Ultrasound-guided versus anatomic landmark-guided percutaneous femoral artery access

BACKGROUND

The use of percutaneous arterial access for endovascular procedures has broad applications, from diagnostic angiography in the coronary and peripheral arteries, to thromboembolectomy in people with ischemic stroke and percutaneous coronary intervention in those with acute myocardial infarction. The rise of these procedures worldwide underscores the importance of obtaining precise and timely arterial access while minimizing the risk of adverse events. Traditionally, anatomic landmarks, such as the anterior superior iliac spine and symphysis pubis, have guided percutaneous common femoral artery (CFA) access, along with manual palpation of the pulse and fluoroscopy to confirm bony landmarks. Anatomic landmarks can be deceptive, however, especially in certain subpopulations, such as those with a high femoral artery bifurcation, elevated body mass index (BMI), or non-palpable femoral pulses. Ultrasound has emerged as a promising tool to guide percutaneous CFA access, offering enhanced visualization and providing real-time guidance. Notwithstanding this theoretical advantage, trials have inconsistently demonstrated an advantage to ultrasound guidance over anatomic landmarks, and concerns surrounding added set-up time and training have limited its uptake both clinically and across society guidelines.

OBJECTIVES

To assess the efficacy and safety of ultrasound compared to anatomic landmarks to guide percutaneous access of the CFA for the purpose of endovascular arterial imaging or treatment.

SEARCH METHODS

The Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase, and CINAHL databases and World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registers to 25 January 2024.

SELECTION CRITERIA

We selected randomized controlled trials comparing ultrasound guidance to anatomic landmark guidance (using manual palpation or fluoroscopy, or both) for percutaneous CFA access in people undergoing endovascular therapy for diagnostic or therapeutic purposes.

DATA COLLECTION AND ANALYSIS

We used standard Cochrane methods. Primary outcomes included first-pass success, time to successful CFA access, and major bleeding (including hematoma requiring transfusion, hematoma extending length of stay, hematoma ≥ 5 cm, unexplained hemoglobin drop, or major/severe bleeding as defined by each trial). Secondary outcomes included overall cannulation success, venipuncture, pain scores, number of access attempts, major complications (including retroperitoneal hematoma, pseudoaneurysms, dissections, arteriovenous fistulae, or occlusions), adverse events (including minor bleeding, infection, and neuropathy) up to 30 days, quality of life, re-intervention rate up to 30 days, and total number of access sites attempted. We conducted sensitivity analyses to determine whether the effect of ultrasound guidance on time to successful CFA access differed across studies that defined this endpoint differently, and to assess the impact of studies that permitted rescue ultrasound on study endpoints.

MAIN RESULTS

Of 1422 records identified through our search of the databases, nine randomized controlled trials enrolling 4447 participants fulfilled our inclusion criteria. All trials were at high risk of bias in at least one domain, with seven trials at overall high risk of bias and the remaining two at overall unclear risk of bias. There may be increased first-pass success (odds ratio [OR] 3.35, 95% confidence interval [CI] 2.53 to 4.44; P < 0.001, I² = 69%; 7 trials, 4274 participants; low certainty evidence) and reduced time to successful CFA access (mean difference [MD] -17.24 s, 95% CI -27.04 to -7.43 s; P < 0.001, I² = 45%; 6 trials, 3570 participants; low certainty evidence) with ultrasound guidance compared to anatomic landmark guidance. Ultrasound guidance may also reduce unintentional venipuncture (OR 0.26, 95% CI 0.18 to 0.38; P < 0.001, I² = 33%; 7 trials, 4178 participants; low certainty evidence) and number of access attempts (MD -0.59, 95% CI -0.91 to -0.26; P < 0.001, I² = 96%; 5 trials, 3362 participants; very low certainty evidence), although the evidence for the latter outcome is very uncertain. Ultrasound guidance may have little to no effect on major bleeding (OR 0.60, 95% CI 0.32 to 1.13; P = 0.11, I² = 38%; 6 trials, 4016 participants; low certainty evidence), overall cannulation success (though the evidence is very uncertain) (OR 1.46, 95% CI 0.93 to 2.30; P = 0.10, I² = 59%; 4 trials, 2520 participants; very low certainty evidence), and likely has little to no effect on pain scores (MD 0.00, 95% CI -0.34 to 0.34; P = 1.00, I² not applicable; 1 trial, 939 participants; moderate certainty evidence). Ultrasound guidance may also have little to no effect on retroperitoneal hematoma, pseudoaneurysm formation, arterial dissection, arteriovenous fistulae, target vessel occlusion, minor bleeding, or infection compared to anatomic landmark guidance (P > 0.05 for all). Lack of data precluded an assessment of re-intervention rates, neuropathy, quality of life, or number of access sites. Sensitivity analysis revealed that ultrasound guidance may reduce time to successful CFA access in studies that defined this outcome as time from administration of local anesthetic to successful sheath insertion (MD -23.65 s, 95% CI -34.28 to -13.01 s; 3 trials, 1517 participants), but not in studies that defined it as time from the first movement of the fluoroscopy table/application of the ultrasound probe to successful sheath insertion (MD -14.85 s, 95% CI -33.45 to 3.75 s; 2 trials, 1941 participants) or time from skin penetration by the access needle to sheath insertion (MD 11.00 s, 95% CI -43.06 to 65.06 s; 1 trial, 112 participants). Sensitivity analysis excluding studies that permitted rescue ultrasound resulted in no change in the overall effect of ultrasound versus anatomic landmark guidance on any of the observed outcomes.

