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Noblé HJ, Mühlbauer N, Ehling J, Bansmann PM. The value of AI-based analysis of fractional flow reserve of volume computed tomographically detected coronary artery stenosis with regard to their hemodynamic relevance. ROFO-FORTSCHR RONTG 2024. [PMID: 38631371 DOI: 10.1055/a-2271-0887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
The aim of our work was to demonstrate the importance of artificial intelligence-based analysis of fractional flow reserves of computed tomographically detected coronary artery stenosis with regard to their hemodynamic relevance in patients with unclear chest pain and suspected stable coronary heart disease with a low to medium pre-test probability.The collective of our retrospective analysis includes 63 patients in whom coronary artery stenosis was detected by volume computed tomographic examination in "one beat, whole heart" mode in the period from March to October 2022. In these patients, the fractional flow reserve was also determined by computed tomography, which was modulated by the use of artificial intelligence.The calculated values of the fractional flow reserve and the degrees of stenosis determined by computed tomography showed a moderate and significant negative correlation for all three coronary vascular territories (LAD/CX/RCA) (correlation coefficient rho = 0.54/0.54/0.6; p < 0.01 respectively). In just over a third (37.6 %) of all stenoses classified as high-grade by computed tomography, the assessment of hemodynamic relevance by calculating the fractional flow reserve deviated from the severity of the stenosis diagnosed by computed tomography, while the results in the peripheral areas "no stenosis/vascular occlusion" were 100 % consistent in each case.The present results of this work illustrate that the calculation of the fractional flow reserve based on artificial intelligence as a supplement to volume computed tomography of the heart can make a decisive contribution to further therapy planning by increasing the specificity of the purely morphological method by the physiological aspect. · Calculation of fractional flow reserve is a useful addition to computed tomography of the heart.. · It provides possibility to dispense with unnecessary further diagnostics by increasing specificity.. · The combination of both procedures leads to therapy optimization for patients.. · Noblé H, Mühlbauer N, Ehling J et al. The value of AI-based analysis of fractional flow reserve of volume computed tomographically detected coronary artery stenosis with regard to their hemodynamic relevance. Fortschr Röntgenstr 2024; DOI: 10.1055/a-2271-0887.
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Affiliation(s)
- Hans-Jürgen Noblé
- Department of Radiology, German Air Force Center of Aerospace Medicine, Cologne, Germany
| | - Nadine Mühlbauer
- Department of Radiology, German Air Force Center of Aerospace Medicine, Cologne, Germany
| | - Josef Ehling
- Department of Radiology, German Air Force Center of Aerospace Medicine, Cologne, Germany
| | - Paul Martin Bansmann
- Institute for Diagnostic and Interventional Radiology, Hospital Porz am Rhein, Cologne, Germany
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2
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Yammine H, Briggs CS, Frederick JR, Stanley G, Crespo Soto H, Nussbaum T, Madjarov JM, Arko FR. Disparities in Outcomes Between Sexes in Type B Aortic Dissection Patients Treated with TEVAR. Ann Vasc Surg 2024; 99:223-232. [PMID: 37797834 DOI: 10.1016/j.avsg.2023.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 08/07/2023] [Accepted: 08/07/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND To evaluate differences in presentation and outcomes between sexes in patients who underwent thoracic endovascular aortic repair for type B aortic dissection (TBAD). METHODS Between January 1, 2012 and January 1, 2017 186 patients underwent thoracic endovascular aortic repair for TBAD at a single institution. Men (n = 112) and women (n = 74) were compared based on presenting demographics, comorbidities, and postoperative complications. Primary outcomes were survival and need for reintervention. RESULTS Women were older (P = 0.04) and had a lower body mass index (P = 0.03). More women (F) presented with continued pain or refractory hypertension (51.0% F, 30.0% M), while more men (M) presented with acute complicated dissections (19.0% F, 39.0% M) (P = 0.008). At presentation, women had statistically higher relative rates of chronic obstructive pulmonary disease (P = 0.05), hyperlipidemia (P = 0.03), and smoking (P = 0.03). Significantly more women were on Medicare without Medicaid (55.0% F, 34.0% M), while men had private insurance (35.0% F, 13.0% M) (P = 0.005). There was no significant difference in blood pressure control at presentation, discharge, or at 30 days. When normalized by body surface area, women had larger ascending aortic diameters (19.2(3.10)F, 17.5(2.40)M, P = 0.0002), as well as proportionally larger true lumens at the left subclavian artery (14.9(2.90)F, 13.4(2.50)M, P = 0.0002), carina (12.6(5.80)F, 9.90(4.80)M, P = 0.0009), and celiac (10.5(4.50)F, 8.50(4.10)M, P = 0.006) levels, and at the largest point of dissection (11.6(6.50)F, 9.60(4.80)M, P = 0.04), as well as proportionately smaller false lumens at the carina (5.90(5.60)F, 9.30(6.10)M, P = 0.003). Despite not being statistically significant, women had lower rates of stroke (6.80% F, 8.00% M, P = 0.7) and acute kidney injury (5.40% F, 11.6% M, P = 0.2), as well fewer days in the intensive care unit (ICU) (3.20(4.30)F, 4.60(6.60)M, P = 0.2) and an overall shorter length of stay (6.80(6.70)F, 8.00(8.20)M, P = 0.5). Kaplan-Meier estimates for survival for women versus men were 96.0% vs. 92.0%, 90.0% vs. 79.0%, and 70.0% vs. 69.0% at 30 days, 1 year, and 3 years, respectively (P = 0.042). Kaplan-Meier estimates for freedom from reintervention for women versus men were 89.0% vs. 90.0%, 58.0% vs. 72.0%, and 48.0% vs. 58.0% at 30 days, 1 year, and 3 years, respectively (P = 0.13). CONCLUSIONS Women present with TBAD at an older age, have more comorbidities, lower socioeconomic status, and have larger ascending aortic diameters for their size. Despite having less severe dissections as evidenced by smaller false lumens and wider true lumens, it does not appear that this correlates with improved outcomes for women when compared to men. It appears that this is one of the few, if not only, aortic pathologies that result in comparable outcomes between sexes.
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Affiliation(s)
- Halim Yammine
- Sanger Heart and Vascular Institute, Atrium Health, Charlotte, NC.
| | - Charles S Briggs
- Sanger Heart and Vascular Institute, Atrium Health, Charlotte, NC
| | - John R Frederick
- Sanger Heart and Vascular Institute, Atrium Health, Charlotte, NC
| | - Gregory Stanley
- Sanger Heart and Vascular Institute, Atrium Health, Charlotte, NC
| | | | - Tzvi Nussbaum
- Sanger Heart and Vascular Institute, Atrium Health, Charlotte, NC
| | - Jeko M Madjarov
- Sanger Heart and Vascular Institute, Atrium Health, Charlotte, NC
| | - Frank R Arko
- Sanger Heart and Vascular Institute, Atrium Health, Charlotte, NC
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Thakker R, Iturrizaga JC, Abu Sharifeh T. Vascular Closure Devices after Femoral Arteriotomy: Insight in High-Risk Patients. J Am Heart Assoc 2022; 12:e028501. [PMID: 36583433 PMCID: PMC9973604 DOI: 10.1161/jaha.122.028501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Ravi Thakker
- Division of Cardiovascular DiseaseUniversity of Texas Medical BranchGalvestonTX
| | - Jose C. Iturrizaga
- Division of Cardiovascular DiseaseUniversity of Texas Medical BranchGalvestonTX
| | - Tareq Abu Sharifeh
- Division of Cardiovascular DiseaseUniversity of Texas Medical BranchGalvestonTX
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4
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Kasliwal N, Pfeiffer WB, Eidt JF, Gunn DC, Ramamoorthy S. Iatrogenic Arteriovenous Fistula Secondary to Percutaneous Coronary Intervention Causing Severe Decompensated Heart Failure. Cureus 2022; 14:e27934. [PMID: 36134099 PMCID: PMC9481213 DOI: 10.7759/cureus.27934] [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] [Accepted: 08/12/2022] [Indexed: 11/05/2022] Open
Abstract
Congestive heart failure has long been a well-known cause of both morbidity and mortality for thousands of people worldwide. Consequences of decompensated heart failure are systemic and widespread, including but not limited to pulmonary edema, dyspnea, hypoxia, peripheral edema, and end-organ hypoperfusion. Common etiologies of congestive heart failure include systemic hypertension, coronary artery disease, longstanding alcohol abuse, valvular dysfunctions, and myocarditis. While the vast majority of congestive heart failure cases are secondary to one of these common etiologies, there is a subset of cases that cannot be traced to any of these causes and are most often grouped under the category of idiopathic. One rarely seen etiology of decompensated heart failure is an arteriovenous fistula, whether naturally occurring or iatrogenic. We report a case of an iatrogenic AV fistula secondary to percutaneous coronary intervention causing severe decompensated heart failure that was successfully treated with surgical ligation.
