Access Site Complications Research Articles

Safety and feasibility of simultaneous left and right heart catheterization via single-arm arterial and venous access.

Catheterization via the radial artery has become the method of choice for evaluation of the coronary arteries; however in patients requiring simultaneous coronary and right heart catheterization upper extremity access is not commonly used. In the present study we aimed to assess whether simultaneous left and right heart catheterization via the radial artery and antecubital vein might increase the vascular access site complications. In this prospective cohort study, 49 patients with congenital and valvular heart disease requiring both left and right heart catheterization were enrolled, and rates of vascular access complications, including radial artery obstruction (RAO), were compared to 49 subjects in the control group who underwent catheterization only via radial artery access. No major vascular complications occurred in the study population. Post-procedural radial artery obstruction was detected in 14 patients (28.5%) in the venous-radial artery group and 7 (14.2%) in the control group (P = 0.09). Age, sex, body mass index, wrist circumference, hemoglobin concentrations, and history of smoking, diabetes mellitus, hypertension, and anticoagulant use did not affect the rate of radial pulse perseverance. However, shorter times of radial compression device removal were significantly related to lower rates of radial artery obstruction in both groups. Right and left heart catheterization via an upper-extremity route in patients with congenital and valvular heart disease is safe and practical with greater patient comfort and no serious vascular complications. A longer duration of radial compression is an important predictor of RAO, regardless of using additional upper-extremity venous access.

Feasibility and Safety of Transradial Aneurysm Embolization: A Systematic Review and Meta-Analysis

Use of the transradial access (TRA) approach for neuroendovascular procedures has been increasing in recent years. Our aim is to assess the feasibility, success rate, and complications associated with TRA for intracranial aneurysm embolization. PubMed, Scopus, and Embase were systematically searched for studies using TRA for intracranial aneurysm embolization. Random-effects models were used to obtain pooled rates of procedural success and complications. Twenty-four studies comprising 1283 (85.9%) TRA and 122 (8.2%) distal TRA aneurysm embolization procedures were included. The pooled success rate of the 18 studies in the meta-analysis was 93.5% (95% confidence interval [CI], 91.1%-95.8%). The pooled thromboembolic complication rate was 0.5% (95% CI, 0.1%-0.9%), the hemorrhagic complication rate was 0.5% (95% CI, 0.1%-0.9%), and the access site complication rate was 0.8% (95% CI, 0.3%-1.3%). One study (4.3%) used exclusively a 7-French guide catheter, and most used a 6-French guide catheter (22 of 23 studies, 95.7%), which was further incorporated as part of a triaxial configuration through a sheathless 8-French system in 4 studies (17.4%), 7-French guide catheter in 2 studies (8.7%), and 8-French sheath in 1 study (4.3%). The embolization techniques used were flow diverter placement in 451 cases (39.1%), coiling in 376 (32.6%), stent-assisted coiling in 127 (11.0%), balloon-assisted coiling in 104 (9.0%), Woven EndoBridge system in 50 (4.3%), and flow diverter placement plus coiling in 42 (3.6%). Treating intracranial aneurysms using various embolization techniques through TRA is feasible and associated with low access site and intraoperative complications.

Abstract No. 117 Effect of preprocedural antiplatelet and anticoagulant use on antegrade access site complication rate during lower extremity peripheral arterial disease interventions

To determine the complication rate of antegrade femoral artery access in patients on anti-platelet and/or anticoagulant medications during peripheral arterial interventions

Abstract No. 517 How many times can a radial artery be accessed?

Radial access has several advantages over femoral access, including lower access site complication rates, reduced periprocedural pain and shorter recovery times. On the other hand, post-procedural arterial occlusion occurs more frequently after radial access compared with femoral access which can be a limitation in patients who require repeat transarterial procedures. Limited data is available regarding how many times a radial artery can be accessed for interventional procedures. The purpose of this study was to evaluate radial artery access in patients who underwent 4 or more transradial procedures via the same radial artery.

