Common Access Research Articles

Initial experiences with percutaneous endovascular aortic reconstruction

Introduction: Percutaneous aortic reconstruction is another milestone in aortic surgery. The evolution of vascular closure devices played a key role by enabling arterial closure after large -bore endovascular devices without the need of arterial cut -down.Objective: Our objective was to determine technical success of percutaneous endovascular aortic repair and to report our initial experience using this technique in a Hungarian cohort.Method: Between 15 October 2020 and 21 March 2021, patients who underwent endovascular aortic reconstruction were prospectively and consecutively collected. Patients who were deemed suitable for common femoral artery per cutaneous access were enrolled to the study. Technical success, access -site complications and risk factors were ana- lyzed.Results: A total of 43 patients underwent endovascular aortic reconstruction during the study period, of whom 38 were deemed feasible for percutaneous repair. Dominantly infrarenal aortic aneurysms were treated (n = 26, 68.4%). After ultrasound -guided access, suture -mediated devices were used 2 (1-4) per artery (median, min-max) for clo- sure. Technical success was reported in 37 out of 38 cases (97.4%). Access site complication was reported in 3 (7.9%) cases. The mean (+/- SD) in -hospital stay was 4.9 (+/- 1.7) days. Out of the 3 cases, 1 required intraoperative femoral cut-down. Sheath-size larger than 18 Fr (1.26, 0.09-17.75, 0.862) and body mass index (1.17, 0.923-1.5, 0.19) were positively associated with access site complication but no significant correlation was reported (OR, 95% CI, p- value). However, in patients with larger than 30 kg/m2 body mass index (n = 12), access-related complication was significantly higher than in smaller patients (p = 0.008).Conclusion: Percutaneous endovascular aortic repair is a promising and safe option that has a high technical success rate in patients deemed eligible for common femoral artery access.

TH4.5 The introduction of a custom made endograft service for patients with complex thoracoabdominal aneurysm

Abstract Introduction Custom made endografts represents a technological advance that has been widely adopted across vascular centres in the United Kingdom. The most recent National Vascular Registry report describes in-hospital mortality for complex as 2.3%. We have reviewed the outcome associated with the introduction of a custom made endograft program in a single Scottish Health Board. Methods Index cases were identified from a prospective radiology database with cases identified from 2008 to 2021. We collected patient demographics, pre-operative assessment, peri-operative and procedure related details and information on surveillance and re-intervention. Results There have been 49 cases performed. Most patients were males over the age of 70-years with significant medical co-morbidity. The mean AAA size was 5.8cm. Most of the procedures have been performed under general anaesthesia with percutaneous common femoral access. Procedural complications have included inability to stent target arteries (coeliac axis twice and right renal artery twice). Other complications have included limb ischaemia and haemorrhagic complications from access. Two critical care bed days have been used. The mean duration of hospital stay is 9-days. There have been no deaths on the index admission. During the follow-up period there have been 6 deaths. One of these deaths was from rupture of abdominal aortic aneurysm (secondary to Type III endoleak). Conclusion These data suggest that the case selection for custom made endografts is good. The cost of the device may be off set by a reduction in critical care utilization/hospital bed stay.

The current practice of transcatheter aortic valve replacement in China.

The purpose of this study is to summarize the current practice and experience of transcatheter aortic valve replacement in China. The relevant articles were identified through computerized searches of the CNKI, WANFANG, VIP, and PubMed databases through February 1, 2022, using the search terms: "transcatheter aortic valve replacement," "transcatheter aortic valve implantation,""China." The database searches identified 22 articles, 2092 patients, 57.65% were male, with a mean age of 74.2 ± 6.0 years, 71.51% of patients were classified by New York Heart Association as class Ⅲ/Ⅳ, Society of Thoracic Surgeons score 8.4 ± 4.1, mean left ventricular ejection fraction 52.8 ± 14.2%, mean transvalvular aortic pressure gradient 59.9 ± 18.9 mmHg. The overall procedural success rate was 97.85%, and 2.15% of patients were converted to sternotomy, mainly due to transcatheter aortic bioprosthesis dislocation. The most common vascular access approach was transfemoral (1071 patients, 51.20%). General anesthesia (48.90%) was the commonly used anesthesia technique. The incidence of postprocedural complications was as follows: permanent pacemaker implantation (10.47%), bleeding events (8.60%), mild paravalvular leakage (17.73%), moderate and severe paravalvular leakage (4.16%), vascular complications (3.30%), stroke (1.43%), respectively. The overall periprocedural period and postprocedural 30-day mortality was 2.72%. Among patients undergoing transcatheter aortic valve replacement in China, device implantation success was achieved in 97.85% of cases. The most common vascular access approach was transfemoral. General anesthesia was the most commonly used anesthetic technique. Paravalvular leakage (458 patients, 21.89%) was the most common complication.