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Takahashi K, Omuro A, Ohya M, Kubo S, Tada T, Tanaka H, Fuku Y, Kadota K. Incidence, Risk Factors, and Prognosis of Cholesterol Crystal Embolism Because of Percutaneous Coronary Intervention. Am J Cardiol 2022; 167:15-19. [PMID: 34986990 DOI: 10.1016/j.amjcard.2021.11.039] [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] [Received: 09/08/2021] [Revised: 11/13/2021] [Accepted: 11/23/2021] [Indexed: 11/18/2022]
Abstract
Cholesterol crystal embolism (CCE) is a rare but serious complication of percutaneous coronary intervention (PCI). However, its incidence, risk factors, and prognosis in the contemporary era are not well known. We included 23,184 patients who underwent PCI in our institution between January 2000 and December 2019 in this study. The diagnosis of CCE was made histologically or by the combination of cutaneous signs and specific blood test results. In patients with CCE, we evaluated the incidence, risk factors, and prognosis. A total of 88 patients (0.38%) were diagnosed with CCE. The incidence of CCE seemed to decline through the investigated 20 years. Positive predictors of CCE were age ≥70 years (68% vs 59%, p = 0.012), aortic aneurysm (23% vs 7.2% p <0.001), and a femoral approach (71% vs 45%, p <0.001), whereas a negative predictor of CCE was the use of an inner sheath (63% vs 77%, p <0.001). The rate of 1-year mortality and the requirement for chronic hemodialysis within 1 year after PCI in patients with CCE were 10% and 11%, respectively. The use of an inner sheath and a nonfemoral approach was associated with a lower incidence of CCE. In conclusion, because the prognosis of patients with CCE is still poor, preprocedural identification of high-risk patients and selection of low-risk procedures could be important for preventing CCE.
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Affiliation(s)
- Kotaro Takahashi
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, Kurashiki, Japan.
| | - Ayumi Omuro
- Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Masanobu Ohya
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, Kurashiki, Japan
| | - Shunsuke Kubo
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, Kurashiki, Japan
| | - Takeshi Tada
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, Kurashiki, Japan
| | - Hiroyuki Tanaka
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, Kurashiki, Japan
| | - Yasushi Fuku
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, Kurashiki, Japan
| | - Kazushige Kadota
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, Kurashiki, Japan
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6
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Semitko SP, Mel'nichenko IS, Karpeeva MI, Bolotov PA, Analeev AI, Azarov AV, Kruk SV, Klimov VP, Sorokin VV, Ioseliani DG. [Choice of an alternative access in failed endovascular intervention through the right radial artery]. ANGIOLOGII︠A︡ I SOSUDISTAI︠A︡ KHIRURGII︠A︡ = ANGIOLOGY AND VASCULAR SURGERY 2020; 26:76-83. [PMID: 32597887 DOI: 10.33529/angio2020203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The transradial access has deservedly become the 'gold standard' while performing various X-ray endovascular interventions both diagnostic and therapeutic ones. However, along with all its advantages, it is not without disadvantages. These difficulties for the most part are related to peculiarities of the anatomy of upper-limb arteries. It is exactly complex anatomy that is the most common cause of complications and compelled change of the access while using the right radial artery. The purpose of our study was to examine the symmetry of complex anatomy of upper-limb arteries in order to choose an optimal and safe way of conversion of the access in case of forced refusal from the right radial access. For this reason there was developed an open multicentre registry acronymized as COMPAAS (COMPlex Anatomy of Arteries and Symmetry). During the work of this Registry from February to December 2018, correspondents of the study became 35 colleagues from 23 clinics of 11 cities of Russia. The working group analysed a total of 127 patients presenting with 157 variants of complex anatomy of lower limb arteries: high bifurcation of the radial artery (84), complete loop or tortuosity (66), and compartmental calcification of brachial arteries (7). The anatomy of arteries on the opposite upper extremity was studied based on angiographic findings. The most frequent variant (84 cases) of complex anatomy was high bifurcation of the radial artery at the level of the a. brachialis (20.9% of cases), with the origin of the brachial artery at the level of the a. axillaris being revealed half as often (9.9%). The maximum percentage of symmetry was observed in the group of patients presenting with compartmental calcification of upper-limb arteries (85.7%). Complete loop or marked (more than 100°) tortuosity of arteries on both arms was revealed in 54% of cases. Besides, in 25% of cases, tortuosity was combined with the high origin of the radial artery. It is noteworthy that none of the 127 patients appeared to have complex anatomy on the a. ulnaris. When revealing pronounced calcification of arteries of the forearm or a combination of high bifurcation with tortuosity, it seems feasible to decide upon conversion of the access to the femoral one (a. femoralis) or ulnar (a. ulnaris). In isolated high bifurcation on the right, effective conversion to the contralateral (left) radial approach is possible in not less than 75% of cases.
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Affiliation(s)
- S P Semitko
- Department of Interventional Cardioagiology, Institute of Professional Education, I.M. Sechenov First Moscow State Medical University of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | - I S Mel'nichenko
- Department of Roentgenosurgical Methods of Diagnosis and Treatment, Mytishchi Municipal Clinical Hospital, Mytishchi, Moscow Region, Russia
| | | | - P A Bolotov
- Department of Roentgenosurgical Methods of Diagnosis and Treatment, Municipal Clinical Hospital named after V.V. Veresaev, Moscow, Russia
| | - A I Analeev
- Department of Roentgenosurgical Methods of Diagnosis and Treatment, Mytishchi Municipal Clinical Hospital, Mytishchi, Moscow Region, Russia
| | - A V Azarov
- Department of Interventional Cardioagiology, Institute of Professional Education, I.M. Sechenov First Moscow State Medical University of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | - S V Kruk
- Department of Roentgenosurgical Methods of Diagnosis and Treatment, Municipal Clinical Hospital named after V.V. Veresaev, Moscow, Russia
| | - V P Klimov
- Department of Roentgenosurgical Methods of Diagnosis and Treatment, Municipal Clinical Hospital named after V.V. Veresaev, Moscow, Russia
| | - V V Sorokin
- Department of Roentgenosurgical Methods of Diagnosis and Treatment, Municipal Clinical Hospital named after V.V. Veresaev, Moscow, Russia
| | - D G Ioseliani
- Department of Interventional Cardioagiology, Institute of Professional Education, I.M. Sechenov First Moscow State Medical University of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
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Li H, Rha SW, Choi BG, Shim MS, Choi SY, Choi CU, Kim EJ, Oh DJ, Cho BR, Kim MH, Kim DI, Jeong MH, Yoo SY, Jeong SS, Kim BO, Hyun MS, Youn YJ, Yoon J. Transradial versus transfemoral intervention in ST-segment elevation myocardial infarction patients in Korean population. Korean J Intern Med 2018; 33:716-726. [PMID: 28859467 PMCID: PMC6030401 DOI: 10.3904/kjim.2016.316] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 01/09/2017] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND/AIMS Transradial intervention (TRI) is becoming the preferred method over transfemoral intervention (TFI) because TRI is associated with lower incidence of major bleeding and vascular complications. However, there has been limited published data regarding the clinical outcomes of TRI versus TFI in Korean patients with ST-elevation myocardial infarction (STEMI). METHODS A total of 689 consecutive STEMI patients who underwent primary percutaneous coronary intervention (PCI) with drug-eluting stents (DESs) from January to December of 2009 at nine university hospitals were enrolled in this study. Mid-term angiographic and 12-month cumulative clinical outcomes of the TRI group (n = 220, 31.9%) were compared to those of the TFI group (n = 469, 28.1%). RESULTS After propensity score matching, in-hospital complications and the 12-month major clinical outcomes during follow-up in the two groups were similar to each other. However, the incidence rates of repeat revascularization (6.4% vs. 0.5%, p = 0.003), target vessel revascularization (6.4% vs. 0.5%, p = 0.003), and major adverse cardiac events (MACE; 11.6% vs. 4.6%, p = 0.018) in the TFI group were higher than those in the TRI group during the 12-month of follow-up. CONCLUSIONS In our study, TRI in STEMI patients undergoing primary PCI with DESs was associated with lower incidence of access site hematoma, 12-month repeat revascularization, and MACE compared to TFI. Therefore, TRI might play an important role in reducing bleeding complications while improving major clinical outcomes in STEMI patients undergoing primary PCI with DESs.
