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Ong DY, Yong E, Huang IKH, Loy LM, Lee ZY, Tan GWL, Quek LHH, Lim GHT, Kwan J, Chan G, Hui TCH, Wu YW, Pua U. The Utility of Ultrasound Guidance to Improve the Safety of Closure of Antegrade Common Femoral Artery Access after Lower Limb Revascularization. J Vasc Interv Radiol 2023; 34:2208-2212. [PMID: 37652297 DOI: 10.1016/j.jvir.2023.08.036] [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: 05/23/2023] [Revised: 08/17/2023] [Accepted: 08/21/2023] [Indexed: 09/02/2023] Open
Abstract
This study aimed to investigate the feasibility of ultrasound (US)-guidance in reducing adverse event (AE) rates when using Angioseal device during antegrade lower limb angioplasty via common femoral artery access. From December 2016 to November 2022, 1,322 patients were identified, including 1,131 (85.6%) patients who underwent US-guided closure and 191 (14.4%) who underwent non-US-guided closure. Moderate AEs were encountered in 10 (5.2%) patients in the non-US-guided closure group compared to 38 (3.4%) patients in the US-guided closure group (P = .208). Severe AEs were encountered in 4 (2.1%) patients in the non-US-guided closure group compared to 3 (0.3%) patients in the US-guided closure group (P = .010). Overall AEs occurred in 14 (7.3%) patients in the non-US-guided closure group compared to 41 (3.6%) patients in the US-guided closure group (P = .029). Binary logistic regression showed that only non-US guidance was an independent risk factor for the occurrence of severe AEs (P = .008).
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Affiliation(s)
- Daniel Yuxuan Ong
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore
| | - Enming Yong
- Department of General Surgery, Tan Tock Seng Hospital, Singapore
| | | | - Liang Meng Loy
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore
| | - Zhong Yun Lee
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore
| | | | | | | | - Justin Kwan
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore
| | - Gabriel Chan
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore
| | | | - Yi-Wei Wu
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore
| | - Uei Pua
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore.
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Minici R, Serra R, Maglia C, Guzzardi G, Spinetta M, Fontana F, Venturini M, Laganà D. Efficacy and Safety of Axiostat ® Hemostatic Dressing in Aiding Manual Compression Closure of the Femoral Arterial Access Site in Patients Undergoing Endovascular Treatments: A Preliminary Clinical Experience in Two Centers. J Pers Med 2023; 13:jpm13050812. [PMID: 37240982 DOI: 10.3390/jpm13050812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/10/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Hemostasis of the femoral arterial access site by manual compression or a vascular closure device is critical to the safe completion of any endovascular procedure. Previous investigations evaluated the hemostatic efficacy at the radial access site of some chitosan-based hemostatic pads. This study aims to assess the efficacy and safety of a new chitosan-based hemostatic dressing, namely Axiostat®, in aiding manual compression closure of the femoral arterial access site in patients undergoing endovascular treatments. Furthermore, the outcomes were compared with evidence on manual compression alone and vascular closure devices. METHODS This investigation is a two-center retrospective analysis of 120 consecutive patients who had undergone, from July 2022 to February 2023, manual compression closure of the femoral arterial access site aided by the Axiostat® hemostatic dressing. Endovascular procedures performed with introducer sheaths ranging from 4 Fr to 8 Fr were evaluated. RESULTS Primary technical success was achieved in 110 (91.7%) patients, with adequate hemostasis obtained in all cases of prolonged manual compression requirements. The mean time-to-hemostasis and time-to-ambulation were 8.9 (±3.9) and 462 (±199) minutes, respectively. Clinical success was achieved in 113 (94.2%) patients, with bleeding-related complications noted in 7 (5.8%) patients. CONCLUSIONS Manual compression aided by the Axiostat® hemostatic dressing is effective and safe in achieving hemostasis of the femoral arterial access site in patients undergoing endovascular treatment with a 4-8 Fr introducer sheath.
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Affiliation(s)
- Roberto Minici
- Radiology Unit, Dulbecco University Hospital, 88100 Catanzaro, Italy
| | - Raffaele Serra
- Vascular Surgery Unit, Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Dulbecco University Hospital, 88100 Catanzaro, Italy
| | - Claudio Maglia
- Radiology Unit, Dulbecco University Hospital, 88100 Catanzaro, Italy
| | - Giuseppe Guzzardi
- Radiology Unit, Maggiore della Carità University Hospital, 28100 Novara, Italy
| | - Marco Spinetta
- Radiology Unit, Maggiore della Carità University Hospital, 28100 Novara, Italy
| | - Federico Fontana
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Insubria University, 21100 Varese, Italy
| | - Massimo Venturini
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, Insubria University, 21100 Varese, Italy
| | - Domenico Laganà
- Radiology Unit, Dulbecco University Hospital, 88100 Catanzaro, Italy
- Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy
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3
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Cheng TW, Farber A, King EG, Levin SR, Arinze N, Malas MB, Eslami MH, Garg K, Rybin D, Siracuse JJ. Access Site Complications Are Uncommon with Vascular Closure Devices or Manual Compression after Lower Extremity Revascularization. J Vasc Surg 2022; 76:788-796.e2. [PMID: 35618194 DOI: 10.1016/j.jvs.2022.03.890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 03/31/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Vascular closure devices (VCD) and manual compression (MC) are used to achieve hemostasis following peripheral vascular interventions (PVI). We sought to compare perioperative outcomes between MC and four VCDs following PVI in a multicenter setting. METHODS The Vascular Quality Initiative was queried for all lower extremity (LE) PVIs with common femoral artery access performed from 2010-2020. VCDs included were MynxGrip® (Cordis, Santa Clara, CA, USA), StarClose SE™ (Abbott, Redwood City, CA, USA), Angio-Seal® (Terumo, Somerset, NJ, USA), and Perclose ProGlide™ (Abbott, Redwood City, CA, USA). In a blinded fashion, these four VCDs (A, B, C, D) were compared to MC for baseline characteristics, procedural details, and outcomes (access site hematoma and stenosis/occlusion). Sheath size >8 Fr were excluded. Propensity score matching (1:1) was performed. Univariable and multivariable analyses were completed for unmatched and matched data. RESULTS There were 84,172 LE PVIs identified: 32,013 (38%) used MC and 52,159 (62%) used VCDs (A-12,675;B-6,224;C-19,872;D-13,388). Overall, average age was 68.7 years and 60.4% were male; indications for intervention were most commonly claudication (43.8%) and tissue loss (40.1%). When compared to MC, VCDs were utilized more often in patients with obesity, diabetes, and end stage renal disease (all P<.001). VCDs were used less often in patients with hypertension, chronic obstructive pulmonary disease, coronary artery disease, prior percutaneous coronary and extremity interventions, and major amputation (all P<.001). VCD use was more common, compared to MC, during femoral-popliteal (73% vs. 63.8%) and tibial interventions (33.8% vs. 22.3%), but less common with iliac interventions (20.6% vs. 34.7%) (all P<.001). Protamine was used less often after VCDs (19.1% vs. 25.6%, P<.001). Overall, there were 2,003 (2.4%) hematomas of which 278 (13.9%) required thrombin/surgical intervention. When compared to MC, any VCD use had fewer hematomas (1.7% vs. 3.6%, P<.001) and hematomas requiring intervention (.2% vs. .5%, P<.001). When divided by hemostatic technique, any hematoma were MC-3.6%; A-1.4%; B-1.2%; C-2.3%; D-1.1%, P<.001. Hematomas requiring intervention were MC-.5%; A-.2%; B-.2%; C-.3%; D-.1%, P<.001. Access site stenosis/occlusion was similar between MC and any VCDs (.2% vs. .2%, P=.12). Multivariable analysis demonstrated that any VCDs and individual VCDs, vs. MC, were independently associated with fewer hematomas. Access site stenosis/occlusion was similar between any VCDs and MC. Matched analysis revealed similar findings. CONCLUSIONS Although overall rates of hematomas requiring intervention were low regardless of hemostatic technique, VCD use, irrespective of type, compared favorably to MC with significantly fewer access site complications after PVI.
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Affiliation(s)
- Thomas W Cheng
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA
| | - Alik Farber
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA
| | - Elizabeth G King
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA
| | - Scott R Levin
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA
| | - Nkiruka Arinze
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA
| | - Mahmoud B Malas
- Division of Vascular and Endovascular Surgery, University of California San Diego, San Diego, CA
| | - Mohammad H Eslami
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Karan Garg
- Division of Vascular Surgery, NYU Langone Medical Center, New York, NY
| | - Denis Rybin
- Department of Biostatistics, Boston University, School of Public Health, Boston, MA
| | - Jeffrey J Siracuse
- Division of Vascular and Endovascular Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MA.
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Korotkikh AV, Babunashvili AM, Kazantsev AN, Tarasyuk ES, Annaev ZS. Distal radial artery access in noncoronary procedures. Curr Probl Cardiol 2022:101207. [PMID: 35460683 DOI: 10.1016/j.cpcardiol.2022.101207] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 04/13/2022] [Indexed: 11/28/2022]
Abstract
Since the beginning of interventional cardiology and for decades, the femoral artery has been the access of choice for both diagnostic and interventional endovascular procedures. Due to an extensive evidence base accumulated over the last 20 years, the majority of interventional cardiologists around the world prefer classical radial artery access for both elective and emergency procedures. A similar trend has been observed for distal radial artery access over the last five years. Noncoronary endovascular surgery undergoes the same stages of improvement and optimization of access, but in a more accelerated way. The goal of this review is to analyze the literature on distal radial artery access in noncoronary procedures.
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Affiliation(s)
- A V Korotkikh
- Cardiac Surgery Clinic, Amur State Medical Academy, Blagoveshchensk, Russia.
| | | | | | - E S Tarasyuk
- Amur Regional Clinical Hospital, Blagoveshchensk, Russia
| | - Z S Annaev
- Novyy Urengoy Central Hospital, Novyy Urengoy, Russia
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Goya R, Takemoto M, Nyuta E, Antoku Y, Yamaguchi A, Furuta N, Eto A, Mito T, Kurachi M, Koga T, Tsuchihashi T. Efficacy and Safety of Nepcell S TM in Achieving Hemostasis After Removal of a 15-Fr Femoral Venous Sheath in Patients Undergoing Cryoballoon Ablation for Atrial Fibrillation. Circ Rep 2021; 3:691-698. [PMID: 34950794 PMCID: PMC8651474 DOI: 10.1253/circrep.cr-21-0105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/21/2021] [Accepted: 10/05/2021] [Indexed: 11/19/2022] Open
Abstract
Background:
Hemostasis at the femoral venous access site after cryoballoon ablation (CA) for atrial fibrillation (AF) is often prolonged because of aggressive anticoagulation and the use of 15-Fr-caliber sheaths. The Nepcell STM
(NC) is a newly developed hemostatic pad made of fibrosed calcium alginate extracted from natural seaweed. The calcium ions from the NC accelerate the clotting cascade. This single-center randomized clinical trial assessed the efficacy and safety of the NC in patients undergoing CA for AF. Methods and Results:
In all, 62 patients undergoing CA for non-valvular paroxysmal AF were randomly assigned to either the NC or control group. The primary endpoints of this study were time to hemostasis, internal hemorrhage, and rebleeding. Secondary endpoints were the length of hospital stay (LOS) and vascular complications at 1 month. The time to hemostasis was significantly shorter in NC than control group (mean [±SD] 377±216 vs. 505±241 s; P=0.031). The frequency of internal hemorrhaging (6% vs. 37%; P=0.003) and rebleeding (0% vs. 13%; P=0.033) was lower in the NC than control group, contributing to a decreased LOS in the NC group (3.56±0.67 vs. 4.23±0.73 days; P<0.001). There were no NC-related vascular complications at the 1-month echographic examination. Conclusions:
The use of NC was associated with a shorter hemostasis time and fewer bleeding complications in patients undergoing CA for AF, leading to a shorter LOS.
