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Yang XC, Qin YL, Xiang H, Mo W, Huang AZ, Xiang B, Xu Y, Zhu ZL. Risk Factors for Postoperative Puncture Site Bleeding after Interventional Treatment of Cerebrovascular Disease via Common Femoral Artery Puncture: A Retrospective Analysis of 710 Cases. TOHOKU J EXP MED 2023; 261:109-116. [PMID: 37407440 DOI: 10.1620/tjem.2023.j054] [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] [Indexed: 07/07/2023]
Abstract
This study aimed to identify the risk factors associated with puncture site bleeding following percutaneous puncture of the common femoral artery during interventional treatment of cerebrovascular disease (CVD). A retrospective analysis was conducted on 710 patients who underwent interventional treatment for CVD via femoral artery puncture. Among them, 26 individuals (3.66%) experienced bleeding at the femoral artery puncture site. Binary logistic regression analysis was performed to identify risk factors for puncture site bleeding. The impact of salt bag compression on postoperative bleeding was evaluated in patients with intermediate to high bleeding risk scores. The bleeding group showed higher blood pressure, lower platelet counts, longer prothrombin time and activated partial thromboplastin time, as well as a higher prevalence of larger vascular sheath sizes and variations in the timing of anti-coagulant and anti-platelet therapy administration. The bleeding risk score was higher in the bleeding group, indicating its predictive value for bleeding risk. Higher bleeding risk score, unstable blood pressure, repeated puncture, and serious vascular conditions were significant risk factors for puncture site bleeding. Application of salt bag compression for a duration of 2 hours reduced postoperative puncture site bleeding in patients with intermediate to high bleeding risk scores. Our study identified several significant risk factors for puncture site bleeding after cerebral vascular intervention via femoral artery puncture, including the bleeding risk score, blood pressure, repeated puncture, and vascular conditions. Implementing salt bag compression as a preventive measure can help mitigate bleeding complications in these high-risk patients.
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Affiliation(s)
- Xiu-Chun Yang
- Department of Interventional Vascular Surgery, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University
| | - Yue-Lan Qin
- Nursing Management Department, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University
| | - Hua Xiang
- Department of Interventional Vascular Surgery, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University
| | - Wei Mo
- Department of Interventional Vascular Surgery, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University
| | - Ai-Zhen Huang
- Department of Interventional Vascular Surgery, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University
| | - Bin Xiang
- Department of Interventional Vascular Surgery, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University
| | - Yuan Xu
- Department of Interventional Vascular Surgery, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University
| | - Zhi-Lan Zhu
- Department of Interventional Vascular Surgery, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University
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2
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Wang SH, Shyu VBH, Chiu WK, Huang RW, Lai BR, Tsai CH. An Overview of Clinical Examinations in the Evaluation and Assessment of Arterial and Venous Insufficiency Wounds. Diagnostics (Basel) 2023; 13:2494. [PMID: 37568858 PMCID: PMC10417660 DOI: 10.3390/diagnostics13152494] [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: 06/10/2023] [Revised: 07/11/2023] [Accepted: 07/17/2023] [Indexed: 08/13/2023] Open
Abstract
Arterial and venous insufficiency are two major causes of chronic wounds with different etiology, pathophysiology, and clinical manifestations. With recent advancements in clinical examination, clinicians are able to obtain an accurate diagnosis of the underlying disease, which plays an important role in the treatment planning and management of patients. Arterial ulcers are mainly caused by peripheral artery diseases (PADs), which are traditionally examined by physical examination and non-invasive arterial Doppler studies. However, advanced imaging modalities, such as computed tomography angiography (CTA) and indocyanine green (ICG) angiography, have become important studies as part of a comprehensive diagnostic process. On the other hand, chronic wounds caused by venous insufficiency are mainly evaluated by duplex ultrasonography and venography. Several scoring systems, including Clinical-Etiology-Anatomy-Pathophysiology (CEAP) classification, the Venous Clinical Severity Score (VCSS), the Venous Disability Score, and the Venous Segmental Disease Score (VSDS) are useful in defining disease progression. In this review, we provide a comprehensive overlook of the most widely used and available clinical examinations for arterial and venous insufficiency wounds.