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Affiliation(s)
- Hu Li
- Department of Cardiovascular, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
- Department of Medicine, Graduate School, Korea University College of Medicine, Seoul, Korea
| | - Seung-Woon Rha
- Department of Medicine, Graduate School, Korea University College of Medicine, Seoul, Korea
- Correspondence to Seung-Woon Rha, M.D. Cardiovascular Center, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul 08308, Korea Tel: +82-2-2626-3020 Fax: +82-2-864-3062 E-mail:
| | - Byoung Geol Choi
- Department of Medicine, Graduate School, Korea University College of Medicine, Seoul, Korea
| | - Min Suk Shim
- Department of Medicine, Graduate School, Korea University College of Medicine, Seoul, Korea
| | - Se Yeon Choi
- Department of Medicine, Graduate School, Korea University College of Medicine, Seoul, Korea
| | - Cheol Ung Choi
- Department of Medicine, Graduate School, Korea University College of Medicine, Seoul, Korea
| | - Eung Ju Kim
- Department of Medicine, Graduate School, Korea University College of Medicine, Seoul, Korea
| | - Dong Joo Oh
- Department of Medicine, Graduate School, Korea University College of Medicine, Seoul, Korea
| | - Byung Ryul Cho
- Department of Cardiology, Kangwon National University Hospital, Chuncheon, Korea
| | - Moo Hyun Kim
- Cardiovascular Center, Dong-A University Hospital, Busan, Korea
| | - Doo-Il Kim
- Cardiovascular Center, Inje University Busan Paik Hospital, Busan, Korea
| | - Myung-Ho Jeong
- Cardiovascular Center, Chonnam National University Hospital, Gwangju, Korea
| | - Sang Yong Yoo
- Cardiovascular Center, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Sang-Sik Jeong
- Cardiovascular Center, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Byung Ok Kim
- Cardiovascular Center, Inje University Sanggye Paik Hospital, Seoul, Korea
| | - Min Su Hyun
- Cardiovascular Center, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Young-Jin Youn
- Cardiovascular Center, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Junghan Yoon
- Cardiovascular Center, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, 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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Kumar V, Soni P, Chadha S, Malik B. Penoscrotal haematoma after cardiac catheterisation. BMJ Case Rep 2017; 2017:bcr-2016-218934. [PMID: 28476905 DOI: 10.1136/bcr-2016-218934] [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: 11/03/2022] Open
Abstract
Scrotal haematoma is an extremely rare complication after cardiac catheterisation (CC) with only few cases reported in literature. We report a 56-year-old patient who developed large scrotal haematoma after CC via transfemoral approach requiring blood transfusion due to haemodynamic instability. After an uneventful elective procedure, he was discharged with a collagen plug-based vascular closure device (Angio-Seal). He developed sudden onset, excruciating groin pain with scrotal swelling and shock. Bleeding was stopped with manual compression over the femoral artery and 2 units of packed red blood cells were transfused. CT angiogram revealed scrotal haematoma without active bleeding. Testicular blood supply remained intact. Scrotal swelling improved with conservative management and patient got discharged 3 days later in a stable condition. The review of literature suggests that penoscrotal haematoma is unusual after CC but may result from arterial injury or bleeding into the fascial planes. Majority of patients require observation but surgery is indicated in selected cases for vascular complications.
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Affiliation(s)
- Vivek Kumar
- Internal Medicine, Maimonides Medical Center, Brooklyn, New York, USA
| | - Parita Soni
- Internal Medicine, Maimonides Medical Center, Brooklyn, New York, USA
| | - Sameer Chadha
- Cardiology, Maimonides Medical Center, Brooklyn, New York, USA
| | - Bilal Malik
- Cardiology, Maimonides Medical Center, Brooklyn, New York, USA
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Sandhu K, Butler R, Nolan J. Expert Opinion: Transradial Coronary Artery Procedures: Tips for Success. Interv Cardiol 2017; 12:18-24. [PMID: 29588725 DOI: 10.15420/icr.2017:2:2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Historically, the majority of coronary procedures have been performed via the femoral artery. However, since the inception of the transradial approach, a number of studies have confirmed that this technique is associated with a significant reduction in vascular complications, equivalent procedure times and radiation exposure to femoral procedures, the ability to perform complex coronary interventions, early ambulation and patient preference. Over the last decade, this has led to an exponential rise in the use of the transradial access site, with several potential technical challenges becoming increasingly recognised. However, with greater experience and technological advancement these potential obstacles may be overcome. The following review highlights the potential challenges and suggests several tips to assist transradial operators with recognising and overcoming these challenges.
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Affiliation(s)
- Kully Sandhu
- Cardiology Department, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Robert Butler
- Cardiology Department, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - James Nolan
- Cardiology Department, Royal Stoke University Hospital, Stoke-on-Trent, UK
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11
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Iskandar S, Atoui M, Rizwan Afzal M, Lavu M, Reddy M, Lakkireddy D. Malignancy Associated Iatrogenic Iliopsoas Abscess -Venous Access Complication From Ablation Procedure. J Atr Fibrillation 2016; 8:1442. [PMID: 27909505 DOI: 10.4022/jafib.1442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Revised: 04/26/2016] [Accepted: 04/27/2016] [Indexed: 11/10/2022]
Abstract
Iliopsoas abscess is a rare condition with a high rate of mortality and morbidity if left untreated. It can occur from hematogenous or lymphatic spread from distant structures or as a result of contiguous spread from adjacent structures. The disease typically occurs in patients with immunocompromised status and the symptoms can be non-specific.1,2 Generally, infectious complications from venous access during atrial fibrillation (AF) procedure are uncommon, and an iatrogenic iliopsoas abscess from percutaneous cardiac procedures has never been reported. We present the first case of iliopsoas abscess from an ablation procedure.
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Affiliation(s)
- Sandia Iskandar
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, Kansas City, KS
| | - Moustapha Atoui
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, Kansas City, KS
| | - Muhammad Rizwan Afzal
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, Kansas City, KS
| | - Madhav Lavu
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, Kansas City, KS
| | - Madhu Reddy
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, Kansas City, KS
| | - Dhanunjaya Lakkireddy
- Division of Cardiovascular Diseases, Cardiovascular Research Institute, University of Kansas Hospital & Medical Center, Kansas City, KS
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Kim S, Kwon JH, Han YH, Kim JS. Usefulness and safety of the "God's Hand" pneumatic compression device for hemostasis in femoral catheterization. Diagn Interv Radiol 2016; 23:49-54. [PMID: 27856404 DOI: 10.5152/dir.2016.15451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE We aimed to assess the usefulness and safety of the God's Hand pneumatic compression device for hemostasis in patients undergoing percutaneous endovascular procedures via femoral artery. METHODS Two hundred thirty-seven patients in whom hemostasis of femoral catheterization was achieved using a God's Hand pneumatic compression device were enrolled. The patients were divided into group A, those in whom the device was applied for four hours, and group B, those in whom the device was applied for two hours, with an additional two hours of bed rest in both groups. Groups A and B were regrouped to groups A' and B' using the propensity score matching method (n=65, for both). Chi-squared test and logistic regression models were used to analyze the relationship between the complication rate and patient characteristics and procedure-related factors. RESULTS Clinical success was achieved in 216 of 237 patients (91.1%): 63 in group A (84%) and 153 in group B (94.4%); in propensity score matched groups, clinical success was seen in 47 patients in group A' (81.5%) and 62 patients in group B' (95.4%). Group B' showed a higher clinical success rate than group A' (P = 0.028). There were no major complications. In logistic regression models, a negative association was noted between the complication rate and the duration of God's Hand application; however, this association was not statistically significant. CONCLUSION The God's Hand pneumatic compression device is effective and safe for the hemostasis of femoral catheterization, and four hours of bed rest is sufficient for hemostasis in selected patients.
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Affiliation(s)
- Sungwon Kim
- Department of Radiology, Dongguk University Graduate School of Medicine, Ilsan Hospital, Goyang, Korea.
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13
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Pfaff J, Herweh C, Pham M, Schönenberger S, Nagel S, Ringleb PA, Bendszus M, Möhlenbruch M. Mechanical Thrombectomy in Patients with Acute Ischemic Stroke and Lower NIHSS Scores: Recanalization Rates, Periprocedural Complications, and Clinical Outcome. AJNR Am J Neuroradiol 2016; 37:2066-2071. [PMID: 27365324 DOI: 10.3174/ajnr.a4862] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 05/05/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND AND PURPOSE Mechanical thrombectomy, in addition to intravenous thrombolysis, has become standard in acute ischemic stroke treatment in patients with large-vessel occlusion in the anterior circulation. However, previous randomized controlled stroke trials were not focused on patients with mild-to-moderate symptoms. Thus, there are limited data for patient selection, prediction of clinical outcome, and occurrence of complications in this patient population. The purpose of this analysis was to assess clinical and interventional data in patients treated with mechanical thrombectomy in case of ischemic stroke with mild-to-moderate symptoms. MATERIALS AND METHODS We performed a retrospective analysis of a prospectively collected stroke data base. Inclusion criteria were anterior circulation ischemic stroke treated with mechanical thrombectomy at our institution between September 2010 and October 2015 with an NIHSS score of ≤8. RESULTS Of 484 patients, we identified 33 (6.8%) with the following characteristics: median NIHSS = 5 (interquartile range, 4-7), median onset-to-groin puncture time = 320 minutes (interquartile range, 237-528 minutes). Recanalization (TICI = 2b-3) was achieved in 26 (78.7%) patients. Two cases of symptomatic intracranial hemorrhage were observed. Favorable (mRS 0-2) and moderate (mRS 0-3) clinical outcome at 90 days was achieved in 21 (63.6%) and 30 (90.9%) patients, respectively. CONCLUSIONS The clinical outcome of patients undergoing mechanical thrombectomy for acute ischemic stroke with mild stroke due to large-vessel occlusion appears to be predominately favorable, even in a prolonged time window. However, although infrequent, angiographic complications could impair clinical outcome. Future randomized controlled trials should assess the benefit compared with the best medical treatment.
