Antegrade Puncture Of Common Femoral Artery Research Articles

Ultrasonography-guided antegrade common femoral artery approach: Factors associated with access time.

The aim of this study was to evaluate the feasibility and safety of ultrasonography-guided antegrade common femoral artery puncture and subsequent superficial femoral artery access without the aid of fluoroscopy. Factors that could affect access time were also assessed. A total of 294 cases from 218 consecutive patients (163 men, 55 women; mean age: 66.9 ± 12.7 years) who underwent lower extremity endovascular procedures were retrospectively evaluated. The time between the injection of local anesthetic and the insertion of the microsheath into the superficial femoral artery was measured. The common femoral artery diameter, cutis thickness, distance between arterial puncture site and common femoral artery bifurcation, degree of common femoral artery calcification, body mass index, and history of previous access were investigated to assess their relationship with access time. Furthermore, all cases were assessed with ultrasonography for access-site complications before discharge. Technical success was achieved in 293 of 294 procedures (99.7%). The mean time for superficial femoral artery access was 1.9 ± 0.8 min (range, 0.7-3.7 min). Additional fluoroscopic guidance was needed in one case. There were moderately positive correlations of body mass index (r = 0.75; p < 0.001) and cutis thickness (r = 0.58; p < 0.001) with access time. The other variables failed to reveal significant correlations with access time. Five groin hematomas occurred after percutaneous transluminal angioplasty. Complications such as pseudoaneurysm, arteriovenous fistula, or retroperitoneal hematoma were not observed. Antegrade common femoral artery puncture with subsequent superficial femoral artery access conducted solely under ultrasonography guidance was feasible and safe. In addition, the antegrade access time showed positive correlations with body mass index and cutis thickness.

FemoSeal® vascular closure device for antegrade common femoral artery access: Safety and technical notes

To retrospectively assess the efficacy and safety of FemoSeal® vascular closure device to achieve hemostasis following antegrade common femoral artery puncture after lower limb revascularization using vascular sheaths from 5 to 8 Fr. We reviewed the hemostatic outcome achieved with FemoSeal in 103 consecutive patients (mean age: 69 ± 8 years, 71 males) that undergone to 111 antegrade common femoral artery accesses for percutaneous lower limbs revascularization using 5- to 8-Fr vascular sheaths. We used FemoSeal in an unselected population, without exclusion criteria. The primary outcome was the technical success, meant as achieving complete hemostasis without immediate complications. Hemostasis was achieved in all 111 puncture sites (100% technical success). We observed eight (7%) puncture site minor complications (hematomas), none of which affecting the patients' outcome or requiring further therapies or increasing the hospital stay. There were no statistically significant differences between the variables potentially related to the occurrence of complications (age, international normalized ratio, platelet count, partial thromboplastin time ratio, body mass index, and common femoral arteries calcification grade) in patients with and without complications. Complications group mean body mass index was 26.4 ± 2.8 kg/m2 versus non-complications group 26.6 ± 4.4 kg/m2, p = 0.92. Mean international normalized ratio and partial thromboplastin time ratio were 1.05 ± 0.01 and 1.05 ± 0.14 versus 1.13 ± 0.2 (p = 0.39) and 1.12 ± 0.23 (p = 0.53), respectively. Common femoral arteries calcification grade was the same (mean: 1, p = 1). Platelet count was 202 × 103/mL ± 66.7 versus 226 × 103/mL ± 91.2, p = 0.55. Mean age was 72.3 ± 10 years versus 72.8 ± 8 years, p = 0.86. The low rate (7%) and grading of the adverse events, combined with the high technical success rate (100%), in an unselected group of patients treated in daily routine, suggest high safety and efficacy of FemoSeal vascular closure device in antegrade common femoral artery puncture site hemostasis when using vascular sheaths ranging from 5 to 8 Fr. Therefore, FemoSeal could be considered as a first-line hemostasis strategy in such cases.

Abstract No. 673 Ultrasonography-guided antegrade common femoral artery puncture: factors associated with puncture time

Abstract No. 673 Ultrasonography-guided antegrade common femoral artery puncture: factors associated with puncture time

Retrospective cohort study on Angio-Seal closure device safety and effectiveness in antegrade superficial femoral artery punctures: A comparison with antegrade common femoral artery punctures

PurposeThis retrospective study evaluates the effectiveness and safety of the Angio-Seal closure device in superficial femoral artery (SFA) antegrade punctures compared to common femoral artery (CFA) antegrade punctures. MethodsOver a period of 46 months from January 2012, consecutive patients who underwent antegrade CFA or SFA punctures using Angio-Seal as a closure device in a single centre were studied. Patients were identified by reading all the individual reports on our radiology system for all patients who underwent any angiographic examination during the study period, and their individual case notes were subsequently reviewed. A retrospective analysis of prospectively collected data on patients' demographics, type of intervention, clinical indication, Angio-Seal size, haemostasis status and complications was performed. ResultsOverall, 194 patients (mean (s.d.) age 74(12) years, 123(44%) males) underwent CFA or SFA antegrade punctures. A total of 228 (CFA group, n = 70, SFA group, n = 158) antegrade punctures were performed. Clinical characteristics of the two groups were comparable. Angio-Seal size 6F was deployed in 69(99%) antegrade CFA punctures and 155(98%) antegrade SFA punctures (P = 1.000). Haemostasis was achieved in 65(93%) antegrade CFA punctures compared to 156(99%) antegrade SFA punctures (P = 0.030). ConclusionAngio-Seal closure device is safe and effective method of haemostasis both in antegrade SFA and CFA punctures with no significant complications or delayed discharge.