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Affiliation(s)
- Reimi Goya
- Nursing Department, Steel Memorial Yawata Hospital Kitakyushu Japan
| | - Masao Takemoto
- Cardiovascular Center, Steel Memorial Yawata Hospital Kitakyushu Japan
| | - Eiji Nyuta
- Cardiovascular Center, Steel Memorial Yawata Hospital Kitakyushu Japan
| | - Yoshibumi Antoku
- Cardiovascular Center, Steel Memorial Yawata Hospital Kitakyushu Japan
| | - Arisa Yamaguchi
- Nursing Department, Steel Memorial Yawata Hospital Kitakyushu Japan
| | - Noriko Furuta
- Nursing Department, Steel Memorial Yawata Hospital Kitakyushu Japan
| | - Ayako Eto
- Nursing Department, Steel Memorial Yawata Hospital Kitakyushu Japan
| | | | - Michiko Kurachi
- Nursing Department, Steel Memorial Yawata Hospital Kitakyushu Japan
| | - Tokushi Koga
- Cardiovascular Center, Steel Memorial Yawata Hospital Kitakyushu Japan
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6
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Ciardetti N, Ciatti F, Nardi G, Di Muro FM, Demola P, Sottili E, Stolcova M, Ristalli F, Mattesini A, Meucci F, Di Mario C. Advancements in Transcatheter Aortic Valve Implantation: A Focused Update. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:711. [PMID: 34356992 PMCID: PMC8306774 DOI: 10.3390/medicina57070711] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 07/09/2021] [Accepted: 07/12/2021] [Indexed: 01/07/2023]
Abstract
Transcatheter aortic valve implantation (TAVI) has become the leading technique for aortic valve replacement in symptomatic patients with severe aortic stenosis with conventional surgical aortic valve replacement (SAVR) now limited to patients younger than 65-75 years due to a combination of unsuitable anatomies (calcified raphae in bicuspid valves, coexistent aneurysm of the ascending aorta) and concerns on the absence of long-term data on TAVI durability. This incredible rise is linked to technological evolutions combined with increased operator experience, which led to procedural refinements and, accordingly, to better outcomes. The article describes the main and newest technical improvements, allowing an extension of the indications (valve-in-valve procedures, intravascular lithotripsy for severely calcified iliac vessels), and a reduction of complications (stroke, pacemaker implantation, aortic regurgitation).
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Carlo Di Mario
- Structural Interventional Cardiology, Department of Clinical and Experimental Medicine, Clinica Medica, Room 124, Careggi University Hospital, Largo Brambilla 3, 50139 Florence, Italy; (N.C.); (F.C.); (G.N.); (F.M.D.M.); (P.D.); (E.S.); (M.S.); (F.R.); (A.M.); (F.M.)
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7
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Choi CH, Hall JK, Malaver D, Applegate RJ, Zhao DXM. A novel technique for postclosure of large-bore sheaths using two Perclose devices. Catheter Cardiovasc Interv 2021; 97:905-909. [PMID: 33098361 DOI: 10.1002/ccd.29351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 09/01/2020] [Accepted: 10/12/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVES This study aimed to assess the feasibility, efficacy, and safety of a novel percutaneous postprocedure closure technique for large arterial sheath removal with the use of two Perclose ProGlide (Abbott Vascular Devices, Redwood City, CA) devices. BACKGROUND Postprocedural closing of large-bore arteriotomies using the Perclose system can be difficult given the subsequent inability of the device to capture sufficient wall tissue. METHODS Our study was a single-center retrospective analysis of 22 consecutive patients who underwent large arteriotomy closure via the postclosure technique with a 12-16-Fr sheath. Efficacy endpoints included successful deployment of the system and hemostasis. Safety endpoints included the incidence of major or minor vascular complications as defined by the Vascular Academic Research Consortium-2 (VARC-2) definitions at 30-day follow-up. RESULTS The postclosure technique resulted in 100% technical success rate and no postprocedural bleeding or vascular complications. CONCLUSION Postclosure technique is a safe, highly effective, and feasible percutaneous method to achieve large-bore arteriotomy hemostasis with low rates of major bleeding or vascular complications and favorable early outcome.
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Affiliation(s)
- Charles H Choi
- Section of Cardiovascular Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Wake Forest Baptist Health, Winston Salem, North Carolina
| | - James Kevin Hall
- Section of Cardiovascular Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Wake Forest Baptist Health, Winston Salem, North Carolina
| | - Diego Malaver
- Section of Cardiovascular Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Wake Forest Baptist Health, Winston Salem, North Carolina
| | - Robert J Applegate
- Section of Cardiovascular Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Wake Forest Baptist Health, Winston Salem, North Carolina
| | - David X M Zhao
- Section of Cardiovascular Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Wake Forest Baptist Health, Winston Salem, North Carolina
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8
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Grant JK, Maniam A, Celli D, Orozco-Sevilla V, Braghiroli J. Large-bore arterial access in the era of structural cardiovascular disease. J Card Surg 2020; 35:3088-3098. [PMID: 32741006 DOI: 10.1111/jocs.14909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 07/15/2020] [Accepted: 07/20/2020] [Indexed: 12/18/2022]
Abstract
Over the last two decades, the medical community witnessed an outstanding and accelerated development on minimally invasive therapies. The definition of what constitutes large bore access is subject to discussion, however within the field it is generally accepted to reflect a catheter diameter exceeding 8-French. We sought in this review to explore the evolution, characteristics and vascular compatibility of the current commercially available devices, analyze the devices along with access site-specific complications rates and finally review the present methods for percutaneous vascular closure.
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Affiliation(s)
- Jelani K Grant
- Department of Medicine, Jackson Memorial Hospital, University of Miami, Coral Gables, Florida
| | - Akash Maniam
- Department of Medicine and Oncology, Sangre Grande County Hospital, Sangre Grande, Trinidad and Tobago
| | - Diego Celli
- Department of Medicine, Jackson Memorial Hospital, University of Miami, Coral Gables, Florida
| | - Vicente Orozco-Sevilla
- Division of Cardiothoracic Surgery, Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Joao Braghiroli
- Cardiovascular Division, Department of Medicine, Jackson Memorial Hospital, University of Miami, Coral Gables, Florida
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9
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Sharma S, Patel N, Jeevanantham V, Gupta K, Earnest MB. Safety and efficacy study of the wound care 360° SiteSeal® vascular closure device in percutaneous cardiac catheterization procedures. Vascular 2020; 29:228-236. [PMID: 32718220 DOI: 10.1177/1708538120934573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Vascular access site complications after percutaneous transfemoral cardiovascular procedures remain a common cause of morbidity and mortality. We evaluated the SiteSeal® VCD for achieving hemostasis following diagnostic cardiac catheterization. METHODS We conducted a prospective case control single center study to assess the safety and efficacy of SiteSeal® VCD compared to standard manual compression following diagnostic cardiac catheterization. Forty patients were enrolled in study to receive either SiteSeal® device or manual compression (20 in each group). RESULTS Patients in the SiteSeal® group achieved hemostasis in a significantly shorter time (4 ± 2.4 vs. 19 ± 2.4 min, P < 0.001), had shorter time from hemostasis to ambulation (95 ± 44 vs. 388 ± 63 min, P < 0.001) and significantly earlier device deployment to discharge time compared to the manual compression group (4.7 ± 1.1 vs. 8.9 ± 4.8 h, P = 0.001). There was one non-major bleeding event in the SiteSeal® group which occurred >24 h after discharge from the hospital and was managed conservatively. In the remaining device patients, there was no clinical or Doppler ultrasound evidence of major or minor vascular complication with good overall patient comfort at discharge, 7 days and 30 days follow-up. CONCLUSIONS In this first clinical experience, the SiteSeal® VCD achieved safe and efficient hemostasis, allowed for earlier ambulation and faster discharge compared to manual compression.
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Affiliation(s)
- Suresh Sharma
- Department of Cardiovascular medicine, 21638University of Kansas Medical Center and Hospital, Kansas City, USA
| | - Nilay Patel
- Department of Cardiovascular medicine, 21638University of Kansas Medical Center and Hospital, Kansas City, USA
| | - Vinodh Jeevanantham
- Department of Cardiovascular medicine, 21638University of Kansas Medical Center and Hospital, Kansas City, USA
| | - Kamal Gupta
- Department of Cardiovascular medicine, 21638University of Kansas Medical Center and Hospital, Kansas City, USA
| | - Matthew B Earnest
- Department of Cardiovascular medicine, 21638University of Kansas Medical Center and Hospital, Kansas City, USA
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10
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Frenzel F, Fries P, Shayesteh-Kheslat R, Buecker A, Massmann A. Single Angio-Seal vascular closure device for transfemoral access exceeding 8F. J Cardiol 2020; 76:211-216. [PMID: 32402666 DOI: 10.1016/j.jjcc.2020.02.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 02/07/2020] [Accepted: 02/18/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND This was a retrospective single-center evaluation for off-label use of a single Angio-Seal-VIP 8F vascular closure device (VCD) (Terumo Interventional Systems, Somerset, NJ, USA) for retrograde transfemoral arterial access exceeding 8F. METHODS Between 2010 and 2018, in 32 consecutive patients (3 females; mean age 67±9; range 46-86 years) retrograde femoral access was performed in 48 groins for aortoiliac stent or stent graft implantations using 9-14F sheaths. For vascular closure, one single Angio-Seal™-VIP 8F was used. Procedural success, closure-related complications, and risk factors were retrospectively evaluated using patient characteristics, duplex-ultrasound, and contrast-enhanced computed tomography angiography (CTA). Receiver-operating-characteristics were used for statistical analysis. RESULTS Technical success for deployment of VCD was 100%. Visual inspection and duplex-ultrasound confirmed immediate hemostasis in 100%. Postinterventional CTA depicted major vascular access site complications in 6.3% (3/48 groins) requiring surgical treatment. A subgroup of 13 patients underwent surgical cut-down one day after VCD deployment as part of a two-staged complex endovascular aortic aneurysm repair procedure, allowing for visual assessment of prior used undersized Angio-SealTM. Patient's height (p=0.028) and severe access site calcifications (p=0.028) proved as predictors for one vessel occlusion and two pseudoaneurysms. Low body-mass-index (BMI) showed a non-significant trend. Sheath-size, common femoral artery depth, or body weight were not indicative for occurrence of complications. CONCLUSIONS In selected cases, without availability of appropriate VCDs, a single Angio-SealTM-VIP 8F served as a feasible option to achieve sufficient hemostasis of transfemoral access exceeding 8F without relevant bleeding complications. Very low BMI, tall body-height, and severe atherosclerosis were identified to predispose to access site complications.
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Affiliation(s)
- Felix Frenzel
- Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Peter Fries
- Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Roushanak Shayesteh-Kheslat
- Clinic for General, Abdominal and Vascular Surgery, Saarland University Medical Center, Homburg/Saar, Germany
| | - Arno Buecker
- Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Alexander Massmann
- Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg/Saar, Germany.
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11
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El-Abd Y, Angle JF. Closure Devices. IMAGE-GUIDED INTERVENTIONS 2020:62-64.e1. [DOI: 10.1016/b978-0-323-61204-3.00008-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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12
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Addepalli A, Benton J, Zhu S, Mann SK, Fall MP, Cox A, Essibayi MA, Unda SR, Brook A, Lee SK, De La Garza Ramos R, Altschul DJ. Risk of Ipsilateral Deep Vein Thrombosis After Use of AngioSeal Closure Device in Aneurysmal Subarachnoid Hemorrhage Patients. World Neurosurg 2019; 134:e162-e165. [PMID: 31605856 DOI: 10.1016/j.wneu.2019.09.170] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 09/29/2019] [Accepted: 09/30/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Deep vein thrombosis (DVT) is a known complication in patients with aneurysmal subarachnoid hemorrhage (aSAH). This study investigated the association between use of the AngioSeal (St. Jude Medical, Minnetonka, MN) vascular closure device and the risk of ipsilateral and any DVT event after angiography in patients with aSAH. METHODS We conducted a review of our institutional cerebral angiography database for the years 2005-2018 to identify all adult patients who underwent angiography for aSAH. We compared the incidence of DVT (occurring within 14 days) between aSAH patients who underwent manual compression versus the AngioSeal closure device. RESULTS A total of 459 aSAH patients underwent angiography; 262 underwent manual compression (57.1%) and 197 received AngioSeal (42.9%). There was a 3.4% rate of ipsilateral DVT in the manual compression group and 7.6% in the AngioSeal closure device group (χ2 test, P = 0.04). Similarly, the rate of any DVT was 8.8% for manual compression and 16.8% for patients who received AngioSeal (χ2 test, P = 0.01). On multivariate analysis, AngioSeal remained a significant independent predictor of ipsilateral DVT (odds ratio 2.4, P = 0.04) and any DVT (odds ratio 2.3, P = 0.01). CONCLUSIONS In aSAH patients undergoing cerebral angiographic procedures with access through the femoral artery, the use of AngioSeal closure device was found to be associated with a significantly increased risk of ipsilateral DVT within 14 days.