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Affiliation(s)
- J Pfaff
- From the Departments of Neuroradiology (J.P., C.H., M.P., M.B., M.M.)
| | - C Herweh
- From the Departments of Neuroradiology (J.P., C.H., M.P., M.B., M.M.)
| | - M Pham
- From the Departments of Neuroradiology (J.P., C.H., M.P., M.B., M.M.)
| | - S Schönenberger
- Neurology (S.S., S.N., P.A.R.), University of Heidelberg, Heidelberg, Germany
| | - S Nagel
- Neurology (S.S., S.N., P.A.R.), University of Heidelberg, Heidelberg, Germany
| | - P A Ringleb
- Neurology (S.S., S.N., P.A.R.), University of Heidelberg, Heidelberg, Germany
| | - M Bendszus
- From the Departments of Neuroradiology (J.P., C.H., M.P., M.B., M.M.)
| | - M Möhlenbruch
- From the Departments of Neuroradiology (J.P., C.H., M.P., M.B., M.M.)
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Vinayakumar D, Kayakkal S, Rajasekharan S, Thottian JJ, Sankaran P, Bastian C. 24h and 30 day outcome of Perclose Proglide suture mediated vascular closure device: An Indian experience. Indian Heart J 2016; 69:37-42. [PMID: 28228304 PMCID: PMC5319010 DOI: 10.1016/j.ihj.2016.06.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 06/20/2016] [Accepted: 06/21/2016] [Indexed: 12/17/2022] Open
Abstract
Introduction Advantages of vascular closure device over manual compression include patient comfort, early mobilisation and discharge, avoidance of interruption of anticoagulation, avoidance of local compression and its sequelae and less time constraint on staff. No published Indian data exist regarding Perclose Proglide suture mediated vascular closure device (SMC). Aim To study the 24 h and 30 day outcome of Perclose Proglide SMC retrospectively. Study design Retrospective observational study conducted in the Department of Cardiology, Government Medical College, Calicut, Kerala from June 2013 to June 2015. Methodology All consecutive patients with Perclose Proglide SMC deployment done by a single operator for achieving access site haemostasis where 24 h and 30 day post-procedure data were available were included. Major and minor complications, procedure success, device failure were predefined. Results 323 patients were analysed. Procedure success rate was 99.7% (322/323). Transient oozing occurred in 44 patients (13.6%), minor and major complications occurred in 2% and 1.5% of patients respectively. Major complication included one case of retroperitoneal bleed, one access site infection, one pseudo aneurysm formation and two access site arterial stenosis. There was no death or complication requiring limb amputation. “Preclose” technique was used successfully in six patients. Primary device failure occurred in 12 cases which were tackled successfully with second Proglide in all except one. Conclusion Perclose Proglide SMC is a safe and effective method to achieve haemostasis up to 22F with less complication rate.
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Affiliation(s)
- Desabandhu Vinayakumar
- Additional Professor, Department of Cardiology, Government Medical College, Calicut, Kerala, India
| | - Shajudeen Kayakkal
- Senior Resident, Department of Cardiology, Government Medical College, Calicut, Kerala, India.
| | - Sandeep Rajasekharan
- Senior Resident, Department of Cardiology, Government Medical College, Calicut, Kerala, India
| | - Julian Johny Thottian
- Senior Resident, Department of Cardiology, Government Medical College, Calicut, Kerala, India
| | - Prasanth Sankaran
- Senior Resident, Department of Cardiology, Government Medical College, Calicut, Kerala, India
| | - Cicy Bastian
- Additional Professor, Department of Cardiology, Government Medical College, Calicut, Kerala, India
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15
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Edem E, Kilic H, Karacan A, Akdemir R. Renal Subcapsular Hematoma Caused by Hydrophilic Guide Wire during Patent Ductus Arteriosus Closure. Heart Views 2016; 17:103-105. [PMID: 27867458 PMCID: PMC5105220 DOI: 10.4103/1995-705x.192558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Hydrophilic guide wire-associated renal subcapsular hematoma (RSH) during patent ductus arteriosus (PDA) closure is an extremely rare clinical condition. Herein, we present the case of a 16-year-old adolescent who suffered accidental hydrophilic 0.035-inch guide wire-related RSH during PDA closure. This RSH was diagnosed by computerized tomography and selective renal angiography. It was successfully treated by conservative treatment.
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Affiliation(s)
- Efe Edem
- Department of Cardiology, Tinaztepe Hospital, Izmir, Turkey
| | - Harun Kilic
- Department of Cardiology, Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Alper Karacan
- Department of Radiology, Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Ramazan Akdemir
- Department of Cardiology, Sakarya University Training and Research Hospital, Sakarya, Turkey
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Feldman A, Suleiman K, Bushari L, Yahalom M, Rozner E, Freedberg NA, Turgeman Y. Bivalirudin versus Unfractionated Heparin during Percutaneous Coronary Intervention in Patients at High Risk for Bleeding. Int J Angiol 2014; 23:227-32. [PMID: 25484553 DOI: 10.1055/s-0034-1372244] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Low/medium-bleeding-risk populations undergoing percutaneous coronary intervention (PCI) show significantly less bleeding with bivalirudin (BIV) than with unfractionated heparin (UFH), but this has not been established for high-risk patients. We performed a randomized double-blind prospective trial comparing efficacy and safety of BIV versus UFH combined with dual antiplatelet therapy during PCI among 100 high-risk patients with non-ST elevation myocardial infarction (NSTEMI) or angina pectoris. The baseline characteristics were similar in both treatment arms. A radial approach was used in 84% of patients with a higher rate in the BIV group (90 vs. 78%, p < 0.05). Study end points were: major and minor bleeding, port-of-entry complications, major adverse cardiac events (MACE) in-hospital, and at long-term follow-up. There was one case of major gastrointestinal bleeding in the BIV group and 7% minor bleeding complications in both categories. Rate of periprocedural myocardial infarction (PPMI) in the BIV group was twice that in the UFH group (20 vs. 10%, p < 0.16). In-hospital MACE rate was higher in BIV patients as well (12 vs. 2%, p = 0.1). By univariate analysis, the femoral approach was the predictor of PPMI and in-hospital MACE. In a multivariate model, the independent predictor of PPMI was previous MI (odds ratio, 7.7; p < 0.0158). PPMI was 49.7 times more likely with the femoral approach plus BIV than the nonfemoral approach plus UFH (p < 0.0021). At 41.5 ± 14 months' follow-up, end points did not significantly differ between the groups. In patients at high risk for bleeding undergoing PCI, BIV was not superior to UFH for bleeding complications, and early and late clinical outcomes.
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Affiliation(s)
| | | | - Limor Bushari
- Heart Institute, Ha'Emek Medical Center, Afula, Israel
| | - Malka Yahalom
- Heart Institute, Ha'Emek Medical Center, Afula, Israel
| | - Ehud Rozner
- Heart Institute, Ha'Emek Medical Center, Afula, Israel
| | | | - Yoav Turgeman
- Heart Institute, Ha'Emek Medical Center, Afula, Israel
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Turley RS, Lidsky ME, Markovic JN, Shortell CK. Emerging role of contrast-enhanced MRI in diagnosing vascular malformations. Future Cardiol 2014; 10:479-86. [PMID: 25301311 DOI: 10.2217/fca.14.34] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Vascular malformations comprise a diverse and rare group of lesions which generally pose a formidable treatment challenge. Requisite for optimal surgical planning are imaging modalities capable of delineating involved anatomy and malformation flow characteristics. In this regard, we and others have purported the advantages of contrast-enhanced MRI. Here, we review the current body of literature regarding the emerging of role of contrast enhanced MRI for the management of vascular malformations.
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Affiliation(s)
- Ryan S Turley
- Division of Vascular Surgery, Duke University, DUMC Box 3443, Durham, NC 27710, USA
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18
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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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19
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Andersen JG, Kløw NE, Johansen O. Safe and feasible immediate retransfer of patients to the referring hospital after acute coronary angiography and percutaneous coronary angioplasty for patients with acute coronary syndrome. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2014; 2:256-61. [PMID: 24222837 DOI: 10.1177/2048872613483587] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Accepted: 03/02/2013] [Indexed: 01/09/2023]
Abstract
BACKGROUND The challenge with fast track (FT) is to avoid compromising medical safety. We aimed to investigate whether patients with acute coronary syndrome could be safely retransferred to the referral hospital on the same day after coronary angiography and/or percutaneous coronary angioplasty (PCI). METHODS AND RESULTS A total of 399 consecutive patients were prospectively randomized: 206 to ordinary care (OC) and 193 to the FT group. Of these, 30% of patients were admitted for unstable angina pectoris and 70% for non-ST-segment elevation myocardial infarction. The FT patients were evaluated for possible same-day return after angiography and/or PCI. Crossover, acute, and 30-day major events were recorded. The radial approach was used in 91 and 87% in the OC and FT group, respectively. Of the FT patients, 95% were returned on the same day and nine crossover patients (4.7%) the next day or later. Major events occurred in nine patients (2.2%); five in the OC and four in the FT group. There were a total of five events within 24 hours. No events were observed during transportation and there were no early retransfers. CONCLUSIONS Immediate written reports and good communication with the referring hospital enabled thoroughly selected patients to be safely returned on the same day as angiography and/or PCI.