AUTHORS' CONCLUSIONS

Ultrasound guidance may confer clinical benefit over anatomic landmark guidance for percutaneous CFA access regarding first-pass success, time to successful CFA access, and unintentional venipuncture, without increasing the risk of adverse events. Evidence for other outcomes including major bleeding, overall cannulation success, number of access attempts, retroperitoneal hematoma, minor bleeding, pseudoaneurysms, arterial dissection, arteriovenous fistulae, arterial occlusion, infection, or pain scores demonstrates no benefit to ultrasound guidance over anatomic landmark guidance. Data on higher-risk subgroups, including people with elevated BMI, extensive atherosclerosis or calcification, and high femoral artery bifurcation, are lacking. Generalizability was also limited by the high risk of bias across most studies and the exclusion of important subgroups (e.g. people with non-palpable pulses).

Safety and Efficacy of Radial Artery Access for Peripheral Vascular Intervention: A Single-Center Experience

Radial artery (RA) access has been increasingly utilized for coronary procedures because of lower rates of access-site complications and improved patient satisfaction. However, limited data are available for RA access for peripheral vascular intervention (PVI). We performed a retrospective review of 143 patients who underwent PVI through RA access from February 2020 to September 2022 at a single institution. Baseline characteristics and follow-up data were ascertained from a prospectively maintained institutional database. Of 491 PVI, 156 (31.8%) were performed through the RA. Anatomical locations for intervention were the femoral (44.8%), iliac (31.1%), popliteal (9.6%) peroneal (2.7%), tibial (9.9%), and subclavian (1.9%) arteries. Procedural access was obtained through the right RA (92.9%), left RA (4.5%), or right ulnar artery (2.6%) using the 6 French R2P Destination Slender sheath in 85, 105, and 119 cm lengths. Atherectomy was used in 34.7%. Mean contrast volume was 105.5 ml and the average fluoroscopy time was 18.5 minutes. Conversion to femoral access occurred in 3 cases (1.9%) because of arterial spasm and noncrossable lesions. Concomitant pedal access occurred in 2 cases (1.3%). Periprocedural complication rate was 3.84%, of which access-site hematoma was most common (3.2%); none required blood transfusion, surgical intervention, or additional hospital stay. There was 1 case (0.64%) of in-hospital stroke. The mortality rate at 30-day, 6-month, and 1-year was 1.4%, 2.8%, and 4.2%, respectively. In conclusion, RA access is feasible for diverse PVI, and future studies are needed to assess safety and benefit compared with femoral artery access.

Predictors of Transfemoral Access Site Complications in Neuroendovascular Procedures: A large Single-Center Cohort Study

OBJECTIVE

The transfemoral (TF) route has historically been the preferred access site for endovascular procedures. However, despite its widespread use, TF procedures may confer morbidity as a result of access site complications. The aim of this study is to provide the rate and predictors of TF access site complications for neuroendovascular procedures.

