1
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Andréka J, Sasi V, Tóth GG, Ruzsa Z. Stent graft implantation from distal radial access-A novel way to treat femoral access site complication during transcatheter aortic valve replacement: A case report. Catheter Cardiovasc Interv 2024; 103:803-807. [PMID: 38415818 DOI: 10.1002/ccd.31001] [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: 08/07/2023] [Revised: 11/24/2023] [Accepted: 02/19/2024] [Indexed: 02/29/2024]
Abstract
In this paper, a case of an 82-year-old man who was admitted to our department with sever symptomatic degenerative aortic valve stenosis is presented and discussed. After all screening procedures, a successful transfemoral transcatheter aortic valve replacement was performed, but the closure of the femoral access was unsuccessful due to suture-based device failure. We decided to perform a prolonged balloon dilatation and external compression at the bleeding site, but the bleeding did not stop; therefore, an iCover stent graft was implanted from distal radial artery access using slender technique. Following that, the bleeding was stopped, and the patient had an uneventful outcome.
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Affiliation(s)
- Judit Andréka
- Internal Medicine Department, University of Szeged, Szeged, Hungary
- Department of Cardiology, Medical University Graz, Graz, Austria
| | - Viktor Sasi
- Internal Medicine Department, University of Szeged, Szeged, Hungary
| | - Gábor G Tóth
- Department of Cardiology, Medical University Graz, Graz, Austria
| | - Zoltán Ruzsa
- Internal Medicine Department, University of Szeged, Szeged, Hungary
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2
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Nadjiri J, Geith T, Mühlmann M, Waggershauser T, Paprottka PM. Safety of sheathless vascular access using braided 4 F selective catheters for common body interventions - a retrospective study. CVIR Endovasc 2023; 6:6. [PMID: 36795179 PMCID: PMC9935754 DOI: 10.1186/s42155-023-00350-5] [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: 12/18/2022] [Accepted: 01/23/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Besides other factors, complication rate of transarterial interventions depends on the size of the vascular access. Therefore, the vascular access is mostly chosen as small as possible while still allowing all planned parts of the intervention. This retrospective analysis is to evaluate the safety and feasibility of sheathless arterial interventions for a broad spectrum of interventions in daily practice. METHODS All sheathless interventions using a 4 F main catheter between May 2018 and September 2021 were included in the evaluation. Additionally, intervention parameters such as type of catheter, use of microcatheter and required change of main catheters were assessed. Information about the use about sheathless approach and catheters were obtained from the material registration system. All catheters were braided. RESULTS 503 sheathless interventions with 4 F catheters from the groin were documented. The spectrum comprised bleeding embolization, diagnostic angiographies, arterial DOTA-TATE-therapy, uterine fibroid embolization, transarterial chemotherapy, transarterial radioembolization and others. In 31 cases (6 %) a change of the main catheter was required. In 381 cases (76 %) a microcatheter was utilized. No clinically relevant adverse events were observed (grade 2 or higher [CIRSE AE-classification]). None of the cases later required conversion to a sheath-based intervention. CONCLUSIONS Sheathless interventions with a 4 F braided catheter from the groin are safe and feasible. It allows for a broad spectrum of interventions in daily practice.
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Affiliation(s)
- Jonathan Nadjiri
- Department of Interventional Radiology, School of medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675, Munich, DE, Germany.
