medicine, McGill University, McGill University Health Centre, Glen Site, 1001 Boulevard Décarie, Montreal, Quebec H4A 3J1, Canada.
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Nishiyama H, Matsumoto H, Izawa D, Toki N. Renal Artery Injury Caused by a 0.035-Inch Guidewire in Navigating a Guiding Sheath during Coil Embolization: A Case Report of Rescue Embolization with n-Butyl-2-Cianoacrylate. JOURNAL OF NEUROENDOVASCULAR THERAPY 2020; 15:58-63. [PMID: 37503453 PMCID: PMC10370614 DOI: 10.5797/jnet.cr.2019-0107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 06/29/2020] [Indexed: 07/29/2023]
Abstract
Objective We report renal artery injury by a guidewire during coil embolization of a cerebral artery aneurysm, which was successfully treated by transarterial embolization using n-butyl-2-cianoacrylate (NBCA). Case Presentation A 65-year-old woman underwent coil embolization for an unruptured cerebral aneurysm, resulting in its complete occlusion. However, her blood pressure decreased during embolization and postoperative abdominal computed tomography (CT) revealed a retroperitoneal hematoma. Intraoperative video revealed that the 0.035-inch guidewire had passed deeply into the right renal artery when the guiding sheath was navigated into the abdominal aorta, suggesting renal artery perforation. Transarterial embolization using NBCA was performed immediately, which resulted in hemostasis. Conclusion Although renal artery perforation with a guidewire is a rare complication, it can have severe consequences. Early diagnosis with prompt and definitive hemostasis is important.
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Affiliation(s)
- Hirokazu Nishiyama
- Department of Neurological Surgery, Kishiwada Tokushukai Hospital, Kishiwada, Osaka, Japan
| | - Hiroyuki Matsumoto
- Department of Neurological Surgery, Kishiwada Tokushukai Hospital, Kishiwada, Osaka, Japan
| | - Daisuke Izawa
- Department of Neurological Surgery, Kishiwada Tokushukai Hospital, Kishiwada, Osaka, Japan
| | - Naotsugu Toki
- Department of Neurological Surgery, Kishiwada Tokushukai Hospital, Kishiwada, Osaka, Japan
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Park SE, Cho SB, Baek HJ, Moon JI, Ryu KH, Ha JY, Lee S, Won J, Ahn JH, Kim R, Choi SY. Clinical experience with distal transradial access for endovascular treatment of various noncoronary interventions in a multicenter study. PLoS One 2020; 15:e0237798. [PMID: 32822396 PMCID: PMC7444561 DOI: 10.1371/journal.pone.0237798] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 08/02/2020] [Indexed: 11/18/2022] Open
Abstract
Background Transradial access is a well-known alternative to conventional transfemoral access for interventional procedures. Recently, transradial access through the “snuffbox”, which lies in the radial dorsal aspect of the hand, has been introduced as a new technique with positional versatility. In this study, we aimed to evaluate the clinical feasibility and safety of distal transradial access for interventional procedures in a retrospective, multicenter study. Material & methods Distal transradial access was attempted in 46 patients (36 men and 10 women; mean age, 64 years) who underwent 47 consecutive procedures from January 2018 to December 2019. Procedures included chemoembolization (19/47, 40.4%), bronchial artery embolization (7/47, 14.9%), renal intervention (3/47, 6.4%), arteriovenous fistula angioplasty (7/47, 14.9%), subclavian artery stenting (5/47, 10.6%), other embolization (5/47, 10.6%), and uterine artery embolization (1/47, 2.1%). We recorded the success rate of the procedures, complications, and postprocedural hemostasis time during the follow-up period. Results The technical success of distal transradial access without major complications was 97.9% (46/47). Of the 46 patients, one patient (2.2%) had a minor complication, which was a thrombotic segmental occlusion of the distal radial artery. Of the enrolled patients, only one patient did not complete the transradial access procedure via the snuffbox because the left proximal subclavian artery was occluded and a crossover to conventional transfemoral access was performed. The mean postprocedural hemostasis time was 131.7 minutes (range, 120–360 minutes). Conclusion Distal transradial access can be a valid option for the endovascular treatment of various noncoronary interventions with technical feasibility and safety.
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Affiliation(s)
- Sung Eun Park
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Soo Buem Cho
- Department of Radiology, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
- * E-mail:
| | - Hye Jin Baek
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Jin Il Moon
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Kyeong Hwa Ryu
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Ji Young Ha
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Sangmin Lee
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Jungho Won
- Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Jong-Hwa Ahn
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Ran Kim
- Department of Radiology, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Sun Young Choi
- Department of Radiology, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
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Hecht HS, Villines TC. Coronary computed tomographic angiography and invasive coronary angiography: A reevaluation. J Cardiovasc Comput Tomogr 2020; 14:374-376. [PMID: 32595081 DOI: 10.1016/j.jcct.2020.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/30/2020] [Accepted: 05/29/2020] [Indexed: 11/16/2022]
Affiliation(s)
- Harvey S Hecht
- Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Todd C Villines
- University of Virginia Health System, Charlottesville, VA, USA
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14
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Kaifi R, Almatrafi M, Alahmary F, Chen A, Macsata R, Sarani B, Zderic V. Reliability and Variability Assessment of Femoral Artery Pseudoaneurysm Measurements Between Pre- and Postprocessed B-mode Ultrasound Images. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2020. [DOI: 10.1177/8756479320908213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: To assess the reliability and variability of femoral artery pseudoaneurysm (FAP) measurements between pre- and postprocessed sonograms acquired in a major medical center in Saudi Arabia as compared with results obtained from a major medical center in the United States. Methods: Retrospective image analysis was conducted on 23 FAP sonograms, which were evaluated by four observers. Observers measured FAP sac and neck from pre- and postprocessed images and remeasured again after 2 weeks, to avoid recall bias. Results: The use of image processing was more profound for the novice observers in measuring FAP neck width and length. The intraclass correlation coefficient (ICC) for FAP neck width improved after segmentation from 0.63 to 0.91; in contrast, the ICC improved from 0.91 to 0.97 for experts. The average ICCs for FAP neck length improved from 0.40 to 0.79 for novices and from 0.86 to 0.95 for experts. The largest variation of values, within observers, were for neck length obtained from the original images. The range varied from 0.16 to 0.37 cm and was reduced to 0.10 to 0.18 cm with segmented images. Conclusion: As demonstrated previously, sonographic image processing resulted in increased reliability and decreased variability for FAP measurements.
