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Gulmez R, Altunova M, Sahin AA, Celik O. A single center study of the efficacy and safety of Pro-Glide used for closure in thoracic endovascular aortic repair in patients with previous groin intervention. Vascular 2024:17085381241236560. [PMID: 38403595 DOI: 10.1177/17085381241236560] [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: 02/27/2024]
Abstract
BACKGROUND This study aimed to evaluate the efficacy and safety of Pro-Glide, a suture-mediated vascular closure device, regarding technical success and complications in patients who had undergone aortic intervention and had previous groin intervention (PGI). METHODS One hundred and thirty-five patients who underwent percutaneous thoracic endovascular aortic repair via the femoral artery and were closed with the Pro-Glide device were analyzed retrospectively. PGI was defined as a history of open surgical access to the femoral artery or wide sheath (>18 F) placement due to endovascular or valvular intervention. The patients were divided into two groups 38 cases with PGI and 97 cases without PGI. RESULTS The overall success rate of closure of the femoral artery with Pro-Glide was not statistically significant between the two groups (93.8% vs 92.1%, p = .711). Sheath sizes were compared between the groups and PGI (+) group had significantly higher sheath sizes compared to PGI (-) group (24.3 ± 1.1 F vs 23.8 ± 1.0 F, p = .011). Three patients in the PGI (+) group and six patients in the PGI (-) group experienced technical failure of the percutaneous femoral approach. Femoral complications were seen after the procedures in four patients in the PGI (+) group and four in the PGI (-) group. The PGI (+) group had a higher complication rate when compared to the PGI (-) group; however, this was not statistically significant (p = .181). CONCLUSION The present study was conducted on a significantly larger sample compared to previous studies and the findings suggest that the Pro-Glide vascular closure device is a safe option for patients with a history of PGI and may not be considered as a contraindication.
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Affiliation(s)
- Recep Gulmez
- Department of Cardiology, University of Health Sciences, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Altunova
- Department of Cardiology, University of Health Sciences, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Anil Sahin
- Department of Cardiology, Liv Bahcesehir Hospital, Faculty of Medicine, Istinye University, Istanbul, Turkey
| | - Omer Celik
- Department of Cardiology, University of Health Sciences, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
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Meertens MM, Tenorio ER, Lemmens CC, Marcondes GB, Lima GBB, Schurink GWH, Mendes BC, Oderich GS, Mees BME. Safety of Percutaneous Femoral Access for Endovascular Aortic Aneurysm Repair Through Previously Surgically Exposed or Repaired Femoral Arteries. J Endovasc Ther 2023; 30:730-738. [PMID: 35514295 PMCID: PMC10503241 DOI: 10.1177/15266028221092980] [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: 11/15/2022]
Abstract
OBJECTIVE Percutaneous femoral artery access is being increasingly used in endovascular aortic repair (EVAR). The technique can be challenging in patients with previously surgically exposed or repaired femoral arteries because of excessive scar tissue. However, a successful percutaneous approach may cause less morbidity than a "re-do" open femoral approach. The aim of this study was to assess the impact of prior open surgical femoral exposure on technical success and clinical outcomes of percutaneous approach. METHODS This study retrospectively reviewed the clinical data of patients who underwent percutaneous EVAR between 2010 and 2020 at 2 major aortic centers. Patients were divided into 2 groups (with or without prior open surgical femoral access) for analysis of clinical outcomes. Only punctures with sheaths ≥12Fr were included for analysis. The access and (pre)closure techniques were similar in both institutions. Primary end points were intraoperative technical success, access-related revision, and access complications. A multivariate analysis was performed to identify determinants of conversion to open approach and femoral access complications in intact and re-do groins. RESULTS A total of 632 patients underwent percutaneous (complex) EVAR: 98 had prior open surgical femoral access and 534 patients underwent de novo femoral percutaneous access. A total of 1099 femoral artery punctures were performed: 149 in re-do and 950 in intact groins. The extent of endovascular repair included 159 infrarenal, 82 thoracic, 368 fenestrated/branched, and 23 iliac branch devices. No significant differences were seen in technical success (re-do 93.3% vs intact 95.3%, p=0.311), access-related surgical revision (0.7% vs 0.6%, p=0.950), and access complications (2.7% vs 4.0%, p=0.443). For the whole group, significant predictors for access complications in multivariate analyses were main access site (odds ratio [OR] 2.39; 95% confidence interval [CI] 1.07%-5.35%; p=0.033) and increase of the procedure time per hour (OR 1.65; 95% CI 1.34%-2.04%; p<0.001), while increase in sheath-vessel ratio had a protective effect (OR 0.33; 95% CI 0.127%-0.85%; p=0.021). Surgical conversion was predicted by main access site (OR 2.32; 95% CI 1.28%-4.19%; p=0.007) and calcification of 50% to 75% of the circumference of the access vessel (OR 3.29; 95% CI 1.38%-7.86%; p=0.005). CONCLUSION Within our population prior open surgical femoral artery exposure or repair had no negative impact on the technical success and clinical outcomes of percutaneous (complex) endovascular aortic aneurysm repair.