| | - Tobias Geith
- grid.6936.a0000000123222966Department of Interventional Radiology, School of medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675 Munich, DE Germany
| | - Marc Mühlmann
- grid.6936.a0000000123222966Department of Interventional Radiology, School of medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675 Munich, DE Germany
| | - Tobias Waggershauser
- grid.6936.a0000000123222966Department of Interventional Radiology, School of medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675 Munich, DE Germany
| | - Philipp M. Paprottka
- grid.6936.a0000000123222966Department of Interventional Radiology, School of medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675 Munich, DE Germany
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3
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Hayakawa N, Kodera S, Takanashi K, Ichihara S, Hirano S, Arakawa M, Inoguchi Y, Kanda J. Combining transradial access and sheathless femoral access for complex iliac artery chronic total occlusions. CVIR Endovasc 2022; 5:56. [PMID: 36279084 PMCID: PMC9590498 DOI: 10.1186/s42155-022-00334-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 10/19/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The transradial approach (TRA) is associated with fewer serious access site-related complications compared with the transfemoral or transbrachial approach. However, TRA has associated problems in complex aortoiliac (AI) lesions, including the procedural difficulty. A bidirectional approach was used combining TRA with a sheathless technique for femoral artery (FA) puncture to treat complex AI lesions, as a minimally-invasive approach. This report describes a representative cases with AI chronic total occlusion in which the combination of TRA and a sheathless technique for FA puncture was useful for guidewire crossing. CASE PRESENTATION Case 1 was a 71-year-old man with intermittent claudication (IC). Control angiography showed total occlusion of the left common iliac artery (CIA) ostium to the distal external iliac artery (EIA). Guidewire externalization was achieved by combining TRA using a 6Fr guiding sheath and a sheathless technique for the left FA. Two nitinol stents were deployed in the CIA to EIA. Case 2 was a 63-year-old man with IC. Control angiography revealed total occlusion of the right CIA ostium to the common femoral artery (CFA) with severe calcification. The antegrade wire could not pass through the CTO lesion because of the calcified CFA occlusion. A 21-G metal needle was used to penetrate the CFA calcification through the distal true lumen of the CFA, and the wire was inserted into the EIA for wire externalization. Three nitinol stents were deployed in the CIA to EIA, and a drug-coated balloon was dilated in the CFA with hemostasis of the distal puncture site. In both cases, the retrograde puncture site was hemostatic during the procedure and postoperative bed rest was not required. CONCLUSIONS TRA combined with a sheathless technique from the FA has the potential to treat AI complex lesions in a less invasive manner.
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Affiliation(s)
- Naoki Hayakawa
- grid.413946.dDepartment of Cardiovascular Medicine, Asahi General Hospital, I-1326 Asahi, Chiba, 289-2511 Japan
| | - Satoshi Kodera
- grid.412708.80000 0004 1764 7572Department of Cardiovascular Medicine, The University of Tokyo Hospital, Tokyo, Japan
| | - Keisuke Takanashi
- grid.413946.dDepartment of Cardiovascular Medicine, Asahi General Hospital, I-1326 Asahi, Chiba, 289-2511 Japan
| | - Shinya Ichihara
- grid.413946.dDepartment of Cardiovascular Medicine, Asahi General Hospital, I-1326 Asahi, Chiba, 289-2511 Japan
| | - Satoshi Hirano
- grid.413946.dDepartment of Cardiovascular Medicine, Asahi General Hospital, I-1326 Asahi, Chiba, 289-2511 Japan
| | - Masataka Arakawa
- grid.413946.dDepartment of Cardiovascular Medicine, Asahi General Hospital, I-1326 Asahi, Chiba, 289-2511 Japan
| | - Yasunori Inoguchi
- grid.413946.dDepartment of Cardiovascular Medicine, Asahi General Hospital, I-1326 Asahi, Chiba, 289-2511 Japan
| | - Junji Kanda
- grid.413946.dDepartment of Cardiovascular Medicine, Asahi General Hospital, I-1326 Asahi, Chiba, 289-2511 Japan
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4
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Nardai S, Zafirovska B, Pataki Á, Nemes B, Tóth J, Deák M, Kedev S, Bertrand OF, Pirlet C, Merkely B, Ruzsa Z. Finding the optimal access for proximal upper limb artery (PULA) interventions: Lessons learned from the PULA multicenter registry. Catheter Cardiovasc Interv 2021; 98:1375-1382. [PMID: 34585817 DOI: 10.1002/ccd.29967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 09/07/2021] [Accepted: 09/21/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The multicenter proximal upper limb artery (PULA) Registry was created to study the optimal puncture sites for the interventions involving the subclavian, axillary, and innominate arteries. BACKGROUND Little is known about the optimal vascular access for PULA interventions, despite the well-known technical complexity of these procedures. METHODS We performed the retrospective analysis of consecutive patients treated for symptomatic steno-occlusive disease of the proximal upper limb arteries between January 2015 and December 2019 in three high-volume centers. Acute thrombotic occlusions were excluded from the study. RESULTS Two hundred and seventy-two patients were treated for significant stenosis and 108 for total occlusion. The baseline patient's characteristics were similar, except for the higher median age of the stenotic patients: 68.5 years (31.1; 90.0) versus 64 years (38.0; 86.0) p = 0.0015. Successful revascularization rate was higher in the stenotic group 93.75% (255/272) versus 86.11% (93/108) p = 0.0230, while the procedure length 27 min (8; 133) versus 46 min (7; 140) p = 0.0001 and fluoroscopy times 439 s (92; 2993) versus 864 s (86; 4176) p = 0.0001 were higher in the occlusion group. The main adverse event rate was similarly low. Dual access was used more often to treat occlusions (60.19% (65/108) vs. 11.40% (31/272) p = 0.0001) without significantly increasing the complication rate. The safest access was ultrasound-guided distal radial artery puncture, significantly better than conventional radial access with 0% (0/31) versus 13.6% (18/131) p = 0.0253 complication. CONCLUSIONS The percutaneous revascularization of proximal upper limb arteries is a safe and effective. Dual access can be applied to increase treatment efficacy, without significantly compromising safety.
