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Mastrorilli D, Forcella E, Miccoli T, De Massari C, Garriboli L. Antegrade Femoral Puncture Using a Suture-Mediated Closure Device in Infrainguinal Endovascular Interventions. Ann Vasc Surg 2025; 112:246-252. [PMID: 39732328 DOI: 10.1016/j.avsg.2024.12.040] [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: 08/29/2024] [Revised: 12/04/2024] [Accepted: 12/05/2024] [Indexed: 12/30/2024]
Abstract
BACKGROUND ProGlide is a suture-mediated vascular closure device (VCD) indicated for retrograde access closure at the common femoral artery (CFA). However, its off-label use for antegrade and/or superficial femoral artery (SFA) access has become common in many practices. This study evaluated the efficacy and safety of ProGlide for femoral artery access closure in patients undergoing antegrade infrainguinal endovascular procedures. METHODS In this single-center retrospective study, we analyzed data from patients with peripheral arterial disease (PAD) who underwent peripheral angioplasty between January 2017 and December 2023. The inclusion criteria were infrainguinal PAD disease, Rutherford classification 3 to 6, the use of an endovascular approach, and access performed through the ipsilateral antegrade femoral artery. The primary endpoint of the study was to evaluate the efficacy and technical success of the Perclose ProGlide closure device during antegrade percutaneous endovascular procedures. Secondary endpoints included intraoperative and postoperative inguinal and vascular complications. RESULTS A total of 301 participants were included in the study. All patients were classified according to the clinical categories of chronic limb ischemia: 111 patients (37%) had severe claudication (class 3) with walking distances of less than 20 meters, 42 patients (14%) had at least one limb with ischemic rest pain (class 4), and 148 patients (49%) had at least one limb with ischemic tissue loss (class 5 or 6). A 6 Fr introducer was used in the majority of cases (88%), with a mean hospital stay of 1.5 ± 0.5 days. Technical success was achieved in 298 patients (99%), and there were no early deaths. A total of 33 hematomas were identified, with 5 patients having major complications. One of these was treated with conservative management, while 4 patients required further interventions. CONCLUSIONS This retrospective study demonstrated the feasibility and safety of using the ProGlide single VCD for antegrade femoral puncture during infrainguinal endovascular interventions. The safety of its deployment can be further optimized by routinely utilizing ultrasound (US) guidance.
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Affiliation(s)
- Davide Mastrorilli
- Department of Vascular Surgery, IRCCS Sacro Cuore-Don Calabria, Negrar, VR, Italy.
| | - Edoardo Forcella
- Department of Vascular Surgery, IRCCS Sacro Cuore-Don Calabria, Negrar, VR, Italy
| | - Tommaso Miccoli
- Department of Vascular Surgery, IRCCS Sacro Cuore-Don Calabria, Negrar, VR, Italy
| | - Chiara De Massari
- Department of Vascular Surgery, IRCCS Sacro Cuore-Don Calabria, Negrar, VR, Italy
| | - Luca Garriboli
- Department of Vascular Surgery, IRCCS Sacro Cuore-Don Calabria, Negrar, VR, Italy
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Sakamoto Y, Hiroyuki O, Yoshida E, Arai K. Infected pseudoaneurysm caused by suture-mediated vascular closure after ablation of atrial fibrillation: A case report. Int J Surg Case Rep 2025; 127:110939. [PMID: 39862662 PMCID: PMC11803246 DOI: 10.1016/j.ijscr.2025.110939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2024] [Revised: 01/18/2025] [Accepted: 01/22/2025] [Indexed: 01/27/2025] Open
Abstract
INTRODUCTION Suture-mediated vascular closure devices have been widely used in catheter ablation, with 0.14-0.3 % incidence of pseudoaneurysm complications. Here, we report the only case at our institution to date of an infectious pseudoaneurysm caused by a suture-mediated vascular closure device following catheter ablation. PRESENTATION OF CASE An 80-year-old man developed a fever 7 days after an atrial fibrillation ablation procedure, using a suture-mediated vascular closure device. Blood cultures revealed the presence of Staphylococcus aureus. Subsequently, a rapidly enlarging mass appeared in the right thigh on the 14th postoperative day. DISCUSSION Computed tomography was suggestive of a pseudoaneurysm, and surgical repair was performed. The mass was incised under balloon expansion at the right common femoral artery, and intraoperative findings confirmed the perforation of the femoral artery and adhesion of the infected tissue, necessitating vascular repair and debridement of the infected area. In our institution's experience, the incidence rate of infectious pseudoaneurysms after the use of vascular closure devices is extremely low at 0.04 %. CONCLUSION Although local infections associated with suturing devices are exceedingly rare, prompt intervention is essential when they occur. This report raises awareness of the importance of diagnosing and managing infected pseudoaneurysms, a complication following catheter ablation, as the onset of the condition occurs with a time lag compared to systemic symptoms.
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Affiliation(s)
- Yusuke Sakamoto
- Department of Cardiology, Tosei General Hospital, Seto, Aichi, Japan.
| | - Osanai Hiroyuki
- Department of Cardiology, Tosei General Hospital, Seto, Aichi, Japan
| | - Eiji Yoshida
- Department of Cardiology, Tosei General Hospital, Seto, Aichi, Japan
| | - Kenji Arai
- Department of Cardiology, Tosei General Hospital, Seto, Aichi, Japan
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Kameda Y, Nemoto N, Inoue B, Takaesu S, Takenaka H, Nagashima Y, Anzai H. The Practice of Percutaneous EVAR under Local Anesthesia. Ann Vasc Dis 2025; 18:24-00129. [PMID: 39877325 PMCID: PMC11774565 DOI: 10.3400/avd.oa.24-00129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2024] [Accepted: 11/28/2024] [Indexed: 01/31/2025] Open
Abstract
Objectives: Endovascular aortic repair (EVAR) should be performed using a less invasive procedure based on the patient's clinical condition, as many patients who undergo this procedure are elderly and have poor surgical tolerance. We report our experience and results of percutaneous EVAR under local anesthesia in order to practice minimally invasive EVAR at our hospital. Methods: In August 2019, we started percutaneous EVAR using Perclose ProGlide under local anesthesia. We compared the backgrounds and surgical outcomes of patients who underwent EVAR at our hospital before and after the introduction of percutaneous EVAR under local anesthesia. Results: We included 148 patients in this study. The age at surgery and prevalence of severe renal dysfunction were significantly higher in percutaneous EVAR under local anesthesia group. The operative time and postoperative hospital stay were significantly shorter in the percutaneous EVAR group under local anesthesia. Conclusions: The introduction of percutaneous EVAR under local anesthesia enabled minimally invasive EVAR to be performed safely even in high-risk patients. (This is a translation of J Jpn Coll Angiol 2022; 62: 1-5.).