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Affiliation(s)
- Reham Kaifi
- Department of Biomedical Engineering, The George Washington University, Washington, DC, USA
| | - Mohammed Almatrafi
- Department of Electrical Engineering, University of Dayton, Dayton, OH, USA
| | - Ferdos Alahmary
- Department of Diagnostic Radiology, King Saud bin Abdulaziz University for Health Science, Jeddah, Saudi Arabia
| | - Andrew Chen
- Department of Biomedical Engineering, The George Washington University, Washington, DC, USA
| | - Robyn Macsata
- Department of Surgery, The George Washington University Medical School, Washington, DC, USA
| | - Babak Sarani
- Department of Surgery, The George Washington University Medical School, Washington, DC, USA
| | - Vesna Zderic
- Department of Biomedical Engineering, The George Washington University, Washington, DC, USA
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15
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Impact of scan quality on the diagnostic performance of CCTA, SPECT, and PET for diagnosing myocardial ischemia defined by fractional flow reserve. J Cardiovasc Comput Tomogr 2020; 14:60-67. [DOI: 10.1016/j.jcct.2019.06.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 05/07/2019] [Accepted: 06/10/2019] [Indexed: 11/20/2022]
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Leesar MA, Al Solaiman F, Azarbal A, Marmagkiolis K, Cilingiroglu M. A Novel Fluoroscopic-guided Technique With Micropuncture Needle for the Common Femoral Artery Access. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 21:668-674. [PMID: 31627988 DOI: 10.1016/j.carrev.2019.08.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 08/18/2019] [Accepted: 08/19/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Randomized trials demonstrated that the rate of access to the center of the CFA was low and not different with fluoroscopy vs. anatomic landmarks. We investigated the role a novel fluoroscopic-guided technique with the micropuncture needle (MPN) for the common femoral artery (CFA) access. METHODS A MPN was advanced to the center of pubis in the 20° ipsilateral right- or left anterior oblique view for the CFA access in 150 patients undergoing cardiac catheterization. After the CFA puncture and guidewire advancement, if the MPN tip was within pelvic-femoral line (the line between pelvic brim and inferior border of the femoral head), a sheath was inserted into the CFA and femoral angiography was performed. The acceptable sites of CFA access were defined zone III, as the sheath position in the middle third of the CFA; Zone II, between the pelvic brim and Zone III; and Zone IV, between the femoral bifurcation and Zone III. High or low access sites were zones I and V, respectively. RESULTS The primary-end point, the CFA access to the center of CFA (zone III) was significantly higher than zones II and IV (64% vs. 13% and 23%; P < 0.001, respectively). The MPN tip was high or low in 17 and 11 patients (19%), respectively, which was readvanced to the center of pubis using fluoroscopy; this resulted in CFA access in 100% of patients. There were no bleeding complications; the baseline and next day hemoglobin levels were 13.0 ± 2.0 g/dl vs. 12.4 ± 1.9 g/dl, respectively; P = NS. CONCLUSIONS The use of this novel fluoroscopic-guided technique with the MPN resulted in access to the CFA in all patients and to the center of the CFA in the majority of patients. There was no significant hemoglobin drop or bleeding complications after the procedure.
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Affiliation(s)
- Massoud A Leesar
- Division of Cardiology, University of Alabama at Birmingham, United States of America.
| | - Firas Al Solaiman
- Division of Cardiology, University of Alabama at Birmingham, United States of America
| | - Amir Azarbal
- Division of Cardiology, University of Alabama at Birmingham, United States of America
| | - Kostas Marmagkiolis
- Citizens Memorial and Vascular Institute Bolivar, Mo and the University of Missouri, Columbia, United States of America
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Al-Hijji MA, Lennon RJ, Gulati R, El Sabbagh A, Park JY, Crusan D, Kanwar A, Behfar A, Lerman A, Holmes DR, Bell M, Singh M. Safety and Risk of Major Complications With Diagnostic Cardiac Catheterization. Circ Cardiovasc Interv 2019; 12:e007791. [PMID: 31284736 DOI: 10.1161/circinterventions.119.007791] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND We aim to study the incidence of major complications related to procedure defined as in-hospital death, myocardial infarction, stroke, pericardial effusion or tamponade, percutaneous coronary intervention due to iatrogenic coronary dissection, or unplanned bypass surgery within 72 hours after diagnostic left heart catheterization (LHC; primary end point). Furthermore, all causes of in-hospital death after LHC were adjudicated and reported (secondary end point). METHODS AND RESULTS Diagnostic LHC procedures (aortic angiography; coronary, including graft, angiography; and left ventricular angiography) from January 1, 2002, through December 31, 2013, were identified using the clinical scheduling system at Mayo Clinic, Rochester, and complications were identified through electronic records. International Classification of Diseases, Ninth Revision billing codes were used. Registration was queried to identify all-cause mortality. All events were reviewed and adjudicated. There were 43 786 diagnostic LHC procedures; 97.3% were coronary angiograms. The mean age of patients was 64.5 years (13.6), and the majority were male (61.5%). Primary end point was seen in 36 (0.082%) procedures or 8.2 of 10 000 LHCs. Combined right sided procedures with LHC did not increase the risk of major complications. Cardiogenic and septic shock, cardiac arrhythmia, and postsurgical complication were the most common causes of in-hospital death after LHC. CONCLUSIONS The overall rates of major complications related to diagnostic cardiac catheterization procedures are extremely rare. The majority of the deaths occurring post-diagnostic LHC procedures were secondary to acute illness rather than directly related to diagnostic procedure.
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Affiliation(s)
- Mohammed A Al-Hijji
- Division of Cardiovascular Medicine, Mayo Clinic and Mayo Foundation, Rochester, MN (M.A.A.-H., R.G., A.E.S., J.Y.P., A.K., A.B., A.L., D.R.H., M.B., M.S.)
| | - Ryan J Lennon
- Division of Biomedical Statistics and Informatics, Mayo Clinic and Mayo Foundation, Rochester, MN(R.J.L., D.C.)
| | - Rajiv Gulati
- Division of Cardiovascular Medicine, Mayo Clinic and Mayo Foundation, Rochester, MN (M.A.A.-H., R.G., A.E.S., J.Y.P., A.K., A.B., A.L., D.R.H., M.B., M.S.)
| | - Abdallah El Sabbagh
- Division of Cardiovascular Medicine, Mayo Clinic and Mayo Foundation, Rochester, MN (M.A.A.-H., R.G., A.E.S., J.Y.P., A.K., A.B., A.L., D.R.H., M.B., M.S.)
| | - Jae Yoon Park
- Division of Cardiovascular Medicine, Mayo Clinic and Mayo Foundation, Rochester, MN (M.A.A.-H., R.G., A.E.S., J.Y.P., A.K., A.B., A.L., D.R.H., M.B., M.S.)
| | - Daniel Crusan
- Division of Biomedical Statistics and Informatics, Mayo Clinic and Mayo Foundation, Rochester, MN(R.J.L., D.C.)
| | - Amrit Kanwar
- Division of Cardiovascular Medicine, Mayo Clinic and Mayo Foundation, Rochester, MN (M.A.A.-H., R.G., A.E.S., J.Y.P., A.K., A.B., A.L., D.R.H., M.B., M.S.)
| | - Atta Behfar
- Division of Cardiovascular Medicine, Mayo Clinic and Mayo Foundation, Rochester, MN (M.A.A.-H., R.G., A.E.S., J.Y.P., A.K., A.B., A.L., D.R.H., M.B., M.S.)
| | - Amir Lerman
- Division of Cardiovascular Medicine, Mayo Clinic and Mayo Foundation, Rochester, MN (M.A.A.-H., R.G., A.E.S., J.Y.P., A.K., A.B., A.L., D.R.H., M.B., M.S.)
| | - David R Holmes
- Division of Cardiovascular Medicine, Mayo Clinic and Mayo Foundation, Rochester, MN (M.A.A.-H., R.G., A.E.S., J.Y.P., A.K., A.B., A.L., D.R.H., M.B., M.S.)
| | - Malcolm Bell
- Division of Cardiovascular Medicine, Mayo Clinic and Mayo Foundation, Rochester, MN (M.A.A.-H., R.G., A.E.S., J.Y.P., A.K., A.B., A.L., D.R.H., M.B., M.S.)
| | - Mandeep Singh
- Division of Cardiovascular Medicine, Mayo Clinic and Mayo Foundation, Rochester, MN (M.A.A.-H., R.G., A.E.S., J.Y.P., A.K., A.B., A.L., D.R.H., M.B., M.S.)