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Affiliation(s)
- Sándor Nardai
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Biljana Zafirovska
- University Clinic of Cardiology, Ss. Cyril and Methodius University, Skopje, Macedonia
| | - Ákos Pataki
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Balázs Nemes
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Júlia Tóth
- Bács-Kiskun County Hospital, Invasive Cardiology Department, Teaching Hospital of the Szent-Györgyi Albert Medical University, Kecskemét, Hungary
| | - Mónika Deák
- Bács-Kiskun County Hospital, Invasive Cardiology Department, Teaching Hospital of the Szent-Györgyi Albert Medical University, Kecskemét, Hungary
| | - Sasko Kedev
- University Clinic of Cardiology, Ss. Cyril and Methodius University, Skopje, Macedonia
| | | | | | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Zoltán Ruzsa
- Bács-Kiskun County Hospital, Invasive Cardiology Department, Teaching Hospital of the Szent-Györgyi Albert Medical University, Kecskemét, Hungary.,Department of Internal Medicine, Invasive Cardiology Division, University of Szeged, Szeged, Hungary
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5
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Society of Interventional Radiology Quality Improvement Standards on Radial Artery Access. J Vasc Interv Radiol 2021; 32:761.e1-761.e21. [PMID: 33933252 DOI: 10.1016/j.jvir.2020.12.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 12/09/2020] [Indexed: 11/23/2022] Open
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6
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Ruzsa Z, Csavajda Á, Nemes B, Deák M, Sótonyi P, Bertrand OF, Merkely B. Distal Radial Artery Access for Superficial Femoral Artery Interventions. JOURNAL OF ENDOVASCULAR THERAPY : AN OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ENDOVASCULAR SPECIALISTS 2020. [PMID: 33044111 DOI: 10.1177/1526602820963022.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To compare the acute success and complication rates of distal radial (DR) vs proximal radial (PR) artery access for superficial femoral artery (SFA) interventions. MATERIALS AND METHODS Between 2016 and 2019, 195 consecutive patients with symptomatic SFA stenosis were treated via DR (n=38) or PR (n=157) access using a sheathless guide. Secondary access was achieved through the pedal artery when necessary. The main outcomes were technical success, major adverse events (MAEs), and access site complications. Secondary outcomes were treatment success, fluoroscopy time, radiation dose, procedure time, and crossover rate to another puncture site. RESULTS Overall technical success was achieved in 188 patients (96.4%): 37 of 38 patients (97.3%) in the DR group and 151 of 157 patients (96.2%) in the PR group (p=0.9). Dual (transradial and transpedal) access was used in 14 patients (36.8%) in the DR group and 28 patients (18.9%) in the PR group (p<0.01). Chronic total occlusions were recanalized in 25 of 26 DR patients (96.1%) and in 79 of 81 PR patients (92.6%) (p=0.57). The crossover rate to femoral access was 0% in the DR group vs 3.2% in the PR group (p=0.59). Stents were implanted in the SFA in 15 DR patients (39.4%) and in 39 patients (24.8%) in the PR group (p=0.1). The contrast volume, fluoroscopy time, radiation dose, and procedure time were not statistically different between the DR and PR groups, nor were the rates of access site complications (2.6% and 7.0%, respectively). The cumulative incidences of MAE at 6 months in the DR and PR groups were 15.7% vs 14.6%, respectively (p=0.8). CONCLUSION SFA interventions can be safely and effectively performed using PR or DR access with acceptable morbidity and a high technical success rate. DR access is associated with few access site complications.