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Affiliation(s)
- Aravind Addepalli
- Leo M. Davidoff Department of Neurosurgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Joshua Benton
- Leo M. Davidoff Department of Neurosurgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Shaoyu Zhu
- Leo M. Davidoff Department of Neurosurgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Shira Kaye Mann
- Leo M. Davidoff Department of Neurosurgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Mame P Fall
- Leo M. Davidoff Department of Neurosurgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Andrew Cox
- Leo M. Davidoff Department of Neurosurgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Santiago René Unda
- Health and Science Department, National University of La Rioja, La Rioja, Argentina
| | - Allan Brook
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Seon-Kyu Lee
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Rafael De La Garza Ramos
- Leo M. Davidoff Department of Neurosurgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - David J Altschul
- Leo M. Davidoff Department of Neurosurgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA.
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Ježek F, Strunina S, Carlson BE, Hozman J. A simulation study of left ventricular decompression using a double lumen arterial cannula prototype during a veno-arterial extracorporeal membrane oxygenation. Int J Artif Organs 2019; 42:748-756. [PMID: 31244372 DOI: 10.1177/0391398819858084] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Veno-arterial extracorporeal membrane oxygenation can be vital to support patients in severe or rapidly progressing cardiogenic shock. In cases of left ventricular distension, left ventricular decompression during veno-arterial extracorporeal membrane oxygenation may be a crucial factor influencing the patient outcome. Application of a double lumen arterial cannula for a left ventricular unloading is an alternative, straightforward method for left ventricular decompression during extracorporeal membrane oxygenation in a veno-arterial configuration. OBJECTIVES The purpose of this article is to use a mathematical model of the human adult cardiovascular system to analyze the left ventricular function of a patient in cardiogenic shock supported by veno-arterial extracorporeal membrane oxygenation with and without the application of left ventricular unloading using a novel double lumen arterial cannula. METHODS A lumped model of cardiovascular system hydraulics has been coupled with models of non-pulsatile veno-arterial extracorporeal membrane oxygenation, a standard venous cannula, and a drainage lumen of a double lumen arterial cannula. Cardiogenic shock has been induced by decreasing left ventricular contractility to 10% of baseline normal value. RESULTS The simulation results indicate that applying double lumen arterial cannula during veno-arterial extracorporeal membrane oxygenation is associated with reduction of left ventricular end-systolic volume, end-diastolic volume, end-systolic pressure, and end-diastolic pressure. CONCLUSIONS A double lumen arterial cannula is a viable alternative less invasive method for left ventricular decompression during veno-arterial extracorporeal membrane oxygenation. However, to allow for satisfactory extracorporeal membrane oxygenation flow, the cannula design has to be revisited.
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Affiliation(s)
- Filip Ježek
- Department of Pathophysiology, First Faculty of Medicine, Charles University, Prague 2, Czech Republic.,Department of Molecular & Integrative Physiology, University of Michigan, Ann Arbor, MI, USA
| | - Svitlana Strunina
- Department of Biomedical Technology, Faculty of Biomedical Engineering, Czech Technical University in Prague, Kladno, Czech Republic
| | - Brian E Carlson
- Department of Molecular & Integrative Physiology, University of Michigan, Ann Arbor, MI, USA
| | - Jiří Hozman
- Department of Biomedical Technology, Faculty of Biomedical Engineering, Czech Technical University in Prague, Kladno, Czech Republic
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Iannaccone M, Saint-Hilary G, Menardi D, Vadalà P, Bernardi A, Bianco M, Montefusco A, Omedè P, D’Amico S, Piazza F, Scacciatella P, D’Amico M, Moretti C, Biondi-Zoccai G, Gasparini M, Gaita F, D’Ascenzo F. Network meta-analysis of studies comparing closure devices for femoral access after percutaneous coronary intervention. J Cardiovasc Med (Hagerstown) 2018; 19:586-596. [PMID: 30045086 DOI: 10.2459/jcm.0000000000000697] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Gabrielli R, Rosati MS, Millarelli M, Dante A, Maiorano M, Musilli A, Chiappa R, Ventura M. FemoSeal ® Device Use for Femoral Artery Closure by Different Techniques. Ann Vasc Surg 2018; 51:18-24. [PMID: 29678650 DOI: 10.1016/j.avsg.2018.02.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Revised: 02/03/2018] [Accepted: 02/09/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Common femoral artery is still the most frequently used site for vascular access, mostly for peripheral arterial interventions, and its puncture remains a significant source of patient's morbidity. Manual compression (MC) has been the gold standard for hemostasis after femoral catheterization until recently, but only in the last few years, vascular closure devices (VCDs) are replacing MC due to their rapid development. Nowadays, vascular surgeons (VSs) are also becoming familiar with VCDs. The purpose of this study was to investigate FemoSeal® arterial closure system use in terms of safety and efficacy in patients undergoing transfemoral peripheral procedure and evaluate the complication risk factors. METHODS A retrospective analysis to compare 2 different specialists and technique with systematic implantation of FemoSeal® VCD was performed in a cohort of vascular patients treated by endovascular procedure with femoral artery access site over a 2-year period and sheaths ranged from 6F to 8F. All the patients were on antiplatelet therapy and received heparin during the procedure. The FemoSeal® was deployed in common femoral arteries. All patients were examined for access site complication by VS in both groups 20-24 hrs after VCD deployment and 1 and 6 weeks after the procedure with clinical visit and ultrasound duplex scan. Complications, as minor and major hematomas, pseudoaneurysm formation, vessel occlusion or dissection, and infection were recorded. RESULTS During the study period, 130 FemoSeal® were deployed in 114 patients, 102 FemoSeal® in VS group, and 28 in interventionalist group. Mean age was 57 ± 24 years. There was no significant difference between the 2 groups in terms of comorbidities. Patient follow-up ranged from 1 to 15 months. All but 3 of the FemoSeal® devices were successfully deployed (all 3 cases in group 2). Mobilization time was 6 ± 4 hrs following interventions, and the discharge time ranged from 6 hrs to 7 days after procedure. Early discharge (within 6 hrs) was obtained in 23% of group 1 and in 0 cases of group 2 (P = 0.008). Delayed discharge was obtained in 74% of group 1 (67 pts) and in 70% of group 2 (18 pts) on postoperative day 1 (P = 0.47). Technical success was achieved in 99% of group 1 and in 93% of group 2 (P = 0.87). There were no perioperative deaths. There were no significant differences in terms of minor bleeding complications (P = 0.21) or infections or transfusion needing (P 0.06) in both groups. FemoSeal®-related complications occurred in 6 patients (1 in group 1 and 5 in group 2; P = 0.0017). All complications occurred following therapeutic intervention with 6F sheath introducer. Complication rate resulted significatively higher in group 2 in terms of pseudoaneurysm development (P < 0.0001) and transfusion needing (P = 0.03) in a subgroup analysis on peripheral arterial disease (Rutherford 3-5). Only chronic limb ischemia was found to be independent predictor of complications due to VCD use. CONCLUSIONS Our data suggest that when simple guidelines are observed, the device is safe, effective, and easy to deploy and allows for early ambulation and discharge. However, appropriate randomized clinical trials could clarify the correct guideline to minimize the complication rates.
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Affiliation(s)
- Roberto Gabrielli
- Department of Vascular and Endovascular Surgery, "San Salvatore Hospital", L'Aquila, Italy.
| | - Maria Sofia Rosati
- Department of Vascular and Endovascular Surgery, "San Salvatore Hospital", L'Aquila, Italy
| | - Massiliano Millarelli
- Department of Vascular and Endovascular Surgery, "Policlinico Casilino Hospital", Rome, Italy
| | - Angelica Dante
- Department of Vascular and Endovascular Surgery, "San Salvatore Hospital", L'Aquila, Italy
| | - Maurizio Maiorano
- Department of Vascular and Endovascular Surgery, "San Salvatore Hospital", L'Aquila, Italy
| | - Aldo Musilli
- Department of Vascular and Endovascular Surgery, "San Salvatore Hospital", L'Aquila, Italy
| | - Roberto Chiappa
- Department of Vascular and Endovascular Surgery, "Policlinico Casilino Hospital", Rome, Italy
| | - Marco Ventura
- Department of Vascular and Endovascular Surgery, "San Salvatore Hospital", L'Aquila, Italy
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Chivot C, Deramond H, Bouzerar R, Yzet T. Safety and Efficacy of Femoral Artery Closure with the FemoSeal Device After Cerebral Thrombectomy Using an 8 French Sheath. Eur J Vasc Endovasc Surg 2018; 55:730-734. [PMID: 29550254 DOI: 10.1016/j.ejvs.2018.02.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 02/11/2018] [Indexed: 11/15/2022]
Abstract
PURPOSE To evaluate the feasibility and safety of using the FemoSeal vascular closure device (VCD) to seal 8F access sites during mechanical thrombectomy for stroke. METHODS A retrospective review of a prospective database was undertaken to evaluate the safety and efficacy of femoral arterial closure using FemoSeal device in all patients who underwent mechanical thrombectomy using an 8F sheath between January 2015 and July 2017. Efficacy endpoints were the successful deployment of the system and haemostasis success. Safety endpoints included the incidence of in hospital access site haematoma >5 cm, bleeding complications, pseudoaneurysms, arteriovenous fistula, infection, or other complications requiring surgery. RESULTS 197 patients (96 men; mean age 68 years, range 25-99) were included. Successful haemostasis with FemoSeal was obtained in 98.9% of the patients. Only one haematoma >5 cm (0.5%) was observed, which reabsorbed spontaneously without issue. Nine haematomas <5 cm (4.5%) were also found. No major complications requiring surgical repair or transfusion were observed. There were no pseudoaneurysms, arteriovenous fistulae, or infections. CONCLUSION The use of the FemoSeal device to close an 8F access sheath puncture site is feasible and safe, with a low complication rate.
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Affiliation(s)
- Cyril Chivot
- Department of Radiology, Amiens University Hospital, Amiens, France.
| | - Hervé Deramond
- Department of Radiology, Amiens University Hospital, Amiens, France
| | - Roger Bouzerar
- Image Processing Department, Amiens University Hospital, Amiens, France
| | - Thierry Yzet
- Department of Radiology, Amiens University Hospital, Amiens, France
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Farooq V, Goedhart D, Ludman P, de Belder MA, Harcombe A, El-Omar M. Relationship Between Femoral Vascular Closure Devices and Short-Term Mortality From 271 845 Percutaneous Coronary Intervention Procedures Performed in the United Kingdom Between 2006 and 2011: A Propensity Score-Corrected Analysis From the British Cardiovascular Intervention Society. Circ Cardiovasc Interv 2017; 9:CIRCINTERVENTIONS.116.003560. [PMID: 27225421 DOI: 10.1161/circinterventions.116.003560] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Accepted: 04/17/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND The impact of vascular closure devices (VCDs) via the femoral arterial access site on short-term mortality in patients undergoing percutaneous coronary intervention is currently unknown. METHODS AND RESULTS The association between femoral arterial vascular access site management (manual pressure [including external clamp] versus VCD) and 30-day mortality was examined in a national real-world registry of 271 845 patients undergoing percutaneous coronary intervention for elective, non-ST-segment-elevation myocardial infarction and ST-segment-elevation myocardial infarction indications in the United Kingdom between 2006 and 2011. Crude and propensity score-corrected analyses were performed using Cox regression, with additional analyses undertaken in clinically relevant subgroups; 40.1% (n=109 001) of subjects were treated with manual pressure and 59.9% (n=162 844) with VCD. Subjects treated with VCD had fewer comorbidities and were less likely to present with ST-segment-elevation myocardial infarction and cardiogenic shock (P<0.001). Crude 30-day mortality was lower in the group treated with VCD compared with manual pressure (hazard ratio [HR], 0.58; 95% confidence interval [CI], 0.54-0.61; 1.4% versus 2.4%, log rank P<0.0001), findings that were substantially reduced but persisted after propensity score correction (HR, 0.91; 95% CI, 0.86-0.97; 1.8% versus 2.0% versus P<0.001). A more pronounced association of VCD with a reduction in 30-day mortality was evident in females (HR, 0.85; 95% CI, 0.77-0.94; Pinteraction=0.037), presentation with acute coronary syndrome (HR, 0.88; 95% CI, 0.83-0.94; Pinteraction=0.0027), or recent lysis (HR, 0.63; 95% CI, 0.40-1.01; Pinteraction=0.0001). CONCLUSIONS When compared with manual pressure, VCD was associated with a minor short-term (30-day) prognostic benefit after propensity score correction in the global population and clinically relevant subgroups. The potential for residual confounding factors impacting on short-term mortality cannot be excluded, despite the study having measured and balanced all recorded confounder factors.