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Affiliation(s)
| | - Daniel R Obaid
- Swansea University Medical School and Morriston Cardiac Centre, Swansea, UK
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Berger D, Desai V, Janardhan S. Con: Liver Biopsy Remains the Gold Standard to Evaluate Fibrosis in Patients With Nonalcoholic Fatty Liver Disease. Clin Liver Dis (Hoboken) 2019; 13:114-116. [PMID: 31061705 PMCID: PMC6491029 DOI: 10.1002/cld.740] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 05/20/2018] [Indexed: 02/04/2023] Open
Affiliation(s)
- Daniel Berger
- Rush University Medical Center, Section of HepatologyChicagoIL
| | - Vishal Desai
- Rush University Medical Center, Section of HepatologyChicagoIL
| | - Sujit Janardhan
- Rush University Medical Center, Section of HepatologyChicagoIL
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LeBlanc NL, Agarwal D, Menzen E, Nomi K, Sisson DD, Scollan KF. Prevalence of major complications and procedural mortality in 336 dogs undergoing interventional cardiology procedures in a single academic center. J Vet Cardiol 2019; 23:45-57. [PMID: 31174729 DOI: 10.1016/j.jvc.2019.01.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 01/17/2019] [Accepted: 01/17/2019] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Overall complication rates associated with a wide range of diagnostic and therapeutic interventional cardiac procedures in a contemporary academic setting have not been reported. ANIMALS, MATERIALS AND METHODS Consecutive interventional procedures performed for client-owned dogs were retrospectively analyzed to characterize procedural complications and mortality. RESULTS Three hundred sixty-four procedures were performed on 336 dogs. Interventions included attempted or completed transvenous pacemaker (PM) implantation (n = 134) with subsequent pacing system revision (n = 8), pulmonic balloon valvuloplasty (BVP) (n = 117) with a subset of patients undergoing an additional BVP (n = 14), transarterial closure of left-to-right shunting patent ductus arteriosus (PDA) (n = 66), diagnostic angiography and/or cardiovascular pressure measurement (n = 9), transvenous temporary pacing (n = 7), septal defect occlusion (n = 5), heartworm extraction (n = 3), and BVP catheter fragment retrieval (n = 1). The prevalence of major perioperative and postoperative complications for all procedures was 5% and 6%, respectively, and the procedural mortality rate was 2%. The overall rate of major complications was 12% for the PM group, 11% for the BVP group, and 2% for the PDA occlusion group. Both PM implantation and BVP have higher rates of major complications overall compared with PDA occlusion (p=0.0151). CONCLUSIONS The results of this study indicate that the prevalence of major complications and mortality associated with interventional cardiac procedures is low; however, significant differences exist in complication rates between procedures.
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Affiliation(s)
- N L LeBlanc
- Oregon State University, Department of Clinical Sciences, College of Veterinary Medicine, 105 Magruder Hall, 700 SW 30(th) Street, Corvallis, Oregon 97331, USA.
| | - D Agarwal
- MedVet Medical and Cancer Center for Pets, Cardiology Department, 3964 Red Bank Road, Cincinnati, Ohio 45227, USA
| | - E Menzen
- Oregon State University, Department of Clinical Sciences, College of Veterinary Medicine, 105 Magruder Hall, 700 SW 30(th) Street, Corvallis, Oregon 97331, USA
| | - K Nomi
- Oregon State University, Department of Clinical Sciences, College of Veterinary Medicine, 105 Magruder Hall, 700 SW 30(th) Street, Corvallis, Oregon 97331, USA
| | - D D Sisson
- Oregon State University, Department of Clinical Sciences, College of Veterinary Medicine, 105 Magruder Hall, 700 SW 30(th) Street, Corvallis, Oregon 97331, USA
| | - K F Scollan
- Oregon State University, Department of Clinical Sciences, College of Veterinary Medicine, 105 Magruder Hall, 700 SW 30(th) Street, Corvallis, Oregon 97331, USA
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Zia S, Singh K, Juneja A, Schor J, Deitch J. Safety and Feasibility of Transradial Access for Noncoronary and Peripheral Vascular Interventions. Ann Vasc Surg 2018; 53:255-261. [DOI: 10.1016/j.avsg.2018.04.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 03/02/2018] [Accepted: 04/01/2018] [Indexed: 11/25/2022]
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23
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Turi ZG. Clip versus suture toe to toe: Perspectives on and beyond the evidence base. Catheter Cardiovasc Interv 2018; 91:408-409. [DOI: 10.1002/ccd.27532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Accepted: 01/22/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Zoltan G. Turi
- Center for Structural and Congenital Heart Disease, Hackensack University Medical Center and Seton Hall Hackensack Meridian School of Medicine; Hackensack New Jersey
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24
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Dogan MV, Grumbach IM, Michaelson JJ, Philibert RA. Integrated genetic and epigenetic prediction of coronary heart disease in the Framingham Heart Study. PLoS One 2018; 13:e0190549. [PMID: 29293675 PMCID: PMC5749823 DOI: 10.1371/journal.pone.0190549] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 12/15/2017] [Indexed: 12/16/2022] Open
Abstract
An improved method for detecting coronary heart disease (CHD) could have substantial clinical impact. Building on the idea that systemic effects of CHD risk factors are a conglomeration of genetic and environmental factors, we use machine learning techniques and integrate genetic, epigenetic and phenotype data from the Framingham Heart Study to build and test a Random Forest classification model for symptomatic CHD. Our classifier was trained on n = 1,545 individuals and consisted of four DNA methylation sites, two SNPs, age and gender. The methylation sites and SNPs were selected during the training phase. The final trained model was then tested on n = 142 individuals. The test data comprised of individuals removed based on relatedness to those in the training dataset. This integrated classifier was capable of classifying symptomatic CHD status of those in the test set with an accuracy, sensitivity and specificity of 78%, 0.75 and 0.80, respectively. In contrast, a model using only conventional CHD risk factors as predictors had an accuracy and sensitivity of only 65% and 0.42, respectively, but with a specificity of 0.89 in the test set. Regression analyses of the methylation signatures illustrate our ability to map these signatures to known risk factors in CHD pathogenesis. These results demonstrate the capability of an integrated approach to effectively model symptomatic CHD status. These results also suggest that future studies of biomaterial collected from longitudinally informative cohorts that are specifically characterized for cardiac disease at follow-up could lead to the introduction of sensitive, readily employable integrated genetic-epigenetic algorithms for predicting onset of future symptomatic CHD.
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Affiliation(s)
- Meeshanthini V. Dogan
- Department of Biomedical Engineering, University of Iowa, Iowa City, Iowa, United States of America
- Department of Psychiatry, University of Iowa, Iowa City, Iowa, United States of America
- Cardio Diagnostics LLC, Coralville, Iowa, United States of America
| | - Isabella M. Grumbach
- Department of Internal Medicine, University of Iowa, Iowa City, Iowa, United States of America
- Iowa City Veterans Affairs Healthcare System, Iowa City, Iowa, United States of America
| | - Jacob J. Michaelson
- Department of Psychiatry, University of Iowa, Iowa City, Iowa, United States of America
| | - Robert A. Philibert
- Department of Biomedical Engineering, University of Iowa, Iowa City, Iowa, United States of America
- Department of Psychiatry, University of Iowa, Iowa City, Iowa, United States of America
- Behavioral Diagnostics LLC, Coralville, Iowa, United States of America
- * E-mail:
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25
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Son SY, Cho KC, Cho P, Lee JH, Myoung SU, Choi JH. Prepuncture Ultrasound Examination Facilitates Safe and Accurate Common Femoral Artery Access for Transfemoral Cerebral Angiography. J Cerebrovasc Endovasc Neurosurg 2017; 19:276-283. [PMID: 29387628 PMCID: PMC5788835 DOI: 10.7461/jcen.2017.19.4.276] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Revised: 08/22/2017] [Accepted: 10/25/2017] [Indexed: 11/23/2022] Open
Abstract
Objective We aimed to introduce our method involving prepuncture ultrasound scan for cannulation of the common femoral artery (CFA) during transfemoral cerebral angiography (TFCA), and to assess the clinical and radiological outcomes. Material and Methods Our study included 90 patients who underwent prepuncture ultrasound examination of the inguinal area for TFCA between April 2015 and June 2015. Prior to skin preparation and draping of the inguinal area, we identified the CFA and its bifurcation using ultrasound. Based on the ultrasound findings, we marked cruciate lines in the inguinal area. Thereafter, we inserted a puncture needle at the interface between the horizontal and vertical lines at a 30-45° angle, simultaneously palpating the pulsation of the femoral artery. After TFCA was completed, femoral artery angiography was performed in the anteroposterior and oblique directions. Clinical and radiological parameters, including CFA cannulation, the ultrasound scan time, the first pass success rate, the time required for the passage of the wire, and complications, were evaluated. Results The mean ultrasound scan time of the CFA and its bifurcation was 72.6 seconds, and the mean time between administration of local anesthesia and wire passage was 67.44 seconds. The first pass success rate was 77.8% (70/90 patients), and the CFA puncture rate was 98.8% (89/90 patients). Although minor complications were noted in 7 patients, no patient reported serious complications (a large hematoma [≥ 5 cm], pseudoaneurysms, dissection, and/or a retroperitoneal hematoma.). Conclusion Prepuncture ultrasound examination might be a simple, safe, and accurate technique for cannulation of the CFA during TFCA.