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Affiliation(s)
- Zoltán Ruzsa
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary.,Cardiology Division, Invasive Cardiology, Bács-Kiskun County Hospital, Kecskemét, Hungary
| | - Ádám Csavajda
- Cardiology Division, Invasive Cardiology, Bács-Kiskun County Hospital, Kecskemét, Hungary
| | - Balázs Nemes
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Mónika Deák
- Cardiology Division, Invasive Cardiology, Bács-Kiskun County Hospital, Kecskemét, Hungary
| | - Péter Sótonyi
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | | | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
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7
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Ruzsa Z, Csavajda Á, Nemes B, Deák M, Sótonyi P, Bertrand OF, Merkely B. Distal Radial Artery Access for Superficial Femoral Artery Interventions. J Endovasc Ther 2020; 28:255-261. [PMID: 33044111 PMCID: PMC8044606 DOI: 10.1177/1526602820963022] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Purpose: To compare the acute success and complication rates of distal radial (DR) vs proximal radial (PR) artery access for superficial femoral artery (SFA) interventions. Materials and Methods: Between 2016 and 2019, 195 consecutive patients with symptomatic SFA stenosis were treated via DR (n=38) or PR (n=157) access using a sheathless guide. Secondary access was achieved through the pedal artery when necessary. The main outcomes were technical success, major adverse events (MAEs), and access site complications. Secondary outcomes were treatment success, fluoroscopy time, radiation dose, procedure time, and crossover rate to another puncture site. Results: Overall technical success was achieved in 188 patients (96.4%): 37 of 38 patients (97.3%) in the DR group and 151 of 157 patients (96.2%) in the PR group (p=0.9). Dual (transradial and transpedal) access was used in 14 patients (36.8%) in the DR group and 28 patients (18.9%) in the PR group (p<0.01). Chronic total occlusions were recanalized in 25 of 26 DR patients (96.1%) and in 79 of 81 PR patients (92.6%) (p=0.57). The crossover rate to femoral access was 0% in the DR group vs 3.2% in the PR group (p=0.59). Stents were implanted in the SFA in 15 DR patients (39.4%) and in 39 patients (24.8%) in the PR group (p=0.1). The contrast volume, fluoroscopy time, radiation dose, and procedure time were not statistically different between the DR and PR groups, nor were the rates of access site complications (2.6% and 7.0%, respectively). The cumulative incidences of MAE at 6 months in the DR and PR groups were 15.7% vs 14.6%, respectively (p=0.8). Conclusion: SFA interventions can be safely and effectively performed using PR or DR access with acceptable morbidity and a high technical success rate. DR access is associated with few access site complications.
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Affiliation(s)
- Zoltán Ruzsa
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary.,Cardiology Division, Invasive Cardiology, Bács-Kiskun County Hospital, Kecskemét, Hungary
| | - Ádám Csavajda
- Cardiology Division, Invasive Cardiology, Bács-Kiskun County Hospital, Kecskemét, Hungary
| | - Balázs Nemes
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Mónika Deák
- Cardiology Division, Invasive Cardiology, Bács-Kiskun County Hospital, Kecskemét, Hungary
| | - Péter Sótonyi
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | | | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
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8
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Nardai S, Végh E, Óriás V, Nemes B, Tóth J, Hüttl A, Hüttl K, Avantadil B, Bertrand OF, Merkely B, Ruzsa Z. Feasibility of distal radial access for carotid interventions: the RADCAR-DISTAL pilot study. EUROINTERVENTION 2020; 15:1288-1290. [PMID: 31036539 DOI: 10.4244/eij-d-19-00023] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Sándor Nardai
- Semmelweis University, Heart and Vascular Center, Budapest, Hungary
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9
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Satish M, Sethi SS, Parikh S, Green P, Ratcliffe J. Dual alternate access sites for the treatment of an ostial left common iliac artery chronic total occlusion. SAGE Open Med Case Rep 2020; 8:2050313X20929194. [PMID: 32547765 PMCID: PMC7273553 DOI: 10.1177/2050313x20929194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Accepted: 04/30/2020] [Indexed: 11/17/2022] Open
Abstract
Growing endovascular strategies with TASC D lesions in aortoiliac disease reflect increasing technical success with evidenced safety and efficacy. In cases of failed transfemoral access, revascularization of iliac chronic total occlusions has prompted the utilization of other alternate access sites (e.g. transradial and transbrachial approaches) as important options in aortoiliac TASC D lesions. We describe a case of successful revascularization of an occluded ostial left common iliac artery in an 81-year-old man using a dual ulnar and tibioperoneal approach (absent radial artery). A Controlled Antegrade and Retrograde Tracking technique was performed where a balloon was advanced from the peroneal artery into the distal cap of the chronic total occlusion in the proximal common femoral artery. Balloon inflation was performed and a glidewire from transulnar access was advanced and re-entered into the true lumen in the common femoral artery. The wire was then snared and externalized out the transpedal access site creating a continuous true lumen from the ulnar artery to the peroneal artery. To reconstruct the aortic bifurcation, kissing balloon inflations were performed from the peroneal as well as the ulnar artery approaches. A 10 mm × 59 mm balloon expandable stent was placed in the ostial left common iliac artery and a 8 mm × 60 mm self-expanding stent was placed in the left external iliac artery successfully.