METHODS

This is a single center retrospective study of TF neuroendovascular procedures performed between 2017 and 2022. The incidence of complications and associated risk factors were analyzed across a large cohort of patients.

RESULTS

The study comprised of 2043 patients undergoing transfemoral neuroendovascular procedures. The composite rate of access site complications was 8.6 % (n = 176). These complications were divided into groin hematoma formation (n = 118, 5.78 %), retroperitoneal hematoma (n = 14, 0.69 %), pseudoaneurysm formation (n = 40, 1.96 %), and femoral artery occlusion (n = 4, 0.19 %). The cross-over to trans radial access rate was 1.1 % (n = 22). On univariate analysis, increasing age (OR=1.0, p = 0.06) coronary artery disease (OR=1.7, p = 0.05) peripheral vascular disease (OR=1.9, p = 0.07), emergent mechanical thrombectomy procedures (OR=2.1, p < 0.001) and increasing sheath size (OR=1.3, p < 0.001) were associated with higher TF access site complications. On multivariate analysis, larger sheath size was an independent risk factor for TF access site complications (OR=1.8, p = 0.02).

CONCLUSION

Several pertinent factors contribute towards the incidence of TF access site complications. Factors associated with TF access site complications include patient demographics (older age) and clinical risk factors (vascular disease), as well as periprocedural factors (sheath size).

Femoral Access-Site Complications with Tenecteplase versus Alteplase before Mechanical Thrombectomy for Large-Vessel-Occlusion Stroke

BACKGROUND AND PURPOSE

IV thrombolysis with alteplase before mechanical thrombectomy for emergent large-vessel-occlusion stroke is associated with access-site bleeding complications. However, the incidence of femoral access-site complications with tenecteplase before mechanical thrombectomy requires exploration. Here, femoral access-site complications with tenecteplase versus alteplase before mechanical thrombectomy for large-vessel-occlusion stroke were compared.

MATERIALS AND METHODS

All patients receiving IV thrombolytics before mechanical thrombectomy for large-vessel-occlusion stroke who presented from January 2020 to August 2022 were reviewed. In May 2021, our health care system switched from alteplase to tenecteplase as the primary thrombolytic for all patients with stroke, facilitating the comparison of alteplase-versus-tenecteplase femoral access-site complication rates. Major (requiring surgery) and minor (managed conservatively) access-site complications were assessed.

RESULTS

One hundred thirty-nine patients underwent transfemoral mechanical thrombectomy for large-vessel-occlusion stroke, of whom 46/139 (33.1%) received tenecteplase and 93/139 (66.9%) received alteplase. In all cases (n = 139), an 8F sheath was inserted without sonographic guidance, and vascular closure was obtained with an Angio-Seal. Baseline demographics, concomitant antithrombotic medications, and periprocedural coagulation lab findings were similar between groups. The incidence of conservatively managed groin hematomas (2.2% versus 4.3%), delayed access-site oozing requiring manual compression (6.5% versus 2.2%), and arterial occlusion requiring surgery (2.2% versus 1.1%) was similar between the tenecteplase and alteplase groups, respectively (P = not significant). No dissection, arteriovenous fistula, or retroperitoneal hematoma was observed.

CONCLUSIONS

Tenecteplase compared with alteplase before mechanical thrombectomy for large-vessel-occlusion stroke is not associated with an alteration in femoral access-site complication rates.

Comparing Outcomes of Transfemoral Versus Transbrachial or Transradial Approach in Carotid Artery Stenting (CAS)

BACKGROUND

While Transfemoral Carotid Artery Stenting (TFCAS) is a valid minimally invasive option for patients who also might be suitable for carotid endarterectomy (CEA) or transcarotid artery revascularization (TCAR), alternative access sites such as transbrachial (TB) or transradial (TR) are only utilized when anatomic factors preclude direct carotid or transfemoral access. In this study, we aimed to evaluate the outcomes of TR/TB access in comparison to TF for percutaneous carotid artery revascularization.