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20
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Vascular closure devices after endovascular procedures in swine: a reliable method? ScientificWorldJournal 2014; 2014:514942. [PMID: 24737976 PMCID: PMC3967389 DOI: 10.1155/2014/514942] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 01/21/2014] [Indexed: 11/18/2022] Open
Abstract
Purpose. To investigate the safety and feasibility of the use of a vascular closure device (VCD) after endovascular procedures in swine. Material and Methods. In a study on endovascular therapy, VCD (StarClose, Abbott Vascular, Il, USA) was used in 20 female swines to achieve immediate hemostasis after percutaneous right femoral artery (FA) access. 10 animals were sacrificed immediately after the study and 10 animals were sacrificed 28 days after the initial study. To ensure complete hemostasis and patency of the femoral artery, a CT-angiography of the puncture site was performed on day 1 (acute and chronic group) and day 28 (chronic group). After the sacrifice, the femoral artery was explanted and examined macroscopically for signs of VCD dysfunction. Results. Technical success rate was 100% with immediate hemostasis being achieved in all animals. No animals showed evidence of hematoma. During explantation, only small traces of coagulated blood were found in the acute group, while there were no signs of hematoma in the chronic group. CT-angiography immediately after VCD application as well as before sacrifice (chronic group) showed patency of the FA in all cases. Conclusion. The use of VCD to achieve hemostasis after endovascular studies in swine is feasible and safe.
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Abstract
Acute limb ischemia may manifest by ischemic rest pain, ischemic ulcers, or gangrene. Acute arterial occlusion can be the result of emboli from a distant source, acute thrombosis of a previously patent artery, or direct trauma to an artery. Toe necrosis resulting from norepinephrine bitartrate (Levophed; Hospira Inc, Lake Forest, Illinois) is a rare case.
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Ruygrok PN, Chou TM. StarClose™ femoral arteriotomy closure device: an advance in arterial closure. Expert Rev Med Devices 2014; 2:247-52. [PMID: 16288587 DOI: 10.1586/17434440.2.3.247] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Millions of femoral arterial punctures are performed annually worldwide for the diagnosis and treatment of cardiovascular disease. Traditionally, hemostasis following arterial sheath removal has employed compression techniques but more recently, a number of arteriotomy closure devices have become available, none of which have been shown to produce an outcome superior to the standard technique of compression. The authors investigated a novel device, which utilizes a nitinol clip that gathers the artery from the outside producing a purse-string-like seal, with very promising results. The authors feel that this device has great potential, may impact significantly on the closure of arteriotomy sites and may also find application in other aspects of procedural medicine.
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Affiliation(s)
- Peter N Ruygrok
- Auckland City Hospital, Cardiology Department, Private Bag 92 024, Auckland 1001, New Zealand.
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23
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Reifart N, Sotoudeh N. The parallel sheath technique in severe iliac tortuosity: a simple and novel technique to improve catheter manoeuvrability. EUROINTERVENTION 2013; 10:231-5. [PMID: 24080523 DOI: 10.4244/eijv10i2a37] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Taha A, Walsh EK, Wright KA, Ahmed I, Supakul N, Awwad EE, Tejada JG. Safety and feasibility of a novel vascular closure device in neurointerventional procedures. Interv Neuroradiol 2013; 19:353-8. [PMID: 24070085 DOI: 10.1177/159101991301900313] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 04/14/2013] [Indexed: 11/15/2022] Open
Abstract
This retrospective study evaluated the safety and feasibility of a new arterial femoral access closure device in neurointerventional procedures. The study includes all consecutive adult patients who underwent femoral arteriotomy closure with the MynxGrip™ closure device after Neurointerventional procedures performed between June and December 2012. All patients had a follow-up color Doppler ultrasound (US) within 48 hours after the procedure, which was independently interpreted by two experienced radiologists to evaluate for access site complications. Device success/failure, sheath size, ambulation time, and periprocedural complications were recorded. Fifty-five closure devices were deployed in 53 patients. There were 23 (43%) males and 30 (57%) females; age ranged from 22 to 84 years (mean: 52.1 years). Thirty of the 55 procedures (55%) were therapeutic and 25 were diagnostic interventions (45%). Sheath sizes used were 5F in 35 procedures (64 %) and 6F in 20 procedures (36%). The right femoral artery was accessed in 51 procedures (93 %) and the left in four procedures (7%). There was only one (1.8 %) minor periprocedural complication (small hematoma). Hemostasis was successful in 51 of the 55 procedures (93 %) with subsequent early ambulation. No device-induced complications associated with serious clinical sequelae were reported. In our small series, the MynxGrip™ femoral access closure device provided a safe and feasible way of closing the femoral artery puncture site after neurointerventional procedures with low minor complication rates and no major complications. Further large prospective randomized trials are necessary to evaluate the efficacy of the device.
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Affiliation(s)
- Ammar Taha
- Department of Radiology, Interventional Neuroradiology, Indiana University School of Medicine; Indianapolis, IN, USA - E-mail:
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Kassem HH, Elmahdy MF, Ewis EB, Mahdy SG. Incidence and predictors of post-catheterization femoral artery pseudoaneurysms. Egypt Heart J 2013. [DOI: 10.1016/j.ehj.2012.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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JAN AFTAB, CREAN PETER, BULLESFELD LUTZ, COLEMAN JAMES, GRUBE EBERHARD, MULVIHILL NIALL. First Clinical Experience With Celt ACD
®
: A Femoral Arterial Puncture Closure Device. J Interv Cardiol 2013; 26:417-24. [DOI: 10.1111/joic.12046] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Wong JM, Ziewacz JE, Panchmatia JR, Bader AM, Pandey AS, Thompson BG, Frerichs K, Gawande AA. Patterns in neurosurgical adverse events: endovascular neurosurgery. Neurosurg Focus 2012; 33:E14. [DOI: 10.3171/2012.7.focus12180] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
As part of a project to devise evidence-based safety interventions for specialty surgery, the authors sought to review current evidence in endovascular neurosurgery concerning the frequency of adverse events in practice, their patterns, and current methods of reducing the occurrence of these events. This review represents part of a series of papers written to consolidate information about these events and preventive measures as part of an ongoing effort to ascertain the utility of devising system-wide policies and safety tools to improve neurosurgical practice.
Based on a review of the literature, thromboembolic events appeared to be the most common adverse events in endovascular neurosurgery, with a reported incidence ranging from 2% to 61% depending on aneurysm rupture status and mode of detection of the event. Intraprocedural and periprocedural prevention and rescue regimens are advocated to minimize this risk; however, evidence on the optimal use of anticoagulant and antithrombotic agents is limited. Furthermore, it is unknown what proportion of eligible patients receive any prophylactic treatment.
Groin-site hematoma is the most common access-related complication. Data from the cardiac literature indicate an overall incidence of 9% to 32%, but data specific to neuroendovascular therapy are scant. Manual compression, compression adjuncts, and closure devices are used with varying rates of success, but no standardized protocols have been tested on a broad scale. Contrast-induced nephropathy is one of the more common causes of hospital-acquired renal insufficiency, with an incidence of 30% in high-risk patients after contrast administration. Evidence from medical fields supports the use of various preventive strategies.
Intraprocedural vessel rupture is infrequent, with the reported incidence ranging from 1% to 9%, but it is potentially devastating. Improvements in device technology combined with proper endovascular technique play an important role in reducing this risk.
Occasionally, anatomical or technical difficulties preclude treatment of the lesion of interest. Reports of such occurrences are scant, but existing series suggest an incidence of 4% to 6%. Management strategies for radiation-induced effects are also discussed. The incidence rates are unknown, but protective techniques have been demonstrated.
Many of these complications have strategies that appear effective in reducing their risk of occurrence, but development and evaluation of systematic guidelines and protocols have been widely lacking. Furthermore, there has been little monitoring of levels of adherence to potentially effective practices. Protocols and monitoring programs to support integrated implementation may be broadly effective.