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Affiliation(s)
- Yuika Kameda
- Cardiovascular Center, SUBARU Health Insurance Society Ota Memorial Hospital, Ota, Gunma, Japan
| | - Naohiko Nemoto
- Cardiovascular Center, SUBARU Health Insurance Society Ota Memorial Hospital, Ota, Gunma, Japan
| | - Bon Inoue
- Cardiovascular Center, SUBARU Health Insurance Society Ota Memorial Hospital, Ota, Gunma, Japan
| | - Satoru Takaesu
- Cardiovascular Center, SUBARU Health Insurance Society Ota Memorial Hospital, Ota, Gunma, Japan
| | - Hiroki Takenaka
- Cardiovascular Center, SUBARU Health Insurance Society Ota Memorial Hospital, Ota, Gunma, Japan
| | - Yoshinori Nagashima
- Cardiovascular Center, SUBARU Health Insurance Society Ota Memorial Hospital, Ota, Gunma, Japan
| | - Hitoshi Anzai
- Cardiovascular Center, SUBARU Health Insurance Society Ota Memorial Hospital, Ota, Gunma, Japan
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Goto T, Fujimura H, Iida T, Horikawa K, Shintani T, Shibuya T, Sakaniwa R, Miyagawa S. Prospective evaluation of automated vascular analysis for ilio-femoral artery lesions before and after percutaneous endovascular aortic repair. J Cardiothorac Surg 2024; 19:497. [PMID: 39198872 PMCID: PMC11351086 DOI: 10.1186/s13019-024-03013-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 08/20/2024] [Indexed: 09/01/2024] Open
Abstract
BACKGROUND This study was conducted to evaluate the differences between pre- and postoperative access conditions in percutaneous endovascular aortic repair (PEVAR). METHODS Between December 2021 and October 2023, PEVAR was performed on 61 patients using the Perclose ProStyle (Abbott Vascular). Enhanced computed tomography and ankle-brachial index tests were performed preoperatively and postoperatively. The inner diameter and area of the iliofemoral artery were automatically measured, and the pre- and postoperative values were compared (114 legs). The same analysis was performed on 12 legs with previous groin operations; open surgical EVAR was performed in 9 legs, an endarterectomy of the femoral artery in 1, and a femoropopliteal bypass in the other leg. RESULTS All patients were discharged without surgical site infections, lymphatic fistulas, or retroperitoneal haematomas. There were no significant differences between the pre-and postoperative inner diameter and inner area of the external iliac artery and common femoral artery. There were no significant differences between the preoperative and postoperative ankle-brachial index tests. In 12 legs with a previous groin operation, the postoperative ankle-brachial index tests and inner diameter and area of the external iliac artery and common femoral artery were statistically equal to the preoperative values. CONCLUSIONS This study can support the safety of percutaneous endovascular aortic repair, even in patients with redo groin operations.
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Affiliation(s)
- Takasumi Goto
- Department of Cardiovascular Surgery, Toyonaka Municipal Hospital, 4-14-1, Shibahara, Toyonaka, Osaka, 560-8565, Japan.
| | - Hironobu Fujimura
- Department of Cardiovascular Surgery, Toyonaka Municipal Hospital, 4-14-1, Shibahara, Toyonaka, Osaka, 560-8565, Japan
| | - Takuma Iida
- Department of Cardiovascular Surgery, Toyonaka Municipal Hospital, 4-14-1, Shibahara, Toyonaka, Osaka, 560-8565, Japan
| | - Kohei Horikawa
- Department of Cardiovascular Surgery, Toyonaka Municipal Hospital, 4-14-1, Shibahara, Toyonaka, Osaka, 560-8565, Japan
| | - Takashi Shintani
- Department of Cardiovascular Surgery, Nippon Life Hospital, Osaka, Japan
| | - Takashi Shibuya
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Ryoto Sakaniwa
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Shigeru Miyagawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
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Murthy K, Kumar J R, Kaur N, Chadha A, Chauhan R, Chadha D. Suture-Based Vascular Closure Versus Surgical Closure of Large Bore Arteriotomies: A Real-World Experience. Cureus 2024; 16:e54856. [PMID: 38533167 PMCID: PMC10964123 DOI: 10.7759/cureus.54856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2024] [Indexed: 03/28/2024] Open
Abstract
INTRODUCTION With the introduction of transcatheter aortic valve implantation (TAVI), endovascular abdominal aortic aneurysm repair (EVAR), thoracic endovascular aortic aneurysm repair (TEVAR), and frequent use of left ventricular assist devices in complicated percutaneous coronary interventions, the use of large bore arterial access has become a necessity. In the index study, we compared the percutaneous closure of large arteriotomies with open surgical (OS) closure. METHODS It was a prospective study in which we compared the technical success and vascular complication rate associated with the use of a suture-based vascular closure device (VCD): Perclose ProGlide (PP) with that of OS closure. The study was carried out at Command Hospital Air Force, Bengaluru, India, from January 1, 2016, to December 31, 2020. The inclusion criteria were any percutaneous intervention involving large bore arterial access (≥12 French (F) sheath). The exclusion criteria were any condition where a persistent need for vascular access at the end of the procedure was required. We noted the baseline characteristics and type of anesthesia for all patients. The primary outcome was technical success and major vascular complications, which included major local site bleeding: Bleeding Academic Research Consortium (BARC) 3 or more, failed hemostasis requiring a second intervention, and acute vessel occlusion. Total time taken for the procedure (TTP), time to ambulation (TTA), and time to discharge post-procedure (TTD) were noted for each patient. The secondary outcomes were any bleeding other than major, local hematoma sized >5 cm at 24 hours, pseudo aneurysm formation at 30 days, and acute limb ischemia at 30 days. RESULTS A total of 120 patients (PP: 60 (males: 54, females: 6), OS: 60 (males: 50, females: 10)) were included in this study. The mean age of patients was comparable in both groups (PP: 71.8 ± 9.62 years and OS: 71.0 ± 7.76 years, p-value: 0.63). Total large arteriotomies (mean size: 18.03F ± 3.34) closed were 184 (PP: 90, OS: 94). The procedures performed were EVAR: 64 (PP: 30, OS: 34), TAVI: 38 (PP: 21, OS: 17), and TEVAR: 18 (PP: 9, OS: 9). All patients in PP group received dual ProGlide with preclose technique. All TEVAR procedures (total arteriotomies: 18) required a vascular sheath of ≥ 24F. There was no statistical difference between the mean size of sheaths used in the two groups. The technical success (PP: 95.55%, OS: 97.87%, 95% CI: -5.78%-10.98%, p-value: 0.48) and rate of major complications were similar in both groups. Three patients in the PP group who had failed hemostasis with two ProGlides were successfully managed with one additional Angioseal (6F) each. The occurrence of hematoma sized larger than 5 cm was significantly more in the PP group compared to the OS group (PP: 7 (7.78%), OS: 0 (0%), p-value: 0.006). While GA was used for all patients who underwent vascular closure with OS, only eight patients (13.33%) in the PP group required GA. The TTP, TTA, and TTD were significantly lower in the PP group as compared to the OS group. CONCLUSION The percutaneous closure of large bore arteriotomies with suture-based VCDs is equally effective and is not associated with increased major vascular complications. In fact, the TTP, TTA, and TTD are significantly lower in the PP group which can translate to better patient comfort and lower costs.
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Affiliation(s)
- Keshava Murthy
- Cardiology Department, Army Hospital Research and Referral, New Delhi, IND
| | - Ratheesh Kumar J
- Cardiology Department, Army Hospital Research and Referral, New Delhi, IND
| | - Navjyot Kaur
- Cardiology Department, Command Hospital Air Force, Bengaluru, IND
| | - Amitoj Chadha
- Emergency Department, St. John's Medical College, Bengaluru, IND
| | - Rajeev Chauhan
- Cardiology Department, Command Hospital Air Force, Bengaluru, IND
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Ikenouchi T, Takigawa M, Goya M, Kudo T, Sasano T. Refractory Deep Vein Thrombosis Caused by Femoral Vein Stenosis Due to Suture-Medicated Vascular Closure Device. Int J Angiol 2023; 32:288-291. [PMID: 37927830 PMCID: PMC10624525 DOI: 10.1055/s-0042-1751230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
Vascular closing devices (VCDs) are widely used to replace manual compression at the femoral puncture site after catheter insertion. Perclose ProGlide is a suture-medicated VCD that is indicated for both arterial and venous access sites. However, there are few reports of complications related to venous use of ProGlide. Here, we describe a case of femoral vein stenosis caused by a suture-medicated VCD after an ablation procedure, which developed refractory deep vein thrombosis even after surgical vascular repair.