METHODS

All patients undergoing non-TCAR carotid artery stenting (CAS) from January 2012 to June 2021 in the Vascular Quality Initiative (VQI) Database were included. Patients were divided into 2 groups based on the access site for CAS: TF or TR/TB. Primary outcomes included stroke/death, technical failure and access site complications (hematoma, stenosis, infection, pseudoaneurysm and AV fistula). Secondary outcomes included stroke, TIA, MI, death, non-home discharge, extended length of postoperative stay (LOS) (>1 day), and composite endpoints of stroke/MI and stroke/death/MI. Univariable and multivariable logistic regression models were used to assess postoperative outcomes, and results were adjusted for relevant potential confounders including age, gender, race, degree of stenosis, symptomatic status, anesthesia, comorbidities, and preoperative medications.

RESULTS

Out of the 23,965 patients, TR/TB approach was employed in 819 (3.4%) while TF was used in 23,146 (96.6%). Baseline characteristics found men were more likely to undergo revascularization using TR/TB approach (69.4% vs. 64.9%, P = 0.009). Patients undergoing TR/TB approach were also more likely to be symptomatic (49.9% vs. 28.6%, P < 0.001). Guideline directed medications were more frequently used with TR/TB including P2Y12 inhibitor (80.3% vs. 74.7%, P < 0.01), statin (83.8% vs. 80.6%), and aspirin (88.3% vs. 84.5%, P = 0.003) preoperatively. On univariate analysis, patients with TB/TR approach experienced higher rates of adverse outcomes. After adjusting for potential confounders, TR/TB patients had no significant increase in the risk of stroke/death [aOR 1.10 (0.69-1.76), P = 0.675]; however, the use of TR/TB access was associated with a more than 2-fold increase in risk for in-hospital MI [aOR 2.39 (1.32-4.30), P = 0.004] and 2-fold increase in risk of technical failure [aOR 2.21 (1.31-3.73) P = 0.003]. The use of TR/TB access was also associated with a 50% reduction in the risk of access site complications [aOR 0.53 (0.32-0.85), P = 0.009].

CONCLUSIONS

This study confirms that although technically more challenging, TR or TB approach serves as a reasonable alternative with lower access site complications for CAS particularly in patients where anatomic factors preclude revascularization by TFCAS or TCAR. However, TR/TB is associated with an increased risk of technical failure and myocardial infarction, which requires further study.

Safety and efficacy of the SeparGateTM balloon-guiding catheter in neurointerventional surgery: A prospective, multicenter, single-arm clinical trial

Objective

To evaluate the safety and efficacy of the SeparGate™ balloon-guiding catheter (BGC) for blocking flow and delivering devices in neurointerventional surgery.

Method

This prospective multicenter single-arm trial enrolled patients who received BGC adjuvant therapy to provide temporary blood flow arrest of the supra-aortic arch arteries and their branch vessels in interventional therapy. The primary endpoint was immediate procedural success rate in flow arrest, device delivery, and withdrawal. The efficacy endpoints were intraoperative product performance, including rigidity, smoothness, fracture resistance of the catheter wall, catheter push performance, compatibility and radiopaque display, integrity, adhesion thrombus after withdrawal and balloon rupture. The safety endpoints were adverse and serious adverse events associated with the test device and serious adverse events resulting in death or serious health deterioration.

Result

A total of 129 patients were included; of them, 128 were analyzed in the full analysis set (FAS) and per protocol set (PPS). Immediate procedural success was achieved in 97.7% of patients with FAS and PPS. The lower bound of the 95% confidence interval was 94.6%, higher than the preset efficacy margin of 94%. Device-related adverse events occurred in 2 (1.6%) cases. One was mild adverse event of vasospasm, which resolved spontaneously. The other was serious adverse event of dissection aggravation, which was treated with stenting angioplasty. No device defects were observed.

Conclusion

In neurointerventional surgery, the SeparGate™ BGC can be used to temporarily block the flow of the supra-aortic arch arteries and their branch vessels and guide the interventional device to the target vascular position.