Access site complications are uncommon with vascular closure devices or manual compression after lower extremity revascularization

ObjectiveVascular closure devices (VCDs) and manual compression (MC) are used to achieve hemostasis after peripheral vascular interventions (PVIs). We sought to compare perioperative outcomes between MC and four VCDs after PVI in a multicenter setting. MethodsThe Vascular Quality Initiative was queried for all lower extremity PVIs with common femoral artery access performed from 2010 to 2020. The VCDs included were MynxGrip (Cordis, Santa Clara, CA), StarClose SE (Abbott Vascular, Redwood City, CA), Angio-Seal (Terumo, Somerset, NJ), and Perclose ProGlide (Abbott Vascular). In a blinded fashion, these four VCDs (labeled A, B, C, and D) were compared to MC for baseline characteristics, procedural details, and outcomes (access site hematoma and stenosis/occlusion). Those with a sheath size >8F were excluded. Propensity score matching (1:1) was performed. Univariable and multivariable analyses were completed for unmatched and matched data. ResultsA total of 84,172 lower extremity PVIs were identified. Of these, 32,013 (38%) had used MC and 52,159 (62%) had used VCDs (A, 12,675; B, 6224; C, 19,872; D, 13,388). The average age was 68.7 years, and 60.4% of the patients were men. The most common indications for intervention were claudication (43.8%) and tissue loss (40.1%). Compared with MC, VCDs were used more often for patients with obesity, diabetes, and end-stage renal disease (P < .001 for all). VCDs were used less often for patients with hypertension, chronic obstructive pulmonary disease, coronary artery disease, prior percutaneous coronary and extremity interventions, and major amputation (P < .001 for all). VCD use was more common than MC during femoropopliteal (73% vs 63.8%) and tibial (33.8% vs 22.3%) interventions but less common with iliac interventions (20.6% vs 34.7%; P < .001 for all). Protamine was used less often with VCDs (19.1% vs 25.6%; P < .001). Overall, 2003 hematomas had developed (2.4%), of which 278 (13.9%) had required thrombin or surgical intervention. Compared with MC, the use of any VCD had resulted in fewer hematomas (1.7% vs 3.6%; P < .001) and fewer hematomas requiring intervention (0.2% vs 0.5%; P < .001). When divided by hemostatic technique, the rate of the development of any hematoma was as follows: MC, 3.6%; VCD A, 1.4%; VCD B, 1.2%; VCD C, 2.3%; and VCD D, 1.1% (P < .001). The rate of hematomas requiring intervention was as follows: MC, 0.5%; VCD A, 0.2%; VCD B, 0.2%; VCD C, 0.3%; and VCD D, 0.1% (P < .001). Access site stenosis/occlusion was similar between the MC and any VCD groups (0.2% vs 0.2%; P = .12). Multivariable analysis demonstrated that any VCD use and the use of the individual VCDs compared with MC were independently associated with the development of fewer hematomas. The incidence of access site stenosis/occlusion was similar between the use of any VCD and MC. The matched analysis revealed similar findings. ConclusionsAlthough the overall rates of hematomas requiring intervention were low regardless of hemostatic technique, VCD use, irrespective of type, compared favorably with MC, with significantly fewer access site complications after PVI.

Access Site Complications by Intracardiac Interventions

In recent decades, the number of intracardiac procedures using percutaneous puncture access has increased manifold. Despite the acquisition by operators of expertise and standardization of methods, the problem of complications remains relevant.&#x0D; AIM: to analyze the frequency and nature of complications of percutaneous access in intracardiac interventions. Suggest recommendations to reduce the incidence of complications.&#x0D; MATERIALS AND METHODS: analysis of data published in international peer-reviewed journals on the topic, as well as the experience of the vascular surgery clinic of St. Katarina's Hospital.&#x0D; CONCLUSIONS: the frequency and severity of complications depend on the experience of the operator, the size and frequency of changing the instrument, as well as compliance with the rules of preoperative diagnosis and postoperative management of the patient.&#x0D; RECOMMENDATIONS: standardized preoperative preparation, careful planning of the intervention, analysis of the state of the access vessels, compliance with the rules of vessel puncture and competent performance of postoperative compression in combination with the use of suturing devices according to indications can reduce the frequency and severity of complications.