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Affiliation(s)
- Takashi Ikenouchi
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masateru Takigawa
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masahiko Goya
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Toshifumi Kudo
- Department of Peripheral Vascular Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
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Mousa MA, Zahwy SSE, Tamara AF, Samir W, Tantawy MA. A comparative study between surgical cut down and percutaneous closure devices in management of large bore arterial access. CVIR Endovasc 2023; 6:53. [PMID: 37899370 PMCID: PMC10613603 DOI: 10.1186/s42155-023-00395-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/26/2023] [Indexed: 10/31/2023] Open
Abstract
BACKGROUND Compared to conventional open surgery, minimally invasive catheter-based procedures have less post procedural complications. Transcatheter aortic valve implantation (TAVI) and endovascular aneurysm repair (EVAR) require large bore arterial access. Optimal site management of large bore arterial access is pivotal to reduce the hospital-acquired complications associated with large bore arterial access. We wanted to compare surgical cutdown versus percutaneous closure devices in site management of large bore arterial access. METHODS Participants planned for TAVI or EVAR with large bore arterial access more than 10 French were included, while participants with history of bypass surgery, malignancies, thrombophilia, or sepsis were excluded. A consecutive sample of 100 participants (mean age 74.66 ± 2.65 years, 61% males) was selected, underwent TAVI or EVAR with surgical cutdown (group 1) versus TAVI or EVAR with Proglide™ percutaneous closure device (group 2). RESULTS The incidence rate of hematoma was significantly lower in group 2 versus group 1 (p = 0.014), the mean procedure time (minutes) and the median hospital stay (days) were significantly higher in group 1 versus group 2 (t(98) = - 2.631, p = 0.01, and U = 2.403, p = 0.018, respectively), and the c-reactive protein pre-procedure and the c-reactive protein post-procedure were significantly lower in group 2 versus group 1 (U = -2.969, p = 0.003, and U = -2.674, p = 0.007, respectively). CONCLUSIONS Our study showed a lower incidence rate of large bore arterial access complications as hematoma, a shorter procedure time, and a shorter hospital stay with percutaneous closure devices compared to surgical cutdown.
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Affiliation(s)
- Mohamed Ahmed Mousa
- Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
| | | | - Ahmed Fathy Tamara
- Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Wafed Samir
- Deaprtment of Cardiology, Faculty of Medicine, Misr University for Science and Technology, 6th of October, Egypt
| | - Mahmoud Ahmed Tantawy
- Deaprtment of Cardiology, Faculty of Medicine, Misr University for Science and Technology, 6th of October, Egypt
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Kania T, Kimyaghalam A, Scarsella J, Guerges M, Breier Y, Deitch J, Malekpour F, Schor J, Singh K. Supra-Aortic Arterial Injuries Following Central Venous Catheterization Managed with Percutaneous Closure Devices: A Comprehensive Literature Review of Current Evidence. Ann Vasc Surg 2023; 96:301-307. [PMID: 37169251 DOI: 10.1016/j.avsg.2023.04.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 04/02/2023] [Accepted: 04/30/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND Inadvertent supra-aortic arterial injuries during central venous catheterization can lead to devastating outcomes. These have been traditionally been managed with open repair or covered stent placement; only recently have percutaneous closure been incorporated into the management of these iatrogenic arterial injuries. METHODS We performed a MEDLINE literature search in the English language, using the PubMed web-based search engine across years 2000 to 2020. This report reviews 34 published case reports and series reporting 71 iatrogenic supra-aortic arterial injuries managed with percutaneous vascular closure devices. RESULTS In our review, the use of a closure device was successful in 87% of cases, even in some cases involving sheath sizes greater than 8F. The devices used in these situations caused minimal complications and offered a quick means to control bleeding. Thus, percutaneous closure devices are a helpful tool that offers an alternative to more invasive open surgical repair. CONCLUSIONS Vascular closure devices offer a minimally invasive and effective approach to the treatment of inadvertent supra-aortic arterial injury following CVC.
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Affiliation(s)
- Thomas Kania
- Staten Island University Hospital, Staten Island, NY.
| | | | | | - Mina Guerges
- Staten Island University Hospital, Staten Island, NY
| | - Yuli Breier
- Touro College of Osteopathic Medicine, New York, NY
| | | | | | | | - Kuldeep Singh
- Staten Island University Hospital, Staten Island, NY
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Wang Q, Wu J, Ma Y, Zhu Y, Song X, Xie S, Liang F, Gimzewska M, Li M, Yao L. Totally percutaneous versus surgical cut-down femoral artery access for elective bifurcated abdominal endovascular aneurysm repair. Cochrane Database Syst Rev 2023; 1:CD010185. [PMID: 36629152 PMCID: PMC9832535 DOI: 10.1002/14651858.cd010185.pub4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Abdominal aortic aneurysms (AAAs) are a vascular condition with significant risk attached, particularly if they rupture. Therefore, it is critical to identify and repair these as an elective procedure before they rupture and require emergency surgery. Repair has traditionally been an open surgical technique that required a large incision across the abdomen. Endovascular abdominal aortic aneurysm repairs (EVARs) are now a common alternative. In this procedure, the common femoral artery is exposed via a cut-down approach and a graft is introduced to the aneurysm in this way. This Cochrane Review examines a totally percutaneous approach to EVAR. This technique gives a minimally invasive approach to femoral artery access that may reduce groin wound complication rates and improve recovery time. However, the technique may be less applicable in people with, for example, groin scarring or arterial calcification. This is an update of the previous Cochrane Review published in 2017. OBJECTIVES To evaluate the benefits and harms of totally percutaneous access compared to cut-down femoral artery access in people undergoing elective bifurcated abdominal endovascular aneurysm repair (EVAR). SEARCH METHODS We used standard, extensive Cochrane search methods The latest search was 8 April 2022. SELECTION CRITERIA We included randomised controlled trials in people diagnosed with an AAA comparing totally percutaneous versus surgical cut-down access endovascular repair. We considered all device types. We only considered studies investigating elective repairs. We excluded studies reporting emergency surgery for ruptured AAAs and those reporting aorto-uni-iliac repairs. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcomes were 1. short-term mortality, 2. failure of aneurysm exclusion and 3. wound infection. Secondary outcomes were 4. major complications (30-day or in-hospital); 5. medium- to long-term (6 and 12 months) complications and mortality; 6. bleeding complications and haematoma; and 7. operating time, duration of intensive treatment unit (ITU) stay and hospital stay. We used GRADE to assess the certainty of evidence for the seven most clinically relevant primary and secondary outcomes. MAIN RESULTS Three studies with 318 participants met the inclusion criteria, 189 undergoing the percutaneous technique and 129 treated by cut-down femoral artery access. One study had a small sample size and did not adequately report the method of randomisation, allocation concealment or preselected outcomes. The other two larger studies had few sources of bias and good methodology; although one study had a high risk of bias in selective reporting. We observed no clear difference in short-term mortality between groups, with only one death occurring overall, in the totally percutaneous group (risk ratio (RR) 1.50, 95% confidence interval (CI) 0.06 to 36.18; 2 studies, 181 participants; low-certainty evidence). One study reported failure of aneurysm exclusion. There was one failure of aneurysm exclusion in the surgical cut-down femoral artery access group (RR 0.17, 95% CI 0.01 to 4.02; 1 study, 151 participants; moderate-certainty evidence). For wound infection, there was no clear difference between groups (RR 0.18, 95% CI 0.01 to 3.59; 3 studies, 318 participants; moderate-certainty evidence). There was no clear difference between percutaneous and cut-down femoral artery access groups in major complications (RR 1.21, 95% CI 0.61 to 2.41; 3 studies, 318 participants; moderate-certainty evidence), bleeding complications (RR 1.02, 95% CI 0.29 to 3.64; 2 studies, 181 participants; moderate-certainty evidence) or haematoma (RR 0.88, 95% CI 0.13 to 6.05; 2 studies, 288 participants). One study reported medium- to long-term complications at six months, with no clear differences between the percutaneous and cut-down femoral artery access groups (RR 0.82, 95% CI 0.25 to 2.65; 1 study, 135 participants; moderate-certainty evidence). We detected differences in operating time, with the percutaneous approach being faster than cut-down femoral artery access (mean difference (MD) -21.13 minutes, 95% CI -41.74 to -0.53 minutes; 3 studies, 318 participants; low-certainty evidence). One study reported the duration of ITU stay and hospital stay, with no clear difference between groups. AUTHORS' CONCLUSIONS Skin puncture may make little to no difference to short-term mortality. There is probably little or no difference in failure of aneurysm exclusion (failure to seal the aneurysms), wound infection, major complications within 30 days or while in hospital, medium- to long-term (six months) complications and bleeding complications between the two groups. Compared with exposing the femoral artery, skin puncture may reduce the operating time slightly. We downgraded the certainty of the evidence to moderate and low as a result of imprecision due to the small number of participants, low event rates and wide CIs, and inconsistency due to clinical heterogeneity. As the number of included studies was limited, further research into this technique would be beneficial.