A Real World 10-Year Experience With Vascular Closure Devices and Large-Bore Access in Patients Undergoing Transfemoral Transcatheter Aortic Valve Implantation

Transcatheter aortic valve replacement (TAVR) has established itself as a safe and efficient treatment option in patients with severe aortic valve stenosis, regardless of the underlying surgical risk. Widespread adoption of transfemoral procedures led to more patients than ever being eligible for TAVR. This increase in procedural volumes has also stimulated the use of vascular closure devices (VCDs) for improved access site management. In a single-center examination, we investigated 871 patients that underwent transfemoral TAVR from 2010 to 2020 and assessed vascular complications according to the Valve Academic Research Consortium (VARC) III recommendations. Patients were grouped by the VCD and both, vascular closure success and need for intervention were analyzed. In case of a vascular complication, the type of intervention was investigated for all VCDs. The Proglide VCD was the most frequently used device (n = 670), followed by the Prostar device (n = 112). Patients were old (median age 83 years) and patients suffered from high comorbidity burden (60% coronary artery disease, 30% type II diabetes, 40% atrial fibrillation). The overall rate of major complications amounted to 4.6%, it was highest in the Prostar group (9.6%) and lowest in the Manta VCD group (1.1% p = 0.019). The most frequent vascular complications were bleeding and hematoma (n = 110, 13%). In case a complication occurred, 72% of patients did not need any further intervention other than manual compression or pressure bandages. The rate of surgical intervention after complication was highest in the Prostar group (n = 15, 29%, p = 0.001). Temporal trends in VCD usage highlight the rapid adoption of the Proglide system after introduction at our institution. In recent years VCD alternatives, utilizing other closure techniques, such as the Manta device emerged and increased vascular access site management options. This 10-year single-center experience demonstrates high success rates for all VCDs. Despite successful closure, a significant number of patients does experience minor vascular complications, in particular bleeding and hematoma. However, most complications do not require surgical or endovascular intervention. Temporal trends display a marked increase in TAVR procedures and highlight the need for more refined vascular access management strategies.

Percutaneous Radial Artery Access for Peripheral Vascular Interventions Is a Safe Alternative for Upper Extremity Access

OBJECTIVE

Percutaneous radial artery access is increasingly being used for peripheral vascular interventions (PVI). Our goal was to characterize practice patterns and perioperative outcomes among patients treated using PVI performed via radial artery access.

METHODS

The Vascular Quality Initiative was queried from 2016-2020 for PVI performed via upper extremity access. Univariable and multivariable analyses evaluated peri-procedure outcomes of radial artery access cases. A separate sample of brachial artery access cases was used as a comparator.

RESULTS

There were 520 radial artery access cases identified. Mean age was 69 ± 10 years and 41.3% were female sex. The majority were performed in the hospital outpatient setting (71.7%). Sheath sizes were ≤ 5 Fr (10%), 6 Fr (78%), and 7 Fr (12%). Ultrasound-guided access and protamine were used in 68.3% and 17.3% of cases, respectively. Interventions were aortoiliac (55%), femoropopliteal (55%), and infrapopliteal (9%). Stenting and atherectomy were performed in 55% and 19% of cases, respectively, and more often with 7 Fr sheaths. Access site complications were any hematoma (4.8%), including hematomas resulting in intervention (0.8%), pseudoaneurysms (1%), and access stenosis/occlusion (0.8%). On multivariable analysis, sheath size was not associated with access site complications. Percutaneous brachial artery access (n=1135) compared to radial access was independently associated with more overall hematomas (OR 1.73, 95% CI 1.06-2.81, P=.03), but access type was not associated with hematomas resulting in intervention (OR 2.15, 95% CI .69-6.72, P=.19).

CONCLUSIONS

Peripheral vascular interventions via radial artery access exhibit a low prevalence of post-procedural access site complications and are associated with fewer minor hematoma complications than interventions performed using brachial artery access. Radial artery access compared with brachial artery access is the preferred technique for peripheral vascular interventions.