Ultrasonography-Guided Antegrade Common Femoral Artery Puncture: Factors Associated with Puncture Time

Ultrasonography-Guided Antegrade Common Femoral Artery Puncture: Factors Associated with Puncture Time

Comparison of Ultrasound-Guided and Fluoroscopy-Assisted Antegrade Common Femoral Artery Puncture Techniques

To prospectively compare the procedural time and complication rates of ultrasound-guided and fluoroscopy-assisted antegrade common femoral artery (CFA) puncture techniques. Hundred consecutive patients, undergoing a vascular procedure for which an antegrade approach was deemed necessary/desirable, were randomly assigned to undergo either ultrasound-guided or fluoroscopy-assisted CFA puncture. Time taken from administration of local anaesthetic to vascular sheath insertion in the superficial femoral artery (SFA), patients' age, body mass index (BMI), fluoroscopy radiation dose, haemostasis method and immediate complications were recorded. Mean and median values were calculated and statistically analysed with unpaired t tests. Sixty-nine male and 31 female patients underwent antegrade puncture (mean age 66.7 years). The mean BMI was 25.7 for the ultrasound-guided (n = 53) and 25.3 for the fluoroscopy-assisted (n = 47) groups. The mean time taken for the ultrasound-guided puncture was 7 min 46 s and for the fluoroscopy-assisted technique was 9 min 41 s (p = 0.021). Mean fluoroscopy dose area product in the fluoroscopy group was 199 cGy cm(2). Complications included two groin haematomas in the ultrasound-guided group and two retroperitoneal haematomas and one direct SFA puncture in the fluoroscopy-assisted group. Ultrasound-guided technique is faster and safer for antegrade CFA puncture when compared to the fluoroscopic-assisted technique alone.

Antegrade Superficial Femoral Artery versus Common Femoral Artery Punctures for Infrainguinal Occlusive Disease

PurposeTo compare the outcomes of planned superficial femoral artery (SFA) and common femoral artery (CFA) antegrade punctures in patients undergoing endovascular interventions for infrainguinal occlusive arterial disease in a single center. Materials and MethodsBetween August 2010 and July 2011, consecutive patients who underwent antegrade puncture of CFA or SFA for infrainguinal occlusive disease were studied. Data including sheath size, rate of closure device usage, and complications relating to the arterial puncture were classified according to Society of Interventional Radiology (SIR) classification and analyzed retrospectively. ResultsThere were 199 antegrade arterial punctures, of which 28 (14%) were planned SFA punctures, performed in 184 patients. All patients had ultrasound-guided puncture. The sheath size ranged from 4 F to 8 F. In 2 of 28 (7%) SFA punctures, a closure device was deployed compared with 43 of 171 (25%) CFA punctures. Six bleeding complications were noted in the CFA puncture group (6 of 171 [3.5%]), of which 2 required urgent operations (repair of a pseudoaneurysm and evacuation of retroperitoneal hematoma). In comparison, only one minor groin hematoma was noted in the SFA puncture group; this did not require any further treatment. No thromboembolic complications were associated with SFA puncture. ConclusionsPlanned antegrade SFA puncture under ultrasound guidance can be performed safely in selected cases with no added morbidity. Interventionalists should have a low threshold for considering antegrade SFA puncture as a first-line access site, especially in patients with a hostile groin.

Efficacy and Safety of Antegrade Common Femoral Artery Access Closure Using the Angio-Seal Device: Experience With 1889 Interventions for Critical Limb Ischemia in Diabetic Patients

To report a retrospective evaluation of the 6-F Angio-Seal closure device in antegrade and retrograde common femoral artery (CFA) punctures during endovascular procedures in diabetic patients with critical limb ischemia (CLI). From January 2005 to March 2009, 2374 diabetic CLI patients underwent interventional procedures in the lower limbs at a single center under systemic anticoagulation (heparin 70 U/kg). In this population, 2016 patients (1184 men; mean age 69.6+/-9.1 years) had 2372 CFA punctures treated with either manual compression [205 punctures in 161 (8.0%) patients] or Angio-Seal deployment (2167 punctures in 1855 patients) and were eligible for this analysis. In the study cohort, there were 1889 antegrade CFA punctures closed with the device in 1626 (87.6%) patients compared to 278 retrograde punctures sealed in 229 (12.4%) patients. The complications from the antegrade CFA punctures were compared to those from retrograde closure and manual compression. The success rate for achieving hemostasis after antegrade and retrograde Angio-Seal placement was 97.9% and 97.8%, respectively. Major complications following antegrade Angio-Seal deployment, retrograde Angio-Seal deployment, and manual compression occurred in 20/1889 (1.1%), 5/278 (1.8%), and 4/205 (2.0%) cases, respectively. All complications developed within 24 hours of the procedure. No further complications were recorded in the 18-month follow-up (range 1-36). The overall complication rates after antegrade puncture closure, retrograde puncture closure, and manual compression at 30 days was 2.5%, 4.0%, and 4.9%, respectively (p = NS). This retrospective study shows that the 6-F Angio-Seal is a valuable and safe vascular closure device for percutaneous transfemoral antegrade access in diabetic patients undergoing interventional procedures for CLI.