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Affiliation(s)
- Vasim Farooq
- From the Department of Cardiology, Manchester Heart Centre, Manchester Royal Infirmary, Central Manchester University Hospitals NHS Trust, Manchester, United Kingdom (V.F., D.G., M.E.-O.); Department of Cardiology, Queen Elizabeth Hospital, Birmingham, United Kingdom (P.L.); Department of Cardiology, The James Cook University Hospital, Middlesbrough, United Kingdom (M.A.d.B.); and Department of Cardiology, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom (A.H.)
| | - Dick Goedhart
- From the Department of Cardiology, Manchester Heart Centre, Manchester Royal Infirmary, Central Manchester University Hospitals NHS Trust, Manchester, United Kingdom (V.F., D.G., M.E.-O.); Department of Cardiology, Queen Elizabeth Hospital, Birmingham, United Kingdom (P.L.); Department of Cardiology, The James Cook University Hospital, Middlesbrough, United Kingdom (M.A.d.B.); and Department of Cardiology, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom (A.H.)
| | - Peter Ludman
- From the Department of Cardiology, Manchester Heart Centre, Manchester Royal Infirmary, Central Manchester University Hospitals NHS Trust, Manchester, United Kingdom (V.F., D.G., M.E.-O.); Department of Cardiology, Queen Elizabeth Hospital, Birmingham, United Kingdom (P.L.); Department of Cardiology, The James Cook University Hospital, Middlesbrough, United Kingdom (M.A.d.B.); and Department of Cardiology, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom (A.H.)
| | - Mark A de Belder
- From the Department of Cardiology, Manchester Heart Centre, Manchester Royal Infirmary, Central Manchester University Hospitals NHS Trust, Manchester, United Kingdom (V.F., D.G., M.E.-O.); Department of Cardiology, Queen Elizabeth Hospital, Birmingham, United Kingdom (P.L.); Department of Cardiology, The James Cook University Hospital, Middlesbrough, United Kingdom (M.A.d.B.); and Department of Cardiology, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom (A.H.)
| | - Alun Harcombe
- From the Department of Cardiology, Manchester Heart Centre, Manchester Royal Infirmary, Central Manchester University Hospitals NHS Trust, Manchester, United Kingdom (V.F., D.G., M.E.-O.); Department of Cardiology, Queen Elizabeth Hospital, Birmingham, United Kingdom (P.L.); Department of Cardiology, The James Cook University Hospital, Middlesbrough, United Kingdom (M.A.d.B.); and Department of Cardiology, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom (A.H.)
| | - Magdi El-Omar
- From the Department of Cardiology, Manchester Heart Centre, Manchester Royal Infirmary, Central Manchester University Hospitals NHS Trust, Manchester, United Kingdom (V.F., D.G., M.E.-O.); Department of Cardiology, Queen Elizabeth Hospital, Birmingham, United Kingdom (P.L.); Department of Cardiology, The James Cook University Hospital, Middlesbrough, United Kingdom (M.A.d.B.); and Department of Cardiology, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom (A.H.).
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Van Mieghem NM, Latib A, van der Heyden J, van Gils L, Daemen J, Sorzano T, Ligthart J, Witberg K, de Kroon T, Maor N, Mangieri A, Montorfano M, de Jaegere PP, Colombo A, Roubin G. Percutaneous Plug-Based Arteriotomy Closure Device for Large-Bore Access: A Multicenter Prospective Study. JACC Cardiovasc Interv 2017; 10:613-619. [PMID: 28335899 DOI: 10.1016/j.jcin.2016.12.277] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 12/22/2016] [Accepted: 12/29/2016] [Indexed: 12/15/2022]
Abstract
OBJECTIVES The authors sought to study the safety and efficacy of the MANTA Vascular Closure Device (VCD), a novel collagen-based technology dedicated to closure of large-bore arteriotomies. BACKGROUND Novel transfemoral therapeutic interventions requiring large-bore catheters have become valid minimally invasive options but have inherent access management challenges. To date, no dedicated vascular closure devices exist for large arteriotomies. METHODS A prospective, single-arm clinical investigation enrolling patients who underwent elective percutaneous interventions with large-bore catheters and planned percutaneous arteriotomy closure in 3 European institutions. RESULTS A total of 50 patients with a mean age of 79.5 ± 8.3 years underwent high-risk percutaneous coronary intervention, balloon aortic valvuloplasty, or transcatheter aortic valve replacement with large-bore catheters sized 12-F to 19-F. MANTA closure was performed by 9 different operators. The 14-F MANTA VCD was deployed in one-third of the overall cohort (16 of 50, 32%), and the 18-F MANTA VCD in the remainder. The MANTA VCD was deployed successfully in all patients. The mean time to hemostasis was 2 min, 23 s. One patient had a major vascular and major bleeding complication with prolonged femoral bleeding that was successfully treated with a covered stent and eventual surgical repair. There were no other access site-related complications. CONCLUSIONS This first multicenter experience demonstrates rapid and reliable hemostasis and low complication rates with the use of the plug-based MANTA VCD for large-bore arteriotomy closure.
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Affiliation(s)
- Nicolas M Van Mieghem
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands.
| | - Azeem Latib
- Department of Interventional Cardiology, San Raffaele Scientific Institute, Milan, Italy; Department of Interventional Cardiology, EMO-GVM Centro Cuore, Milan, Italy
| | - Jan van der Heyden
- Department of Cardiology and Cardiac Surgery, St. Antonius Ziekenhuis, Nieuwegein, the Netherlands
| | - Lennart van Gils
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Joost Daemen
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | - Jurgen Ligthart
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Karin Witberg
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Thom de Kroon
- Department of Cardiology and Cardiac Surgery, St. Antonius Ziekenhuis, Nieuwegein, the Netherlands
| | | | - Antonio Mangieri
- Department of Interventional Cardiology, San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Montorfano
- Department of Interventional Cardiology, San Raffaele Scientific Institute, Milan, Italy
| | - Peter P de Jaegere
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Antonio Colombo
- Department of Interventional Cardiology, San Raffaele Scientific Institute, Milan, Italy; Department of Interventional Cardiology, EMO-GVM Centro Cuore, Milan, Italy
| | - Gary Roubin
- Essential Medical, Inc, Malvem, Pennsylvania; Cardiovascular Associates, Birmingham, Alabama
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Comparison of manual compression and vascular hemostasis devices after coronary angiography or percutaneous coronary intervention through femoral artery access: A meta-analysis of randomized controlled trials. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2017; 19:151-162. [PMID: 28941744 DOI: 10.1016/j.carrev.2017.08.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 08/11/2017] [Accepted: 08/15/2017] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To compare the efficacy and safety of manual compression (MC) with vascular hemostasis devices (VHD) in patients undergoing coronary angiography (CA) or percutaneous coronary intervention (PCI) through femoral artery access. INTRODUCTION The use of femoral artery access for coronary procedures may result in access-related complications, prolonged immobility and discomfort for the patients. MC results in longer time-to-hemostasis (TTH) and time-to-ambulation (TTA) compared to VHDs but its role in access-related complications remains unclear in patients undergoing coronary procedures. METHODS We searched MEDLINE, EMBASE, Cochrane CENTRAL and relevant references for English language randomized controlled trials (RCT) from inception through September 30, 2016. We performed the meta-analysis using random effects model. The outcomes were time-to-hemostasis, time-to-ambulation, major bleeding, large hematoma >5cm, pseudoaneurysm and other adverse events. RESULTS The electronic database search resulted in a total of 44 RCTs with a total of 18,802 patients for analysis. MC, compared to VHD resulted in longer TTH [mean difference (MD): 11.21min; 95% confidence interval (CI) 8.13-14.29; P<0.00001] and TTA [standardized mean difference: 1.2 (0.79-1.62); P<0.00001] along with excess risk of hematoma >5cm formation [risk ratio (RR): 1.38 (1.15-1.67); P=0.0008]. MC resulted in similar risk of major bleeding [1.01 (0.64-1.60); P=0.95] pseudoaneurysm [0.99 (0.75-1.29); P=0.92], infections [0.52 (0.25-1.10); P=0.09], need of surgery [0.60 (0.29-1.22); P=0.16), AV fistula [0.93 (0.68-1.27); P=0.63] and ipsilateral leg ischemia [0.95 (0.57-1.60); P=0.86] compared to VHD. CONCLUSION Manual compression increase time-to-hemostasis, time-to-ambulation and risk of hematoma formation compared vascular hemostasis devices.
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Safety and efficacy of combined micropuncture and shallow angle femoral artery access for neurovascular angiography. J Vasc Access 2017; 18:264-268. [PMID: 26044902 DOI: 10.5301/jva.5000388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2015] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION The AXERA 2 low-angle vascular access device utilizes a dual arteriotomy mechanism in which the standard access tract is compressed by a vascular sheath inserted over the second, low-angle tract. It is unknown whether this device could be effectively used with 21-gauge micropuncture access, as the micropuncture introducer makes a larger arteriotomy than the 19-gauge needle provided with the AXERA 2 system. MATERIALS AND METHODS A retrospective review was performed on 189 patients who underwent common femoral artery access for diagnostic cerebrovascular angiography using either combined micropuncture and AXERA 2 access or standard access with manual pressure hemostasis. Demographic and procedural data were reviewed along with complications related to vascular access and times to bed elevation, ambulation and discharge. RESULTS Combined micropuncture and AXERA 2 access was performed on 110 patients and 79 patients had standard access. The AXERA device was successfully used in 91.8% of the cases. Demographic data, anticoagulant use and sheath sizes were similar between both subsets. Use of the AXERA 2 was associated with two bleeding complications (1.8%) compared with 10 (12.7%) with manual pressure hemostasis alone. Institution-specific protocol allowed shorter mean manual compression time, as well as shorter times to ambulation and discharge with the AXERA 2. CONCLUSIONS Use of the AXERA 2 device with micropuncture access did not infer increased bleeding risk than standard arterial access in this patient series. The considerable incidence of device use failures suggests a learning curve associated with its use.
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Pseudoaneurysm of the deep femoral artery caused by a guide wire following femur intertrochanteric fracture with a hip nail: A case report. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2017; 51:266-269. [PMID: 28457795 PMCID: PMC6197181 DOI: 10.1016/j.aott.2017.03.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 03/03/2015] [Accepted: 03/28/2015] [Indexed: 02/06/2023]
Abstract
An 85-year-old woman developed severe swelling and pain in the proximal thigh after internal fixation of an intertrochanteric fracture of the femur with a hip nail. In order to identify the causes and determine the effective treatment, angiography was performed. The results of the angiography revealed a pseudoaneurysm of a branch of deep femoral artery. Endovascular embolization was used to treat the pseudoaneurysm. After reviewing all possible causes, we found a mistake in insertion of a guide wire for hip nail. Using intraoperative fluoroscopic images, we found the mal-positioned guide wire located posterior to trochanter on lateral view of hip. This case study reminds us that pseudoaneurysm can occur in a guide wire during hip nailing. Surgeons can avoid this complication with confirmation of lateral and anteroposterior view of hip.