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Affiliation(s)
- Qi Wang
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Jing Wu
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China
| | - Yanfang Ma
- School of Chinese Medicine, Hong Kong Baptist University, Hong Kong, China
| | - Ying Zhu
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Xiaoyang Song
- Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shitong Xie
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China
| | - Fuxiang Liang
- Department of Cardiovascular Surgery, The First Hospital of Lanzhou University, Lanzhou, China
| | - Madelaine Gimzewska
- Academic Department of Vascular Surgery, Imperial College London, London, UK
| | - Meixuan Li
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China
| | - Liang Yao
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada
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Singh G, Scalise F, Bianchi P, Cireni L, Sorropago G, Casana R, Tolva V. Sheath Size Up and Down With Single Proglide - A Technique for Achieving Hemostasis With Use of Large Size Delivery System During Endovascular Graft Placement. Ann Vasc Surg 2021; 78:190-196. [PMID: 34464729 DOI: 10.1016/j.avsg.2021.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/25/2021] [Accepted: 06/12/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND A total percutaneous approach for management of aortic pathologies with endovascular grafts requires the use of large size delivery-systems. The diameter of these delivery systems usually exceeds the recommended sizes for most of the currently available percutaneous closure devices. A safe, effective and simple vascular access site closure device is desirable for success for percutaneous procedures for aortic pathologies. Hence, we aim to study safety and effectiveness of the use of a single suture based vascular access closure device (ProGlide) using a technique involving serial up and downsizing of the sheath size to achieve access site hemostasis in patients undergoing endovascular graft placement using femoral artery approach. MATERIALS AND METHODS We studied all consecutive patients who underwent endovascular grafting from January 2018 to December 2019. It is a retrospective observational study comparing procedural and short-term outcomes between single ProGlide use and surgical cut-down for femoral access site closure. We excluded patients with femoral artery minimal luminal diameter less than 5 mm, the presence of an aneurysm of the femoral artery, ≥180 degrees of calcium present at femoral/ external iliac artery and history of any vascular closure device use in the last six months. RESULTS We included 30 patients in single ProGlide group and 30 patients in the surgical cut-down group. One-third of the procedures were urgent procedures in the single Proglide group. Single ProGlide was successful in 93.34% patients and failure (6.66%) was seen due to hematoma and pseudoaneurysm in one patient each detected before discharge. The primary end-point defined by the success of procedure did not differ between the two groups. There were higher complications in the surgical group till 30 days as evidenced by infection, hematoma and neuronal injury. The secondary end-point, defined by the composite of complication events after discharge till 30 days was significantly higher in the surgical group (P-0.005) CONCLUSION: In patients with suitable femoral artery anatomy who undergo endovascular graft placement, effective hemostasis can be achieved safely using up and downsizing of the sheath with a single suture-based technique (Proglide). The results of the study could be considered hypothesis generating and needs to be confirmed in a randomized controlled trial before being adopted in clinical practice.
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Affiliation(s)
- Gurbhej Singh
- Department of Interventional Cardiology, Policlinico di Monza, Monza, Italy; Dayanand Medical College and Hospital, Ludhiana, India
| | - Filippo Scalise
- Department of Interventional Cardiology, Policlinico di Monza, Monza, Italy
| | - Paolo Bianchi
- Department of Vascular Surgery, Policlinico di Monza, Monza, Italy
| | - Lea Cireni
- Department of Vascular Surgery, Policlinico di Monza, Monza, Italy
| | - Giovanni Sorropago
- Department of Interventional Cardiology, Policlinico di Monza, Monza, Italy
| | - Renato Casana
- Department of Surgery. Istituto Auxologico Italiano IRCCS, Milano. Italy
| | - Valerio Tolva
- Department of Vascular Surgery, Policlinico di Monza, Monza, Italy; Department of Surgery. Istituto Auxologico Italiano IRCCS, Milano. Italy; Department of Vascular Surgery, Grande Ospedale Metropolitano Niguarda, Milan, Italy.
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11
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Bi G, Wang Q, Xiong G, Chen J, Luo D, Deng J, Qin X. Is percutaneous access superior to cutdown access for endovascular abdominal aortic aneurysm repair? A meta-analysis. Vascular 2021; 30:825-833. [PMID: 34259113 DOI: 10.1177/17085381211032765] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The objective is to investigate whether percutaneous access (pEVAR) is superior to cutdown access (cEVAR) in terms of safety and efficacy during endovascular repair of abdominal aortic aneurysms (AAAs). METHODS We searched PubMed, Embase, and Cochrane Library from January 1999 to December 2020 for studies reporting on the comparison between percutaneous and cutdown techniques for endovascular repair of AAAs. Outcomes evaluated were technical success rates, access site-related complications and operative time, and hospital stay. RESULTS Four randomized controlled trials and nine observational studies with a total of 1683 patients comprising 2715 groin accesses were eligible for the meta-analysis. pEVAR was associated with a lower risk of overall complications (odds ratio (OR) = 0.63; p = .005) and seroma/lymphorrhea (OR, 0.18; p = .0001) and shortened operation time (MD = -39.04; p = .002) and the length of hospital stay (MD = -0.75; p < .00001) compared with cEVAR. The technical success rate for pEVAR was 95.1% (694/729), with an overall OR of 0.27 (95% CI 0.14-0.55, p = .0003) comparing pEVAR with cEVAR. Furthermore, pEVAR did not increase the risk of site infection, femoral artery thrombosis, postoperative hematoma, nerve injury, dissection, and bleeding. CONCLUSION Percutaneous endovascular aneurysm repair is a safe and effective method for the treatment of AAA. It reduces the risk of overall complications and shortens the operation time and hospital stay. The technical success rate of pEVAR is lower than that of cEVAR, which may be linked to the selection of patients, operator experience, and the use of ultrasound. Large definitive trials are required to draw robust conclusions.