Dialysis-dependent Patients Have Increased Risk of Myocardial Infarction and Perioperative Death Following Carotid Revascularization Using Transcarotid Artery Revascularization

Dialysis-dependent patients have been reported to have high rates of stroke and death following carotid revascularization; however, recent data suggests that outcomes for the treatment of carotid stenosis in dialysis-dependent patients may be better than previously surmised. The effect of dialysis dependence on outcomes following transcarotid artery revascularization (TCAR) remains unclear. We aimed to study outcomes following the treatment of symptomatic and asymptomatic carotid stenosis using TCAR among dialysis-dependent patients. The Vascular Quality Initiative was used to assess all patients undergoing TCAR. Outcomes were compared between dialysis-dependent patients and those who were not. Patients with asymptomatic and symptomatic carotid stenosis were assessed separately. Primary outcomes included perioperative mortality, stroke, and transient ischemic attack (TIA). Secondary outcomes included myocardial infarction, overall cardiac complications, surgical site infection, length of stay, access site complications, cranial nerve injury, and hemodynamic instability. Cardiac complication included myocardial infarction, congestive heart failure and/or dysrhythmias. Univariate and multivariable analysis using multivariable logistic regression and cox regression models were used. A total of 20,927 patients undergoing TCAR were identified from 2016 to 2021. Among patients with asymptomatic carotid stenosis 12,275 (98.6%) were not on dialysis and 173 patients (1.4%) were on dialysis. Among patients with symptomatic carotid stenosis 8348 (98.5%) were not on dialysis, and 128 patients (1.5%) were on dialysis. Among asymptomatic and symptomatic patients, dialysis was not associated with an increased risk of perioperative stroke or TIA (Table). Asymptomatic dialysis-dependent patients had increased risk of perioperative mortality (0.7% vs 4.6%; P < .001), myocardial infarction (0.5% vs 2.3%; P = .002), and cardiac complications (1.9% vs 4.6%; P = .011). All dialysis patients had increased risks of prolonged length of stay. After adjustment, asymptomatic patients remained at increased odds of perioperative mortality (odd ratio [OR], 5.8; 95% confidence interval [CI], 2.2-15.0), stroke/mortality (OR, 2.9; 95% CI, 1.2-6.8), myocardial infarction (OR, 3.3; 95% CI, 1.1-9.2), and overall cardiac complications (OR, 2.2; 95% CI, 1.1-4.6). Perioperative revascularization outcomes among dialysis-dependent patients undergoing TCAR for carotid artery stenosis demonstrate acceptable stroke and TIA, when compared with nondialysis patients. Similar to previous studies studying carotid endarterectomy and carotid artery stenting, dialysis dependence is associated with increased risk of myocardial infarction and perioperative mortality following TCAR. Thus, carotid revascularization should be used selectively in asymptomatic dialysis-dependent patients.TablePerioperative outcomesAsymptomatic (n = 12,448)Symptomatic (n = 8476)No dialysis (n = 12,275, 98.6%)Dialysis (n = 173, 1.4%)P valueNo dialysis (n = 8,348, 98.5%)Dialysis (n = 128, 1.5%)P valuePerioperative mortality650.7%54.6%<.001891.5%22.5%.495Stroke/perioperative mortality1671.9%65.6%.0062334.0%44.9%.658Stroke1130.9%21.2%.7411712.0%21.6%.699TIA500.4%10.6%.722660.8%21.6%.333MI660.5%42.3%.002490.6%00.0%.381Cardiac complication2341.9%84.6%.0111922.3%43.1%.564Surgical site infection30.0%00.0%.83830.0%00.0%.831LOS >2 days146612%4224%<.001308937%6551%.001Access site complications3342.7%84.6%.1302372.8%00.0%.053Cranial nerve injury230.2%00.0%.569290.4%00.0%.496Hemodynamic instability (requiring IV medications).099.064 Hypotension203857%2847%130454%2341% Hypertension151643%3253%112646%3359%IV, intravenous; LOS, length of stay; MI, myocardial infarction; TIA, transient ischemic attack.Neurological events include stroke or TIA; cardiac complications include MI, congestive heart failure, and dysrhythmia. Boldface entries indicate statistical significance. Open table in a new tab