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Affiliation(s)
- Szu-Han Wang
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Keelung Branch, Keelung 204, Taiwan; (S.-H.W.); (V.B.-H.S.); (B.-R.L.)
- Graduate Institute of Biomedical Informatics, Taipei Medical University, Taipei 110, Taiwan
| | - Victor Bong-Hang Shyu
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Keelung Branch, Keelung 204, Taiwan; (S.-H.W.); (V.B.-H.S.); (B.-R.L.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
| | - Wen-Kuan Chiu
- Division of Plastic Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan;
- Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
| | - Ren-Wen Huang
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
- Division of Trauma Plastic Surgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Bo-Ru Lai
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Keelung Branch, Keelung 204, Taiwan; (S.-H.W.); (V.B.-H.S.); (B.-R.L.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
| | - Chia-Hsuan Tsai
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Keelung Branch, Keelung 204, Taiwan; (S.-H.W.); (V.B.-H.S.); (B.-R.L.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
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3
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Gedney R, Villacreses CF, Wooster MD, Genovese EA. Percutaneous, Antegrade Access of the Superficial Femoral Artery can be Safely Used in Procedures for the Treatment of Lower Extremity Limb Ischemia. Ann Vasc Surg 2023; 91:218-222. [PMID: 36481670 DOI: 10.1016/j.avsg.2022.11.005] [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: 07/07/2022] [Revised: 10/06/2022] [Accepted: 11/02/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Recent studies have shown that antegrade access for treatment of infrainguinal peripheral vascular disease is associated with decreased radiation exposure and contrast use without a significant increase in access complication, although data are limited on antegrade superficial femoral artery (SFA) access for larger sheath sizes. We aim to describe a single institution's contemporary experience with percutaneous antegrade SFA access. METHODS A retrospective review of percutaneous, infrainguinal endovascular interventions for arterial occlusive disease at a major academic institution was conducted between 2018 and 2020. Antegrade, percutaneous, SFA access cases were included. Information on demographics, indication, sheath size, arteries treated, type of intervention, concurrent pedal access, closure devices, and complications was collected and analyzed. RESULTS A total of 45 patients with an average body mass index of 25.25 were identified. Indications for intervention included tissue loss (64.4%), rest pain (6.7%), claudication (13.3%), and acute limb ischemia (11.1%). Of which, 80.0% of patients had multilevel interventions. Angioplasty was performed in 68.8% of patients, stenting in 8.3%, atherectomy in 15.6%, and thrombectomy in 7.3%. Nearly a quarter of cases involved concurrent pedal access. Maximum sheath size was 4F for 4.4% of patients, 5F for 28.9%, 6F for 46.7%, 7F for 11.1%, and 8F for 8.9%. The closure device was utilized in 75.6% of cases, with no closure device failures. In the entire cohort, there were no demonstrated access site complications. CONCLUSIONS This study demonstrates percutaneous, antegrade SFA access for complex endovascular interventions for infrainguinal occlusive disease can be effectively utilized, even with larger sheath size. Moreover, routine use of closure devices is safe, improving patient comfort and expediting time to ambulation.