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Lakshmanadoss U, Wong WS, Kutinsky I, Khalid MR, Williamson B, Haines DE. Figure-of-eight suture for venous hemostasis in fully anticoagulated patients after atrial fibrillation catheter ablation. Indian Pacing Electrophysiol J 2017; 17:134-139. [PMID: 29192589 PMCID: PMC5652276 DOI: 10.1016/j.ipej.2017.02.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 01/24/2017] [Accepted: 02/14/2017] [Indexed: 11/08/2022] Open
Abstract
Introduction Limited data exists for types of venous closure and its associated complications in patients after atrial fibrillation (AF) catheter ablation. We evaluated the subcutaneous figure-of-eight closure (FO8) for achieving venous hemostasis after AF catheter ablation compared to manual pressure. Methods 284 consecutive patients that underwent AF catheter ablation by two operators were included. All patients received continuous therapeutic warfarin or interrupted novel oral anticoagulants (NOAC) and heparin (ACT300-400 s) without reversal. Patients were divided into two groups: 1) sheaths were left in place and pulled once ACT < 180 s, with hemostasis being achieved with manual pressure (MP); and 2) a subcutaneous FO8 suture closed the venous access site immediately after the ablation on each groin site and sheaths were removed immediately after the ablation despite full anticoagulation with heparin and warfarin or interrupted NOAC. Sutures were removed after four hours, and the patients laid flat for an additional two hours. Results The MP group (n = 105) was similar to the FO8 group (n = 179). Time in bed was 573 ± 80 min for MP group vs. 373 ± 49 min for FO8 group (p < 0.0001). Eleven hematomas were seen in the MP group compared to seven in the FO8 group (P = 0.041). Conclusions In fully anticoagulated patients undergoing AF catheter ablation, excellent hemostasis was achieved with figure-of-eight sutures, with no major vascular complications, a lower hematoma rate, and a significantly shorter flat-time-in-bed compared to manual pressure.
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Affiliation(s)
| | - Wai Shun Wong
- Beaumont Health, Royal Oak, MI and Oakland University William Beaumont School of Medicine, Rochester, MI, United States
| | - Ilana Kutinsky
- Beaumont Health, Royal Oak, MI and Oakland University William Beaumont School of Medicine, Rochester, MI, United States
| | - M Rizwan Khalid
- University of Rochester Medical Center, Rochester, NY, United States
| | - Brian Williamson
- Beaumont Health, Royal Oak, MI and Oakland University William Beaumont School of Medicine, Rochester, MI, United States
| | - David E Haines
- Beaumont Health, Royal Oak, MI and Oakland University William Beaumont School of Medicine, Rochester, MI, United States
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Aytemir K, Canpolat U, Yorgun H, Evranos B, Kaya EB, Şahiner ML, Özer N. Usefulness of ‘figure-of-eight’ suture to achieve haemostasis after removal of 15-French calibre femoral venous sheath in patients undergoing cryoablation. Europace 2016; 18:1545-1550. [PMID: 26705565 DOI: 10.1093/europace/euv375] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023] Open
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Kalapatapu VR, Ali AT, Masroor F, Moursi MM, Eidt JF. Techniques for Managing Complications of Arterial Closure Devices. Vasc Endovascular Surg 2016; 40:399-408. [PMID: 17038574 DOI: 10.1177/1538574406293760] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
According to data reported by the American Heart Association, more than 5 million diagnostic and therapeutic catheterizations are performed each year in the United States. The number of catheterizations has tripled since 1979. It has been estimated that complications related to the access site result in more than 75,000 surgical procedures annually. Thus, improved management of the access site itself is essential to achieve the greater goals of improved care and reduced cost. Manual compression directly over the site of arterial puncture usually results in adequate hemostasis but has several significant drawbacks. Manual compression is uncomfortable for the patient, is fatiguing and time-consuming for staff, and necessitates several hours of costly in-hospital observation. In addition, it may be ineffective in achieving hemostasis, especially in the setting of systemic anticoagulation or following the use of large-bore devices. Based on the perceived need for an improved method of managing the arterial access site following catheterization, various vascular sealing devices have been developed. There are at least 8 (and the number is increasing) hemostatic vascular closure devices that are currently approved by the FDA for access site closure after femoral arterial catheterization. The chief advantage attributed to vascular sealing devices is accelerated access site hemostasis, even in the setting of anticoagulation, leading to earlier ambulation and hospital discharge following arterial catheterization. The most important drawbacks related to vascular sealing devices include the cost of the devices and the possibility of increased access site complications. Despite the paucity of properly designed studies supporting their use, it is estimated that over one million vascular sealing devices are used annually in the United States, a number that has increased dramatically in the past 5 years.In this review, we present a brief description of the design and function of the most widely used devices, describe the most common mechanisms of failure, and recommend strategies for management of access site complications including hemorrhage, arterial obstruction, and infection.
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Abstract
Hemostatic puncture closure devices for the femoral artery are currently marketed as a means of shortening hemostasis, ambulation, and observation times after cardiac catheterization procedures. Some of these devices are deployed external to the artery, but at least one device, Angio-SealA (Sherwood, Davis & Geck), includes a polymer anchor that is deployed inside the artery. Major complications may arise from the use of this device, including thrombosis, embolization of the anchor, and infection. The manufacturer does not claim that the device reduces the incidence of local complications as compared to the traditional technique of manual compression. The author presents a case of infection of the groin involving the Angio-Seal device in which the patient presented with septic shock and renal failure after cardiac catheterization. A large abscess was present, and removal of the device required arterial surgery in an infected field. The author reports on the technique and precautions used to surgically remove the device and to prevent further complications.
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Tomlinson MA, Beese R, Banwell M, Loosemore T, Buckenham TM, Dormandy JA. Sequential Retroperitoneal Venous Hemorrhage and Embolism of an Angio-Seal Puncture Closure Device Complicating Iliac Artery Angioplasty. J Endovasc Ther 2016. [DOI: 10.1177/152660289900600309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To present a case of iatrogenic puncture closure device embolization complicating surgery for retroperitoneal hemorrhage (RPH) secondary to angioplasty-induced common iliac vein trauma. Methods and Results: A 78-year-old woman with rest pain underwent successful kissing balloon dilation of her aortoiliac bifurcation for a calcified ostial stenosis of the left common iliac artery. Hemostatic puncture closure devices (Angio-Seal) were used to secure both femoral punctures. A right-sided retroperitoneal hematoma developed, and during surgical exploration of the right groin, the Angio-Seal device was removed. The only bleeding site found was the external iliac artery puncture and it was repaired. She again became hypovolemic 18 hours later and was returned to surgery, where bilateral groin explorations and laparotomy by the vascular surgical team found a tear in the left common iliac vein. After repair, the patient was stable for 48 hours when the left leg became critically ischemic. Angiography detected a new high-grade stenosis in the left profunda femoris artery; embolectomy retrieved a footplate from the left puncture closure device. The patient died 11 days later from multiorgan failure. Conclusions: RPH should be considered early as an occult cause of hypovolemic shock developing soon after even technically straightforward iliac angioplasty. Interventionists should be aware that using the Angio-Seal device risks acute limb ischemia if footplate embolization occurs.
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Affiliation(s)
| | - Richard Beese
- Department of Vascular Surgery, Radiology, St. George's Hospital, London, United Kingdom
| | | | | | - Timothy M. Buckenham
- Department of Vascular Surgery, Radiology, St. George's Hospital, London, United Kingdom
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Henry M, Amor M, Allaoui M, Tricoche O. A New Access Site Management Tool: The Angio-Seal™ Hemostatic Puncture Closure Device. J Endovasc Ther 2016. [DOI: 10.1177/152660289500200309] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: Given the increasing number of percutaneously applied endovascular therapies, the incidence of access-related vascular complications can be expected to rise, particularly in association with those techniques requiring large sheaths or anticoagulation. The need exists for a safe, easy to use, and effective hemostatic technique to replace the labor-intensive method of manual compression. Methods: A bioabsorbable, sheath-delivered vascular closure device (Angio-Seal™) has been developed that deposits a small collagen plug within the arterial wall to mechanically seal the puncture defect. An anchor connected by suture to the plug is first deployed in the arterial lumen and pulled flush against the interior arterial wall to guard against intraluminal deposition of the collagen. Results: The Angio-Seal device was deployed successfully in 80 (96%) of 83 attempts involving common femoral arteries accessed for peripheral angioplasty (n = 30), coronary angiography (n = 30), and coronary angioplasty (n = 16). Three popliteal artery access sites and one femoropopliteal bypass graft were also treated. Hemostasis was immediate in 78 cases (98%); 2 sites required a 5-minute manual compression to effect a secure seal. Three devices failed to deploy, and manual pressure was used to close the puncture. Nondeployment did not cause any sequelae, and no complications were encountered with the technique. Conclusions: This novel vascular closure device is quick (< 1 minute application time) and simple to use, providing a positive seal of common femoral artery puncture sites for both peripheral and coronary interventions. It appears to be a reliable alternative to standard manual hemostasis.
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Affiliation(s)
| | - Max Amor
- Polyclinique d'Essey-Ies-Nancy, Nancy, France
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Fokkema TM, Minnee RC, Kock GAH, Blomjous JGAM, Vahl AC, Leijdekkers VJ. Comparison of a collagen plug arterial closure device with manual compression after endovascular interventions for peripheral artery disease. J Vasc Surg 2016; 64:104-108.e1. [PMID: 27038835 DOI: 10.1016/j.jvs.2016.02.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 02/02/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Arterial closure devices (ACDs) seem to be safe and effective to obtain hemostasis for cardiac interventions and diagnostic vascular procedures. However, only limited evidence is presented on therapeutic interventions in patients with peripheral atherosclerotic disease. We compared ischemic and hemorrhagic complications of an ACD vs manual compression (MC) after puncture of the femoral artery for endovascular lower extremity procedures. METHODS The records of all subsequent endovascular interventions for peripheral artery disease performed in a large teaching hospital, from January 2012 to April 2014, were retrospectively reviewed. The primary outcome was an ischemic complication requiring reintervention. Secondary outcomes were hematoma (needing conservative or invasive intervention) and infection (needing intervention or antibiotics). Multivariate analysis was performed to identify predictors for any complication. RESULTS The Angio-Seal (St. Jude Medical, Minnetonka, Minn) closure device was used in 244 of 463 endovascular interventions (54%). Five patients (2%) who received an ACD needed emergency surgery for ischemic complications vs none in the MC group (P = .06). Hematomas occurred in 22 patients (9%) after ACD vs in six (3%) after MC (adjusted odds ratio [OR], 3.4; 95% confidence interval [CI], 1.4-8.9; P = .015). There were no infections in either group. ACD (OR, 3.8; 95% CI, 1.5-9.7) and current smoking (OR, 2.6; 95% CI, 1.01-6.7) were independent predictors for any complication. CONCLUSIONS This study demonstrates that ACD use in patients with peripheral artery disease can lead to serious adverse events resulting in increased morbidity. Therefore, the potential benefits of an ACD over MC should be carefully weighed.