Acute safety and efficacy outcome of pulmonary vein isolation using pulsed field ablation technology

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Pulsed field ablation (PFA) is a new technology for electrical isolation of pulmonary veins (PVI) using electroporation for irreversible cell death. First data imply a very low complication rate in terms of esophageal lesion, phrenic nerve palsy and pulmonary vein stenosis. We present our datas of our first patients concerning acute safety and efficacy. Method 38 patients with paroxysmal and persistent atrial fibrillation (AF) consecutively underwent PFA ablation including complete PVI of all pulmonary veins in all cases (including 14 redo cases ), mean age 68,3 year, and a mean ejection fraction of 56 %, mean CHADSVASC Score 3. 19 patients had paroxysmal AF, in 21 patients additional posterior wall isolation was performed. Additional anatomical and voltage characterization with CARTO was performed before and after ablation. Post ablation, all patients underwent endoscopic evaluation of the esophagus and all eligible patients were screened for silent cerebral lesions (SCL) using cerebral magnetic resonance imaging (MRI). All acute procedure data and complications were documented. Results In all 38 patients effective PVI using only PFA catheter was achieved (100 %) within a mean procedure time of 81±15 min and a mean fluoroscopy time of 18± 5 min. In 2 patients left atrial macroreentrant tachycardia was effectively terminated with PFA pulses in the PV-mitral-annular isthmus region. In no patient an esophageal lesion could be detected (0%). Cerebral MRI was performed in 18 cases and revealed SCLs (47 %) in 5 patients (3 patients with multiple lesions, 2 patiens with 3 lesions, max size of 8 mm). No symptomatic complications including pericardial effusion or access site complications were noted. Conclusion PFA is a highly effective method for acute PVI. No relevant symptomatic complications were noted. Of note, no patient had esophageal injury related to the ablation but 40% of patients undergoing post-ablation MRI had documented SCE. Further data have to be collected to discuss these findings properly.

A National Registry Analysis Comparing Extremity Access for Complex Aneurysm Repairs

Physician-modified endografts (PMEGs) and custom-manufactured devices (CMDs) have traditionally been deployed through a combination of upper and lower extremity access. Single-institution studies have demonstrated increased risks of access site complications and stroke when upper extremity access was used compared with a total transfemoral approach. This study compared the outcomes after the use of PMEGs and CMDs in a large national database between transfemoral-only access and mixed upper extremity access.

Improving procedural success rate of retrograde ethanol infusion in the vein of Marshall

