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The use of the Safeguard pressure-assisted device for maintenance of hemostasis following angiography in children. J Vasc Interv Radiol 2022; 33:1084-1088. [DOI: 10.1016/j.jvir.2022.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/29/2022] [Accepted: 04/07/2022] [Indexed: 11/22/2022] Open
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Requejo F, Teplisky DJ, Nguyen TN, Abdalkader M. Direct carotid artery access for neurointerventional procedures in infants. J Neurointerv Surg 2021; 14:973-975. [PMID: 34635579 DOI: 10.1136/neurintsurg-2021-018092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 09/16/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Femoral access is the primary route for neurointerventional procedures in children. However, endovascular treatment may not always be possible through a femoral approach, necessitating conversion to alternative access routes. OBJECTIVE To review the feasibility and safety of direct carotid puncture (DCP) in infants undergoing neuroendovascular interventions. METHODS We conducted a retrospective review of all infants who underwent DCP as the access route to treat neuroendovascular pathologies between January 2011 and January 2021. Patients' demographics, clinical presentation, imaging findings, and technical details were reviewed. RESULTS Between January 2011 and January 2021, five infants aged between 28 and 150 days underwent DCP out of 1129 neuroendovascular interventions performed in our institution (0.4%). All five infants (100%) were diagnosed with intracranial fistulas and were found to have severe tortuosity of the cervical arteries. DCP was performed as the initial access route in 2/5 patients and as crossover after a failed femoral attempt in 3/5 patients. DCP was performed under ultrasound guidance in all patients. Closure was performed by manual compression, without complications. Ultrasound showed patent cervical vessels in all patients at 3 months' follow-up. CONCLUSION Direct carotid access is a feasible and safe alternative route to treat neuroendovascular pathologies in infants and can be considered in cases of inaccessible or failed transfemoral access or in cases with severe arterial tortuosity in infants with intracranial fistulas.
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Affiliation(s)
- Flavio Requejo
- Department of Pediatric Interventional Neuroradiology, Hospital de Pediatría Prof Dr Juan P Garrahan, Buenos Aires, Argentina
| | - Darío Javier Teplisky
- Department of Pediatric Interventional Radiology, Hospital de Pediatría Prof Dr Juan P Garrahan, Buenos Aires, Argentina
| | - Thanh N Nguyen
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Mohamad Abdalkader
- Department of Radiology, Boston Medical Center, Boston, Massachusetts, USA
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Chaudhary N, Elijovich L, Martinez M, Fifi JT, Ortega-Gutierrez S, Shaibani A, Pandey AS, Suzuki S, Field RR, Gemmete JJ, Cooke DL, Narayanan S, Hetts SW, Orbach DB, Pearl MS. Pediatric diagnostic cerebral angiography: practice recommendations from the SNIS Pediatric Committee. J Neurointerv Surg 2021; 13:762-766. [PMID: 33875551 DOI: 10.1136/neurintsurg-2021-017389] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/25/2021] [Accepted: 03/28/2021] [Indexed: 12/24/2022]
Affiliation(s)
- Neeraj Chaudhary
- Radiology, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Lucas Elijovich
- Departments of Neurology and Neurosurgery, Semmes-Murphey Clinic, Memphis, Tennessee, USA
| | - Mesha Martinez
- Neurointerventional Radiology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Johanna T Fifi
- Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Santiago Ortega-Gutierrez
- Division of Neurointerventional Surgery-Interventional Neuroradiology, University of Iowa, Iowa City, Iowa, USA
| | - Ali Shaibani
- Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Radiology, Northwestern Memorial HealthCare Corp, Chicago, Illinois, USA
| | - Aditya S Pandey
- Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Shuichi Suzuki
- Neurosurgery, University of California Irvine, Orange, California, USA
| | - R Ryan Field
- Anesthesia, Neurosurgery, University of California Irvine, Orange, California, USA
| | - Joseph J Gemmete
- Radiology and Neurosurgery, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Daniel L Cooke
- Radiology and Biomedical Imaging, University California San Francisco, San Francisco, California, USA
| | - Sandra Narayanan
- Neurology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Darren B Orbach
- Neurointerventional Radiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Monica S Pearl
- Radiology, Children's National Hospital, Washington, District of Columbia, USA .,Radiology and Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
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Starke RM, Snelling B, Al-Mufti F, Gandhi CD, Lee SK, Dabus G, Fraser JF. Transarterial and transvenous access for neurointerventional surgery: report of the SNIS Standards and Guidelines Committee. J Neurointerv Surg 2019; 12:733-741. [PMID: 31818970 DOI: 10.1136/neurintsurg-2019-015573] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 11/07/2019] [Accepted: 11/12/2019] [Indexed: 12/11/2022]
Abstract
The purpose of this publication is to provide a comprehensive review on the techniques and tools used for vascular access in neurointerventional procedures. Using published literature, we reviewed data on access methods, sites, tools, and techniques for neurointerventions. Recommendations are provided based on quality of data/levels of evidence and, where appropriate, expert consensus. While tools and techniques continue to be developed, current literature and experience supports certain principles regarding vascular access for neurointerventional procedures.