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Affiliation(s)
- Judith M. Wong
- 1Department of Health Policy and Management, Harvard School of Public Health
- 2Center for Surgery and Public Health and
- 3Departments of Neurosurgery,
| | - John E. Ziewacz
- 4Department of Neurosurgery, University of Michigan Health Systems, Ann Arbor, Michigan; and
| | - Jaykar R. Panchmatia
- 5Department of Orthopaedics and Trauma, Heatherwood and Wexham Park Hospitals, London, United Kingdom
| | - Angela M. Bader
- 1Department of Health Policy and Management, Harvard School of Public Health
- 2Center for Surgery and Public Health and
- 6Anesthesiology, Perioperative and Pain Medicine, and
| | - Aditya S. Pandey
- 4Department of Neurosurgery, University of Michigan Health Systems, Ann Arbor, Michigan; and
| | - B. Gregory Thompson
- 4Department of Neurosurgery, University of Michigan Health Systems, Ann Arbor, Michigan; and
| | | | - Atul A. Gawande
- 1Department of Health Policy and Management, Harvard School of Public Health
- 2Center for Surgery and Public Health and
- 7Surgery, Brigham and Women's Hospital, Boston, Massachusetts
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Merriweather N, Sulzbach-Hoke LM. Managing Risk of Complications at Femoral Vascular Access Sites in Percutaneous Coronary Intervention. Crit Care Nurse 2012; 32:16-29; quiz first page after 29. [DOI: 10.4037/ccn2012123] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Percutaneous coronary intervention for acute coronary syndrome or non–ST-elevation myocardial infarction requires the use of potent oral and intravenous anti-platelet and antithrombin medications. Although these potent antithrombotic agents and regimens may increase the effectiveness of percutaneous coronary intervention, they are also generally associated with an increased risk of vascular access complications such as hematoma, retroperitoneal hematoma, pseudoaneurysm, arterial occlusion, and arteriovenous fistula, which in turn are associated with increased morbidity, mortality, and costs. Risk factors predisposing patients to these complications are both modifiable (procedure technique, medications, hemostasis method) and nonmodifiable (sex, age, body mass index, blood pressure, renal function). Patients’ risks can be reduced by nurses who are knowledgeable about these risk factors and identify complications before they become problematic.
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Affiliation(s)
- Nakia Merriweather
- Nakia Merriweather is a cardiology nurse in the echocardiography laboratory at the Hospital of the University of Pennsylvania, Philadelphia
| | - Linda M. Sulzbach-Hoke
- Linda M. Sulzbach-Hoke is a clinical nurse specialist on a 48-bed progressive care unit at the Hospital of the University of Pennsylvania, providing nursing care to adult cardiac patients. Her research and several of her publications support evidence-based nursing practice, specifically in patients undergoing percutaneous coronary intervention
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Lidsky ME, Spritzer CE, Shortell CK. The role of dynamic contrast-enhanced magnetic resonance imaging in the diagnosis and management of patients with vascular malformations. J Vasc Surg 2012; 56:757-64.e1. [DOI: 10.1016/j.jvs.2012.02.032] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Revised: 01/09/2012] [Accepted: 02/10/2012] [Indexed: 01/23/2023]
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Sarin SN, Shah RK, Chun A, Akman A, Arora S, Rahbar R, Neville R, Venbrux AC. Use of the 8-F Angio-Seal Vascular Closure Device in Large-Caliber Arteriotomies. J Endovasc Ther 2012; 19:497-500. [DOI: 10.1583/12-3881.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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31
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Deitch SG, Gupta R. Radioembolization complicated by dissection of the common femoral artery. Semin Intervent Radiol 2012; 28:133-6. [PMID: 22654248 DOI: 10.1055/s-0031-1280650] [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: 10/18/2022]
Abstract
The common femoral artery is the most frequently used access site for angiographic procedures in interventional radiology. Potential complications of common femoral arteriotomy include hematoma formation, pseudoaneurysm, uncontrolled groin or retroperitoneal bleeding, acute arterial occlusion, dissection, and arteriovenous fistula formation. In a case such as the one described here, with a common femoral artery dissection with intraluminal thrombus and vessel occlusion, the complication may have occurred at the time of access or at the time of closure, with both procedure-associated and patient-specific risk factors affecting the overall risk of complications. Though some studies have shown an increased risk of complications with the use of arterial closure devices, others have found no increase. In any patient with symptoms following a femoral arteriotomy, rapid diagnosis and treatment is necessary to avoid further complications. Both patient-specific and procedure-associated risk factors should be considered prior to arteriotomy and usage of an arterial closure device.
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Affiliation(s)
- Sarah G Deitch
- Department of Radiology, Northwestern University, Chicago, Illinois
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Renal artery perforation related with hydrophilic guide wire during coronary intervention: successful treatment with polyvinyl alcohol injection. Can J Cardiol 2012; 28:612.e5-7. [PMID: 22575577 DOI: 10.1016/j.cjca.2012.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Revised: 02/29/2012] [Accepted: 03/12/2012] [Indexed: 11/23/2022] Open
Abstract
Hydrophilic guide wire-related renal artery perforation (RAP) and subsequent retroperitoneal hemorrhage (RPH) during coronary angiography (CAG) is very rare. We present the case of a 68-year-old woman who suffered accidental hydrophilic 0.035-inch guide wire piercing-related RAP and RPH during CAG and coronary intervention. This RAP was diagnosed by bedside ultrasonography and selective renal angiography, and was successfully treated by transcatheter polyvinyl alcohol injection.
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Khatri R, Rostambeigi N, Hassan AE, Carlson B, Rodriguez GJ, Qureshi AI. The use of vascular closure devices outside the catheterization laboratory after neurointerventional procedures is safe and effective: evidence from a retrospective study. J Endovasc Ther 2012; 19:239-45. [PMID: 22545890 DOI: 10.1583/11-3764.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE To investigate the feasibility and safety of vascular closure device (VCD) deployment outside the catheterization laboratory. METHODS Medical records were reviewed of all 799 patients (396 men; mean age 56 ± 16 years) who underwent deployment of 918 VCDs following diagnostic or therapeutic neurointerventional procedures over a 2-year period at 2 comprehensive stroke centers. The rates of major vascular complications in patients undergoing VCD deployment in and outside the catheterization laboratory were compared. Major vascular complications were adjudicated using definitions by the Society of Interventional Radiology; comparisons were made between different procedure types and closure devices. RESULTS During the observation period, 103 (11.2%) of 918 VCD deployments were performed outside the catheterization laboratory. Age, gender, procedure type, and device types were not different between the groups. A total of 10 (1.1%) major vascular complications occurred, including dissection requiring angioplasty (n = 1), hematoma requiring blood transfusion (n = 4), pseudoaneurysm requiring thrombin injection (n = 2), and lower limb ischemia necessitating surgical removal of the VCD (n = 3). Rates of major vascular complications were not significantly different between VCDs deployed inside the catheterization laboratory [1.0% (8/815)] compared to outside [1.9% (2/103), p = 0.3]. CONCLUSION VCD deployment outside the catheterization laboratory does not increase the rate of major vascular complications and may be an alternative approach for femoral artery hemostasis when VCD deployment needs to be deferred.
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Affiliation(s)
- Rakesh Khatri
- Zeenat Qureshi Stroke Research Center, University of Minnesota, Minneapolis, Minnesota 55455, USA
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Kordestani SS, Noohi F, Azarnik H, Basiri H, Hashemi MJ, Abdi S, Mohebi A, Madani M, NayebHabib F. A Randomized Controlled Trial on the Hemostasis of Femoral Artery Using Topical Hemostatic Agent. Clin Appl Thromb Hemost 2012; 18:501-5. [DOI: 10.1177/1076029611432745] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: Evaluation of the effect of using a topical hemostatic agent named “ChitoHem®” on different factors on patients undergoing diagnostic coronary angiography. Methods: The present blind, randomized, controlled study included 124 patients randomly divided into 2 groups. In the treatment group following femoral sheath removal, ChitoHem® powder and in the control group conventional hemostatic procedure was applied. Results: In the treatment group, time to hemostasis, ambulation, and the use of sandbag were significantly shorter compared with the control group, respectively (4.6 ± 1.3 vs 12.4 ± 4.4 minutes, 3.5 ± 2.7 vs 23.0 ± 1.73 hours and 1.6 vs 98.4%; P < .05). There were no significant differences in hematoma formation and re-bleeding between the 2 groups. Conclusion: It was exhibited ChitoHem® topical hemostatic powder used on treatment patients undergoing diagnostic coronary angiography was statistically superior at reducing the time to hemostasis and ambulation as well as the use of sandbags compared with manual compression in control group.