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Affiliation(s)
- Mohan Satish
- Center for Interventional Vascular Therapy, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, NY, USA
| | - Sanjum S Sethi
- Center for Interventional Vascular Therapy, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, NY, USA
| | - Sahil Parikh
- Center for Interventional Vascular Therapy, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, NY, USA
| | - Philip Green
- Center for Interventional Vascular Therapy, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, NY, USA
| | - Justin Ratcliffe
- Center for Interventional Vascular Therapy, Columbia University Irving Medical Center/New York Presbyterian Hospital, New York, NY, USA
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10
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Endovascular control of pelvic hemorrhage: Concomitant use of resuscitative endovascular balloon occlusion of the aorta and endovascular intervention. J Trauma Acute Care Surg 2020; 86:155-159. [PMID: 30575686 DOI: 10.1097/ta.0000000000002079] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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11
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Jovin IS, Rajab M. Arm Pain after Transradial Coronary Procedures. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 20:726-727. [DOI: 10.1016/j.carrev.2019.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 06/05/2019] [Indexed: 11/16/2022]
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12
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Ruzsa Z, Berta B, Tóth J, Nemes B, Katona A, Hüttl A, Ungi I, Bertrand OF, Merkely B. Short- and long-term results with a percutaneous treatment in critical hand ischaemia. Catheter Cardiovasc Interv 2019; 93:1301-1310. [PMID: 30927324 DOI: 10.1002/ccd.28166] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 12/27/2018] [Accepted: 02/09/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND The aim of this prospective registry was to determine the feasibility, safety, and outcomes of percutaneous transluminal angioplasty and thrombolysis in the treatment of critical hand ischemia (CHI). METHODS One-hundred one patients (aged 60.6 ± 15.3 years) were treated for CHI between 2012 and 2016 in three cardiovascular centers. Anatomically, the upper arm was divided into three segments (I-subclavian, II-brachial, and III-forearm). We examined the rates of technical and clinical success, major adverse events (MAEs), and vascular complications at 1 year and at long-term follow-up. RESULTS Nineteen patients (18.8%) were treated for acute CHI, and 82 (81.2%) for chronic CHI. Median follow-up was 36.9 (19.6-68.3) months. Clinical symptoms were isolated rest pain in 91 patients (90.1%) and digital ulcer or gangrene in 10 patients (9.9%). The technical and clinical success rate of intervention was 96.0% (97/101) and 84.2% (85/101) at 1 year. Angioplasty was performed in Segments I, II, and III in 28 (27.7%), in 29 (28.7%), and 44 (43.5%) patients. Stent implantation was necessary in 47 patients (46.8%). Vascular access site complications were found in 2.1% of the sample. After 1 year, MAEs occurred in 27 patients (26.9%), and the target lesion revascularization rate was 11.9%. In two patients (1.9%), thoracic sympatectomy was necessary, and two patients (1.9%) underwent minor finger amputations. CONCLUSIONS Angioplasty of hand vessels for CHI is a feasible and safe procedure with acceptable rates of technical success and hand healing. MAEs are frequent because the rate of severe comorbidities is high.