Narrative review of vascular iatrogenic trauma and endovascular treatment

Iatrogenic injury is unfortunately a leading cause of morbidity and mortality for patients worldwide. The etiology of iatrogenic injury is broad, and can be seen with both diagnostic and therapeutic interventions. While steps can be taken to reduce the occurrence of iatrogenic injury, it is often not completely avoidable. Once iatrogenic injury has occurred, prompt recognition and appropriate management can help reduce further harm. The objective of this narrative review it to help reader better understand the risk factors associated with, and treatment options for a broad range of potential iatrogenic injuries by presenting a series of iatrogenic injury cases. This review also discusses rates, risk factors, as well as imaging and clinical signs of iatrogenic injury with an emphasis on endovascular and minimally invasive treatments. While iatrogenic vascular injury once required surgical intervention, now minimally invasive endovascular treatment is a potential option for certain patients. Further research is needed to help identify patients that are at the highest risk for iatrogenic injury, allowing patients and providers to reconsider or avoid interventions where the risk of iatrogenic injury may outweigh the benefit. Further research is also needed to better define outcomes for patients with iatrogenic vascular injury treated with minimally invasive endovascular techniques verses conservative management or surgical intervention.

Analysis of predictive and preventive factors for access complications associated with vascular closure devices in complicated endovascular procedures

PURPOSE

The main goal is to evaluate the effectiveness of angioseal and starclose vascular closure devices (VCDs) in high-risk patients under intensive anticoagulation who require therapeutic angiographic procedures and to discuss which factors are important in complications associated with VCDs.

MATERIALS AND METHODS

Medical records of the patients who underwent therapeutic complex interventional vascular procedures were reviewed retrospectively. One hundred sixty-six patients were divided into two groups regarding VCDs used for access-site closure after the procedure: group 1, (angioseal); group 2, (starclose). Data including patients' demographics and comorbidity information, procedural characteristics, and complications were analyzed.

RESULTS

The device deployment success rate was 100%. For the procedural characteristics, there was no significant difference between the groups except access site (P = 0.016) and sheath size > 6F (P = 0.0001). No major complications had occurred in none of the patients. Minor complications including hematoma, access-site pain, and access-site infection, except prolonged hemostasis did not differ significantly between groups. The patients' demographic and periprocedural factors were not significantly correlated with the development of complications.

CONCLUSION

Contrary to published reports, our study showed that demographic and periprocedural factors may not be responsible for the vascular access-site complications associated with VCDs.

Access-site complications in ultrasound-guided endovascular thrombectomy: a single-institution retrospective cohort study

OBJECTIVE

Mechanical endovascular thrombectomy (EVT) is an increasingly relied-on treatment for clot retrieval in the context of ischemic strokes, which otherwise are associated with significant morbidity and mortality. Despite several known risks associated with this procedure, there is a high degree of technical heterogeneity across both centers and operators. The most common procedural complications occur at the point of transfemoral access (the common femoral artery), and include access-site hematomas, dissections, and pseudoaneurysms. Other interventional fields have previously popularized the use of ultrasound to enhance the anatomical localization of structures relevant to vascular access and thereby reducing access-site complications. In this study, the authors aimed to describe the ultrasound-guided EVT technique performed at a large, quaternary neurovascular referral center, and to characterize the effects of ultrasound guidance on access-site complications.

METHODS

A retrospective chart review of all patients treated with EVT at a single center between January 2013 and August 2020 was performed. Patients in this cohort were treated using a universal, unique, ultrasound-guided, single-wall puncture technique, which bears several theoretical advantages over the standard technique of arterial puncture via palpation.

RESULTS

There were 479 patients treated with EVT within the study period. Twenty patients in the cohort were identified as having experienced some form of access-site complication. Eight (1.67%) of these patients experienced minor access-site complications, all of which were groin hematomas and none of which were clinically significant, as defined by requiring surgical or interventional management or transfusion. The remaining 12 patients experienced arterial dissection (n = 5), arterial pseudoaneurysm (n = 4), retroperitoneal hematoma (n = 2), or arterial occlusion (n = 1), with only 1.04% (5/479) requiring surgical or interventional management or transfusion.

CONCLUSIONS

The authors found an overall reduction in total access-site complications as well as minor access-site complications in the study cohort compared with previously published randomized controlled trials and observational studies in the recent literature. The findings suggested that there may be a role for routine use of ultrasound-guided puncture techniques in EVT to decrease rates of complications.