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Affiliation(s)
- Ryan Gedney
- Division of Vascular Surgery, Medical University of South Carolina, Charleston, SC.
| | - Camila F Villacreses
- Division of Vascular Surgery, Medical University of South Carolina, Charleston, SC
| | - Mathew D Wooster
- Division of Vascular Surgery, Medical University of South Carolina, Charleston, SC
| | - Elizabeth A Genovese
- Division of Vascular Surgery, Medical University of South Carolina, Charleston, SC
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4
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Heiss C, Olinic DM, Belch JJF, Brodmann M, Mazzolai L, Stanek A, Madaric J, Krentz A, Schlager O, Lichtenberg M, Frank U. Management of chronic peripheral artery disease patients with indication for endovascular revascularization. VASA 2022; 51:121-137. [PMID: 35418243 DOI: 10.1024/0301-1526/a000998] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
With an increasing global burden of patients with chronic peripheral artery disease (PAD) the safe and effective provision of lower limb revascularisation is a growing medical need. Endovascular procedures for the treatment of PAD have become a crucial cornerstone of modern vascular medicine, and the first line revascularisation approach if technically feasible and taking patient choice into consideration. With the increasing age of patients with PAD and the increasing number of comorbidities open vascular surgery is also often not feasible. We outline a framework of key messages, endorsed by the board of the European Society of Vascular Medicine for pre-, peri- and post procedural management of patients requiring endovascular arterial procedures of the lower limbs. These key messages emphasize the important and increasing role of interventional vascular physicians.
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Affiliation(s)
- Christian Heiss
- Department of Clinical and Experimental Medicine, University of Surrey, Faculty of Health and Medical Sciences, Guildford, United Kingdom.,Department of Vascular Medicine, Surrey and Sussex Healthcare NHS Trust, Redhill, United Kingdom.,The authors contributed equally
| | - Dan-Mircea Olinic
- Iuliu Hatieganu University of Medicine and Pharmacy, Emergency Hospital, Medical Clinic no. 1, Cluj-Napoca, Romania.,The authors contributed equally
| | - Jill J F Belch
- Institute of Cardiovascular Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, United Kingdom
| | - Marianne Brodmann
- Division of Angiology, Department of Internal Medicine, Medical University, Graz, Austria
| | - Lucia Mazzolai
- Division of Angiology, Heart and Vessel Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Agata Stanek
- Department of Internal Diseases, Angiology and Physical Medicine, Medical University of Silesia, Bytom, Poland
| | - Juraj Madaric
- Clinic of Angiology, National Cardiovascular Institute, Bratislava, Slovakia
| | - Andrew Krentz
- Institute for Cardiovascular & Metabolic Research, University of Reading, UK
| | - Oliver Schlager
- Division of Angiology. Department of Medicine II, Medical University of Vienna, Vienna, Austria
| | | | - Ulrich Frank
- Department of Angiology, Cantonal Hospital of Grisons, Chur, Switzerland.,The authors contributed equally
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5
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Ciprian Cacuci A, Krankenberg H, Ingwersen M, Gayed M, Stein SD, Kretzschmar D, Schulze PC, Thieme M. Access Site Complications of Peripheral Endovascular Procedures: A Large, Prospective Registry on Predictors and Consequences. J Endovasc Ther 2021; 28:746-754. [PMID: 34137662 DOI: 10.1177/15266028211025044] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE The purpose of this study was to investigate predictors and consequences of acute vascular access site complications (ASCs) related to peripheral endovascular diagnostic or interventional procedures. Despite improvement of puncture techniques, access site-related morbidity and mortality is still considerable. MATERIALS AND METHODS A total of 5263 participants who underwent 5385 endovascular procedures at a single center were consecutively included in this prospective, observational study. Primary outcomes were ASCs defined as composite of puncture site hematoma, pseudoaneurysm, arteriovenous fistula, and overt puncture site bleeding on the first day after procedure. RESULTS ASCs occurred in 16.6% of peripheral endovascular procedures (78.6% hematomas, 18.9% pseudoaneurysms, 1.4% arteriovenous fistulas, 1.1% overt bleedings). Independent predictors were advanced age [odds ratio (OR) per 10 years: 1.12, p=0.004], female sex (OR men, 0.77; p=0.001), lysis (OR 3.56; p<0.001), periprocedural heparin (OR 5000 IU, 1.96; p=0.001; OR >5000 IU, 3.56; p=0.02), time to access (OR per 10 seconds, 1.01; p<0.001), sheath size (OR per French, 1.59; p<0.001), brachial artery access (OR vs retrograde transfemoral, 4.58; p<0.001), and compression only (OR Angio-Seal, 0.57, p=0.02; ProGlide, 0.36, p<0.001; FemoSeal, 0.57, p<0.001). Treatment was required in 20.2% and prolonged hospitalization in 17.7% of ASC. Three participants died from access site-related bleeding. CONCLUSION ASCs after peripheral endovascular procedures are associated with advanced age, female sex, periprocedural antithrombotic medication, brachial artery access, postinterventional bleeding, and nonuse of vascular closure devices.