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Affiliation(s)
- Seon Yong Son
- Department of Neurosurgery, Bundang Jesaeng General Hospital, Sungnam, Korea
| | - Kwang-Chun Cho
- Department of Neurosurgery, Bundang Jesaeng General Hospital, Sungnam, Korea
| | - Pyunggoo Cho
- Department of Neurosurgery, Bundang Jesaeng General Hospital, Sungnam, Korea
| | - Ju Hyung Lee
- Department of Neurosurgery, Bundang Jesaeng General Hospital, Sungnam, Korea
| | - Seong Uk Myoung
- Department of Radiology, Bundang Jesaeng General Hospital, Sungnam, Korea
| | - Jai Ho Choi
- Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
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Owens JT, Bhatty S, Donovan RJ, Tordini A, Danyi P, Patel K, Wegelin JA, Jovin IS. Usefulness of a Nonsuture Closure Device in Patients Undergoing Diagnostic Coronary and Peripheral Angiography. Int J Angiol 2017; 26:228-233. [PMID: 29142488 DOI: 10.1055/s-0037-1607037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Vascular access site complications can follow diagnostic coronary and peripheral angiography. We compared the complication rates of the Catalyst vascular closure device, with the complication rates after manual compression in patients undergoing diagnostic angiographic procedures via femoral access. We studied 1,470 predominantly male patients undergoing diagnostic coronary and peripheral angiography. Catalyst closure devices were used in 436 (29.7%) patients and manual compression was used in 1,034 (70.3%) patients. The former were allowed to ambulate after 2 hours, while the latter were allowed to ambulate after 6 hours. Major complications occurred in 4 (0.9%) patients who had a Catalyst device and in 14 (1.4%) patients who had manual compression (odds ratio [OR]: 0.67, 95% confidence interval [CI]: 0.22-2.1, p = 0.49). Any complications occurred in 51 (11.7%) patients who had a Catalyst closure device and in 64 (6.2%) patients who had manual compression (OR: 2, CI: 1.4-3, p < 0.01). After adjustment for other variables and for a propensity score reflecting the probability to receive the closure device, the association of major complications with the use of the closure device remained not significant (OR: 0.54, 95% CI: 0.17-1.7, p = 0.29), while the association of any complications with the use of the Catalyst device remained significant (OR: 1.9, 95% CI: 1.3-2.9, p < 0.01). The Catalyst device was not associated with an increased risk of major groin complications but was associated with an increased risk of any complications compared with manual compression. Patients receiving the closure device ambulated sooner.
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Affiliation(s)
- John T Owens
- Department of Medicine, McGuire VA Medical Center, Virginia Commonwealth University, Richmond, Virginia
| | - Shaun Bhatty
- Department of Medicine, McGuire VA Medical Center, Virginia Commonwealth University, Richmond, Virginia
| | - Robert J Donovan
- Department of Medicine, McGuire VA Medical Center, Virginia Commonwealth University, Richmond, Virginia
| | - Andrea Tordini
- Department of Medicine, McGuire VA Medical Center, Virginia Commonwealth University, Richmond, Virginia
| | - Peter Danyi
- Department of Medicine, McGuire VA Medical Center, Virginia Commonwealth University, Richmond, Virginia
| | - Kalpesh Patel
- Department of Medicine, McGuire VA Medical Center, Virginia Commonwealth University, Richmond, Virginia
| | - Jacob A Wegelin
- Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia
| | - Ion S Jovin
- Department of Medicine, McGuire VA Medical Center, Virginia Commonwealth University, Richmond, Virginia
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Aziz A, Hansen HS, Sechtem U, Prescott E, Ong P. Sex-Related Differences in Vasomotor Function in Patients With Angina and Unobstructed Coronary Arteries. J Am Coll Cardiol 2017; 70:2349-2358. [PMID: 29096805 DOI: 10.1016/j.jacc.2017.09.016] [Citation(s) in RCA: 120] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 09/04/2017] [Accepted: 09/06/2017] [Indexed: 01/04/2023]
Abstract
BACKGROUND Coronary vasomotor dysfunction is an important mechanism for angina in patients with unobstructed coronary arteries. OBJECTIVES The purpose of this study was to determine sex differences in the prevalence and clinical presentation of vasomotor dysfunction in a European population and to examine sex differences in the dose of acetylcholine leading to a positive acetylcholine provocation test (ACH test). METHODS Between 2007 and 2014, we included 1,379 consecutive patients with stable angina, unobstructed coronaries and ACH test performed for epicardial vasospasm or coronary microvascular dysfunction (CMD) due to microvascular spasm. The predictive value of sex, risk factors, symptoms, and noninvasive test results was analyzed by means of logistic regression. RESULTS The mean patient age was 62 years, and 42% were male. There were 813 patients (59%) with a pathological ACH test, 33% for CMD and 26% for epicardial vasospasm. A pathological test was more common in females (70% vs. 43%; p < 0.001). In a multivariable logistic regression model the sex difference was statistically significant with a female-male odds ratio for CMD and epicardial vasospasm of 4.2 (95% confidence interval: 3.1 to 5.5; p < 0.001) and 2.3 (95% confidence interval: 1.7 to 3.1; p < 0.001), respectively. Effort-related symptoms, but neither risk factors nor noninvasive stress tests, contributed to predicting a pathological test. Female patients were more sensitive to acetylcholine with vasomotor dysfunction occurring at lower ACH doses compared with male patients. CONCLUSIONS Vasomotor dysfunction is frequent in patients with angina and unobstructed coronaries in a European population. Female patients have a higher prevalence of vasomotor dysfunction (especially CMD) compared with male patients. A pathological ACH test was observed at lower ACH doses in women compared with men.