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Affiliation(s)
- Zoltán Ruzsa
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary.,Invasive Cardiology, Bács-Kiskun County Hospital, Kecskemét, Hungary
| | - Balázs Berta
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Júlia Tóth
- Invasive Cardiology, Bács-Kiskun County Hospital, Kecskemét, Hungary
| | - Balázs Nemes
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - András Katona
- Albert Szent-Györgyi Clinical Center, 2nd Department of Medicine and Cardiology Center, Medical Faculty, University of Szeged, Szeged, Hungary
| | - Arthúr Hüttl
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Imre Ungi
- Albert Szent-Györgyi Clinical Center, 2nd Department of Medicine and Cardiology Center, Medical Faculty, University of Szeged, Szeged, Hungary
| | | | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
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13
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Posham R, Young LB, Lookstein RA, Pena C, Patel RS, Fischman AM. Radial Access for Lower Extremity Peripheral Arterial Interventions: Do We Have the Tools? Semin Intervent Radiol 2019; 35:427-434. [PMID: 30728658 DOI: 10.1055/s-0038-1676341] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The benefits of transradial arterial access (TRA) versus transfemoral arterial access (TFA) have been extensively described in the literature; however, TFA remains the predominant access site choice in the management of peripheral arterial disease (PAD). There are still significant unmet needs for operators wishing to provide the same effective interventions for lower extremity PAD via TRA as with TFA. This article provides an up-to-date review of the literature and devices currently available for operators wishing to treat lower extremity PAD via TRA and the limitations they may face.
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Affiliation(s)
| | | | | | | | - Rahul S Patel
- Icahn School of Medicine at Mount Sinai, New York, New York
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14
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Meertens MM, Ng E, Loh SEK, Samuel M, Mees BME, Choong AMTL. Transradial Approach for Aortoiliac and Femoropopliteal Interventions: A Systematic Review and Meta-analysis. J Endovasc Ther 2018; 25:599-607. [PMID: 30086665 PMCID: PMC6136071 DOI: 10.1177/1526602818792854] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE To present a systematic review and meta-analysis comparing the transradial approach for aortoiliac and femoropopliteal interventions to the traditional transfemoral access. METHODS A search of the public domain databases MEDLINE, SCOPUS, Web of Science, and Cochrane Library Databases was performed to identify studies related to the use of the transradial approach for infra-aortic procedures. Meta-analysis was used to compare the transradial to the transfemoral route in terms of procedure success, complications, procedure parameters, and hospital length of stay. Results are presented as the odds ratio (OR) and 95% confidence interval (CI). RESULTS Nineteen studies containing 638 patients with transradial access for lower limb interventions were selected. Lesions were treated from the aortic bifurcation down to the popliteal artery. The mean technical success rate was 90.9%, conversion to a transfemoral approach was necessary in 9.9%, and complications were reported in 1.9%. The meta-analysis included 4 comparative studies involving 114 transradial and 208 transfemoral procedures. There was no significant advantage of either approach in terms of procedure success (OR 5.0, 95% CI 0.49 to 50.83, p=0.17), but the risk of developing a complication was significantly lower (OR 0.25, 95% CI 0.07 to 0.86, p=0.03) with the transradial approach. CONCLUSION Transradial access for lower limb endovascular interventions can be performed with comparable technical success and a lower overall complication profile compared to transfemoral access.
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Affiliation(s)
- Max M. Meertens
- SingVaSC, Singapore Vascular Surgical
Collaborative, Singapore
- Department of Vascular Surgery,
Maastricht University Medical Center, Maastricht, the Netherlands
- European Vascular Center
Aachen-Maastricht, Aachen, Germany
| | - Eugene Ng
- SingVaSC, Singapore Vascular Surgical
Collaborative, Singapore
- Department of Vascular Surgery, Westmead
Hospital, Westmead, NSW, Australia
| | - Stanley E. K. Loh
- SingVaSC, Singapore Vascular Surgical
Collaborative, Singapore
- Department of Diagnostic Imaging,
National University Hospital, Singapore
| | - Miny Samuel
- SingVaSC, Singapore Vascular Surgical
Collaborative, Singapore
- Systematic Review Unit, Yong Loo Lin
School of Medicine, National University of Singapore
| | - Barend M. E. Mees
- Department of Vascular Surgery,
Maastricht University Medical Center, Maastricht, the Netherlands
- European Vascular Center
Aachen-Maastricht, Aachen, Germany
| | - Andrew M. T. L. Choong
- SingVaSC, Singapore Vascular Surgical
Collaborative, Singapore