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Affiliation(s)
- Talje M Fokkema
- Department of Vascular Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
| | - Robert C Minnee
- Department of Vascular Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Gert-Aldert H Kock
- Department of Interventional Radiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Joost G A M Blomjous
- Department of Interventional Radiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Anco C Vahl
- Department of Vascular Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Vanessa J Leijdekkers
- Department of Vascular Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
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Robertson L, Andras A, Colgan F, Jackson R. Vascular closure devices for femoral arterial puncture site haemostasis. Cochrane Database Syst Rev 2016; 3:CD009541. [PMID: 26948236 PMCID: PMC10372718 DOI: 10.1002/14651858.cd009541.pub2] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Vascular closure devices (VCDs) are widely used to achieve haemostasis after procedures requiring percutaneous common femoral artery (CFA) puncture. There is no consensus regarding the benefits of VCDs, including potential reduction in procedure time, length of hospital stay or time to patient ambulation. No robust evidence exists that VCDs reduce the incidence of puncture site complications compared with haemostasis achieved through extrinsic (manual or mechanical) compression. OBJECTIVES To determine the efficacy and safety of VCDs versus traditional methods of extrinsic compression in achieving haemostasis after retrograde and antegrade percutaneous arterial puncture of the CFA. SEARCH METHODS The Cochrane Vascular Trials Search Co-ordinator searched the Specialised Register (April 2015) and the Cochrane Central Register of Controlled Trials (CENTRAL) (2015, Issue 3). Clinical trials databases were searched for details of ongoing or unpublished studies. References of articles retrieved by electronic searches were searched for additional citations. SELECTION CRITERIA We included randomised and quasi-randomised controlled trials in which people undergoing a diagnostic or interventional procedure via percutaneous CFA puncture were randomised to one type of VCD versus extrinsic compression or another type of VCD. DATA COLLECTION AND ANALYSIS Two authors independently extracted data and assessed the methodological quality of trials. We resolved disagreements by discussion with the third author. We performed meta-analyses when heterogeneity (I(2)) was < 90%. The primary efficacy outcomes were time to haemostasis and time to mobilisation (mean difference (MD) and 95% confidence interval (CI)). The primary safety outcome was a major adverse event (mortality and vascular injury requiring repair) (odds ratio (OR) and 95% CI). Secondary outcomes included adverse events. MAIN RESULTS We included 52 studies (19,192 participants) in the review. We found studies comparing VCDs with extrinsic compression (sheath size ≤ 9 Fr), different VCDs with each other after endovascular (EVAR) and percutaneous EVAR procedures and VCDs with surgical closure after open exposure of the artery (sheath size ≥ 10 Fr). For primary outcomes, we assigned the quality of evidence according to GRADE (Grades of Recommendation, Assessment, Development and Evaluation) criteria as low because of serious imprecision and for secondary outcomes as moderate for precision, consistency and directness.For time to haemostasis, studies comparing collagen-based VCDs and extrinsic compression were too heterogenous to be combined. However, both metal clip-based (MD -14.81 minutes, 95% CI -16.98 to -12.63 minutes; five studies; 1665 participants) and suture-based VCDs (MD -14.58 minutes, 95% CI -16.85 to -12.32 minutes; seven studies; 1664 participants) were associated with reduced time to haemostasis when compared with extrinsic compression.For time to mobilisation, studies comparing collagen-, metal clip- and suture-based devices with extrinsic compression were too heterogeneous to be combined. No deaths were reported in the studies comparing collagen-based, metal clip-based or suture-based VCDs with extrinsic compression. For vascular injury requiring repair, meta-analyses demonstrated that neither collagen (OR 2.81, 95% CI 0.47 to 16.79; six studies; 5731 participants) nor metal clip-based VCDs (OR 0.49, 95% CI 0.03 to 7.95; three studies; 783 participants) were more effective than extrinsic compression. No cases of vascular injury required repair in the study testing suture-based VCD with extrinsic compression.Investigators reported no differences in the incidence of infection between collagen-based (OR 2.14, 95% CI 0.88 to 5.22; nine studies; 7616 participants) or suture-based VCDs (OR 1.66, 95% CI 0.22 to 12.71; three studies; 750 participants) and extrinsic compression. No cases of infection were observed in studies testing suture-based VCD versus extrinsic compression. The incidence of groin haematoma was lower with collagen-based VCDs than with extrinsic compression (OR 0.46, 95% CI 0.40 to 0.54; 25 studies; 10,247 participants), but no difference was evident when metal clip-based (OR 0.79, 95% CI 0.46 to 1.34; four studies; 1523 participants) or suture-based VCDs (OR 0.65, 95% CI 0.41 to 1.02; six studies; 1350 participants) were compared with extrinsic compression. The incidence of pseudoaneurysm was lower with collagen-based devices than with extrinsic compression (OR 0.74, 95% CI 0.55 to 0.99; 21 studies; 9342 participants), but no difference was noted when metal clip-based (OR 0.76, 95% CI 0.20 to 2.89; six studies; 1966 participants) or suture-based VCDs (OR 0.79, 95% CI 0.25 to 2.53; six studies; 1527 participants) were compared with extrinsic compression. For other adverse events, researchers reported no differences between collagen-based, clip-based or suture-based VCDs and extrinsic compression.Limited data were obtained when VCDs were compared with each other. Results of one study showed that metal clip-based VCDs were associated with shorter time to haemostasis (MD -2.24 minutes, 95% CI -2.54 to -1.94 minutes; 469 participants) and shorter time to mobilisation (MD -0.30 hours, 95% CI -0.59 to -0.01 hours; 469 participants) than suture-based devices. Few studies measured (major) adverse events, and those that did found no cases or no differences between VCDs.Percutaneous EVAR procedures revealed no differences in time to haemostasis (MD -3.20 minutes, 95% CI -10.23 to 3.83 minutes; one study; 101 participants), time to mobilisation (MD 1.00 hours, 95% CI -2.20 to 4.20 hours; one study; 101 participants) or major adverse events between PerClose and ProGlide. When compared with sutures after open exposure, VCD was associated with shorter time to haemostasis (MD -11.58 minutes, 95% CI -18.85 to -4.31 minutes; one study; 151 participants) but no difference in time to mobilisation (MD -2.50 hours, 95% CI -7.21 to 2.21 hours; one study; 151 participants) or incidence of major adverse events. AUTHORS' CONCLUSIONS For time to haemostasis, studies comparing collagen-based VCDs and extrinsic compression were too heterogeneous to be combined. However, both metal clip-based and suture-based VCDs were associated with reduced time to haemostasis when compared with extrinsic compression. For time to mobilisation, studies comparing VCDs with extrinsic compression were too heterogeneous to be combined. No difference was demonstrated in the incidence of vascular injury or mortality when VCDs were compared with extrinsic compression. No difference was demonstrated in the efficacy or safety of VCDs with different mechanisms of action. Further work is necessary to evaluate the efficacy of devices currently in use and to compare these with one other and extrinsic compression with respect to clearly defined outcome measures.
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Affiliation(s)
- Lindsay Robertson
- Freeman HospitalDepartment of Vascular SurgeryNewcastle upon Tyne Hospitals NHS Foundation TrustHigh HeatonNewcastle upon TyneUKNE7 7DN
| | - Alina Andras
- Keele University, Guy Hilton Research CentreInstitute for Science and Technology in MedicineThornburrow DriveHartshillStoke‐on‐TrentUKST4 7QB
- Freeman HospitalNorthern Vascular CentreNewcastle upon TyneUKNE7 7DN
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Shin DG, Kim TH, Uhm JS, Kim JY, Joung B, Lee MH, Pak HN. Early Experience of Novel Oral Anticoagulants in Catheter Ablation for Atrial Fibrillation: Efficacy and Safety Comparison to Warfarin. Yonsei Med J 2016; 57:342-9. [PMID: 26847285 PMCID: PMC4740525 DOI: 10.3349/ymj.2016.57.2.342] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 06/08/2015] [Accepted: 06/17/2015] [Indexed: 01/26/2023] Open
Abstract
PURPOSE Compared with warfarin, novel oral anticoagulants (NOACs) are convenient to use, although they require a blanking period immediately before radiofrequency catheter ablation for atrial fibrillation (AF). We compared NOACs and uninterrupted warfarin in the peri-procedural period of AF ablation. MATERIALS AND METHODS We compared 141 patients treated with peri-procedural NOACs (72% men; 58 ± 11 years old; 71% with paroxysmal AF) and 281 age-, sex-, AF type-, and history of stroke-matched patients treated with uninterrupted warfarin. NOACs were stopped 24 hours before the procedure and restarted on the same procedure day after hemostasis was achieved. RESULTS We found no difference in the CHA₂DS₂-VASc (p=0.376) and HAS-BLED scores (p=0.175) between the groups. The preprocedural anticoagulation duration was significantly shorter in the NOAC group (76.3 ± 110.7 days) than in the warfarin group (274.7 ± 582.7 days, p<0.001). The intra-procedural total heparin requirement was higher (p<0.001), although mean activated clotting time was shorter (350.0 ± 25.0 s vs. 367.4 ± 42.9 s, p<0.001), in the NOAC group than in the warfarin group. There was no significant difference in thromboembolic events (1.4% vs. 0%, p=0.111) or major bleeding (1.4% vs. 3.9%, p=0.235) between the NOAC and warfarin groups. Minor stroke occurred in two cases within 10 hours of the procedure (underlying CHA₂DS₂-VASc scores 0 and 1) in the NOAC group. CONCLUSION Pre-procedural anticoagulation duration was shorter and intra-procedural heparin requirement was higher with NOAC than with uninterrupted warfarin during AF ablation. Although the peri-procedural thromboembolism and bleeding incidences did not differ, minor stroke occurred in two cases in the NOAC group.
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Affiliation(s)
- Dong Geum Shin
- Department of Cardiology, Yonsei University Health System, Seoul, Korea
| | - Tae Hoon Kim
- Department of Cardiology, Yonsei University Health System, Seoul, Korea
| | - Jae Sun Uhm
- Department of Cardiology, Yonsei University Health System, Seoul, Korea
| | - Joung Youn Kim
- Department of Cardiology, Yonsei University Health System, Seoul, Korea
| | - Boyoung Joung
- Department of Cardiology, Yonsei University Health System, Seoul, Korea
| | - Moon Hyoung Lee
- Department of Cardiology, Yonsei University Health System, Seoul, Korea
| | - Hui Nam Pak
- Department of Cardiology, Yonsei University Health System, Seoul, Korea.
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Amer O, Binger S, Desch S, Harnoss HM, Schuler G, Thiele H, Eitel I. Incidence, predictors, and treatment options of critical limb ischaemia after use of collagen plug-based vascular closure devices. EUROINTERVENTION 2015; 11:816-23. [PMID: 26603989 DOI: 10.4244/eijv11i7a166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Limited data are available on the frequency and predictors of vascular closure device (VCD) failure with subsequent vascular complications. The aim of this study was to investigate the incidence, clinical characteristics, and treatment options in patients with critical limb ischaemia (CLI) after use of a collagen plug-based VCD. METHODS AND RESULTS A high-volume, single-centre prospectively maintained database was retrospectively interrogated, and cases of collagen plug-based VCD-related CLI were identified between June 2006 and December 2013. CLI was defined as acute onset of rest pain after VCD application requiring endovascular or surgical treatment. Among 13,595 coronary procedures, 43 patients (0.3%) were identified with an Angio-Seal-related CLI. In a multivariable logistic regression analysis, peripheral artery disease and renal insufficiency were identified as independent predictors for CLI after Angio-Seal application. Treatment was performed in 27 patients (63%) by surgery and in 16 patients (37%) with endovascular angioplasty. CONCLUSIONS CLI after use of a collagen plug-based VCD is rare. Peripheral artery disease was identified as an independent predictor of CLI. Interventional cardiologists should be aware of potentially high-risk patients and complications after use of a VCD to provide prompt and adequate therapy.
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Affiliation(s)
- Omran Amer
- Department of Internal Medicine - Cardiology, University of Leipzig - Heart Center, Leipzig, Germany
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Jiang J, Zou J, Ma H, Jiao Y, Yang H, Zhang X, Miao Y. Network Meta-analysis of Randomized Trials on the Safety of Vascular Closure Devices for Femoral Arterial Puncture Site Haemostasis. Sci Rep 2015; 5:13761. [PMID: 26349075 PMCID: PMC4562233 DOI: 10.1038/srep13761] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 08/05/2015] [Indexed: 11/09/2022] Open
Abstract
The safety of vascular closure devices (VCDs) is still debated. The emergence of more related randomized controlled trials (RCTs) and newer VCDs makes it necessary to further evaluate the safety of VCDs. Relevant RCTs were identified by searching PubMed, EMBASE, Google Scholar and the Cochrane Central Register of Controlled Trials electronic databases updated in December 2014. Traditional and network meta-analyses were conducted to evaluate the rate of combined adverse vascular events (CAVEs) and haematomas by calculating the risk ratios and 95% confidence intervals. Forty RCTs including 16868 patients were included. Traditional meta-analysis demonstrated that there was no significant difference in the rate of CAVEs between all the VCDs and manual compression (MC). Subgroup analysis showed that FemoSeal and VCDs reported after the year 2005 reduced CAVEs. Moreover, the use of VCDs reduced the risk of haematomas compared with MC. Network meta-analysis showed that AngioSeal, which might be the best VCD among all the included VCDs, was associated with reduced rates of both CAVE and haematomas compared with MC. In conclusion, the use of VCDs is associated with a decreased risk of haematomas, and FemoSeal and AngioSeal appears to be better than MC for reducing the rate of CAVEs.