Development of a nursing outcome for a percutaneous procedure

OBJECTIVES

To develop a nursing outcome, consistent with the standardized format of outcomes within the nursing Outcomes Classification (NOC). This outcome will include an outcome label, an outcome definition, and clinical indicators. The proposed use for this outcome is to evaluate the access site of a percutaneous procedure.

METHODS

Concept analysis with a scoping review. Initially, content experts were recruited to validate the indicators of the proposed outcome in order to complete a consensus validation. After consensus validation, a review of the proposed outcome and its indicators was completed by two of the editors of the NOC team to confirm that the outcome label, definition, and indicators were consistent with the NOC taxonomy. During this review, edits were made on the label name and definition.

FINDINGS

After a series of reviews, the initial outcome of Vascular Status: Percutaneous Procedure Access was changed to Tissue Injury Severity: Percutaneous Procedure. In addition, the original definition of the condition of an access site for percutaneous procedure by venous or arterial puncture and health of surrounding tissues was edited to: Severity of complications from a needle-puncture access through the skin and into deeper tissues. The outcome has 11 indicators to be used to formulate a target rating for use in the clinical setting. The indicators were not edited over the course of the reviews.

CONCLUSION

The proposed outcome will assist nurses in evaluating the access site of percutaneous procedures and in identifying possible complications.

IMPLICATIONS FOR THE NURSING PRACTICE

This research contributes to the refinement of the NOC taxonomy by having a new outcome that meets clinical practice needs.

Safeguard pressure assisted device for local femoral hemostasis in neuroendovascular procedures: A single center study of 879 patients

BACKGROUND

Various vascular closure devices (VCDs) are available for local hemostasis after percutaneous transfemoral approach for neuroendovascular procedures but they have been associated with an increased complication rate and limitations to a re-puncture of the artery. We evaluated the safety and efficacy of Safeguard® 24 cm pressure assisted device (Merit Medical, West Jordan, UT, USA) and the associated complications.

METHODS

From September 2016 to December 2019, 879 patients underwent neuroendovascular procedures via transfemoral approach using an introducer sheath ranging from 4 to 6-French and they were included in a prospective database. We registered the demographic characteristics and procedural factors. We evaluated the device failure and associated complications.

RESULTS

The Safeguard® was successful in 862 cases (98.1 %) with post-procedural local bleeding in 17 patients (1.9%). On univariate analysis, an association with local bleeding was observed with age >60 years (Odds ratio [OR] = 3.2, P = 0.04) and the use of an introducer sheath >4 F ([OR] = 3.1, P = 0.007). Female gender, antithrombotic medication and type of procedure (diagnostic or interventional) were not associated with local bleeding. On binary logistic regression analysis, there was association only for age >60 years ([OR] = 3, P = 0.04).

CONCLUSION

The Safeguard® 24 cm is safe and efficient. It is simple to use and it can be applied independently from vessel anatomic characteristics. It should though be used with caution in case of a femoral introducer sheath larger than 4 Fr and patients older than 60 years.

Safety and efficacy of the SeparGate™ balloon-guiding catheter in neurointerventional surgery: Study protocol of a prospective multicenter single-arm clinical trial

Background

The balloon-guiding catheter (BGC) reportedly reduces the number of retrievals and occurrence of distal emboli, achieving superior revascularization results and improved clinical outcomes in acute stroke. This study will aim to examine the efficacy and safety of the new SeparGate™ BGC.

Design

This prospective multicenter single-arm clinical trial will aim to include 128 patients who fulfill its inclusion and exclusion criteria. All patients will receive endovascular interventional therapy with BGC assistance. The primary endpoint will be the immediate surgical success rate, while the secondary endpoint will be product performance. The safety evaluation will include serious adverse events such as puncture site hematoma and bleeding, cerebral vasospasm, vessel dissection, vessel perforation, air embolism, thrombus (acute or subacute), vessel occlusion, distal embolization, infection, adverse reaction to antiplatelet and anticoagulant drugs, intracranial hemorrhage, stroke, death, and device defect.

Discussion

The prospective multicenter trial will provide safety and efficacy information for the SeparGate™ BGC. Its findings will provide a clinical reference for endovascular adjuvant therapy of cerebrovascular disease.

Trial registration

ChiCTR1800014459.