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Retrograde ethanol infusion in the vein of Marshall (VOM) is a relatively new adjunctive therapy of atrial arrhythmias. The VOM is an epicardial left atrial vein. Its surrounding autonomic ganglia and proarrhythmogenic muscle fibers are accepted extrapulmonary triggers of AF and can be ablated by retrograde ethanol infusion. This facilitates the achievement of bidirectional mitral isthmus block. Moreover, it seems to improve outcomes in terms of rhythm stability if performed in addition to RF ablation in persistent atrial fibrillation. However, retrograde ethanol infusion in the vein of Marshall (VOM) can be technically challenging. Technical improvement of the procedure has the potential of higher primary success rate and therefore may secondary lead to better outcome of interventional therapy of persistent AF. Purpose International experienced centers achieve an acute procedural success rate around 85%. The purpose of our investigation was to study the impact of adding procedural techniques to the standard procedure as described before on the acute procedural success. Methods We analyzed all ethanol infusions in the VOM performed in our department between Nov 2019 and Nov 2021. Our standard approach resembles the technique published before primarily performed via a transfemoral access. If a VOM is angiographically not visible using the standard approach, we perform a rotational angiography. In case of negative angiography of the VOM, we try the atraumatic wiring assuming a typical anatomical location of the vein draining just proximal of the valve of Vieussens into the CS. If very proximal location of the VOM in the CS led to an instable catheter via transfemoral access we used transjugular access and a CRT-sheath. We collected data on additionally used techniques and their value for acute procedural success. All data are given as mean ± SD or number/percentages. Results Ethanol infusions were mostly performed as standalone procedures (136/147, 92,5%) or in a minority of cases as adjunctive therapy during RF-ablation. The ethanol infusion was succesful in 143 of the 147 patients (97%). In 21 patients (14%) extention of the technique exceeding the standard approach led to a succesful procedure. A rotational angiography revealed a previously not visible VOM in 5 patients (3,4%). Atraumatic wiring of the angiographic negative VOM in typical position was successful in 11 patients (7,5%). 5 patients (3,4%) benefitted from a transjugular venous access. Periprocedural complications were rare. We observed no vascular access site complications or pericardial effusion/tamponade. One patient suffered from a transient ischemic attack one week after the procedure. Conclusions Acute procedural success of ethanol infusion in the VOM amounted to 83% using the standard approach. We were able to improve the success rate to 97% by adding further imaging and modifying the technical approach while the positive safety profile remained.

Real-World Data Showing Lack of Complications Without Use of Closure Devices in the Office-based Vascular Procedure Center

Closure devices are available in a range of different schemata to close the percutaneous arteriotomy. Although they may contribute to room turnover and increased time to ambulation, they carry the risk of dissection, thrombosis, failure, and expense that may bring a patient back for an avoidable operation, causing undue stress to a patient who elected to avoid the hospital to seek office-based care. In addition, there is hardship of a foreign object in the skin, increasing inflammation and scarring should the groin need to be reaccessed or exposed. In an office-based setting where adequate manual pressure can be held, their use may be obviated and unnecessary. Without real-world examples of protocols and complication rates, many surgeons may be uncomfortable with this transition. Using our Vascular Quality Initiative database, all patients who underwent an office-based endovascular procedure in which groin access was employed (aortic, iliac, or peripheral stenting, balloon angioplasty, atherectomy, and diagnostic angiograms) from 2015 to 2021 were identified. These procedures were elective and mainly for occlusive disease. Preoperative patient characteristics, procedure characteristics, and access-related outcomes were analyzed. Access guidance was uniformly obtained with ultrasound imaging. In our protocol, protamine is administered routinely. Fifteen minutes of pressure is uniformly held on each groin by the surgical technician, over an area marked out by the surgeon. The patient lays flat for 3-4 hours afterward, depending on sheath size. Patients are reached by telephone 1-3 days after their procedure to assess their immediate postprocedure status. Five hundred eighty-three patients met inclusion criteria. These were 61% male, 67% White, and 30% African American, with an average body mass index of 28. Thirty-six percent needed assistance with daily activities. Thirty percent had coronary artery disease, 22% chronic obstructive pulmonary disease, 45% diabetes mellitus, and 45% were smokers. Preoperative medications that included 73% aspirin and 57% clopidogrel. Redo-groin status was in 61% of patients. On average, largest sheath size was 6F, ranging from 4F to 8F. Protamine was administered in >80% of cases. Access site complication requiring additional observation was 0.5% (n = 3) and these were all hematomas. There were no postprocedure bleeds on follow-up. Any sort of postprocedure complication was 0.9%. Complication causing hospital admission was 0.2%, and none were related to access. The use of closure devices incurs the added risk. These data show a 6-year experience in the office-based setting that not using closure devices and instead using manual pressure is safe without significant complication. This should prompt discussion regarding the necessity of using closure devices in office-based endovascular procedures.