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Affiliation(s)
- Soheila S. Kordestani
- Department of Biomedical Engineering, Amir Kabir University of Technology, Tehran, Islamic Republic of Iran
| | - Fereidoon Noohi
- Shahid Rajaee Teaching Hospital, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Hossein Azarnik
- Shahid Rajaee Teaching Hospital, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Hossein Basiri
- Shahid Rajaee Teaching Hospital, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - M. J. Hashemi
- Shahid Rajaee Teaching Hospital, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - S. Abdi
- Shahid Rajaee Teaching Hospital, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - A. Mohebi
- Shahid Rajaee Teaching Hospital, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - M. Madani
- Shahid Rajaee Teaching Hospital, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Farzaneh NayebHabib
- Department of Biomedical Engineering, Amir Kabir University of Technology, Tehran, Islamic Republic of Iran
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Bhatty S, Cooke R, Shetty R, Jovin IS. Femoral vascular access-site complications in the cardiac catheterization laboratory: diagnosis and management. Interv Cardiol 2011. [DOI: 10.2217/ica.11.49] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Wanitschek MM, Suessenbacher A, Dörler J, Pachinger O, Moes N, Alber HF. Safety and efficacy of femoral artery closure with the FemoSeal® device after coronary angiography using a 7 French sheath. Perfusion 2011; 26:447-52. [DOI: 10.1177/0267659111409967] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Post-cardiac catheterization femoral artery hemostasis can be accomplished with several mechanisms, including the FemoSeal® hemostasis device which has been designed and approved for closure of 6 French (F) arterial puncture sites. The aim of this study was to investigate whether the FemoSeal® vascular closure device can effectively and safely seal 7F arterial puncture sites after diagnostic and interventional cardiac catheterizations. Femoral artery puncture sites of 50 consecutive patients undergoing cardiac catheterization were closed with the FemoSeal® vascular closure device, according to the manufacturer’s instructions. Efficacy endpoints were time to hemostasis and successful ambulation. Safety endpoints included bleeding complications, vessel occlusion and pseudoaneurysms. Mean time to hemostasis was 57.8±26.3 seconds (0-125 seconds). Hemostasis was achieved in 100 percent of the 50 patients. One patient suffered minor bleeding the next day, i.e. local hematoma. This clinical study demonstrates that the FemoSeal® vascular closure device, initially approved for closure of 6F arterial puncture sites, shows promising efficacy and safety to seal a larger (7F) femoral arterial puncture sites after diagnostic and interventional cardiac catheterizations.
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Affiliation(s)
- MM Wanitschek
- The University Clinic of Internal Medicine III, Cardiology, Innsbruck Medical University, Innsbruck, Austria
| | - A Suessenbacher
- The University Clinic of Internal Medicine III, Cardiology, Innsbruck Medical University, Innsbruck, Austria
| | - J Dörler
- The University Clinic of Internal Medicine III, Cardiology, Innsbruck Medical University, Innsbruck, Austria
| | - O Pachinger
- The University Clinic of Internal Medicine III, Cardiology, Innsbruck Medical University, Innsbruck, Austria
| | - N Moes
- The University Clinic of Internal Medicine III, Cardiology, Innsbruck Medical University, Innsbruck, Austria
| | - HF Alber
- The University Clinic of Internal Medicine III, Cardiology, Innsbruck Medical University, Innsbruck, Austria
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Chung J, Lee DW, Kwon OS, Kim BS, Shin YS. Angio-Seal™ Evolution™ versus Manual Compression for Common Femoral Artery Puncture in Neurovascular Diagnostic Angiography : A Prospective, Non-Randomized Study. J Korean Neurosurg Soc 2011; 49:153-6. [PMID: 21556234 DOI: 10.3340/jkns.2011.49.3.153] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2010] [Revised: 02/21/2011] [Accepted: 03/03/2011] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE This prospective, non-randomized study compared the safety and efficacy of the Angio-Seal™ Evolution™ to that of manual compression for common femoral artery punctures in neurovascular diagnostic angiography. METHODS From June 2009 to September 2009, we performed 169 diagnostic trans-femoral cerebral angiographies, using either the Angio-Seal™ Evolution™ or manual compression to achieve hemostasis. We included 60 patients in this study, 30 in each group. We defined minor complications as those requiring no further treatment such as hematoma size less than 6 cm and bruise size less than 25 cm. Major complications were those requiring surgery of the femoral artery pseudoaneurysm and/or the second line increase of hospital stay even without further treatment. RESULTS Mean time to hemostasis was 0.42±0.04 minutes for the angioseal and 15.83±1.63 minutes for manual compression (p<0.001). Overall complication rate did not differ between the 2 groups. After the patients were fully mobile, at 24 hours, the rate of onset of new complication differed significantly between the 2 groups (p=0.032). In the angioseal group, 5 (16.7%) of the 30 patients experienced the onset of a new complication after 24 hours, including 3 (60.0%) of the 5 who experienced major complications. CONCLUSION The Angio-Seal™ Evolution™ is effective at decreasing mean time to hemostasis, like other closing devices. However, it may not be effective at producing early ambulation and discharge, compared to manual compression, because delayed complications may occur significantly after 24 hours.
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Affiliation(s)
- Joonho Chung
- Department of Neurosurgery, Inha University School of Medicine, Incheon, Korea
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Trabattoni D, Montorsi P, Fabbiocchi F, Lualdi A, Gatto P, Bartorelli AL. A new kaolin-based haemostatic bandage compared with manual compression for bleeding control after percutaneous coronary procedures. Eur Radiol 2011; 21:1687-91. [PMID: 21476127 DOI: 10.1007/s00330-011-2117-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2010] [Revised: 01/15/2011] [Accepted: 02/21/2011] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Bleeding and vascular access site complications are an important cause of morbidity after percutaneous femoral procedures. New haemostatic dressings have been developed to control heavy bleeding. To evaluate the efficacy of a new kaolin-based haemostatic bandage for femoral artery closure after diagnostic or interventional procedures compared with manual compression. METHODS The first pilot European trial using this haemostatic bandage was performed at the in Milan, Italy. Two-hundred patients (71% male, mean age 66 ± 11 years) undergoing angiography or PCI via a femoral approach were randomised to the haemostatic bandage (n = 100) or manual compression (n = 100) following sheath removal. The mean active clotting time (ACT) at haemostasis was 146 ± 24 s (range 98-198 s). Haemostasis was achieved in 5.4 ± 1.5 min with the bandage vs 25 ± 15 min after manual compression, p < 0.001. No haemostasis failure occurred in either group. No differences in oozing, minor and major haematomas and pseudoaneurysms were observed. All patients ambulated at 4 h. Major bleeding, re-bleeding or haematoma did not occur after early (4 h after the procedure) ambulation following use of the bandage. CONCLUSIONS The haemostatic bandage obtained prompt and significantly shorter haemostasis than controls. This novel haemostatic device allowed for early ambulation without clinical complications.
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Affiliation(s)
- Daniela Trabattoni
- Department of Cardiovascular Sciences, Centro Cardiologico Monzino, University of Milan, Milan, Italy.
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39
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Lombardo A, van den Berg JC. Preventing vascular access site complications during interventional procedures. Interv Cardiol 2010. [DOI: 10.2217/ica.10.82] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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40
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Patel MR, Jneid H, Derdeyn CP, Klein LW, Levine GN, Lookstein RA, White CJ, Yeghiazarians Y, Rosenfield K. Arteriotomy Closure Devices for Cardiovascular Procedures. Circulation 2010; 122:1882-93. [PMID: 20921445 DOI: 10.1161/cir.0b013e3181f9b345] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
Atheroembolic renal disease develops when atheromatous aortic plaques rupture, releasing cholesterol crystals into the small renal arteries. Embolisation often affects other organs, such as the skin, gastrointestinal system, and brain. Although the disease can develop spontaneously, it usually develops after vascular surgery, catheterisation, or anticoagulation. The systemic nature of atheroembolism makes diagnosis difficult. The classic triad of a precipitating event, acute or subacute renal failure, and skin lesions, are strongly suggestive of the disorder. Eosinophilia further supports the diagnosis, usually confirmed by biopsy of an affected organ or by the fundoscopic finding of cholesterol crystals in the retinal circulation. Renal and patient prognosis are poor. Treatment is mostly preventive, based on avoidance of further precipitating factors, and symptomatic, aimed to the optimum treatment of hypertension and cardiac and renal failure. Statins, which stabilise atherosclerotic plaques, should be offered to all patients. Steroids might have a role in acute or subacute progressive forms with systemic inflammation.
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42
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Yip HK, Chung SY, Chai HT, Youssef AA, Bhasin A, Yang CH, Chen SM, Hang CL, Hsieh YK, Chen CJ, Chang LT, Sun CK, Wu CJ. Safety and efficacy of transradial vs transfemoral arterial primary coronary angioplasty for acute myocardial infarction: single-center experience. Circ J 2009; 73:2050-5. [PMID: 19755749 DOI: 10.1253/circj.cj-09-0334] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND The aim of the present study was to test the hypothesis that the transradial arterial approach (TRA) is not inferior to the transfemoral arterial approach (TFA) for <or=Killip 3 acute myocardial infarction (AMI) patients undergoing primary percutaneous coronary intervention (PCI). METHODS AND RESULTS This study enrolled 506 AMI patients undergoing primary PCI using the TRA (group 1) between March 2002 and May 2007, and 810 AMI patients undergoing primary PCI using TFA (group 2) between May 1993 and February 2002. The results demonstrated that puncture to first balloon-inflation time was similar in both groups; however, the procedure time was shorter in group 1 than in group 2 (P<0.0001). Additionally, the incidences of stenting, tirofiban therapy and final normal coronary blood flow of the infarct-related artery were higher, whereas the frequency of intra-aortic balloon pump support was lower in group 1 than in group 2 (all P<0.02). Although the 30-day mortality rate did not differ between the 2 groups (P=0.341), the rate of combined major vascular and bleeding complications was higher in group 2 than in group 1 (P<0.0001). CONCLUSIONS Initial selection of TRA is not inferior to initial selection of TFA for AMI patients undergoing primary PCI. However, in the present study, the incidence of combined vascular and bleeding complications was lower with the TRA than with the TFA approach.