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Affiliation(s)
- Ahmed Aziz
- Department of Cardiology, Robert Bosch Krankenhaus, Stuttgart, Germany; Department of Cardiology, Odense University Hospital, Odense, Denmark.
| | | | - Udo Sechtem
- Department of Cardiology, Robert Bosch Krankenhaus, Stuttgart, Germany
| | - Eva Prescott
- Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Peter Ong
- Department of Cardiology, Robert Bosch Krankenhaus, Stuttgart, Germany
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Cazelli JG, Camargo GC, Kruczan DD, Weksler C, Felipe AR, Gottlieb I. Prevalence and Prediction of Obstructive Coronary Artery Disease in Patients Undergoing Primary Heart Valve Surgery. Arq Bras Cardiol 2017; 109:348-356. [PMID: 28977048 PMCID: PMC5644215 DOI: 10.5935/abc.20170135] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 06/13/2017] [Indexed: 11/20/2022] Open
Abstract
Background The prevalence of coronary artery disease (CAD) in valvular patients is
similar to that of the general population, with the usual association with
traditional risk factors. Nevertheless, the search for obstructive CAD is
more aggressive in the preoperative period of patients with valvular heart
disease, resulting in the indication of invasive coronary angiography (ICA)
to almost all adult patients, because it is believed that coronary artery
bypass surgery should be associated with valve replacement. Objectives To evaluate the prevalence of obstructive CAD and factors associated with it
in adult candidates for primary heart valve surgery between 2001 and 2014 at
the National Institute of Cardiology (INC) and, thus, derive and validate a
predictive obstructive CAD score. Methods Cross-sectional study evaluating 2898 patients with indication for heart
surgery of any etiology. Of those, 712 patients, who had valvular heart
disease and underwent ICA in the 12 months prior to surgery, were included.
The P value < 0.05 was adopted as statistical significance. Results The prevalence of obstructive CAD was 20%. A predictive model of obstructive
CAD was created from multivariate logistic regression, using the variables
age, chest pain, family history of CAD, systemic arterial hypertension,
diabetes mellitus, dyslipidemia, smoking, and male gender. The model showed
excellent correlation and calibration (R² = 0.98), as well as excellent
accuracy (ROC of 0.848; 95%CI: 0.817-0.879) and validation (ROC of 0.877;
95%CI: 0.830 - 0.923) in different valve populations. Conclusions Obstructive CAD can be estimated from clinical data of adult candidates for
valve repair surgery, using a simple, accurate and validated score, easy to
apply in clinical practice, which may contribute to changes in the
preoperative strategy of acquired heart valve surgery in patients with a
lower probability of obstructive disease.
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Affiliation(s)
| | | | - Dany David Kruczan
- Instituto Estadual de Cardiologia Aloysio de Castro, Rio de Janeiro, RJ, Brazil
| | - Clara Weksler
- Instituto Nacional de Cardiologia, Rio de Janeiro, RJ, Brazil
| | | | - Ilan Gottlieb
- Instituto Nacional de Cardiologia, Rio de Janeiro, RJ, Brazil
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Chun EJ. Ultrasonographic evaluation of complications related to transfemoral arterial procedures. Ultrasonography 2017; 37:164-173. [PMID: 29145350 PMCID: PMC5885482 DOI: 10.14366/usg.17047] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 08/23/2017] [Accepted: 08/25/2017] [Indexed: 12/18/2022] Open
Abstract
The transfemoral arterial approach is used to gain access for angiography, percutaneous coronary interventions, or various endovascular therapies. To decrease the risk of procedure-related vascular complications, it is recommended to puncture the common femoral artery in its middle segment. However, due to inadequate access or anatomical variability, various complications, including hematoma, pseudoaneurysm, arteriovenous fistula, thrombosis, or dissection, can occur after transfemoral arterial interventions. Duplex ultrasound has proven to be an excellent noninvasive modality that provides not only anatomic but also hemodynamic information, effectively detecting and differentiating various femoral puncture-related complications. Radiologists should be familiar with the characteristic sonographic findings of the entire spectrum of transfemoral puncture-related vascular complications for early detection and proper treatment.
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Affiliation(s)
- Eun Ju Chun
- Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Korea
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Tan XW, Zheng Q, Shi L, Gao F, Allen JC, Coenen A, Baumann S, Schoepf UJ, Kassab GS, Lim ST, Wong ASL, Tan JWC, Yeo KK, Chin CT, Ho KW, Tan SY, Chua TSJ, Chan ESY, Tan RS, Zhong L. Combined diagnostic performance of coronary computed tomography angiography and computed tomography derived fractional flow reserve for the evaluation of myocardial ischemia: A meta-analysis. Int J Cardiol 2017; 236:100-106. [DOI: 10.1016/j.ijcard.2017.02.053] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 01/19/2017] [Accepted: 02/15/2017] [Indexed: 12/13/2022]
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Shammas NW, Shammas GA, Jones-Miller S, Gumpert MR, Gumpert MJ, Harb C, Chammas MZ, Shammas WJ, Khalafallah RA, Barzgari A, Bou Dargham B, Daher GE, Rachwan RJ, Shammas AN. Predictors of common femoral artery access site complications in patients on oral anticoagulants and undergoing a coronary procedure. Ther Clin Risk Manag 2017; 13:401-406. [PMID: 28408835 PMCID: PMC5384737 DOI: 10.2147/tcrm.s130624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background It is unclear whether patients on oral anticoagulants (OAC) undergoing a procedure using common femoral artery access have higher adverse events when compared to patients who are not anticoagulated at the time of the procedure. Methods We retrospectively reviewed data from consecutive patients who underwent a cardiac procedure at a tertiary medical center. Patients were considered (group A) fully or partially anticoagulated if they had an international normalized ratio (INR) ≥1.6 on the day of the procedure or were on warfarin or new OAC within 48 h and 24 h of the procedure, respectively. The nonanticoagulated group (group B) had an INR <1.6 or had stopped their warfarin and new OAC >48 h and >24 h preprocedure, respectively. The index primary end point of the study was defined as the composite end point of major bleeding, vascular complications, or cardiovascular-related death during index hospitalization. The 30-day primary end point was defined as the occurrence of the index primary end point and up to 30 days postprocedure. Results A total of 779 patients were included in this study. Of these patients, 27 (3.5%) patients were in group A. The index primary end point was met in 11/779 (1.4%) patients. The 30-day primary composite end point was met in 18/779 (2.3%) patients. There was no difference in the primary end point at index between group A (1/27 [3.7%]) and group B (10/752 [1.3%]; P=0.3155) and no difference in the 30-day primary composite end point between group A (2/27 [7.4%]) and group B (16/752 [2.1%]; P=0.1313). Multivariable analysis showed that a low creatinine clearance (odds ratio [OR] =0.56; P=0.0200) and underweight patients (<60 kg; OR =3.94; P=0.0300) were independent predictors of the 30-day primary composite end point but not oral anticoagulation (P=0.1500). Conclusion Patients on OAC did not have higher 30-day major adverse events than those who were not anticoagulated at index procedure.