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Affiliation(s)
- Guoshan Bi
- Department of Vascular Surgery, 117742The First Affiliated Hospital of Guangxi Medical University, Guangxi, China.,Department of Vascular Surgery, 575432The Second Affiliated Hospital of University of South China, Hunan Province, China
| | - Quanwen Wang
- Department of Vascular Surgery, 575432The Second Affiliated Hospital of University of South China, Hunan Province, China
| | - Guozuo Xiong
- Department of Vascular Surgery, 575432The Second Affiliated Hospital of University of South China, Hunan Province, China
| | - Jie Chen
- Department of Vascular Surgery, 575432The Second Affiliated Hospital of University of South China, Hunan Province, China
| | - Dongyang Luo
- Department of Vascular Surgery, 117742The First Affiliated Hospital of Guangxi Medical University, Guangxi, China
| | - Jiangbei Deng
- Department of Vascular Surgery, 117742The First Affiliated Hospital of Guangxi Medical University, Guangxi, China
| | - Xiao Qin
- Department of Vascular Surgery, 117742The First Affiliated Hospital of Guangxi Medical University, Guangxi, China
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12
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Lee YH, Su TW, Su IH, Yu SY, Hsu MY, Hsin CH, Wei WC, Chu SY, Tseng JH, Ko PJ. Comparison between Totally Percutaneous Approach and Femoral Artery Cut-Down in Endovascular Aortic Repair of Ruptured Abdominal Aortic Aneurysms in a Single Hospital. Ann Vasc Surg 2021; 74:141-147. [PMID: 33508462 DOI: 10.1016/j.avsg.2020.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 12/08/2020] [Accepted: 12/13/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE To evaluate the short-term outcome of totally percutaneous endovascular aortic repair (pEVAR) of ruptured abdominal aortic aneurysms (AAAs) compared with femoral cut-down endovascular aortic repair (cEVAR). MATERIALS AND METHODS The medical records of patients with ruptured AAAs that underwent EVAR between March 2010 and April 2017 were retrospectively reviewed. Demographic information, preoperative vital signs, preoperative laboratory data, method of anesthesia, procedure duration, aneurysm morphology, brand of device used, length of hospital stay, access complications, and short-term outcomes were recorded. Univariate as well as multivariate logistic regression was used to identify predictors of 30-day mortality. RESULTS Among 77 patients with ruptured AAAs, 17 (22.1%) received cEVAR and 60 (77.9%) received pEVAR. Significant differences in the procedure time (P = 0.004), method of anesthesia (P = 0.040), and 30-day mortality (P = 0.037) were detected between the cEVAR and pEVAR groups. Local anesthesia plus intravenous general anesthesia (odds ratio = 0.141, P = 0.018) was an independent factor associated with 30-day mortality and local anesthesia was better than general anesthesia for 24-hr mortality (P = 0.001) and 30-day mortality (P = 0.003). CONCLUSION In patients with ruptured AAAs, pEVAR procedures took less time than cEVAR procedures, but the length of hospital stay did not differ significantly. The 30-day mortality rate was lower with pEVAR than with cEVAR. Local anesthesia may be the key factor in EVAR to improved technical and clinical success.
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Affiliation(s)
- Yu-Hsien Lee
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taiwan
| | - Ta-Wei Su
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taiwan
| | - I-Hao Su
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taiwan
| | - Sheng-Yueh Yu
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taiwan
| | - Ming-Yi Hsu
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taiwan
| | - Chun-Hsien Hsin
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taiwan
| | - Wen-Cheng Wei
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taiwan.
| | - Sung-Yu Chu
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taiwan
| | - Jeng-Hwei Tseng
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taiwan
| | - Po-Jen Ko
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taiwan
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13
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Sahin AA, Guner A, Demir AR, Uzun N, Onan B, Topel C, Çelik Ö. Comparison between PeRcutanEous and surgical femoral aCcess for endovascuLar aOrtic repair in patientS with typE III aortic Dissection (PRECLOSE Trial). Vascular 2020; 29:616-623. [PMID: 33054676 DOI: 10.1177/1708538120965310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Aortic dissections are cardiovascular events with high mortality and morbidity rates. Management might be either with medical or interventional approach. Recently, thoracic endovascular intervention (TEVAR) becomes the first treatment of choice because of its better results and lower rates of complications in patients with type III aortic dissections. The intervention might be performed via femoral artery either with percutaneous or with surgical approach. Because of large sheath insertion to femoral artery, Pre-close technique is described in literature. The aim of this study was to investigate and compare the outcomes and safety of 'Pre-close technique' to surgical approach in patients with type III aortic dissections who underwent TEVAR with femoral access ≥22 F. METHODS A total of 96 patients whom had type III aortic dissection and was performed TEVAR were retrospectively included in the study. Fifty-six patients had TEVAR with percutaneous approach and these patients are named as P-TEVAR group, and 40 patients had TEVAR with surgical approach and these patients are named as S-TEVAR group. Pre- and post-procedural data with complications and procedural data during TEVAR were evaluated for both groups and compared in between. RESULTS The main finding was that there was no significant difference between S-TEVAR and P-TEVAR groups in terms of complications and technical success. Operating room time was significantly decreased in P-TEVAR group (P < 0.001). Overall success rate for femoral approach in patients with Pre-close technique was 94.6% and was 100% for surgical approach. P-TEVAR group had post-operative complications in three patients and S-TEVAR group had in four patients. CONCLUSIONS Total percutaneous approach with Pre-close technique using Pro-Glide device is a safe and feasible method of femoral access in patients with type III aortic dissections.
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Affiliation(s)
- Ahmet A Sahin
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Ahmet Guner
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Ali R Demir
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Nedim Uzun
- Department of Emergency Medicine, Gaziosmanpasa Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Burak Onan
- Department of Cardiovascular Surgery, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Cagdas Topel
- Department of Radiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Ömer Çelik
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
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14
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Dunn K, Jessula S, Herman CR, Smith M, Lee MS, Casey P. Safety and effectiveness of single ProGlide vascular access in patients undergoing endovascular aneurysm repair. J Vasc Surg 2020; 72:1946-1951. [PMID: 32276013 DOI: 10.1016/j.jvs.2020.03.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 03/04/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the safety and effectiveness of single ProGlide use per bilateral access site for endovascular aneurysm repair (EVAR) of abdominal aortic aneurysms. METHODS A retrospective cohort study was performed for all elective percutaneous EVARs from November 2015 to December 2017 at the QEII Health Sciences Centre (Halifax, Nova Scotia, Canada). Exposure of interest was number of ProGlides used per access site, dichotomized into bilateral single ProGlide closure vs nonsingle ProGlide closure on at least one femoral arteriotomy. Outcomes included Valve Academic Research Consortium (VARC)-2 and Bleeding Academic Research Consortium (BARC) criteria. Groups were compared with Fisher exact test, analysis of variance, or Wilcoxon rank sum, as appropriate. Logistic regression was used to compare the effect of single ProGlide use on VARC-2 and BARC criteria. RESULTS A total of 131 cases were included, of which 116 had bilateral single ProGlide use for access closure. Baseline characteristics including comorbidities and smoking status were compared between groups. Groups were similar for all characteristics except smoking status, with an increased proportion of former smokers in the nonsingle ProGlide group. There were 119 (90.8%) patients who had single ProGlide use on the right femoral artery and 121 (92.4%) on the left; 16 (12.2%) patients had ProGlide deployment issues. Median maximal right and left femoral sheath diameters were 16F (interquartile range [IQR], 16F-18F) and 14F (IQR, 14F-16F), respectively. Median length of stay was 1 day (IQR, 1-1 day). VARC-2 criteria occurred in 8 of 131 (6.11%) patients, 6 of 116 (5.17%) with bilateral single ProGlides and 2 of 15 (13.3%) with nonsingle ProGlides. BARC criteria occurred in 6 of 131 (4.58%) patients, 5 of 116 (4.31%) with bilateral single ProGlides and 1 of 15 (6.67%) with nonsingle ProGlides. Single ProGlide use was not associated with a difference in VARC-2 (odds ratio, 0.35; 95% confidence interval, 0.64-1.94) or BARC (odds ratio, 0.63; 95% confidence interval, 0.07-6.79) criteria. No patients developed pseudoaneurysms or required repeated intervention for bleeding. CONCLUSIONS Single ProGlide use per vascular access site in patients undergoing EVAR is a safe and effective method for access closure with sheath diameters up to and including 16F.