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Affiliation(s)
- Andrei Ciprian Cacuci
- Department of Angiology, Cardiology, Diabetology, Regiomed-Vascular Center, Sonneberg, Germany
| | - Hans Krankenberg
- Department of Angiology, Cardiology, Diabetology, Regiomed-Vascular Center, Sonneberg, Germany
| | - Maja Ingwersen
- Department of Angiology, Cardiology, Diabetology, Regiomed-Vascular Center, Sonneberg, Germany.,Department of Radiology, Jena University Hospital, Jena, Germany
| | - Mohamed Gayed
- Department of Angiology, Cardiology, Diabetology, Regiomed-Vascular Center, Sonneberg, Germany
| | - Sven Daniel Stein
- Department of Angiology, Cardiology, Diabetology, Regiomed-Vascular Center, Sonneberg, Germany
| | | | | | - Marcus Thieme
- Department of Angiology, Cardiology, Diabetology, Regiomed-Vascular Center, Sonneberg, Germany.,Clinic of Internal Medicine I, Jena University Hospital, Jena, Germany
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6
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Mikhailov IP, Kungurtsev EV, Arustamyan VA, Muslimov RS. [Surgical treatment of a patient with false aneurysm of the ulnar artery]. Khirurgiia (Mosk) 2021:70-72. [PMID: 33710830 DOI: 10.17116/hirurgia202103170] [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: 11/17/2022]
Abstract
Today, the number of endovascular procedures is steadily growing. For example, there were 40.005 endovascular interventions in 2018. Most patients are discharged within 1-2 days after intervention due to its effectiveness and minimal invasiveness. However, physicians do not always note local postoperative complications. Multidisciplinary approach in follow-up and treatment of such patients is important. In particular, we talk about awareness of doctors of polyclinics about possible complications after arterial puncture. Effectiveness and favorable result of surgical treatment of local postoperative complications after arterial puncture are reported in the manuscript.
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Affiliation(s)
- I P Mikhailov
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
| | - E V Kungurtsev
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
| | - V A Arustamyan
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
| | - R Sh Muslimov
- Sklifosovsky Research Institute for Emergency Care, Moscow, Russia
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7
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Lim C, Won H, Ko YG, Lee SJ, Ahn CM, Min PK, Lee JH, Yoon CH, Yu CW, Lee SW, Lee SR, Choi SH, Chae IH, Choi D. Association between Body Mass Index and Clinical Outcomes of Peripheral Artery Disease after Endovascular Therapy: Data from K-VIS ELLA Registry. Korean Circ J 2021; 51:696-707. [PMID: 34327883 PMCID: PMC8326216 DOI: 10.4070/kcj.2021.0040] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 04/28/2021] [Accepted: 06/09/2021] [Indexed: 12/12/2022] Open
Abstract
We investigated the association between body mass index and clinical outcomes of peripheral artery disease (PAD) after endovascular therapy (EVT). A total of 2914 PAD patients undergoing EVT were participated according to body mass index groups. Underweight was significantly associated with increased risk of major adverse cardiovascular events (MACE) (adjusted hazard ratio [HR], 1.540; 95% confidence interval [CI], 1.091–2.173) and major adverse limb events (MALE) (adjusted HR, 1.523; 95% CI, 1.066–2.177) compared with normal weight. Plus, overweight was associated with lower risk of MACE and not with MALE. However, obesity showed no significant association with MACE or MALE. Background and Objectives Few studies have investigated the obesity paradox in clinical outcomes of peripheral artery disease (PAD). We investigated the association between body mass index (BMI) and clinical outcomes in PAD patients undergoing endovascular therapy (EVT). Methods Patients (n=2,914) from the retrospective Korean Vascular Intervention Society Endovascular Therapy in Lower Limb Artery Disease registry were categorized according to BMI: underweight (<18.5 kg/m2, n=204), normal weight (18.5–25 kg/m2, n=1,818), overweight (25–30 kg/m2, n=766), or obese (≥30 kg/m2, n=126). Groups were compared for major adverse cardiovascular events (MACE) and major adverse limb events (MALE). Results The underweight and obese groups were older and had more frequent critical limb ischemia and