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Affiliation(s)
- Nicolas W Shammas
- Midwest Cardiovascular Research Foundation.,Cardiology Division, Genesis Heart Institute, Davenport, IA, USA
| | | | - Susan Jones-Miller
- Midwest Cardiovascular Research Foundation.,Cardiology Division, Genesis Heart Institute, Davenport, IA, USA
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Mignatti A, Friedmann P, Slovut DP. Targeting the safe zone: A quality improvement project to reduce vascular access complications. Catheter Cardiovasc Interv 2017; 91:27-32. [PMID: 28296143 DOI: 10.1002/ccd.26988] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 12/06/2016] [Accepted: 01/28/2017] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The aim of this study was to assess the effectiveness of a quality improvement (QI) program in reducing vascular complications during cardiac catheterization. BACKGROUND Vascular access complications during cardiac catheterization are associated with higher morbidity and mortality. We implemented a QI program focused on using micropuncture techniques and targeting the "safe zone," an area below the inferior border of the inferior epigastric artery and above the inferior border of the femoral head, for femoral artery puncture. METHODS Our catheterization laboratory implemented a protocol that required all operators to use micro puncture technique during diagnostic and/or percutaneous coronary interventions and to document arteriotomy in the "safe zone." We also encouraged use of vascular ultrasound, radial artery approach, and increased use of vascular closure devices (VCDS). We analyzed data on 3120 patients (2013, pre-QI cohort) and 3222 patients (2014, QI cohort). Data on vascular complications were prospectively collected and compared with the rate of complications that occurred during the same time one year prior when the QI project was not in effect. RESULTS Baseline characteristics of two cohorts of patients were similar. Compliance with the protocol was excellent. Appropriate documentation of the wire exiting the needle was observed in 95% of cases. VCD use increased from 35% in 2013 to 60% in 2014 (P < 0.001) There were no significant differences in the overall number of complications after implementation of the QI project (1.03% complications before QI implementation and 0.96% after QI implementation. P = 0.79) but there was an absolute reduction in the number of hematomas (0.77 vs. 0.40% in 2013 vs. 2014, respectively, P = 0.06) and of pseudoaneurysms (0.35 vs. 0.19% P = 0.20). Correlates of major vascular complications included), age > 75 years (HR 3.1, P < 0.0001), and PCI (vs. diagnostic cath). CONCLUSIONS Micropuncture technique in association with "safe zone targeting "did not significantly reduce vascular complications in patients undergoing cardiac catheterization, but a trend toward decrease of hematomas and pseudoaneurysms was noted. Factors such as age and type of procedure (PCI vs. diagnostic) play a significant role in the occurrence of vascular complications. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Andrea Mignatti
- Department of Cardiology, Northshore Hospital, Manhassett, New York
| | - Patricia Friedmann
- Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center, Bronx, New York
| | - David Paul Slovut
- Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center, Bronx, New York.,Division of Cardiology, Montefiore Medical Center, Bronx, New York
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Kurisu K, Osanai T, Kazumata K, Nakayama N, Abumiya T, Shichinohe H, Shimoda Y, Houkin K. Ultrasound-guided Femoral Artery Access for Minimally Invasive Neuro-intervention and Risk Factors for Access Site Hematoma. Neurol Med Chir (Tokyo) 2016; 56:745-752. [PMID: 27194178 PMCID: PMC5221772 DOI: 10.2176/nmc.oa.2016-0026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Although ultrasound (US) guidance for venous access is becoming the “standard of care” for preventing access site complications, its feasibility for arterial access has not been fully investigated, especially in the neuro-interventional population. We conducted the first prospective cohort study on US-guided femoral artery access during neuro-interventional procedure. This study included 64 consecutive patients who underwent US-guided femoral artery access through 66 arterial access sites for diagnostic and/or neuro-interventional purposes. The number of attempts required for both the sheath insertion and the success of anterior wall puncture were recorded. In addition, the occurrence of major complications and hematoma formation on the arterial access site examined by US were statistically analyzed. The median number of attempts was 1 (1–2) and first-pass success rate was 63.6%. Anterior wall puncture was achieved in 98.5%. In one case (1.5%), a pseudoaneurysm was observed. In all cases, US clearly depicted a common femoral artery (CFA) and its bifurcation. Post-procedural hematoma was detected in 13 cases (19.7%), most of which were “tiny” or “moderate” in size. Low body mass index and antiplatelet therapy were the independent risk factors for access site hematoma. The US-guided CFA access was feasible even in neuro-interventional procedure. The method was particularly helpful in the patients with un-palpable pulsation of femoral arteries. To prevent arterial access site hematoma, special care should be taken in patients with low body mass index and who are on antiplatelet therapy.
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Affiliation(s)
- Kota Kurisu
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine
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Batyraliev T, Ayalp MR, Sercelik A, Karben Z, Dinler G, Besnili F, Ozgul S, Perchucov I. Complications of Cardiac Catheterization: A Single-Center Study. Angiology 2016; 56:75-80. [PMID: 15678259 DOI: 10.1177/000331970505600110] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In Turkey as well as in the whole world, cardiac catheterization is an invasive intervention that is being increasingly used both for diagnosis and treatment. With technological and pharmacologic development and experience, the indications for this intervention are ever increasing. This invasive intervention brings, of course, some complications with it. These may range from local ones to death. In this study the authors analyzed the local cardiac complications and those related to other systems that they encountered in 10,445 catheterizations conducted for diagnosis and treatment in their clinic over a 26-month period. They found the rate of all complications to be 3.54% (2.05% diagnostic, 9.1% therapeutic). Of these complications, 1.89% (0.80% diagnostic, 6.02% therapeutic) were cardiac, 1.27% (0.97% diagnostic, 2.4% therapeutic) local. They found that the ratios of death were 0.09% for diagnostic interventions, 1.13% for therapeutic interventions, and 0.31% altogether. In the diagnostic group 0.02% required urgent coronary bypass surgery, and 0.41% needed urgent coronary bypass surgery in the therapeutic group. In conclusion, despite the noticeable changes in patient profile and application, the ratios for cardiac catheterization have changed little over the years.
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Derham C, Davies JF, Shahbazi R, Homer-Vanniasinkam S. Iatrogenic Limb Ischemia Caused by Angiography Closure Devices. Vasc Endovascular Surg 2016; 40:492-4. [PMID: 17202097 DOI: 10.1177/1538574406294075] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Described are 2 cases of lower limb ischemia that resulted after deployment of 2 different arterial closure devices. One patient presented acutely with lower limb ischemia after an Angio-Seal (St Jude Medical, Minnetonka, Minn) device deployed at the conclusion of cerebral artery aneurysm embolization. The second patient, who underwent angioplasty for aortic recoarctation, presented with claudication 1 week after deployment of the Perclose (Perclose, Redwood City, Calif) device. The use of such devices can result in significant complications, and cardiologists, interventional radiologists, and vascular surgeons are advised to have a high index of suspicion for such complications and work in close conjunction to provide prompt and adequate treatment.
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Affiliation(s)
- Chris Derham
- Leeds Vascular Institute, Leeds General Infirmary, Great George Street, Leeds, United Kingdom.
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Ong P, Athanasiadis A, Sechtem U. Intracoronary Acetylcholine Provocation Testing for Assessment of Coronary Vasomotor Disorders. J Vis Exp 2016. [PMID: 27583694 DOI: 10.3791/54295] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Intracoronary acetylcholine provocation testing (ACH-test) is an established method for assessment of epicardial coronary artery spasm in the catheterization laboratory which was introduced more than 30 years ago. Due to the short half-life of acetylcholine it can only be applied directly into the coronary arteries. Several studies have demonstrated the safety and clinical usefulness of this test. However, acetylcholine testing is only rarely applied in the U.S. or Europe. Nevertheless, it has been shown that 62% of Caucasian patients with stable angina and unobstructed coronary arteries on coronary angiography suffer from coronary vasomotor disorders that can be diagnosed with acetylcholine testing. In recent years it has been appreciated that the ACH-test not only assesses the presence of epicardial spasm but that it can also be useful for the detection of coronary microvascular spam. In such cases no epicardial spasm is seen after injection of acetylcholine but ischemic ECG shifts are present together with a reproduction of the patient's symptoms during the test. This article describes the experience with the ACH-test and its implementation in daily clinical routine.
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Affiliation(s)
- Peter Ong
- Department of Cardiology, Robert-Bosch-Krankenhaus;
| | | | - Udo Sechtem
- Department of Cardiology, Robert-Bosch-Krankenhaus
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Rübenthaler J, Reiser M, Clevert DA. Diagnostic vascular ultrasonography with the help of color Doppler and contrast-enhanced ultrasonography. Ultrasonography 2016; 35:289-301. [PMID: 27669962 PMCID: PMC5040140 DOI: 10.14366/usg.16027] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 08/12/2016] [Accepted: 08/12/2016] [Indexed: 11/05/2022] Open
Abstract
The use of ultrasonography and especially of contrast-enhanced ultrasonography (CEUS) in the diagnosis of vascular pathologies before and after interventions has significantly increased over the past years due to the broader availability of modern ultrasound systems with CEUS capabilities and more trained user experience in this imaging modality. For the preinterventional and postinterventional work-up of carotid diseases, duplex ultrasound as well as CEUS have been established as the standard-of-care examination procedures for diagnosis, evaluation, and follow-up. In addition to its use for carotid arterial diseases, ultrasonography has also become the primary modality for the screening of vascular pathologies. This review describes the most common pathologies found in ultrasonography of the carotid arteries, the abdominal aorta, and the femoral arteries.