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Affiliation(s)
- Krista Dunn
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - Samuel Jessula
- Division of General Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Christine R Herman
- Division of Vascular Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada; Division of Cardiac Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Matthew Smith
- Division of Vascular Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Min S Lee
- Division of Vascular Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Patrick Casey
- Division of Vascular Surgery, Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
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15
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Schneider DB, Krajcer Z, Bonafede M, Thoma E, Hasegawa J, Bhounsule P, Thiel E. Clinical and economic outcomes of ProGlide compared with surgical repair of large bore arterial access. J Comp Eff Res 2019; 8:1381-1392. [DOI: 10.2217/cer-2019-0082] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Aim: This study compared real-world complication rates, hospitalization duration and costs, among patients undergoing arterial repair using the Perclose ProGlide (ProGlide) versus surgical cutdown (Cutdown). Materials & methods: Retrospective study of matched patients who underwent transcatheter aortic valve replacement/repair, endovascular abdominal aortic aneurysm repair, thoracic endovascular aortic repair or balloon aortic valvuloplasty with arterial repair by either ProGlide or Cutdown between 1 January 2013 and 24 April 2017. Results: Infections and blood transfusions were lower in the ProGlide cohort. Patients in the ProGlide cohort had a 42.5% shorter index hospitalization, which corresponded to US$14,687 lower costs. Conclusion: The use of ProGlide for arterial repair was associated with significantly lower transfusion rates, shorter index hospitalization and lower hospitalization costs compared with surgical cutdown.
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Affiliation(s)
- Darren B Schneider
- St Luke's Episcopal Hospital, Texas Heart Institute, Baylor College of Medicine, Houston, TX 77030, USA
| | - Zvonimir Krajcer
- New York Presbyterian Hospital/Weill Cornell Medical Center, Weill Cornell Medicine, New York, NY 10065, USA
| | | | | | | | | | - Ellen Thiel
- IBM Watson Health, IBM, Cambridge, MA 02142, USA
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16
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Baldino G, Barosso M, Persi F, Mortola P, De Caro G, Gori A. Clinical and economic impact of "Pevar-First" approach in daily practice: a single-center experience. ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY 2019. [DOI: 10.23736/s1824-4777.19.01403-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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17
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Sorropago G, Singh G, Sorropago A, Sole A, Rossi J, Tolva VS, Stabile E, Scalise F. A new Percutaneous technique for effective vascular Access Site closure in patients undergoing Transfemoral aortic valve implantation and thoraco-abdominal aortic aneurysm rEpair: the PASTE study. EUROINTERVENTION 2018; 14:e1278-e1285. [DOI: 10.4244/eij-d-18-00245] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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18
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Baldino G, Persi F, Mortola P, Gori A. An Alternative Technique to Achieve Haemostasis During PEVAR Using Perclose ProGlide. EJVES Short Rep 2018; 41:8-9. [PMID: 30426095 PMCID: PMC6224330 DOI: 10.1016/j.ejvssr.2018.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Revised: 09/09/2018] [Accepted: 10/04/2018] [Indexed: 12/17/2022] Open
Abstract
Introduction Percutaneous endovascular abdominal aortic aneurysm repair (PEVAR) using the Perclose ProGlide suture mediated closure device is currently performed on a global scale. A safe, effective, and cheap technique for achieving haemostasis during PEVAR is described that allows the reversible downsizing of the arteriotomy, without using any other devices. Technique The procedure consists of pulling the blue thread of the pre-implanted ProGlide, advancing the knot close to the arterial wall by pushing it with the dilator of a small introducer sheath, and maintaining the system under tension by grasping the end of the blue thread with a haemostat until bleeding control is achieved. Discussion Seventeen PEVAR femoral access downsizing procedures have been performed between February and June 2018 and no complications were observed. The technique could be useful in everyday practice and has now become the author's standard practice. The described technique allows haemostasis to be achieved during PEVAR procedures. The downsizing method is reversible at any time of the PEVAR procedure. The described technique could add a useful tip to daily surgical activity.
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Affiliation(s)
- Giuseppe Baldino
- Corresponding author. Vascular and Endovascular Surgery Department, Galliera Hospital, Mura delle Cappuccine 14 - 16128, Genoa, Italy.
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19
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Maeda K, Ohki T, Kanaoka Y, Baba T, Shukuzawa K, Takizawa R, Omori M. A new option using adjunctive microsheath angiography to increase the safety during percutaneous endovascular aortic aneurysm repair. THE JOURNAL OF CARDIOVASCULAR SURGERY 2018; 61:78-83. [PMID: 30168307 DOI: 10.23736/s0021-9509.18.10595-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Percutaneous endovascular aortic repair (PEVAR) is widespread for the treatment of abdominal aortic aneurysm (AAA). The purpose of this study was to present outcomes of PEVAR using simultaneous angiography via microsheath. METHODS There were 100 punctures in 50 patients undergoing PEVAR for AAA. All cases used the ProGlide closure device (Abbot Vascular, Santa Clara, CA, USA) for PEVAR, and another puncture with microsheath placed on the common femoral artery for a second insertion point of the ProGlide. Basically, a single ProGlide was used for each puncture in the PEVAR. Hemostasis, stenosis, dissection, and distal embolization were confirmed in angiography via the adjunctive microsheath after removal of the delivery system. Since the PEVAR for AAA requires at least two punctures, this procedure was applied to both sites. Primary outcome was technical success and occurrence rates of access-related complications in PEVAR. Technical success was defined as complete hemostasis without surgical intervention and the need for conversion to general anesthesia. RESULTS Technical success was achieved in 98% (98/100) of the cases. Access-related complications on perioperative periods were identified in two cases. One case involved a tip of the microsheath being transected by the ProGlide that led to a distal embolization, which is why a cut down was required to retrieve the tip of the sheath. Another case required a cut down due to persistent hemorrhage from the puncture site of the microsheath. Although persistent hemorrhage was identified in five punctures (5.0%) via the adjunctive microsheath angiography, additional manual compression or ProGlide achieved complete hemostasis. Both stenosis and dissection following PEVAR were not identified in any case. CONCLUSIONS A supporting angiography via microsheath in confirming the absence of hemorrhage, stenosis, dissection, and distal embolization may be worthwhile to selectively use for cases of PEVAR.