infrapopliteal artery disease than the normal or overweight groups (all p<0.001). Hypertension and diabetes were more frequent and current smoking was less frequent in the overweight and obese groups than the underweight or normal weight groups (all p <0.001). The underweight group showed the higher rates of MACE and MALE at 3 years (17.2%, 15.7%) compared with the normal weight (10.8%, 11.7%), overweight (8.4%, 10.7%), or obese groups (8.7%, 14.3%) (log-rank p<0.001, p=0.015). In contrast, the risk of MACE was lower in the overweight than the normal weight group (adjusted hazard ratio, 0.706; 95% CI, 0.537–0.928). Conclusions In PAD patients undergoing EVT, underweight was an independent predictor for MACE and MALE, whereas MACE risk was lower for overweight than normal weight patients. Trial Registration ClinicalTrials.gov Identifier: NCT02748226
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Affiliation(s)
- Chewan Lim
- Division of Cardiology, Department of Internal Medicine, Myongji Hospital, Hanyang University College of Medicine, Goyang, Korea
| | - Hoyoun Won
- Cardiovascular & Arrhythmia Center, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Young Guk Ko
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
| | - Seung Jun Lee
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Chul Min Ahn
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Pil Ki Min
- Division of Cardiology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Hwan Lee
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Chang Hwan Yoon
- Division of Cardiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Cheol Woong Yu
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Seoul, Korea
| | - Seung Whan Lee
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang Rok Lee
- Division of Cardiology, Department of Internal Medicine, Chonbuk National University Hospital, Jeonju, Korea
| | - Seung Hyuk Choi
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - In Ho Chae
- Division of Cardiology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Donghoon Choi
- Division of Cardiology, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
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Clinical Outcomes of Ambulatory Endovascular Treatment Using 4-French and 6-French Femoral Access Strategies: The Bio4amb Multicentre Trial. Cardiovasc Intervent Radiol 2020; 44:689-697. [PMID: 33367944 PMCID: PMC8060188 DOI: 10.1007/s00270-020-02738-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 12/02/2020] [Indexed: 12/24/2022]
Abstract
Purpose Ambulatory peripheral vascular interventions have been steadily increasing. In ambulatory procedures, 4F devices might be particularly useful having the potential to reduce access-site complications; however, further evidence on their safety and efficacy is needed. Materials and Methods BIO4AMB is a prospective, non-randomized mulitcentre, non-inferiority trial conducted in 35 centres in Europe and Australia comparing the use of 4F- and 6F-compatible devices. The main exclusion criteria included an American Society of Anaesthesiologists class ≥ 4, coagulation disorders, or social isolation. The primary endpoint was access-site complications within 30 days. Results The 4F group enrolled 390 patients and the 6F group 404 patients. Baseline characteristics were similar between the groups. Vascular closure devices were used in 7.7% (4F group) and 87.6% (6F group) of patients. Patients with vascular closure device use in the 4F group were subsequently excluded from the primary analysis, resulting in 361 patients in the 4F group. Time to haemostasis was longer for the 4F group, but the total procedure time was shorter (13.2 ± 18.8 vs. 6.4 ± 8.9 min, p < 0.0001, and 39.1 ± 25.2 vs. 46.4 ± 27.6 min, p < 0.0001). Discharge on the day of the procedure was possible in 95.0% (4F group) and 94.6% (6F group) of patients. Access-site complications were similar between the groups (2.8% and 3.2%) and included predominantly groin haematomas and pseudoaneurysms. Major adverse events through 30 days occurred in 1.7% and 2.0%, respectively. Conclusions Ambulatory peripheral vascular interventions are feasible and safe. The use of 4F devices resulted in similar outcomes compared to that of 6F devices. Supplementary Information The online version of this article (10.1007/s00270-020-02738-5) contains supplementary material, which is available to authorized users.