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Affiliation(s)
- Johannes Rübenthaler
- Department of Clinical Radiology, Ludwig-Maximilians-University of Munich-Grosshadern Campus, Munich, Germany
| | - Maximilian Reiser
- Department of Clinical Radiology, Ludwig-Maximilians-University of Munich-Grosshadern Campus, Munich, Germany
| | - Dirk-André Clevert
- Department of Clinical Radiology, Ludwig-Maximilians-University of Munich-Grosshadern Campus, Munich, Germany
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Jensen UJ, Jensen J, Ahlberg G, Tornvall P. Virtual reality training in coronary angiography and its transfer effect to real-life catheterisation lab. EUROINTERVENTION 2016; 11:1503-10. [DOI: 10.4244/eijy15m06_05] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Vascular access in critical limb ischemia. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2016; 17:190-8. [DOI: 10.1016/j.carrev.2016.02.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 02/04/2016] [Indexed: 11/22/2022]
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Amer O, Binger S, Desch S, Harnoss HM, Schuler G, Thiele H, Eitel I. Incidence, predictors, and treatment options of critical limb ischaemia after use of collagen plug-based vascular closure devices. EUROINTERVENTION 2015; 11:816-23. [PMID: 26603989 DOI: 10.4244/eijv11i7a166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Limited data are available on the frequency and predictors of vascular closure device (VCD) failure with subsequent vascular complications. The aim of this study was to investigate the incidence, clinical characteristics, and treatment options in patients with critical limb ischaemia (CLI) after use of a collagen plug-based VCD. METHODS AND RESULTS A high-volume, single-centre prospectively maintained database was retrospectively interrogated, and cases of collagen plug-based VCD-related CLI were identified between June 2006 and December 2013. CLI was defined as acute onset of rest pain after VCD application requiring endovascular or surgical treatment. Among 13,595 coronary procedures, 43 patients (0.3%) were identified with an Angio-Seal-related CLI. In a multivariable logistic regression analysis, peripheral artery disease and renal insufficiency were identified as independent predictors for CLI after Angio-Seal application. Treatment was performed in 27 patients (63%) by surgery and in 16 patients (37%) with endovascular angioplasty. CONCLUSIONS CLI after use of a collagen plug-based VCD is rare. Peripheral artery disease was identified as an independent predictor of CLI. Interventional cardiologists should be aware of potentially high-risk patients and complications after use of a VCD to provide prompt and adequate therapy.
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Affiliation(s)
- Omran Amer
- Department of Internal Medicine - Cardiology, University of Leipzig - Heart Center, Leipzig, Germany
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Azzalini L, Tosin K, Chabot-Blanchet M, Avram R, Ly HQ, Gaudet B, Gallo R, Doucet S, Tanguay JF, Ibrahim R, Grégoire JC, Crépeau J, Bonan R, de Guise P, Nosair M, Dorval JF, Gosselin G, L'Allier PL, Guertin MC, Asgar AW, Jolicœur EM. The Benefits Conferred by Radial Access for Cardiac Catheterization Are Offset by a Paradoxical Increase in the Rate of Vascular Access Site Complications With Femoral Access: The Campeau Radial Paradox. JACC Cardiovasc Interv 2015; 8:1854-64. [PMID: 26604063 DOI: 10.1016/j.jcin.2015.07.029] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 07/30/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The purpose of this study was to assess whether the benefits conferred by radial access (RA) at an individual level are offset by a proportionally greater incidence of vascular access site complications (VASC) at a population level when femoral access (FA) is performed. BACKGROUND The recent widespread adoption of RA for cardiac catheterization has been associated with increased rates of VASCs when FA is attempted. METHODS Logistic regression was used to calculate the adjusted VASC rate in a contemporary cohort of consecutive patients (2006 to 2008) where both RA and FA were used, and compared it with the adjusted VASC rate observed in a historical control cohort (1996 to 1998) where only FA was used. We calculated the adjusted attributable risk to estimate the proportion of VASC attributable to the introduction of RA in FA patients of the contemporary cohort. RESULTS A total of 17,059 patients were included. At a population level, the VASC rate was higher in the overall contemporary cohort compared with the historical cohort (adjusted rates: 2.91% vs. 1.98%; odds ratio [OR]: 1.48, 95% confidence interval [CI]: 1.17 to 1.89; p = 0.001). In the contemporary cohort, RA patients experienced fewer VASC than FA patients (adjusted rates: 1.44% vs. 4.19%; OR: 0.33, 95% CI: 0.23 to 0.48; p < 0.001). We observed a higher VASC rate in FA patients in the contemporary cohort compared with the historical cohort (adjusted rates: 4.19% vs. 1.98%; OR: 2.16, 95% CI: 1.67 to 2.81; p < 0.001). This finding was consistent for both diagnostic and therapeutic catheterizations separately. The proportion of VASCs attributable to RA in the contemporary FA patients was estimated at 52.7%. CONCLUSIONS In a contemporary population where both RA and FA were used, the safety benefit associated with RA is offset by a paradoxical increase in VASCs among FA patients. The existence of this radial paradox should be taken into consideration, especially among trainees and default radial operators.
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Affiliation(s)
- Lorenzo Azzalini
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Kunle Tosin
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | | | - Robert Avram
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Hung Q Ly
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Benoit Gaudet
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Richard Gallo
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Serge Doucet
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | | | - Réda Ibrahim
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Jean C Grégoire
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Jacques Crépeau
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Raoul Bonan
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Pierre de Guise
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - Mohamed Nosair
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | | | - Gilbert Gosselin
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | | | | | - Anita W Asgar
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada
| | - E Marc Jolicœur
- Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada.
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Li S, Tang X, Peng L, Luo Y, Dong R, Liu J. The diagnostic performance of CT-derived fractional flow reserve for evaluation of myocardial ischaemia confirmed by invasive fractional flow reserve: a meta-analysis. Clin Radiol 2015; 70:476-86. [DOI: 10.1016/j.crad.2014.12.013] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 12/12/2014] [Accepted: 12/18/2014] [Indexed: 11/28/2022]
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Abstract
Common femoral artery (CFA) access is an important step of many vascular interventional procedures such as peripheral arterial, aortic, and endovascular oncologic interventions. The anatomical location of the CFA as it crosses over the femoral head provides a unique location to establish a relatively large arterial access to a vessel that is conveniently located near the aorta and its major branches. A proper access helps the interventionist with the remainder of the procedure and diminishes the risk of severe complications leading to surgery, thrombolysis, patient morbidity, or occasionally mortality. On the contrary, a suboptimal access can jeopardize the entire procedure and may lead to limb and life-threatening complications. With the introduction of ultrasonography-assisted CFA access, the process has become more predictable and possibly less adventurous; however, there remain tips and tricks that can guarantee a safe and proper start for any arterial procedure. We review the preprocedural evaluation, procedural techniques, and postprocedural care to optimize CFA access.
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Affiliation(s)
- Hamid Rajebi
- Department of Diagnostic Radiology, Upstate Medical University, Syracuse, NY.