Clip-based arterial haemostasis after antegrade common femoral artery puncture

Background Given the frequent involvement of infra-popliteal arteries, an ipsilateral antegrade common femoral artery puncture (ACFAP) is usually preferred to a contralateral retrograde femoral access for percutaneous transluminal angioplasty (PTA) in patients with critical limb ischemia (CLI). Because of the frequent difficulty to get a sufficient manual pressure on the puncture site, ACFAP is burdened by a high number of bleeding local complications, including retroperitoneal haematoma. We report a series of patients who consecutively received a clip-based arterial closure device after ACFAP and ipsilateral PTA for CLI. Methods Thirty patients (73 ± 6 years; 18 men; 100% diabetes) admitted to our hospital because of CLI consecutively underwent peripheral PTA after an ACFAP and received a clip-based arterial closure device. Time to haemostasis was defined as the interval elapsed between clip deployment and first observed haemostasis. All patients were mobilized after 6 h. Follow-up was 30 days. Results All patients were on double anti-platelet therapy. At the end of the procedure, Activation Clotting Time was 226 ± 37 s. Procedural success in delivering the clip was 100%. Time to haemostasis was 21 ± 19 s. No major local vascular complications and in particular no retroperitoneal bleeding were documented. All patients could be discharged within the following 3 days. No major complications were noted during a 30 days follow-up. Conclusions The use of a clip-based arterial closure device after ACFAP for peripheral PTA in CLI seems to be safe and effective.

Angio-Seal in Antegrade Endovascular Interventions: Technical Success and Complications in a 55-Patient Series

To assess the technical success and complications of Angio-Seal vascular closure device in antegrade common femoral artery (CFA) punctures. Over a 14-month period, 55 patients (37 men; age range 37-94 years) underwent antegrade CFA Angio-Seal placement at a single center; the clinical data and angiograms were reviewed retrospectively. A total of 56 antegrade CFA punctures were made for hemostasis; 6-F Angio-Seal devices (40 model STS and 12 model VIP) were deployed in 52 CFAs, and 8-F Angio-Seal devices were deployed in 4. The technical success rate was 98.2% (55/56). Two (3.6%) patients developed small, non-expanding hematomas (<5 cm) during deployment of the device. There was 1 episode of device/operator failure, presumably due to extravascular deployment within soft tissue. None of the patients developed pseudoaneurysm, arterial injury, or large hematomas requiring transfusion. Small calcified plaques at the puncture site did not influence the outcome. This series suggests that Angio-Seal may be a safe and effective device for hemostasis in antegrade CFA punctures. Further randomized trials testing its risk-benefit balance in comparison to standard manual compression are warranted.

Sonographically guided antegrade common femoral artery access.

To evaluate the feasibility of sonographically guided antegrade common femoral artery puncture and superficial femoral artery access. Fifty antegrade common femoral artery punctures and superficial femoral artery access procedures were performed under sonographic guidance alone in 30 consecutive patients (24 male and 6 female; mean age, 55.1 +/- 25.7 years; range, 13-85 years). The indications were (1) insertion of a vascular sheath for balloon angioplasty in 42 attempts (24 patients with lower leg ischemia) and (2) insertion of an angiographic catheter for 1-shot intra-arterial chemoinfusion therapy in 8 attempts (6 patients with distal femoral osteosarcomas). Technical success was achieved in 28 of 30 patients or 48 (96%) of 50 procedures (95% confidence interval, 80.39-98.32). The average procedure time +/- SD (excluding the failures) was 3 +/- 1 minutes (range, 2-6 minutes). In the 2 failures (2 [4%] of 50) in which common femoral artery punctures were accomplished, further superficial femoral artery cannulations were completed under fluoroscopic road map angiographic guidance. A small groin hematoma was noted in 1 patient. No arteriovenous fistula or pseudoaneurysm was encountered. Sonographically guided antegrade common femoral artery puncture and selective cannulation of the superficial femoral artery are feasible and safe. They may be used as adjunctive modalities in difficult cases of common femoral artery access.

Antegrade selective catheterization of the superficial femoral artery using a movable-core guide wire.

A simplified method of selective antegrade catheterization of the superficial femoral artery using a movable-core guide wire is described. This technique obviates the need for multiple catheter and guide wire manipulations and exchanges when preferential passage of the guide wire into the profunda femoral artery occurs following antegrade common femoral artery puncture.