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Affiliation(s)
- Max M. Meertens
- Department of Vascular Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
- European Vascular Center Aachen-Maastricht, Aachen, Germany
| | - Emanuel R. Tenorio
- Division of Vascular and Endovascular Surgery, University of Texas Health Science, Houston, TX, USA
| | - Charlotte C. Lemmens
- Department of Vascular Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
- European Vascular Center Aachen-Maastricht, Aachen, Germany
| | - Giulianna B. Marcondes
- Division of Vascular and Endovascular Surgery, University of Texas Health Science, Houston, TX, USA
| | - Guilherme B. B. Lima
- Division of Vascular and Endovascular Surgery, University of Texas Health Science, Houston, TX, USA
| | - Geert Willem H. Schurink
- Department of Vascular Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
- European Vascular Center Aachen-Maastricht, Aachen, Germany
| | - Bernardo C. Mendes
- Division of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Gustavo S. Oderich
- Division of Vascular and Endovascular Surgery, University of Texas Health Science, Houston, TX, USA
| | - Barend M. E. Mees
- Department of Vascular Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
- European Vascular Center Aachen-Maastricht, Aachen, Germany
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Mandigers TJ, Lomazzi C, Domanin M, Piffaretti G, van Herwaarden JA, Trimarchi S. Vascular Access Challenges in Thoracic Endovascular Aortic Repair: A Literature Review. Ann Vasc Surg 2022. [PMID: 37534575 DOI: 10.1016/j.avsg.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND This review aims to comprehensively summarize access challenges in thoracic endovascular aortic repair (TEVAR) by describing vascular access routes, associated risks, outcomes, and complications. METHODS A literature search was conducted utilizing the PubMed (Medline), Scopus, and Web of Science databases. Qualitative and quantitative data from selected studies are extracted and discussed according to available standards for narrative reviews. RESULTS In total, there were 109 eligible studies based on predefined inclusion- and exclusion criteria. There were 39 original articles or reviews and 57 case series or case reports. This article summarizes the evidence from these studies and discusses traditional retrograde access routes and techniques for TEVAR via a femoral or iliac route, with or without the use of conduits. Next, alternative antegrade access routes and techniques via a brachial, axillary, carotid, ascending aorta, transapical, transcaval, or another route are discussed. Vascular access complications are presented with specific attention to the importance of gender and alternative antegrade access routes. CONCLUSIONS Multiple access routes and techniques are currently available to overcome access challenges associated with TEVAR, based on low grade evidence from heterogeneous studies. Future research that compares different access routes and techniques might help in the development of a tailored access protocol for specific patients with challenging TEVAR access.
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Kontopodis N, Kehagias E, Tavlas E, Galanakis N, Tsetis D, Ioannou CV. The Use of a Suture Mediated Vascular Closure Device to Achieve Hemostasis following Arterial Access through Previously Implanted Synthetic Grafts. Ann Vasc Surg 2021; 73:496-499. [PMID: 33556517 DOI: 10.1016/j.avsg.2021.01.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/05/2021] [Accepted: 01/07/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Percutaneous endovascular aneurysm repair (EVAR) and peripheral interventions using the Perclose Proglide suture mediated system has not been adequately studied in patients with synthetic grafts at access sites. METHODS We report the use of the Perclose Proglide in 10 patients in whom previously inserted synthetic grafts in the groin were punctured for arterial access (5 for peripheral interventions and 5 undergoing EVAR). In patients undergoing peripheral interventions a single device was used, while in patients undergoing EVAR 2 devices were employed per access site. The preclosing technique was used in every case. RESULTS Hemostasis was achieved in all patients. No complications were observed except for a small laceration and a localized hemodynamically nonsignificant stenosis, without any clinical sequel. CONCLUSIONS This small case series indicates the feasibility of percutaneous access with the Perclose Proglide system to perform EVAR and peripheral endovascular interventions in the presence of synthetic grafts in the groin, with promising outcomes.