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Affiliation(s)
- Hon-Kan Yip
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University Collage of Medicine, Kaohsiung, Taiwan, ROC
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43
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Incidence and outcome of femoral vascular complications among 18,165 patients undergoing cardiac catheterisation. Int J Cardiol 2009; 135:66-71. [DOI: 10.1016/j.ijcard.2008.03.035] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2007] [Revised: 01/15/2008] [Accepted: 03/05/2008] [Indexed: 11/22/2022]
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44
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Lønnebakken MT, Gerdts E, Wirsching J, Pedersen OM. Ultrasound in evaluation of post-interventional femoral vein obstruction: a case report. Cardiovasc Ultrasound 2009; 7:14. [PMID: 19323809 PMCID: PMC2667400 DOI: 10.1186/1476-7120-7-14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2009] [Accepted: 03/26/2009] [Indexed: 11/30/2022] Open
Abstract
Ultrasound is the preferred imaging modality in diagnosis of vascular complications following cardiac catheterization and intervention. In some cases, however, bleeding surrounding the femoral vessels, may severely distort the color Doppler images, making detection of venous complications especially difficult. This report refers to such a case where post-catheterization haematoma was suspected to cause an obstruction of the femoral vein. Spectral Doppler recordings of blood flow in the common femoral vein, up-stream, distal to the hemorrhagic area, confirmed the diagnosis of obstruction by demonstrating changes in the venous flow pattern in the common femoral vein, consistent with venous hypertension. Due to the poor quality of the ultrasound images, the exact cause of the obstruction had to be established by another imaging modality, not affected by haemorrhages. CT showed that the common femoral vein was compressed at the puncture site by surrounding haemorrhages. Thus, when bleeding due to cardiac catheterization is associated with possible venous obstruction and findings by color Doppler are equivocal due to degradation of the color-Doppler image, detection of venous hypertension by spectral Doppler, performed distal to the bleeding area, strongly supports the presence of venous obstruction where the exact cause may be established by CT.
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45
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Relationships among patient characteristics, comorbidities, and vascular complications post-percutaneous coronary intervention. Heart Lung 2008; 37:190-5. [DOI: 10.1016/j.hrtlng.2007.06.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2006] [Accepted: 06/05/2007] [Indexed: 11/22/2022]
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Kadner A, Schmidli J, Schwegler I, Dick F, Schönhoff F, Carrel T, Savolainen H. Complications associated with the arterial puncture closure device--Angio-Seal. Vasc Endovascular Surg 2008; 42:225-7. [PMID: 18230871 DOI: 10.1177/1538574407312657] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Arterial puncture closure devices (APCD) are frequently used after cardiac catheterization. Here, the diagnosis and therapy of femoral artery complications after the use of the Angio-Seal APCD is reported. PATIENTS AND METHODS The Angio-Seal APCD was deployed in 1600 patients undergoing transfemoral catheterization. RESULTS In 7 of 1600 cases (0.4%) vascular complications occurred following Angio-Seal deployment. Diagnosis was made by duplex sonography. Intraoperative findings consisted of a complete occlusion with dissection of the femoral artery in all patients. In 6 cases, the femoral bifurcation had to be reconstructed after endarterectomy. Follow-up is complete with a mean of 6 months. CONCLUSION The Angio-Seal device should not be used for closure of the superficial femoral artery and in patients with severe arteriosclerosis. The application of arteriography as well as the use of ultrasound-guided puncture is advisable. In all cases, surgical intervention was successful and an adequate therapy for management of complications.
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Affiliation(s)
- Alexander Kadner
- Swiss Cardiovascular Center, University Hospital, Freiburgerstrasse, Bern, Switzerland.
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47
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Wang DS, Chu LF, Olson SE, Miller FJ, Valji K, Wong WH, Rose SC, Austin M, Kuo MD. Comparative Evaluation of Noninvasive Compression Adjuncts for Hemostasis in Percutaneous Arterial, Venous, and Arteriovenous Dialysis Access Procedures. J Vasc Interv Radiol 2008; 19:72-9. [DOI: 10.1016/j.jvir.2007.08.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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48
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Schumacher PM, Ross CB, Wu YC, Donahue RM, Ranval TJ, Dattilo JB, Guzman RJ, Naslund TC. Ischemic complications of percutaneous femoral artery catheterization. Ann Vasc Surg 2007; 21:704-12. [PMID: 17980794 DOI: 10.1016/j.avsg.2007.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2007] [Revised: 04/02/2007] [Accepted: 05/30/2007] [Indexed: 11/19/2022]
Abstract
Ischemic injuries following percutaneous femoral artery catheterization are uncommon but have been associated with vascular closure devices (VCDs). The purpose of this study was to retrospectively compare ischemic and hemorrhagic complications of femoral artery catheterization and to identify factors associated with ischemic injuries. The operative registries of the attending vascular surgeons at one academic and two community hospitals were retrospectively reviewed to identify all complications of femoral artery catheterization requiring operative intervention. Demographic, clinical, procedural, operative, and outcome data were compared between patients who sustained ischemic and hemorrhagic complications. From January 2001 to December 2006, 95 patients required operative management of complications related to femoral artery catheterization including 40 patients who experienced ischemic (group 1) and 55 patients who experienced hemorrhagic (group 2) complications. Compared to those sustaining hemorrhagic complications, ischemic complications were more frequently associated with younger age, smoking, VCD deployment, and, when controlling for VCD use, female gender. Time to presentation was also significantly longer in patients experiencing ischemic complications. Ischemic complications are increasingly recognized following femoral artery catheterization. Vascular surgeons should anticipate a new pattern of injury following femoral artery catheterization, one that often requires complex arterial reconstruction.
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Affiliation(s)
- Paul M Schumacher
- Department of Vascular Surgery, Vanderbilt University Medical Center, Nashville, TN 37232-2735, USA
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49
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Peters SA, Yazar A, Lemburg SP, Heyer CM. Renal perforation and retroperitoneal hematoma: an unusual complication following cardiac catheterization. Int J Cardiovasc Imaging 2007; 23:805-8. [PMID: 17285265 DOI: 10.1007/s10554-006-9202-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2006] [Accepted: 12/23/2006] [Indexed: 10/23/2022]
Abstract
Retroperitoneal hematoma (RPH) is a well-recognised, albeit rare complication of percutaneous transfemoral cardiac catheterization. We describe an unusual case of renal perforation and RPH following transfemoral cardiac catheterization for endomyocardial biopsy. Diagnosis was made based on multidetector computed tomography (MDCT) which clearly depicted active renal hemorrhage in short acquisition time. The case expands the spectrum of possible complications of percutaneous transfemoral cardiac catheterization and illustrates the usefulness MDCT in quickly and adequately detecting RPH.
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Affiliation(s)
- Soeren A Peters
- Institute of Diagnostic Radiology, Interventional Radiology, and Nuclear Medicine, BG Clinics Bergmannsheil, Ruhr-University of Bochum, Buerkle-de-la-Camp Platz, Bochum, 44791, Germany
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50
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Ratnam LA, Raja J, Munneke GJ, Morgan RA, Belli AM. Prospective Nonrandomized Trial of Manual Compression and Angio-Seal and Starclose Arterial Closure Devices in Common Femoral Punctures. Cardiovasc Intervent Radiol 2007; 30:182-8. [PMID: 17200896 DOI: 10.1007/s00270-006-0226-1] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We compared the use of manual compression and Angio-Seal and Starclose arterial closure devices to achieve hemostasis following common femoral artery (CFA) punctures in order to evaluate safety and efficacy. A prospective nonrandomized, single-center study was carried out on all patients undergoing CFA punctures over 1 year. Hemostasis was achieved using manual compression in 108 cases, Angio-Seal in 167 cases, and Starclose in 151 cases. Device-failure rates were low and not significantly different in the two groups (manual compression and closure devices; p = 0.8). There were significantly more Starclose (11.9%) patients compared to Angio-Seal (2.4%), with successful initial deployment subsequently requiring additional manual compression to achieve hemostasis (p < 0.0001). A significant number of very thin patients failed to achieve hemostasis (p = 0.014). Major complications were seen in 2.9% of Angio-Seal, 1.9% of Starclose, and 3.7% of manual compression patients, with no significant difference demonstrated; 4.7% of the major complications were seen in female patients compared to 1.3% in males (p = 0.0415). All three methods showed comparable safety and efficacy. Very thin patients are more likely to have failed hemostasis with the Starclose device, although this did not translate into an increased complication rate. There is a significant increased risk of major puncture-site complications in women with peripheral vascular disease.
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Affiliation(s)
- Lakshmi A Ratnam
- Department of Radiology, St. George's Hospital, Blackshaw Road, London, SW17 0QT, UK
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