Transradial versus Transfemoral Approaches in Diagnostic and Therapeutic Neuroendovascular Interventions: A Meta-Analysis of Current Literature

The adoption of the transradial approach (TRA) has been increasing in popularity as a primary method to conduct both diagnostic and therapeutic interventions. As this technique gains broader acceptance and use within the neuroendovascular community, comparing its complication profile with a better-established alternative technique, the transfemoral approach (TFA), becomes more important. This study aimed to evaluate the safety of TRA compared with TFA in patients undergoing diagnostic, therapeutic, and combined neuroendovascular procedures. A systematic review and meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A literature search of PubMed and other databases was conducted for studies from all available dates. To compare TRA and TFA, we performed an indirect meta-analysis between studies that mentioned the complications of the procedures. Our search yielded 532 studies, of which 108 met full inclusion criteria. A total of 54,083 patients (9137 undergoing TRA and 44,946 undergoing TFA) were included. Access site complication rate was lower in TRA (1.62%) compared with TFA (3.31%) (P < 0.01). Neurological complication rate was lower in TRA (1.64%) compared with TFA (3.82%) (P= 0.02 and P < 0.01, respectively). Vascular spasm rate was higher in TRA (3.65%) compared with TFA (0.88%) (P < 0.01). Wound infection complication rate was higher in TRA (0.32%) compared with TFA (0.2%) (P < 0.01). Patients undergoing TFA are significantly more likely to experience access site complications and neurological complications compared with patients undergoing TRA. Patients undergoing TRA are more likely to experience complications such as wound infections and vascular spasm.

Left Subclavian Artery Coverage is Not Associated with Neurological Deficits in Trauma Patients Undergoing Thoracic Endovascular Repair

Endovascular repair of the thoracic aorta (TEVAR) outcomes have been studied with an interest in complications related to left subclavian artery (LSA) coverage in patients with atherosclerotic pathologies; however, specific data on the management of the LSA in a trauma population are lacking. The objective of this study is to evaluate outcomes following TEVAR for traumatic aortic injury based on LSA coverage. The Vascular Quality Initiative thoracic endovascular aortic repair module (2010-2017) was analyzed. Patients were included if they had a traumatic aortic injury requiring TEVAR. Patients were placed in 2 groups based on coverage of the LSA. Patients were propensity score matched and the primary outcomes were cerebrovascular symptoms and spinal cord ischemia. Additional clinical and resource utilization outcomes were analyzed. Four hundred and fifty one patients were included in the analysis. There were 268 patients in the LSA not-covered group and 183 patients in the LSA covered group. The mean aortic injury grade was 2.88±0.056 vs. 2.88±0.049 in the covered versus not-covered group (P=0.957). Glasgow coma scale and injury severity score were not different between the groups. There was no difference between groups for cerebrovascular symptoms or spinal cord ischemia, 1.4% vs. 2.8%, P=0.684 and 0% vs. 2.1%, P=0.247, after propensity score matching. Significant differences in access site complications and resource utilization were identified between groups. This is the largest series to evaluate complications based on LSA coverage following TEVAR in trauma patients. Our data demonstrate that coverage of the LSA during TEVAR following blunt trauma is associated with no difference in central nervous system outcomes. As such, LSA revascularization strategies, while possible, are not directly supported by these data and should be individualized based on each patient's specific clinical scenario.

Access Site Complications and Management of the Transradial Approach for Neurointerventions.