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9
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Grözinger G, Hallecker J, Grosse U, Syha R, Ketelsen D, Brechtel K, Lescan M, Nikolaou K, Artzner C. Tibiopedal and distal femoral retrograde vascular access for challenging chronic total occlusions: predictors for technical success, and complication rates in a large single-center cohort. Eur Radiol 2020; 31:535-542. [PMID: 32725333 PMCID: PMC7755625 DOI: 10.1007/s00330-020-07082-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/29/2020] [Accepted: 07/16/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To evaluate the safety and effectiveness of tibiopedal and distal femoral access for retrograde crossing of chronic total occlusion (CTO) in Rutherford stage III to VI peripheral arterial occlusive disease, and to determine factors that correlate with technical success. MATERIAL AND METHODS One hundred seventy-one consecutive patients were included in this retrospective study. Rutherford stages were III, IV, and V/VI in 24%, 8%, and 67% of patients. Inclusion criteria were CTO at the superficial femoral (SFA), popliteal (PA), and/or below-the-knee (BTK) level, and a failed antegrade treatment followed by a distal retrograde approach. The numbers of occluded vascular levels (OVL), lesion length, degree of calcification, technical success rate, complications, and clinical outcome were noted. RESULTS OVL were 1 in 72%, 2 in 20%, and 3 in 8% of patients. CTOs were longer than 20 cm in 45.6% of cases and showed severe calcifications in 50.3%. Target vessels for distal access were the distal SFA/PA in 17% and BTK in 83%. The overall technical success rate was 82%. Severe calcification decreased technical success (p = 0.01) despite lesion length and Rutherford stage. Clinical outcome improved in 123/152 patients with a significant increase of the median ABI (N = 158) from 0.53 (interquartile range 0.39 to 0.61) to 0.85 (0.59 to 1.03; p < 0.001). Complications were reported in 7.6% cases with 2.3% related to the distal vascular access. CONCLUSION The tibiopedal and distal femoral retrograde access presents a safe and effective treatment option of CTOs at the thigh and/or BTK after a failed antegrade attempt improving clinical outcome. Technical success decreased with lesion's degree of calcification. KEY POINTS • Safety and effectiveness of the tibiopedal and distal femoral access for retrograde crossing of chronic total occlusion. • Target lesion's degree of calcification decreases technical success. • Complications related to the distal vascular access were rare.
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Affiliation(s)
- Gerd Grözinger
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany
| | - Jan Hallecker
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany.,Ihre-Radiologen.de MVZ GmbH, Interventional and Diagnostic Imaging Centers, Heinz-Galinski-Strasse, 13347, Berlin, Germany
| | - Ulrich Grosse
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany
| | - Roland Syha
- Department of Diagnostic and Interventional Radiology, Prosper Hospital Recklinghausen, Mühlenstrasse 27, 45659, Recklinghausen, Germany
| | - Dominik Ketelsen
- Ihre-Radiologen.de MVZ GmbH, Interventional and Diagnostic Imaging Centers, Heinz-Galinski-Strasse, 13347, Berlin, Germany
| | - Klaus Brechtel
- Ihre-Radiologen.de MVZ GmbH, Interventional and Diagnostic Imaging Centers, Heinz-Galinski-Strasse, 13347, Berlin, Germany
| | - Mario Lescan
- Department of Thoracic and Cardiovascular Surgery, University Medical Center Tübingen, Tübingen, Germany
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany
| | - Christoph Artzner
- Department of Diagnostic and Interventional Radiology, University Hospital of Tübingen, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany.