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Accuracy of 64-slice coronary computed tomography in patients with tako-tsubo cardiomyopathy. Int J Cardiol 2015; 186:196-7. [PMID: 25828111 DOI: 10.1016/j.ijcard.2015.03.250] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 03/17/2015] [Indexed: 11/20/2022]
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Bui JT, Jajko R, Zivin SP. Massive Hemorrhage from Arterial Access during Intracranial Aneurysm Stent-Assisted Embolization: Endovascular Diagnosis and Therapy. Semin Intervent Radiol 2015; 32:14-7. [PMID: 25762842 DOI: 10.1055/s-0034-1396958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Massive hemorrhage from arterial access in patients receiving anticoagulation and antiplatelet therapy is a rare but potentially devastating complication. The authors present a patient who developed a large retroperitoneal and anterior abdominal wall hemorrhage following an unintentional and unrecognized arterial injury during an endovascular procedure. Reversal of anticoagulation in patients who have undergone stent-assisted coil embolization of intracranial aneurysms is an undesirable approach due to the risk of thromboembolism; rather, transcatheter embolization of the bleeding source should be considered.
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Affiliation(s)
- James T Bui
- Division of Interventional Radiology, Department of Radiology, University of Illinois Hospital and Health Sciences System, Chicago, Illinois
| | - Robert Jajko
- Division of Interventional Radiology, Department of Radiology, University of Illinois Hospital and Health Sciences System, Chicago, Illinois
| | - Sean P Zivin
- Division of Interventional Radiology, Department of Radiology, University of Illinois Hospital and Health Sciences System, Chicago, Illinois
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Fihn SD, Blankenship JC, Alexander KP, Bittl JA, Byrne JG, Fletcher BJ, Fonarow GC, Lange RA, Levine GN, Maddox TM, Naidu SS, Ohman EM, Smith PK, Anderson JL, Halperin JL, Albert NM, Bozkurt B, Brindis RG, Curtis LH, DeMets D, Guyton RA, Hochman JS, Kovacs RJ, Ohman EM, Pressler SJ, Sellke FW, Shen WK. 2014 ACC/AHA/AATS/PCNA/SCAI/STS focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines, and the American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Thorac Cardiovasc Surg 2014; 149:e5-23. [PMID: 25827388 DOI: 10.1016/j.jtcvs.2014.11.002] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Fihn SD, Blankenship JC, Alexander KP, Bittl JA, Byrne JG, Fletcher BJ, Fonarow GC, Lange RA, Levine GN, Maddox TM, Naidu SS, Ohman EM, Smith PK. 2014 ACC/AHA/AATS/PCNA/SCAI/STS Focused Update of the Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease. Circulation 2014; 130:1749-67. [DOI: 10.1161/cir.0000000000000095] [Citation(s) in RCA: 388] [Impact Index Per Article: 38.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Ahn HY, Lee HJ, Lee HJ, Yang JH, Yi JS, Lee IW. Assessment of the optimal site of femoral artery puncture and angiographic anatomical study of the common femoral artery. J Korean Neurosurg Soc 2014; 56:91-7. [PMID: 25328644 PMCID: PMC4200372 DOI: 10.3340/jkns.2014.56.2.91] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 05/05/2014] [Accepted: 08/16/2014] [Indexed: 11/29/2022] Open
Abstract
Objective The purpose of this study was to evaluate demographic and clinical factors affecting the common femoral artery diameter and length, and anatomical relationship between the femoral head and the common femoral artery during angiography. Methods We retrospectively reviewed 109 femoral angiograms. We collected the clinical data of the patients and estimated the common femoral artery diameter and length. We divided the areas in the angiogram from cephalic to caudal direction (zone 0 to 5). The lowest levels of the inferior epigastric artery loop and points of the common femoral artery bifurcation were checked. Results The luminal diameter of the common femoral artery was 6.19±1.20 mm. Height, weight, body surface area, as well as common femoral artery diameter were significantly greater in men than in women (p<0.005). The length of the common femoral artery was 27.59±8.87 mm. Height, weight and body surface area showed strong positive relationships with common femoral artery diameter. All of the inferior epigastric artery loops were located above the center of the femoral head. The point of common femoral artery bifurcation was above the center of the femoral head in 4.59% of femoral angiograms. Conclusions Males and patients with a high body surface area have a larger common femoral artery diameter. The cumulative probability of optimal targeting between the lowest margin of the inferior epigastric artery loop and the common femoral artery bifurcation is the highest in zone 3 puncture.
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Affiliation(s)
- Ho-Young Ahn
- Department of Neurosurgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
| | - Hyung-Jin Lee
- Department of Neurosurgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
| | - Hong-Jae Lee
- Department of Neurosurgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
| | - Ji-Ho Yang
- Department of Neurosurgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
| | - Jin-Seok Yi
- Department of Neurosurgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
| | - Il-Woo Lee
- Department of Neurosurgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
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Fihn SD, Blankenship JC, Alexander KP, Bittl JA, Byrne JG, Fletcher BJ, Fonarow GC, Lange RA, Levine GN, Maddox TM, Naidu SS, Ohman EM, Smith PK. 2014 ACC/AHA/AATS/PCNA/SCAI/STS focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines, and the American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol 2014; 64:1929-49. [PMID: 25077860 DOI: 10.1016/j.jacc.2014.07.017] [Citation(s) in RCA: 551] [Impact Index Per Article: 55.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Ong P, Athanasiadis A, Borgulya G, Vokshi I, Bastiaenen R, Kubik S, Hill S, Schäufele T, Mahrholdt H, Kaski JC, Sechtem U. Clinical usefulness, angiographic characteristics, and safety evaluation of intracoronary acetylcholine provocation testing among 921 consecutive white patients with unobstructed coronary arteries. Circulation 2014; 129:1723-30. [PMID: 24573349 DOI: 10.1161/circulationaha.113.004096] [Citation(s) in RCA: 225] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Coronary spasm can cause myocardial ischemia and angina in patients with and those without obstructive coronary artery disease. However, provocation tests using intracoronary acetylcholine administration are rarely performed in clinical routine in the United States and Europe. Thus, we assessed the clinical usefulness, angiographic characteristics, and safety of intracoronary acetylcholine provocation testing in white patients with unobstructed coronary arteries. METHODS AND RESULTS From September 2007 to June 2010, a total of 921 consecutive patients (362 men, mean age 62±12years) who underwent diagnostic angiography for suspected myocardial ischemia and were found to have unobstructed coronary arteries (no stenosis ≥50%) were enrolled. The intracoronary acetylcholine provocation testing was performed directly after angiography according to a standardized protocol. Three hundred forty-six patients (35%) reported chest pain at rest, 222 (22%) reported chest pain on exertion, 238 (24%) reported a combination of effort and resting chest pain, and 41 (4%) presented with troponin-positive acute coronary syndrome. The overall frequency of epicardial spasm (>75% diameter reduction with angina and ischemic ECG shifts) was 33.4%, and the overall frequency of microvascular spasm (angina and ischemic ECG shifts without epicardial spasm) was 24.2%. Epicardial spasm was most often diffuse and located in the distal coronary segments (P<0.01). No fatal or irreversible nonfatal complications occurred. However, 9 patients (1%) had minor complications (nonsustained ventricular tachycardia [n=1], fast paroxysmal atrial fibrillation [n=1], symptomatic bradycardia [n=6], and catheter-induced spasm [n=1]). CONCLUSIONS Epicardial and microvascular spasm are frequently found in white patients with unobstructed coronary arteries. Epicardial spasm is most often diffuse and located in the distal coronary segments. The intracoronary acetylcholine provocation test is a safe technique to assess coronary vasomotor function.
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Affiliation(s)
- Peter Ong
- Robert-Bosch-Krankenhaus, Department of Cardiology, Stuttgart, Germany (P.O., A.A., S.H. T.S., H.M., U.S.); St George's University of London, Clinical Trials Unit, London, United Kingdom (G.B.); and Cardiovascular Sciences Research Centre, St George's University of London, London, United Kingdom (I.V., R.B., S.K., J.C.K.)
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