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Affiliation(s)
- Koji Maeda
- Department of Vascular Surgery, Jikei University School of Medicine, Minato-ku, Tokyo, Japan -
| | - Takao Ohki
- Department of Vascular Surgery, Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Yuji Kanaoka
- Department of Vascular Surgery, Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Takeshi Baba
- Department of Vascular Surgery, Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Kota Shukuzawa
- Department of Vascular Surgery, Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Reo Takizawa
- Department of Vascular Surgery, Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Makiko Omori
- Department of Vascular Surgery, Jikei University School of Medicine, Minato-ku, Tokyo, Japan
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20
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A systematic review of vascular closure devices for femoral artery puncture sites. J Vasc Surg 2018; 68:887-899. [DOI: 10.1016/j.jvs.2018.05.019] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 05/15/2018] [Indexed: 12/17/2022]
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21
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Karaolanis G, Kostakis ID, Moris D, Palla VV, Moulakakis KG. Fascia Suture Technique and Suture-mediated Closure Devices: Systematic Review. Int J Angiol 2018; 27:13-22. [PMID: 29483761 PMCID: PMC5825226 DOI: 10.1055/s-0037-1620241] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background The aim of the present study is to review the available data on suture-mediated closure devices (SMCDs) and fascia suture technique (FST), which are alternatives for minimizing the invasiveness of percutaneous endovascular aortic aneurysm repair (p-EVAR) and reduce the complications related to groin dissections. Methods The Medline, ClinicalTrials.gov, and Cochrane library - Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched for publications regarding SMCD and FST between January 1999 and December 2016. Results We review 37 original articles, 30 referring to SMCDs (Prostar XL and Proglide), which included 3,992 patients, and 6 articles referring to FST, which include 426 patients. The two techniques are compared only in one article (100 patients). The two types of SMCDs were Prostar and Proglide. In most studies on SMCDs, the reported technical success rates were between 89 and 100%, but the complication rates varied greatly between 0 and 25%. Concerning FST, the technical success rates were also high, ranging between 87 and 99%. However, intraoperative complication rates ranged between 1.2 and 13%, whereas postoperative complication rates varied from 0.9 to 6.2% for the short-term and from 1.9 to 13.6% for the long-term. Conclusions SMCDs and FST seem to be effective and simple methods for closing common femoral artery (CFA) punctures after p-EVAR. FST can reduce the access closure time and the procedural costs with a quite short learning curve, whereas it can work as a bailout procedure for failed SMCDs suture. The few failures of the SMCDs and FST that may occur due to bleeding or occlusion can easily be managed.
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Affiliation(s)
- Georgios Karaolanis
- Vascular Unit, First Department of Surgery, National and Kapodistrian University of Athens, “Laiko” General Hospital, Athens, Greece
| | - Ioannis D. Kostakis
- Second Department of Propedeutic Surgery, National and Kapodistrian University of Athens, “Laiko” General Hospital, Athens, Greece
| | - Demetrios Moris
- Vascular Unit, First Department of Surgery, National and Kapodistrian University of Athens, “Laiko” General Hospital, Athens, Greece
| | - Viktoria-Varvara Palla
- Vascular Unit, First Department of Surgery, National and Kapodistrian University of Athens, “Laiko” General Hospital, Athens, Greece
| | - Konstantinos G. Moulakakis
- Department of Vascular Surgery, Athens University Medical School, Attikon University Hospital, Athens, Greece
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Yang L, Liu J, Li Y. Femoral Artery Closure Versus Surgical Cutdown for Endovascular Aortic Repair: A Single-Center Experience. Med Sci Monit 2018; 24:92-99. [PMID: 29304034 PMCID: PMC5765710 DOI: 10.12659/msm.905350] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND To compare the outcome and complication rates of femoral artery closure and surgical cutdown for endovascular aortic repair procedures (EVAR). MATERIAL AND METHODS Patients underwent either percutaneous femoral artery closure (PA group) or surgical cutdown (SC group) for EVAR between July 2011 and June 2016 and EVAR procedures were used for all cases. Data on outcomes and complications were collected and compared. RESULTS The SC group contained 55 patients and the PA group contained 60 patients and the technical success rates were 100.0% and 98.0%, respectively. The mean operation time, time to ambulation, and postoperative hospital stay were significantly shorter in the PA group (P<0.01). The estimated intraoperative blood loss and wound pain scores were significantly higher in the SC group (P<0.01). However, the PA procedure was more expensive (P<0.01). The overall incidence rate of complications was higher in the SC group (P=0.026). CONCLUSIONS The PA technique had a high success rate, shorter operation time and hospital stay, and fewer wound complications compared to SC. Thus, PA might be the preferred choice for selected EVAR procedures.
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Affiliation(s)
- Lin Yang
- Department of Vascular Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland)
| | - Jianlin Liu
- Department of Vascular Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland)
| | - Yanzi Li
- Department of Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China (mainland)
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Saadi EK, Saadi M, Saadi R, Tagliari AP, Mastella B. Totally Percutaneous Access Using Perclose Proglide for Endovascular Treatment of Aortic Diseases. Braz J Cardiovasc Surg 2017; 32:43-48. [PMID: 28423129 PMCID: PMC5382908 DOI: 10.21470/1678-9741-2016-0065] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Accepted: 01/06/2017] [Indexed: 12/18/2022] Open
Abstract
Objective To evaluate our experience following the introduction of a percutaneous
program for endovascular treatment of aortic diseases using Perclose
Proglide® assessing efficacy, complications and identification of
potential risk factors that could predict failure or major access site
complications. Methods A retrospective cohort study during a two-year period was performed. All the
patients submitted to totally percutaneous endovascular repair (PEVAR) of
aortic diseases and transcatheter aortic valve implantation since we started
the total percutaneous approach with the preclosure technique from November
2013 to December 2015 were included in the study. The primary endpoint was
major ipsilateral access complication, defined according to PEVAR trial.
Results In a cohort of 123 patients, immediate technical success was obtained in 121
(98.37%) patients, with only two (0.82%) cases in 242 vascular access sites
that required intervention immediately after the procedure. Pairwise
comparisons revealed increased major access complication among patients with
>50% common femoral artery (CFA) calcification vs. none
(P=0.004) and > 50% CFA calcification
vs. < 50% CFA calcification
(P=0.002). Small artery diameter (<6.5 mm) also
increased major access complication compared to bigger diameters (> 6.5
mm) (P=0.027). Conclusion The preclosure technique with two Perclose Proglide® for PEVAR is safe
and effective. Complications occur more often in patients with unfavorable
access site anatomy and the success rate can be improved with proper patient
selection.
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Affiliation(s)
- Eduardo Keller Saadi
- Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Marina Saadi
- Universidade Luterana do Brasil (ULBRA), Canoas, RS, Brazil
| | - Rodrigo Saadi
- Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
| | - Ana Paula Tagliari
- Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Bernardo Mastella
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
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van der Merwe J, Casselman F, Beelen R, Van Praet F. Total Percutaneous Cardiopulmonary Bypass for Robotic and Endoscopic Atrioventricular Valve Surgery. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2017. [DOI: 10.1177/155698451701200415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Johan van der Merwe
- From the Department of Cardiovascular and Thoracic Surgery, OLV Clinic, Aalst, Belgium
| | - Filip Casselman
- From the Department of Cardiovascular and Thoracic Surgery, OLV Clinic, Aalst, Belgium
| | - Roel Beelen
- From the Department of Cardiovascular and Thoracic Surgery, OLV Clinic, Aalst, Belgium
| | - Frank Van Praet
- From the Department of Cardiovascular and Thoracic Surgery, OLV Clinic, Aalst, Belgium
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Total Percutaneous Cardiopulmonary Bypass for Robotic and Endoscopic Atrioventricular Valve Surgery. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2017; 12:296-299. [PMID: 28594658 DOI: 10.1097/imi.0000000000000367] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Continuous technological advances in endoscopic-, robotic- and catheter-based cardiac interventions are paralleled by rapid evolution in cannulation strategies for circulatory support. The recent introduction of suture-based percutaneous vascular closure devices resulted in innovative strategies to deliver peripheral endovascular therapeutic devices through the iliac and femoral arteries. Percutaneous access allows rapid postoperative mobilization and potentially avoids the devastating neuro-lympho-vascular- and wound infection morbidities associated with conventional open surgical exposure. We routinely perform endoscopic port access surgery for all isolated atrioventricular valve pathology and extended the application of suture-based percutaneous vascular closure device to establish total percutaneous peripheral cardiopulmonary bypass in disabled, immune-suppressed, and morbidly obese patients at risk neuro-lympho-vascular- and wound infection. In this report, we provide a stepwise description of our total percutaneous peripheral cardiopulmonary bypass technique.