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10
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Spiliopoulos S, Tsochatzis A, Festas G, Reppas L, Christidi F, Palialexis K, Brountzos E. A New Preprocedural Score to Predict Bleeding Complications of Endovascular Interventions for Peripheral Artery Disease. J Endovasc Ther 2019; 26:816-825. [PMID: 31379278 DOI: 10.1177/1526602819866191] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Purpose: To investigate the bleeding complications associated with endovascular therapy (EVT) for peripheral artery disease (PAD) and develop a dedicated peripheral bleeding score (PBS). Materials and Methods: This prospective, single-center study enrolled 530 patients (mean age 67.6±9.8 years; 396 men) undergoing endovascular procedures between August 2016 and July 2018 for chronic PAD. Primary endpoints were the incidence of 30-day bleeding complications [minor and major (prolonging hospitalization, causing permanent sequelae, or resulting in death)], the identification of factors associated with bleeding events, and the development of a dedicated PBS based on univariate and multivariate analysis. Hazard ratios (HR) and 95% confidence intervals (CI) are reported. The HAS-BLED score was compared with the PBS. Results: The overall peripheral bleeding complication rate was 3.8% (20/530), of which 3.2% (17/530) were major and included 4 (0.7%) active retroperitoneal bleeding events and 13 (2.4%) pseudoaneurysms. The annualized incidences of overall bleeding and major bleeding complications were 1.9% and 1.6%, respectively. Multivariable regression analysis identified age ≥75 as a correlate of significantly increased bleeding risk (HR 3.32, 95% CI 1.12 to 9.80, p<0.02). Male gender (HR 0.193, 95% CI 0.49 to 0.75, p<0.001) and statin therapy (HR 0.245, 95% CI 0.08 to 0.71, p=0.01) were correlated with a significantly decreased bleeding risk. Based on the regression analysis findings an 8-point PBS was developed, demonstrating 75.0% sensitivity and 78.4% specificity in detecting bleeding complications. The HAS-BLED score failed to identify 30-day bleeding events. Conclusion: The annualized incidence of bleeding complications associated with peripheral EVT was low. Advanced age and female sex were correlated with increased bleeding risk. The PBS demonstrated satisfactory statistical performance and could be considered for inclusion in the preprocedural endovascular checklist to help optimize intra- and postprocedural care.