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Affiliation(s)
- Nikolaos Kontopodis
- Vascular SurgeryUnit, Department of Cardiothoracic and Vascular Surgery, University Hospital of Heraklion, Crete, Greece.
| | - Elias Kehagias
- Interventional Radiology Unit, Department of Radiology, University Hospital of Heraklion, Crete, Greece
| | - Emmanouel Tavlas
- Vascular SurgeryUnit, Department of Cardiothoracic and Vascular Surgery, University Hospital of Heraklion, Crete, Greece
| | - Nikolaos Galanakis
- Interventional Radiology Unit, Department of Radiology, University Hospital of Heraklion, Crete, Greece
| | - Dimitrios Tsetis
- Interventional Radiology Unit, Department of Radiology, University Hospital of Heraklion, Crete, Greece
| | - Christos V Ioannou
- Vascular SurgeryUnit, Department of Cardiothoracic and Vascular Surgery, University Hospital of Heraklion, Crete, Greece
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Endovascular Treatment of Spontaneous and Isolated Infrarenal Acute Aortic Syndrome with Unibody Aortic Stent-Grafts. World J Surg 2020; 44:4267-4274. [PMID: 32880679 PMCID: PMC7599153 DOI: 10.1007/s00268-020-05754-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2020] [Indexed: 11/01/2022]
Abstract
INTRODUCTION Spontaneous acute aortic syndrome (IAAS) is rarely localized in the infrarenal aorta. The endovascular approach is preferred over conventional open surgery with fewer complications. However, dedicated endovascular devices for IAAS treatment are unavailable. The aim was to report a large single-center experience using unibody stent-grafts to address IAAS. METHODS From April 2016 to March 2019, a retrospective analysis of patients presenting spontaneous and isolated IAAS was performed. Patients addressed with the unibody stent-graft (AFX endovascular AAA system; Endologix Inc., Irvine, CA) were included in the study. Indications to IAAS treatment were persistent symptoms and/or dilated abdominal aorta (>3 cm). The measured outcomes were technical success; early outcomes (<30 days) including mortality, morbidity, symptoms recurrence, and endoleak occurrence; and late outcomes (>30 days) including mortality, symptoms recurrence, endoleak occurrence, stent-graft patency, and survival. Median follow-up was 23.77 ± 10 months. RESULTS Twenty-one patients with IAAS were included. Indications to treatment were symptoms in 14 (67%) patients and dilated abdominal aorta in 7 (33%). Technical success was achieved in all cases. No perioperative mortality and 1 (4.8%) early femoral access complication was encountered. During the follow-up were registered 1 (4.8%) aortic unrelated death and 1 (4.8%) stent-graft limb stenosis. The 36 months estimated survival and freedom from reintervention were 92% (CI: 37-43; SE: 1.7) and 94% (CI: 37-44; SE: 1.7), respectively. CONCLUSIONS The endovascular treatment of IAAS with unibody stent-graft (AFX endovascular AAA system; Endologix Inc.) is safe and effective with promising mid-term outcomes. The use of unibody stent-grafts expands the endovascular indication, despite the usual anatomic IAAS features. Larger studies with longer follow-up are required to validate the outcomes of the reported technique.
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Çelik Ö, Şahin AA, Güner A, Demir AR, Uzun N, Ertürk M. Clinical efficacy and safety of the PRO-glide device as a sUture-mediated ClosurE in Thoracic EndoVascular Aortic Repair in patients with previous groin intervention (from the PRODUCE-TEVAR Trial). Vascular 2020; 29:237-243. [PMID: 32829695 DOI: 10.1177/1708538120949669] [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: 11/15/2022]
Abstract
BACKGROUND While the percutaneous approach is increasingly preferred, suture-mediated closure devices have been put into clinical practice to close the femoral artery during procedures requiring a large-sized introducer. However, scar in the groin is considered a contraindication or an exclusion criterion for percutaneous procedures. The aim of our study was to investigate the outcomes and safety of Pro-Glide device as suture-mediated closure device in patients who underwent thoracic endovascular aortic repair with percutaneous femoral access ≥22 F who had previous groin intervention. METHODS A total of 73 patients who underwent endovascular repair with percutaneous femoral access were retrospectively included in the study. Previous groin intervention was defined as history of open surgical access or large sheath insertion (>18 F) to femoral artery because of endovascular or valvular intervention. Patients were divided into two groups as who had previous groin intervention PGI (+) and had not PGI (-). RESULTS A total of 73 patients [60 male (82.2%)] were included in the study. Seventeen patients had PGI, and 56 did not. When groups were compared in terms of sheath sizes, a significantly higher sheath sizes were used in PGI (+) patients (24.5 ± 1.1 F vs. 23.8 ± 0.9 F, p = 0.005). The overall success rate in the femoral approach with pre-close technique was statistically insignificant between two groups (94.1% vs. 96.4%, p = 0.55). One patient in PGI (+) group and two patients in PGI (-) had technical failure for percutaneous femoral approach. One patient (5.9%) in PGI (+) group and one patient (1.8%) in PGI (-) group had femoral complications after the procedures; however, there was no significant difference between the groups in terms of complications (5.9% vs. 1.8%, p = 0.13). CONCLUSION Pro-Glide device may be a safe and less invasive method for femoral access in patients with PGI and might not be considered as a contraindication for patients with history of PGI.