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Affiliation(s)
- Jun Jiang
- Department of General Surgery, the First Affiliated Hospital of Nanjing Medical University, No.300 Guangzhou Road, Nanjing 210029, China
| | - Junjie Zou
- Department of General Surgery, the First Affiliated Hospital of Nanjing Medical University, No.300 Guangzhou Road, Nanjing 210029, China
| | - Hao Ma
- Department of General Surgery, the First Affiliated Hospital of Nanjing Medical University, No.300 Guangzhou Road, Nanjing 210029, China
| | - Yuanyong Jiao
- Department of General Surgery, the First Affiliated Hospital of Nanjing Medical University, No.300 Guangzhou Road, Nanjing 210029, China
| | - Hongyu Yang
- Department of General Surgery, the First Affiliated Hospital of Nanjing Medical University, No.300 Guangzhou Road, Nanjing 210029, China
| | - Xiwei Zhang
- Department of General Surgery, the First Affiliated Hospital of Nanjing Medical University, No.300 Guangzhou Road, Nanjing 210029, China
| | - Yi Miao
- Department of General Surgery, the First Affiliated Hospital of Nanjing Medical University, No.300 Guangzhou Road, Nanjing 210029, China
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Vascular Closure Devices in Interventional Radiology Practice. Cardiovasc Intervent Radiol 2015; 38:781-93. [DOI: 10.1007/s00270-015-1116-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Accepted: 04/09/2015] [Indexed: 12/17/2022]
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Dal Molin A, Faggiano F, Bertoncini F, Buratti G, Busca E, Casarotto R, Gaboardi S, Allara E. Bed rest for preventing complications after transfemoral cardiac catheterisation: a protocol of systematic review and network meta-analysis. Syst Rev 2015; 4:47. [PMID: 25903277 PMCID: PMC4406333 DOI: 10.1186/s13643-015-0036-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Accepted: 03/24/2015] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Transfemoral cardiac catheterisation is an invasive medical procedure used for therapeutic or diagnostic purposes. Postoperative bed rest can prevent a number of complications such as bleeding and haematoma formation and can result in side effects such as back pain and urinary discomfort. Currently, there is no consensus regarding the optimal length of bed rest. Our objective is to assess the effects of post-catheterisation length of bed rest on bleeding and haematoma, other vascular complications, patient symptoms and patient discomfort, among patients who underwent transfemoral cardiac catheterisation. METHODS We wrote this protocol in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols statement. We defined the search query by using the PICO framework (Population: Patients undergoing cardiac catheterisation; INTERVENTION early mobilisation; Comparison: late mobilisation; OUTCOMES early and late complications). We will search six biomedical databases and five online registries to obtain both published and unpublished studies. We will include randomised controlled trials and quasi-randomised controlled trials, and their quality will be independently appraised with the Cochrane Effective Practice and Organisation of Care criteria for quality assessment. We will carry out a pairwise meta-analysis and network meta-analysis to estimate the overall intervention effects from both direct and indirect comparisons. DISCUSSION This review may have considerable implications for practice and help to achieve an effective and efficient management of patients who underwent cardiac catheterisation. This review will be grounded in an expanded search of 11 resources and will employ innovative statistical methods such as network meta-analysis. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration number: CRD42014014222 .
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Affiliation(s)
- Alberto Dal Molin
- School of Nursing, Biella Hospital, Corso Pella 10, 13900, Biella, Italy. .,Department of Translational Medicine, Università del Piemonte Orientale, Via Salaroli 17, 28100, Novara, Italy.
| | - Fabrizio Faggiano
- Department of Translational Medicine, Università del Piemonte Orientale, Via Salaroli 17, 28100, Novara, Italy.
| | - Fabio Bertoncini
- Internal Medicine, Ospedale degli Infermi, Via Dei Ponderanesi 2, 13875, Ponderano - Biella, Italy.
| | - Giulia Buratti
- Nursing Home 'Villa Poma', Viale della Rimembranza 7, 13816, Miagliano, Biella, Italy.
| | - Erica Busca
- Inpatient Neonatology/Neonatal Intensive Care Unit, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Ospedale Ostetrico Ginecologico S.Anna, Corso Spezia 60, 10126, Torino, Italy.
| | - Roberta Casarotto
- Semi Intensive Medicine and Nephrology, Ospedale degli Infermi, Via Dei Ponderanesi 2, 13875, Ponderano - Biella, Italy.
| | - Samanta Gaboardi
- Emergency Room, Ospedale degli Infermi, Via Dei Ponderanesi 2, 13875, Ponderano - Biella, Italy.
| | - Elias Allara
- Department of Translational Medicine, Università del Piemonte Orientale, Via Salaroli 17, 28100, Novara, Italy. .,School of Public Health, University of Torino, Via Santena 5 bis, 10126, Torino, Italy.
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Evaluation of a structured training program for arterial femoral sheath removal after percutaneous arterial catheter procedures by assistant personnel. Am J Cardiol 2015; 115:879-83. [PMID: 25661570 DOI: 10.1016/j.amjcard.2015.01.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 01/06/2015] [Accepted: 01/06/2015] [Indexed: 11/24/2022]
Abstract
After cardiac catheterization procedures, arterial closure can be achieved by manual compression (MC), using external mechanical compression devices, or by applying vascular closure devices (VCDs) with comparable vascular access site-related complication rates. The aim of the present study was to assess vascular access site-related complications during the implementation of structured sheath removal and MC by paramedics after catheterization procedures. After an observational phase of 3 months to assess the baseline complication rate, a structured 4-level training program was implemented to train assistant personnel, in this case paramedics, in the management of sheath removal by MC. Access site-related complication rates after sheath removal were assessed prospectively and MC by paramedics compared with MC by physicians and application of VCDs. To account for imbalances in procedure- and patient-related risk factors of access-site complications, propensity score-based matching analysis was performed (ClinicalTrials.gov identifier NCT00825331). All consecutive percutaneous transfemoral arterial cardiac catheterization procedures were prospectively assessed over a period of 8 months (n = 3,503). MC was performed in 2,315 cases, of which 180 were performed by paramedics and 2,135 by physicians; VCDs were applied in 1,188 procedures. Rates of access site-related complications were significantly lower for paramedics compared with physicians (p = 0.03) and similar between paramedics and VCDs (p = 0.77). In conclusion a structured program for paramedics to be trained in sheath removal after percutaneous cardiac catheterization procedures can be readily implemented during clinical routine with low in-hospital complication rates.
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Kerré S, Kustermans L, Vandendriessche T, Bosmans J, Haine SE, Miljoen H, Vrints CJ, Beutels P, Wouters K, Claeys MJ. Cost-effectiveness of contemporary vascular closure devices for the prevention of vascular complications after percutaneous coronary interventions in an all-comers PCI population. EUROINTERVENTION 2015; 10:191-7. [PMID: 24952056 DOI: 10.4244/eijv10i2a32] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The present observational case-control study assessed the cost-effectiveness of contemporary vascular closure devices (VCDs) for the prevention of vascular complications in an all-comers transfemoral percutaneous coronary intervention (PCI) population. METHODS AND RESULTS A total of 8,292 consecutive PCI patients were enrolled from a single-centre prospective registry from January 2005 to December 2010. VCDs were available from July 2007 and, from that time point, VCDs were implanted in 1,780 of the 5,394 patients (33%). Vascular complications occurred in 221 (2.7%) patients. The use of VCDs was independently associated with a 53% risk reduction (OR 0.47, 95% CI: 0.3-0.7) in vascular complications (3.0% vs. 1.5%) and with a 65% risk reduction (IRR 0.37, 95% CI: 0.32-0.43) in the post-PCI length of hospital stay (LOS) (mean 2.8 vs. 1.5 days). Mainly due to the reduced LOS, the patients with VCDs accrued vascular direct medical costs (VCD, diagnosis and treatment of vascular complications, post-PCI LOS) that were on average 498€ less than those accrued by the non-VCD patients. The cost-effectiveness was present across all vascular risk profiles. CONCLUSIONS In this large, all-comers transfemoral PCI population, the use of VCDs was independently associated with a reduction in the rate of vascular complications and the post-PCI length of hospital stay and proved to be cost-saving across all vascular risk profiles.
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Affiliation(s)
- Steven Kerré
- Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium
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Rafie IM, Uddin MM, Ossei-Gerning N, Anderson RA, Kinnaird TD. Patients undergoing PCI from the femoral route by default radial operators are at high risk of vascular access-site complications. EUROINTERVENTION 2014; 9:1189-94. [PMID: 24561736 DOI: 10.4244/eijv9i10a200] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS Radial artery (RA) access for PCI has a lower incidence of vascular access-site (VAS) complications than the femoral artery (FA) approach. However, even for default radial operators certain patients are intervened upon from the FA. We examined the demographics and incidence of VAS complications when default radial operators resort to the FA for PCI. METHODS AND RESULTS The demographics and VAS complications were compared by access site retrospectively for all PCI cases performed by default radial operators (n=1,392). A modified ACUITY trial definition of major VAS complication was used. FA puncture occurred in 25.2% (351/1,392) of cases. Patients were more likely to be female, older and weigh less than patients undergoing PCI from the RA. The FA procedure was likely to be more complex with larger sheaths, more left main stem, graft and multivessel intervention, and there was a greater proportion of emergency cases. Despite increased case complexity, glycoprotein inhibitors were used less frequently in femoral cases (26.5% vs. 36.8%, p<0.001). A VAS complication occurred in 12.5% (44/351) of cases. CONCLUSIONS The risk factors for access-site bleeding are disproportionately high in the population requiring FA puncture by default radial operators, and as a result such patients have a high rate of vascular access-site complications.
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Affiliation(s)
- Ihsan M Rafie
- Department of Cardiology, University Hospital of Wales, Cardiff, United Kingdom
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Angio-Seal hopes for antegrade puncture require better evidence. Eur J Vasc Endovasc Surg 2014; 48:226-7. [PMID: 24951375 DOI: 10.1016/j.ejvs.2014.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 05/22/2014] [Indexed: 11/21/2022]
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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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Clinical and economic evaluation of ambulatory endovascular treatment of peripheral arterial occlusive lesions. Ann Vasc Surg 2013; 28:137-43. [PMID: 24183403 DOI: 10.1016/j.avsg.2013.06.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Revised: 06/11/2013] [Accepted: 06/13/2013] [Indexed: 11/21/2022]
Abstract
BACKGROUND Ambulatory management of patients is an alternative to conventional hospitalization. In this study we evaluate the results of a prospective cohort study of patients receiving ambulatory endovascular treatment for peripheral arterial lesions. METHODS From June 2008 to October 2010, ambulatory management was proposed for endovascular treatment of peripheral arterial lesions. An arterial closure device (Angio-Seal(®); St. Jude Medical) was used. For ambulatory treatment, patients were prohibited from driving a vehicle at discharge, had to be accompanied the first night after the procedure, had to live <1 hour from a medical facility, had to be reachable by telephone the day after the intervention, and had to remain hospitalized in the event of a complication. The principal criterion was morbimortality at 1 month. Secondary criteria were clinical improvement, patency, complications related to the arterial closure, and costs evaluation at 1 month. RESULTS Forty-five patients were included and 50 ambulatory procedures were carried out. The patients presented with claudication (92%) or a critical ischemia (8%) of the lower extremities. All procedures were carried out by femoral puncture (retrograde in 94% and anterograde in 6% of the cases). The patients presented with iliac (68%) and femoropopliteal (64%) lesions. Lesions included stenoses (70%), thromboses (16%), and intrastent restenoses (14%). The rate of failure of ambulatory hospitalization was 16% (n = 8) without a serious undesirable event: 2 patients were hospitalized after a surgical conversion for iliac rupture and disinsertion of stent; 3 patients developed a hematoma during the intervention at the point of puncture; and in 3 cases the system of percutaneous closure failed. The mean duration of hospitalization was 1.36 ± 1.33 days. At 1 month, clinical improvement was observed in 97.5% of cases, with a primary patency of 100%. No perioperative rehospitalization or puncture site complications were observed. Ambulatory management made it possible to save 42 days of hospitalization, with associated costs of 10,971€, compared with conventional hospitalization. The additional costs related to use of the Angio-Seal amounted to 7427€. CONCLUSION Ambulatory endovascular treatment of patients presenting with peripheral arterial lesions is reliable and effective and may contribute to savings in healthcare spending.