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Affiliation(s)
- Stavros Spiliopoulos
- 2nd Department of Radiology, Division of Interventional Radiology, Medical School, "Attikon" University General Hospital, National and Kapodistrian University of Athens, Greece
| | - Athanasios Tsochatzis
- 2nd Department of Radiology, Division of Interventional Radiology, Medical School, "Attikon" University General Hospital, National and Kapodistrian University of Athens, Greece
| | - Georgios Festas
- 2nd Department of Radiology, Division of Interventional Radiology, Medical School, "Attikon" University General Hospital, National and Kapodistrian University of Athens, Greece
| | - Lazaros Reppas
- 2nd Department of Radiology, Division of Interventional Radiology, Medical School, "Attikon" University General Hospital, National and Kapodistrian University of Athens, Greece
| | - Foteini Christidi
- 1st Department of Neurology, Medical School, Aeginition Hospital, National and Kapodistrian University of Athens, Greece
| | - Konstantinos Palialexis
- 2nd Department of Radiology, Division of Interventional Radiology, Medical School, "Attikon" University General Hospital, National and Kapodistrian University of Athens, Greece
| | - Elias Brountzos
- 2nd Department of Radiology, Division of Interventional Radiology, Medical School, "Attikon" University General Hospital, National and Kapodistrian University of Athens, Greece
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Common femoral artery antegrade and retrograde approaches have similar access site complications. J Vasc Surg 2019; 69:1160-1166.e2. [DOI: 10.1016/j.jvs.2018.06.226] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 06/29/2018] [Indexed: 12/22/2022]
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Patel A, Parikh R, Bertrand OF, Kwan TW. A Novel Patent Hemostasis Protocol - Prevention of Pseudoaneurysm after Tibiopedal Arterial Access for Evaluation and Treatment of Peripheral Arterial Disease. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 20:598-602. [PMID: 30262239 DOI: 10.1016/j.carrev.2018.08.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 08/20/2018] [Accepted: 08/30/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Pseudoaneurysm (PSA) is a rare complication (0.2%) after transpedal arterial access (TPA) for endovascular treatment of peripheral arterial disease, occurring only in the posterior tibial artery (PTA) likely related to the anatomy of the vessel leading to unfavorable circumstances for adequate hemostasis. We describe a novel patent hemostasis protocol for TPA access to avoid PSA. METHODS We prospectively studied 586 patients with symptomatic PAD who underwent 1038 peripheral procedures between 02/2016 and 02/2017 via TPA (dorsalis pedis artery (DP)/anterior tibial artery (ATA), PTA or peroneal artery (PA)). Hemostasis for the DP/ATA was achieved with the Vasostat™ device, while TR Band™ was used for PTA/PA, as per our new protocol (figure). Patent hemostasis technique was confirmed using Doppler. RESULTS Of the 1038 procedures, 733 (88% interventional) were done via the DP/ATA, 176 (92% interventional) were done via the PTA and 129 (64% interventional) were via the PA. The incidence of PSA related to any access site was 0.0%. All access sites were patent on Doppler ultrasound at 30 day follow up. CONCLUSION PSA associated with TPA is very rare, it can be easily prevented with the above described patent hemostasis protocol while preserving the patency of the access site. CONDENSED ABSTRACT Pseudoaneurysm (PSA) is a rare complication (0.2%) after transpedal arterial access (TPA). We describe a novel patent hemostasis protocol for TPA access to avoid PSA. We prospectively studied 586 patients with symptomatic PAD who underwent 1038 endovascular procedures via TPA (dorsalis pedis artery (DP)/anterior tibial artery (ATA), PTA or peroneal artery (PA)). Hemostasis for the DP/ATA was achieved with the Vasostat™ device, while TR Band™ was used for PTA/PA, as per our new protocol (figure). Patent hemostasis technique was confirmed using Doppler. The incidence of PSA related to any access site was 0.0%. All access sites were patent on Doppler ultrasound at 30 day follow up. PSA associated with TPA is very rare, it can be easily prevented with the above described patent hemostasis protocol while preserving the patency of the access site.
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Affiliation(s)
- Apurva Patel
- Mount Sinai Beth Israel Medical Center, New York, NY, United States of America
| | - Roosha Parikh
- Mount Sinai Beth Israel Medical Center, New York, NY, United States of America
| | - Olivier F Bertrand
- Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada
| | - Tak W Kwan
- Mount Sinai Beth Israel Medical Center, New York, NY, United States of America; Chinatown Cardiology, P.C., New York, NY, United States of America.
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Patel A, Parikh R, Huang Y, Liou M, Ratcliffe J, Bertrand OF, Puma J, Kwan TW. Pseudoaneurysm after transpedal arterial access for evaluation and treatment of peripheral arterial disease. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2017; 18:123-127. [DOI: 10.1016/j.carrev.2016.10.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 10/08/2016] [Accepted: 10/11/2016] [Indexed: 11/30/2022]
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