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Affiliation(s)
- Ömer Çelik
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Anıl Şahin
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Güner
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ali Rıza Demir
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Nedim Uzun
- Department of Emergency Medicine, Gaziosmanpasa Taksim Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Ertürk
- Department of Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
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Hofmann M, Pecoraro F, Planer D, Pfammatter T, Puippe G, Bettex D, Veith FJ, Lachat M, Chaykovska L. Early outcomes with a single-sided access endovascular stent. J Vasc Surg 2018; 68:83-90.e2. [PMID: 29602473 DOI: 10.1016/j.jvs.2017.11.069] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 11/09/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The objective of this study was to report the 1-year follow-up study results of the new Horizon stent graft (Endospan, Herzliya, Israel) from two different prospective consecutive trials. The Horizon abdominal aortic aneurysm stent graft system is a 14F profile system requiring only a single access site. It consists of three modules, introduced separately: base limb (iliac to iliac limb); distal aortic limb; and proximal aortic limb with a bare suprarenal crown and active fixation. METHODS Data from the first in man (FIM) clinical study with 10 patients enrolled and the pivotal study with 30 patients were analyzed. Outcomes measured were freedom from major adverse events (MAEs) including all-cause mortality, myocardial infarction, renal failure, respiratory failure, paraplegia, stroke, bowel ischemia, and procedural blood loss ≥1000 mL. Performance end points included successful delivery and deployment of the device, freedom from aneurysm growth ≥5 mm, type I or type III endoleak, stent graft occlusion, conversion to open surgery, rupture, and stent graft migration. RESULTS In the FIM study, one conversion to open surgery with >1000 mL of blood loss was registered perioperatively. In the pivotal study, no perioperative MAE was registered. Overall, at 1-year follow-up, two deaths and one aneurysm growth unrelated to endoleak were registered. CONCLUSIONS The results of both the FIM and pivotal studies demonstrated that 39 of 40 procedures were successful for delivery and deployment of the Horizon stent graft. No MAE was registered during the follow-up. The primary safety and performance end points were met in both studies.
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Affiliation(s)
- Michael Hofmann
- Cardiovascular Surgery Unit, University Hospital Zurich, Zurich, Switzerland
| | - Felice Pecoraro
- Cardiovascular Surgery Unit, University Hospital Zurich, Zurich, Switzerland; Vascular Surgery Unit, AOUP "P. Giaccone", University of Palermo, Palermo, Italy.
| | - David Planer
- Department of Cardiology, Hadassah Medical Center, Jerusalem, Israel
| | - Thomas Pfammatter
- Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Gilbert Puippe
- Interventional Radiology, University Hospital Zurich, Zurich, Switzerland
| | - Dominique Bettex
- Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland
| | - Frank J Veith
- Cardiovascular Surgery Unit, University Hospital Zurich, Zurich, Switzerland; New York University Medical Center, New York, NY
| | - Mario Lachat
- Cardiovascular Surgery Unit, University Hospital Zurich, Zurich, Switzerland
| | - Lyubov Chaykovska
- Cardiovascular Surgery Unit, University Hospital Zurich, Zurich, Switzerland
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Pecoraro F, Lachat M, Cayne N, Pakeliani D, Rancic Z, Puippe G, Criado F, Pfammatter T, Veith F, Krüger B, Neff T. Mid-term Results of Chimney and Periscope Grafts in Supra-aortic Branches in High Risk Patients. Eur J Vasc Endovasc Surg 2017; 54:295-302. [DOI: 10.1016/j.ejvs.2017.06.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Accepted: 06/20/2017] [Indexed: 01/16/2023]
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