- Division of Vascular Surgery, National
University Heart Centre, Singapore
- Department of Surgery, Yong Loo Lin
School of Medicine, National University of Singapore
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Lorenzoni R, Roffi M. Commentary: The Long and Winding Road. J Endovasc Ther 2018; 25:608-610. [PMID: 30153773 DOI: 10.1177/1526602818795873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Roberto Lorenzoni
- 1 Diagnostic and Interventional Cardiology Unit, Department of Cardiology, San Luca Hospital, Lucca, Tuscany, Italy
| | - Marco Roffi
- 2 Interventional Cardiology Unit, University Hospitals, Geneva, Switzerland
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16
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Ruzsa Z, Bellavics R, Nemes B, Hüttl A, Nyerges A, Sótonyi P, Bertrand OF, Hüttl K, Merkely B. Combined Transradial and Transpedal Approach for Femoral Artery Interventions. JACC Cardiovasc Interv 2018; 11:1062-1071. [DOI: 10.1016/j.jcin.2018.03.038] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 02/26/2018] [Accepted: 03/20/2018] [Indexed: 10/14/2022]
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17
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Hanna EB, Mogabgab ON, Baydoun H. Combined Radial and Femoral Access Strategy and Radial-Femoral Rendezvous in Patients With Long and Complex Iliac Occlusions. Vasc Endovascular Surg 2018; 52:448-454. [PMID: 29554860 DOI: 10.1177/1538574418764819] [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: 11/15/2022]
Abstract
We present cases of complex, calcified iliac occlusive disease revascularized via a combined radial-femoral access strategy. Through a 6-French, 125-cm transradial guiding catheter, antegrade guidewires and catheters are advanced into the iliac occlusion, while retrograde devices are advanced transfemorally. The transradial and transfemoral channels communicate, allowing the devices to cross the occlusion into the true lumen (radial-femoral antegrade-retrograde rendezvous).
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Affiliation(s)
- Elias B Hanna
- 1 Department of Medicine, Cardiovascular Section, Louisiana State University, New Orleans, LA, USA
| | - Owen N Mogabgab
- 2 Department of Medicine, Cardiovascular Section, Tulane University, New Orleans, LA, USA
| | - Hassan Baydoun
- 2 Department of Medicine, Cardiovascular Section, Tulane University, New Orleans, LA, USA
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18
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Lorenzoni R, Lisi C, Lorenzoni G, Tessandori L, Bovenzi F. Endovascular treatment of iliac and common femoral arteries disease by the transradial access: A prospective, feasibility study. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2017; 19:314-318. [PMID: 28931471 DOI: 10.1016/j.carrev.2017.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Revised: 08/10/2017] [Accepted: 08/15/2017] [Indexed: 02/03/2023]
Abstract
AIM To report feasibility and safety of endovascular interventions on iliac and common femoral arteries, using the transradial access (TRA). METHODS 100 consecutive patients (19 women; mean age 71, range 37-90years) with critical limb ischemia (30%) or claudication, and TASC A-D lesions in iliac or common femoral arteries, were prospectively enrolled, from January 2013 to June 2015, to be treated via the TRA. Exclusion criteria included no palpable radial arteries (RA) and the presence of a fistula for hemodialysis. Patients were evaluated for procedural technical success, in-hospital complications, and 30days clinical success (defined as improvement of at least one grade in the Rutherford classification of symptoms). RESULTS A total of 131 iliac and common femoral arteries lesions were treated (58 in common iliac arteries, 38 in external iliac arteries and 35 in common femoral arteries). Ninety-two stents were deployed in 58 patients. Procedural technical success was achieved in 91% of the lesions; with 95% technical success rate in common iliac arteries, 87% in external iliac arteries and 89% in common femoral arteries; with 72% technical success rate in occlusions and 98% in stenosis. No in-hospital complications were observed. At 30days, 93 patients (93%) had an improvement of at least one category in the Rutherford classification of symptoms (clinical success rate 93%); 12 patients (12%) had an asymptomatic occlusion of the RA. CONCLUSIONS TRA can be used to treat iliac and common femoral arteries lesions with a high grade of technical success and a low rate of complications.
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Affiliation(s)
- Roberto Lorenzoni
- Cardiovascular Department, San Luca Hospital, Lucca, Tuscany, Italy.
| | - Cristiano Lisi
- Cardiovascular Department, San Luca Hospital, Lucca, Tuscany, Italy
| | - Giulia Lorenzoni
- Department of Diagnostic and Interventional Radiology, University of Pisa, Pisa, Tuscany, Italy
| | - Laura Tessandori
- Cardiovascular Department, San Luca Hospital, Lucca, Tuscany, Italy
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