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Sheth RA, Walker TG, Saad WE, Dariushnia SR, Ganguli S, Hogan MJ, Hohenwalter EJ, Kalva SP, Rajan DK, Stokes LS, Zuckerman DA, Nikolic B. Quality improvement guidelines for vascular access and closure device use. J Vasc Interv Radiol 2013; 25:73-84. [PMID: 24209907 DOI: 10.1016/j.jvir.2013.08.011] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 08/15/2013] [Accepted: 08/16/2013] [Indexed: 12/17/2022] Open
Affiliation(s)
- Rahul A Sheth
- Division of Vascular Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit St., Gray 290, Boston, MA 02114
| | - T Gregory Walker
- Division of Vascular Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit St., Gray 290, Boston, MA 02114
| | - Wael E Saad
- Department of Radiology, University of Michigan Medical Center, Ann Arbor, Michigan.
| | - Sean R Dariushnia
- Department of Interventional Radiology and Image-guided Medicine, Emory University, Atlanta, Georgia
| | - Suvranu Ganguli
- Division of Vascular Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit St., Gray 290, Boston, MA 02114
| | - Mark J Hogan
- Section of Vascular and Interventional Radiology, Department of Radiology, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio
| | - Eric J Hohenwalter
- Department of Radiology, Medical College of Wisconsin, Froedtert Memorial Lutheran Hospital, Milwaukee, Wisconsin
| | - Sanjeeva P Kalva
- Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Dheeraj K Rajan
- Department of Medical Imaging, University of Toronto, University Health Network, Toronto, Ontario, Canada
| | - Leann S Stokes
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Darryl A Zuckerman
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
| | - Boris Nikolic
- Department of Radiology, Stratton Medical Center, Albany, New York
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Modi S, Gadvi R, Babu S. Initial experience with Angioseal™: Safety and efficacy of the endovascular closure device. Indian J Radiol Imaging 2013; 23:134-8. [PMID: 24082477 PMCID: PMC3777322 DOI: 10.4103/0971-3026.116566] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Vascular access site management is crucial to safe, efficient, and comfortable diagnostic or interventional percutaneous procedures. The Angioseal™ vascular closure device has been shown to be safe and effective in reducing the time to hemostasis following angiographic or interventional procedures. Relatively few studies have been conducted in the UK to assess the safety and efficacy of the device in a local setting. Materials and Methods: Data were retrospectively reviewed on 147 patients who underwent either diagnostic angiography or percutaneous interventional procedures from January 2008 to October 2009, and who had the femoral access site closed by 6F VIP Angioseal. A total of 147 patients (F: 49, M: 98), including 80 right femoral punctures, 57 left femoral punctures, and 10 bilateral punctures were reviewed using radiological reports and patients’ clinical data. Data on antiplatelet and anticoagulant therapy were recorded. All procedures were carried out by two interventional radiologists at a single institution, under similar operating conditions. Results: There were a total of six complications (4.47%), of which one was a major complication (0.75%), i.e., retroperitoneal bleed. There were five minor complications (3.73%), which included device deployment failure (2), device malfunction (2), and a superficial hematoma (>6 cm). Total complications were 6 out of 157 (3.8%) [95% CI = 0.8-6.8%)]. Successful hemostasis was achieved in less than 5 min in over 97% of patients. Successful device deployment was seen in over 98% of cases. Conclusion: We conclude that in our experience, the Angioseal vascular closure device is a safe and efficient means of achieving hemostasis post antegrade or retrograde puncture for diagnostic and percutaneous intervention procedures.
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Affiliation(s)
- Sachin Modi
- Department of Interventional Radiology, Sandwell and West Birmingham NHS Trust, Birmingham, West Midlands, UK
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Rieben MA, Appling S, MacDonald R. Wire vascular closure device: Evaluation of an evidence-based protocol for post-endovascular procedure patients. JOURNAL OF VASCULAR NURSING 2013; 31:68-71. [DOI: 10.1016/j.jvn.2012.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Accepted: 08/08/2012] [Indexed: 11/29/2022]
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Isfort P, Urban U, Mahnken AH, Penzkofer T, Bruners P, Pfeffer J, Steinseifer U, Günther RW, Schmitz-Rode T. Animal experimental evaluation of a new sealing device for indwelling arterial catheters. Acta Radiol 2013; 54:521-5. [PMID: 23474769 DOI: 10.1177/0284185113476022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Hematoma is a common complication following arterial puncture. To date no device that allows sealing of an arterial puncture site with in-situ catheter has been developed. PURPOSE To evaluate a newly developed arterial sealing device for endovascular catheters in an in-vivo experimental setting. MATERIAL AND METHODS A peelable collagen-based vascular sealing device for endovascular catheters was tested in acute (follow-up: 4 h; n = 2) and chronic (follow-up: 1 week; n = 4) settings in the femoral artery (FA) of sheep. After implantation correct position of the device as well as patency of the FA were verified angiographically. In the chronic group, hematoma was excluded and patency of FA was assured using color Doppler ultrasound 1 and 3 days after the procedure. After 1 week a final ultrasound and an angiography were performed for final evaluation. Thereafter, the animals were sacrificed and the puncture site was dissected and analyzed macroscopically. RESULTS Sufficient sealing of the puncture site could be observed in all animals. In acute and chronic experiments, neither a hematoma at the puncture site nor other complications were observed after positioning the sealing device. Follow-up color Doppler ultrasounds (CDUS) and final angiography revealed patent FAs in all animals. Macroscopic evaluation of dissection material proved collagen plug and catheter being in place. CONCLUSION Our preliminary in-vivo results demonstrate a safe and convenient vascular sealing system for endovascular catheters. No acute or chronic complications were observed.
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Affiliation(s)
- Peter Isfort
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen
| | - Ute Urban
- Department of Cardiovascular Engineering (CVE), Institute of Applied Medical Engineering (AME) – Helmholtz Institute, RWTH Aachen University, Aachen, Germany
| | - Andreas Horst Mahnken
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen
| | - Tobias Penzkofer
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen
| | - Philipp Bruners
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen
| | - Joachim Pfeffer
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen
| | - Ulrich Steinseifer
- Department of Cardiovascular Engineering (CVE), Institute of Applied Medical Engineering (AME) – Helmholtz Institute, RWTH Aachen University, Aachen, Germany
| | - Rolf Wilhelm Günther
- Department of Diagnostic and Interventional Radiology, RWTH Aachen University Hospital, Aachen
| | - Thomas Schmitz-Rode
- Department of Cardiovascular Engineering (CVE), Institute of Applied Medical Engineering (AME) – Helmholtz Institute, RWTH Aachen University, Aachen, Germany
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Zhou Y, Guo Z, Bai Y, Zhao X, Qin Y, Chen S, Wu H, Huang X, Li S, Liu B. Femoral Venous Hemostasis in Children Using the Technique of “Figure-of-Eight” Sutures. CONGENIT HEART DIS 2013; 9:122-5. [PMID: 23682833 DOI: 10.1111/chd.12098] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/18/2013] [Indexed: 11/26/2022]
Affiliation(s)
- Yong Zhou
- Department of Cardiology; No.411 Hospital of PLA; Shanghai China
- Department of Cardiology; Changhai Hospital, Second Military Medical University; Shanghai China
| | - Zhifu Guo
- Department of Cardiology; Changhai Hospital, Second Military Medical University; Shanghai China
| | - Yuan Bai
- Department of Cardiology; Changhai Hospital, Second Military Medical University; Shanghai China
| | - Xianxian Zhao
- Department of Cardiology; Changhai Hospital, Second Military Medical University; Shanghai China
| | - Yongwen Qin
- Department of Cardiology; Changhai Hospital, Second Military Medical University; Shanghai China
| | - Shaoping Chen
- Department of Cardiology; Changhai Hospital, Second Military Medical University; Shanghai China
| | - Hong Wu
- Department of Cardiology; Changhai Hospital, Second Military Medical University; Shanghai China
| | - Xinmiao Huang
- Department of Cardiology; Changhai Hospital, Second Military Medical University; Shanghai China
| | - Songhua Li
- Department of Cardiology; Changhai Hospital, Second Military Medical University; Shanghai China
| | - Bo Liu
- Department of Cardiology; Changhai Hospital, Second Military Medical University; Shanghai China
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Low-angle Vascular Access for Neurovascular Procedures Using the Arstasis AXERA Access Device. J Vasc Interv Radiol 2013; 24:693-7. [DOI: 10.1016/j.jvir.2013.01.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Revised: 01/11/2013] [Accepted: 01/12/2013] [Indexed: 12/20/2022] Open
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Vascular closure device failure in contemporary practice. JACC Cardiovasc Interv 2013; 5:837-44. [PMID: 22917455 DOI: 10.1016/j.jcin.2012.05.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2011] [Revised: 04/12/2012] [Accepted: 05/12/2012] [Indexed: 11/22/2022]
Abstract
OBJECTIVES The goal of this study was to assess the frequency and predictors of vascular closure device (VCD) deployment failure, and its association with vascular complications of 3 commonly used VCDs. BACKGROUND VCDs are commonly used following percutaneous coronary intervention on the basis of studies demonstrating reduced time to ambulation, increased patient comfort, and possible reduction in vascular complications as compared with manual compression. However, limited data are available on the frequency and predictors of VCD failure, and the association of deployment failure with vascular complications. METHODS From a de-identified dataset provided by Massachusetts Department of Health, 23,813 consecutive interventional coronary procedures that used either a collagen plug-based (n = 18,533), a nitinol clip-based (n = 2,284), or a suture-based (n = 2,996) VCD between June 2005 and December 2007 were identified. The authors defined VCD failure as unsuccessful deployment or failure to achieve immediate access site hemostasis. RESULTS Among 23,813 procedures, the VCD failed in 781 (3.3%) procedures (2.1% of collagen plug-based, 6.1% of suture-based, 9.5% of nitinol clip-based VCDs). Patients with VCD failure had an excess risk of "any" (7.7% vs. 2.8%; p < 0.001), major (3.3% vs. 0.8%; p < 0.001), or minor (5.8% vs. 2.1%; p < 0.001) vascular complications compared with successful VCD deployment. In a propensity score-adjusted analysis, when compared with collagen plug-based VCD (reference odds ratio [OR] = 1.0), nitinol clip-based VCD had 2-fold increased risk (OR: 2.0, 95% confidence interval [CI]: 1.8 to 2.3, p < 0.001) and suture-based VCD had 1.25-fold increased risk (OR: 1.25, 95% CI: 1.2 to 1.3, p < 0.001) for VCD failure. VCD failure was a significant predictor of subsequent vascular complications for both collagen plug-based VCD and nitinol clip-based VCD, but not for suture-based VCD. CONCLUSIONS VCD failure rates vary depending upon the type of VCD used and are associated with significantly higher vascular complications as compared with deployment successes.
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Haj-Hassan AM, Hamdan-Mansour AM, Zeilani RS, Nabolsi MM. Femoral sheath removal after cardiac catheterization in the Jordanian hospitals: An explorative study. Health (London) 2013. [DOI: 10.4236/health.2013.53057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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49
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Tordini A, Polkampally PR, Jovin IS. Vascular closure devices in percutaneous coronary and peripheral interventions: rationale and results. Interv Cardiol 2012. [DOI: 10.2217/ica.12.56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Funke C, Pfiffner R, Husmann M, Pfammatter T. The Use of the “Preclosure” Technique for Antegrade Aspiration Thrombectomy with Large Catheters in Acute Limb Ischemia. Cardiovasc Intervent Radiol 2012; 36:377-84. [DOI: 10.1007/s00270-012-0455-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2012] [Accepted: 07/15/2012] [Indexed: 12/17/2022]
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