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Affiliation(s)
- Robert M Starke
- Neurological Surgery, University of Miami MILLER School of Medicine, Miami Beach, Florida, USA.,Neurosurgery, Westchester Medical Center, Valhalla, New York, USA
| | - Brian Snelling
- Neurological Surgery, University of Miami MILLER School of Medicine, Miami Beach, Florida, USA.,Neurosurgery, Westchester Medical Center, Valhalla, New York, USA
| | - Fawaz Al-Mufti
- Neurology and Neurosurgery, Westchester Medical Center, Valhalla, New York, USA
| | - Chirag D Gandhi
- Neurosurgery, Westchester Medical Center, Valhalla, New York, USA
| | - Seon-Kyu Lee
- Radiology, Montefiore Hospital and Medical Center, Bronx, New York, USA
| | - Guilherme Dabus
- Interventional Neuroradiology and Neuroendovascular Surgery, Miami Cardiac and Vascular Institute and Baptist Neuroscience Center, Miami, Florida, USA
| | - Justin F Fraser
- Neurological Surgery, University of Kentucky, Lexington, Kentucky, USA
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An update on the use of an arterial closure device following femoral arterial puncture in children. Pediatr Radiol 2019; 49:1217-1221. [PMID: 31190109 DOI: 10.1007/s00247-019-04442-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 05/13/2019] [Accepted: 05/28/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND The use of arterial closure devices in achieving femoral hemostasis has been well documented in adults but insufficiently studied in the pediatric population. An earlier study from our institution of 40 Angio-Seal devices in 38 patients concluded that the arterial closure device is safe in children with only a single minor complication. Ongoing experience with this device at our institution, however, suggests a higher rate of complication. OBJECTIVE To retrospectively evaluate the safety and efficacy of the Angio-Seal in a pediatric population. MATERIALS AND METHODS A retrospective analysis reviewed all cases in which the Angio-Seal was deployed from June 2011 to September 2017. Peri-procedural documentation was reviewed for pre-procedure labs, clinical effectiveness in achieving hemostasis and complications related to the use of this device. Logistic regression analysis was also used to evaluate the relationship between patient demographic, vessel size and indication for angiography, and the presence or absence of complications. RESULTS During the study period, 48 additional Angio-Seal devices were deployed in 41 consecutive patients. Five patients were excluded for being older than 18 years. The mean age of the patients was 13.3 years (range: 4-18 years) with 18 patients female. The mean common femoral artery diameter was 5.98 mm in short axis diameter (range: 4-9 mm). Complications were present in 6/43 cases (14%) including 3 minor and 3 major complications that included additional procedures. No significant relationship was identified between vessel size, age and the indication for angiography, and the rate of complication on logistic regression analysis. CONCLUSION While percutaneous arterial closure devices can be efficacious for achieving hemostasis, our experience demonstrates a higher rate of complications in children, contrary to a previous report. The deployment of such devices should be performed with prejudice in this population.
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