The transradial approach has increasingly been used for neurointerventions because of the improved safety profile compared with transfemoral. However, it is important to be aware of potential complications such as radial artery (RA) spasm, RA occlusion, pseudoaneurysm, extravasation, arteriovenous fistula, and wrist hematoma as well as their management. To present our institution's experience with the prevention and management of local access site complications associated with the transradial approach for neuroendovascular interventions. We conducted a retrospective analysis of a prospectively maintained database and identified 1524 consecutive neuroendovascular procedures performed using transradial access from April 2018 to February 2021. Among 1524 procedures, local transradial complications occurred in 1.7%. Major complications occurred at a rate of 1.2% including RA extravasation (0.3%), delayed RA occlusion (0.6%), pseudoaneurysm (0.1%), compartment syndrome (0.1%), infection (0.1%), and avulsion of the RA in 0.1% (1 of 1524) with no serious clinical consequence. Although RA occlusion is included in major complications, all cases were asymptomatic and did not require any intervention. Minor complications occurred at a rate of 0.5% including severe RA spasm (0.3%) and hematoma (0.3%). No patient in the cohort died or suffered from permanent disability from a complication related to the transradial approach. Transradial access for neurointervention has a low rate of local complications, particularly when taking appropriate prevention measures. Appropriate management of complications can prevent procedural failure and has low morbidity rates demonstrating the overall safety profile of transradial access even when complications occur.

Incidence of Access Site Complications in Patients Receiving Tenecteplase as Bridging Therapy to Endovascular Treatment (P9-10.010)

Incidence of Access Site Complications in Patients Receiving Tenecteplase as Bridging Therapy to Endovascular Treatment (P9-10.010)

Percutaneous versus surgical femoral access in minimally invasive cardiac operations.

Both surgical and percutaneous femoral accesses for the establishment of extracorporeal circulation are used in minimally invasive cardiac surgeries. The goal of this study was to compare the outcomes with the MANTA vascular closure device after percutaneous arterial decannulation via the surgical approach. Between November 2018 and January 2021, a total of 490 consecutive patients underwent minimally invasive cardiac operations at our institution. Cannulation and decannulation of femoral vessels were under direct vision surgically or percutaneously. The MANTA system was used to close the femoral artery in all patients with percutaneous cannulation. Demographic, clinical and procedural data were collected retrospectively. Surgical cut-down and suture closure of the femoral artery was performed in 222 patients (45.3%); percutaneous access and closure with the MANTA system was used in 268 patients (54.7%). The surgical group presented a significantly higher incidence of any access site complication compared to the percutaneous group [18 patients (8.1%) vs 6 patients (2.2%); P = 0.003]. Lymph fistula and wound healing disorders occurred more frequently in the surgical group (3.2% vs 0% [P = 0.004] and 3.6% vs 0% [P = 0.002], respectively). Median procedural duration and stays in the intensive care unit were significantly lower in the percutaneous group {127 [interquartile range (IQR) 97-158] min vs 150 (IQR 117-185) min (P < 0.001) and 1 (IQR 1-2) day vs 2 (IQR 1-3) days (P = 0.008), respectively}. Percutaneous access and closure with the MANTA system are feasible, safe and associated with lower incidences of all-cause access site complications and shorter stays in the intensive care unit compared to surgical access and closure in minimally invasive cardiac surgeries.

Percutaneous plug-based vascular closure device in 1000 consecutive transfemoral transcatheter aortic valve implantations