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Gimzewska M, Jackson AIR, Yeoh SE, Clarke M, Cochrane Vascular Group. Totally percutaneous versus surgical cut-down femoral artery access for elective bifurcated abdominal endovascular aneurysm repair. Cochrane Database Syst Rev 2017; 2:CD010185. [PMID: 28221665 PMCID: PMC6464496 DOI: 10.1002/14651858.cd010185.pub3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Abdominal aortic aneurysms (AAAs) are a vascular condition with significant risk attached, particularly if they rupture. It is, therefore, critical to identify and repair these as an elective procedure before they rupture and require emergency surgery. Repair has traditionally been an open surgical technique that required a large incision across the abdomen. Endovascular abdominal aortic aneurysm repairs (EVARs) are now a common alternative. In this procedure, the common femoral artery is exposed via a cut-down approach and a graft introduced to the aneurysm in this way. This review examines a totally percutaneous approach to EVAR. This technique gives a minimally invasive approach to femoral artery access that may reduce groin wound complication rates and improve recovery time. The technique may, however, be less applicable in people with, for example, groin scarring or arterial calcification. This is an update of the review first published in 2014. OBJECTIVES This review aims to compare the clinical outcomes of percutaneous access with surgical cut-down femoral artery access in elective bifurcated abdominal endovascular aneurysm repair (EVAR). SEARCH METHODS For this update the Cochrane Vascular Information Specialist (CIS) searched their Specialised Register (last searched October 2016) and CENTRAL (2016, Issue 9). We also searched clinical trials registries and checked the reference lists of relevant retrieved articles. SELECTION CRITERIA We considered only randomised controlled trials. The primary intervention was a totally percutaneous endovascular repair. We considered all device types. We compared this against surgical cut-down femoral artery access endovascular repair. We only considered studies investigating elective repairs. We excluded studies reporting emergency surgery for a ruptured abdominal aortic aneurysm and those reporting aorto-uni-iliac repairs. DATA COLLECTION AND ANALYSIS Two review authors independently collected all data. Owing to the small number of trials identified we did not conduct any formal sensitivity analysis. Heterogeneity was not significant for any outcome. MAIN RESULTS Two studies with a total of 181 participants met the inclusion criteria, 116 undergoing the percutaneous technique and 65 treated by cut-down femoral artery access. One study had a small sample size and did not adequately report method of randomisation, allocation concealment or pre-selected outcomes. The second study was a larger study with few sources of bias and good methodology.We observed no significant difference in mortality between groups, with only one mortality occurring overall, in the totally percutaneous group (risk ratio (RR) 1.50; 95% confidence interval (CI) 0.06 to 36.18; 181 participants; moderate-quality evidence). Only one study reported aneurysm exclusion. In this study we observed only one failure of aneurysm exclusion in the surgical cut-down femoral artery access group (RR 0.17, 95% CI 0.01 to 4.02; 151 participants; moderate-quality evidence). No wound infections occurred in the cut-down femoral artery access group or the percutaneous group across either study (moderate-quality evidence).There was no difference in major complication rate between cut-down femoral artery access and percutaneous groups (RR 0.91, 95% CI 0.20 to 1.68; 181 participants; moderate-quality evidence); or in bleeding complications and haematoma (RR 0.94, 95% CI 0.31 to 2.82; 181 participants; high-quality evidence).Only one study reported long-term complication rates at six months, with no differences between the percutaneous and cut-down femoral artery access group (RR 1.03, 95% CI 0.34 to 3.15; 134 participants; moderate-quality evidence).We detected differences in surgery time, with percutaneous approach being significantly faster than cut-down femoral artery access (mean difference (MD) -31.46 minutes; 95% CI -47.51 minutes to -15.42 minutes; 181 participants; moderate-quality evidence). Only one study reported duration of ITU (intensive treatment unit) and hospital stay, with no difference found between groups. AUTHORS' CONCLUSIONS This review shows moderate-quality evidence of no difference between the percutaneous approach compared with cut-down femoral artery access group for short-term mortality, aneurysm exclusion, major complications, wound infection and long-term (six month) complications, and high-quality evidence for no difference in bleeding complications and haematoma. There was a difference in operating time, with moderate-quality evidence showing that the percutaneous approach was faster than the cut-down femoral artery access technique. We downgraded the quality of the evidence to moderate as a result of the limited number of studies, low event numbers and imprecision. As the number of included studies were limited, further research into this technique would be beneficial. The search identified one ongoing study, which may provide an improved evidence base in the future.
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Affiliation(s)
- Madelaine Gimzewska
- Usher Institute of Population Health Sciences and Informatics, The University of EdinburghCochrane VascularTeviot PlaceEdinburghUKEH8 9AG
| | - Alexander IR Jackson
- University Hospital Southampton NHS Foundation TrustSouthampton General HospitalTremona RoadSouthamptonUKS016 6YD
- University of SouthamptonClinical and Experimental Sciences Academic UnitSouth Academic Block, Mailpoint 801Southampton General Hospital, Tremona RoadSouthamptonUKS016 6YD
| | - Su Ern Yeoh
- The University of EdinburghCollege of Medicine and Veterinary MedicineEdinburghUKEH16 4TJ
| | - Mike Clarke
- Freeman HospitalNorthern Vascular CentreFreeman RoadNewcastle upon TyneUKNE7 7DN
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Cao Z, Wu W, Zhao K, Zhao J, Yang Y, Jiang C, Zhu R. Safety and Efficacy of Totally Percutaneous Access Compared With Open Femoral Exposure for Endovascular Aneurysm Repair. J Endovasc Ther 2017; 24:246-253. [PMID: 28164730 DOI: 10.1177/1526602816689679] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Purpose: To compare the safety and efficacy of percutaneous (PEVAR) vs open femoral access (OFA) techniques for endovascular aneurysm repair (EVAR). Methods: A systematic review of English-language articles (Medline, EMBASE, and Cochrane databases) between January 1999 and August 2016 returned 11 studies including 1650 patients with 2500 groin accesses eligible for the meta-analysis. Data extracted from each study were synthesized to evaluate technical success rates, procedure time, and complications for the 2 access approaches. Data are presented as the odds ratio (OR) or mean difference (MD) with 95% confidence intervals (CI). The quality of individual studies was evaluated based on the Newcastle-Ottawa scale. Results: The mean technical success rate in the PEVAR group was 94.5% (785/831). The overall OR was 0.38 (95% CI 0.12 to 1.18, p=0.09), indicating no significant difference between the methods. The procedure time in PEVAR was shorter than OFA (mean difference −24.52, 95% CI −46.45 to −22.60, p<0.001). Overall, the total complication rate was 15.3% in the OFA group vs 7.8% in the PEVAR group (OR 0.52, 95% CI 0.37 to 0.73, p<0.001). The meta-analysis identified significant differences between groups for all complications (p<0.001) and the following individual adverse events: wound infection (OR 0.28, 95% CI 0.10 to 0.81, p=0.02), pseudoaneurysm (OR 8.07, 95% CI 1.54 to 42.32, p=0.01), seroma (OR 0.10, 95% CI 0.02 to 0.55, p=0.008), and lymphocele or lymph leak (OR 0.19, 95% CI 0.04 to 0.92, p=0.04). Conclusion: PEVAR had a similar technical success rate, shorter procedure time, and lower complication rate compared with OFA. Thus, percutaneous access appears to be the preferential approach for EVAR. However, larger and randomized studies are needed to draw definitive conclusions.
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Affiliation(s)
- Zhanjiang Cao
- Department of Vascular Surgery, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
| | - Weiwei Wu
- Department of Vascular Surgery, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
| | - Keqiang Zhao
- Department of Vascular Surgery, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
| | - Junlai Zhao
- Department of Vascular Surgery, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
| | - Yu Yang
- Department of Vascular Surgery, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
| | - Chao Jiang
- Department of Vascular Surgery, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
| | - Rongrong Zhu
- Department of Vascular Surgery, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
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