BackgroundArterial access-site related complications constitute a large proportion of adverse events related to cardiac interventions requiring large-bore devices and have significant implications on morbidity, mortality and hospital cost. AimsTo evaluate the safety and effectiveness of a novel percutaneous plug-based vascular closure device (VCD) in 1000 consecutive patients undergoing transfemoral transcatheter aortic valve implantation (TAVI). MethodsA single-center observational study evaluating a plug-based VCD (MANTA, Teleflex/Essential Medical Inc., Malvern, Pennsylvania, USA) in patients undergoing TAVI at the Karolinska University Hospital, Stockholm, Sweden. The primary outcome was VCD-related major vascular complication according to the criteria of the Valve Academic Research Consortium (VARC)-2. ResultsFrom May 2017 to September 2020 a total of 1000 consecutive patients underwent transfemoral TAVI with arterial access-site management using the MANTA VCD. VARC-2 major vascular complications occurred in 42 (4.2%) patients: 17 (1.7%) patients intraoperatively received a covered stent, 17 (1.7%) patients underwent surgical repair during hospital stay, 3 (0.3%) patients underwent vascular surgery after discharge, 3 (0.3%) patients had major bleeding and 2 (0.2%) patients had symptoms of claudication with conservative treatment. No significant differences in major complications were seen between individual interventionists irrespective of experience with the device. A larger sheath outer diameter to femoral artery inner diameter ratio was the only factor associated with a significant increase of VCD-related major vascular complications. ConclusionThis largest ever real-world evaluation of MANTA for large-bore arteriotomy closure in transfemoral TAVI patients indicates effective and safe arterial access-site management with low complication rates and short learning curve.Clinical Trial Registration: http://www.clinicaltrials.gov. Unique identifier: NCT04392492.

Transradial Access in Coronary Angiography: A Study of its Safety and Efficacy in Comparison to Transfemoral Access

Introduction: Coronary angiography is traditionally performed through transfemoral access. Transradial access is increasingly being used for this purpose for its various advantages. However, its use in Bangladesh is less well studied. The aim of this study was to find out the safety and efficacy of transradial access as compared to transfemoral access. Methods: This was a single-center, cross-sectional study. 100 randomly selected elective coronary angiography from August 2017 to September 2018 by the same operator using either transradial access or transfemoral access were analyzed. Results: Among 100 coronary angiography, transradial access were 50 and transfemoral access were 50. Fluoroscopy time was 3.08[1-9] vs 1.47 [1-17] minutes (p=.014), dose area product was 4807 [1947-11489] vs 3202 [1130-12826] ìGy.m2 (P&lt;0.001), total dose was 788 [276-2055] vs 520 [158-2424] mGy (p&lt;0.001). Transradial failure occurred in 4 (8%) cases. Transfemoral failure occurred in 1 (2%) case. There was no significant difference in failure rate between the groups (p= 0.169). Ecchymosis was the commonest (10% in transradial access vs 22% in transfemoral access, p= 0.102) among post procedure complications. Other complications like thrombophlebitis (6% vs 18%, p=0.004); hematoma (0% vs 12%, p= 0.005); puncture site bleed (2% vs 4%, p= 0. 039) were seen in TRA and transfemoral access, respectively. Conclusion: Access site complications are more in transfemoral access. Transradial access is an effective alternative to transfemoral access, and it can be performed safely by experienced operators. J Bangladesh Coll Phys Surg 2022; 40: 93-98

Strategies for Facilitating Totally Percutaneous Transfemoral TAVR Procedures.

Transcatheter aortic valve replacement (TAVR) has transformed the treatment of aortic stenosis and should ideally be performed as a totally percutaneous procedure via the transfemoral (TF) approach. Peripheral vascular disease may impede valve delivery, and vascular access site complications are associated with adverse clinical outcome and increased mortality. We review strategies aimed to facilitate TF valve delivery in patients with hostile vascular anatomy and achieve percutaneous management of vascular complications.

Save the radial: go distally

Coronary artery disease is the leading cause of death worldwide. Percutaneous coronary intervention (PCI) is one of the most widely performed medical procedures used to save lives, currently over 3 million annually worldwide. The femoral artery has been the preferred vascular access site. However, radial access is gaining extensive popularity due to the benefits of earlier ambulation, fewer access site complications, and decreased rates of bleeding. Improvements in technology and understanding of the anatomic features of the vascular system have led to new insights into coronary angiography procedures. Distal radial access, which was first used in 2017, shows a higher success rate and fewer complications than previous sites; therefore, it might be the future for cardiovascular intervention. For this purpose, we conducted this prospective study at Beirut Cardiac Institute (BCI) comparing the two arms: radial vs. distal radial artery techniques through the anatomical snuffbox, in terms of patient’s length of stay, complication rate, and success rate of each procedure.