Evaluation of common bean (Phaseolus vulgaris) genotypes for resistance to common bacterial blight and angular leaf spot diseases, and agronomic performances

Common bean is the most important pulse crops worldwide and in Ethiopia for its multipurpose uses. However, common bean production and productivity is mainly constrained by common bacterial blight (CBB) and angular leaf spot (ALS) diseases. Identifying and using resistant common bean genotypes is the best option to reduce the impact of such bacterial and fungal diseases. Field experiments were carried out to evaluate the genetic resistance of 25 common bean genotypes as treatments to CBB and ALS diseases, and agronomic performances at Haramaya and Melkassa, Ethiopia, during the 2019 and 2020 main cropping seasons. The treatments were arranged in a 5 × 5 triple lattice design with three replications. Data on disease intensity, growth, grain yield and yield components were recorded. Analysis of variance indicated significant (p < 0.0001) variations existed among the genotypes for diseases intensity, grain yield and yield components. Eight genotypes, namely DAB-388, DAB-478, DRKDDRB-70, DRKDDRB-81, NUA-225, NUA-517, NUA-536 and NUA-577 attained relatively low disease severity, AUDPC and disease progress rate next to the checks Zoasho (DAB-96) and Gorossa (Biofort large seed-5) to both common bean diseases regardless of locations and seasons. The genotype DAB-525 showed a moderately resistant reaction to both CBB and ALS, and the other genotypes demonstrated variable disease resistance reactions at both locations and in the two cropping years. Similarly, genotypes DAB-388, NUA-225, NUA-517, and NUA-577 relatively executed well for grain yield and yield components at both experimental fields in the 2019 and 2020 main cropping seasons. Disease severity and grain yield variably and negatively associated with reaction groups of genotypes evaluated for reaction CBB and ALS diseases. In the study, resistance to CBB and ALS diseases and good agronomic performing common bean genotypes were identified which could be important for smallholder and commercial bean production in the study area and other similar agro-ecologies in Ethiopia. It is suggested that a large number of common bean accessions should be evaluated in CBB and ALS hot spot agro-ecologies of Ethiopia for more sources of resistance and better agronomic advantages.

Deep reinforcement learning based flexible preamble allocation for RAN slicing in 5G networks

One of the most difficult challenges in radio access network slicing occurs in the connection establishment phase where multiple devices use a common random access channel in order to gain access to the network. It is now very well known that random access channel congestion is a serious issue in case of sporadic arrival of machine-to-machine nodes and may result in a significant delay for all nodes. Hence, random access channel resources are also needed to be allocated to different services to enable random access network slicing. In the random access channel procedure, the nodes transmit a selected preamble from a predefined set of preambles. If multiple nodes transmit the same preamble at the same random access channel opportunity, a collision occurs at the eNodeB. To isolate the one service class from others during this phase, one approach is to allocate different preamble subsets to different service classes. This research proposes an adaptive preamble subset allocation method using deep reinforcement learning. The proposed method can distribute preambles to different service classes according to their priority providing virtual isolation for service classes. The results indicate that the proposed mechanism can quickly adapt the preamble allocation according to the changing traffic demands of service classes.

The lack of property rights can make natural disasters worse: The case of small-scale fisheries in Chile

Developing countries tend to suffer the most from natural disasters, but the mechanisms underlying this outcome are poorly understood. In this paper, I study one of the potential mechanisms behind this pattern: the lack of strong and well-defined property rights for renewable resources. Using fisheries as an example, I examine how different property rights regimes dictating who has access to the resource could determine the overall exposure, as well as the cost of the rebuilding paths that fishers follow after a natural disaster. Using small-scale fisheries in Chile as a case study, I show that fisheries operating in common access are on average more exposed and also follow costlier recovery paths after the tsunami that hit the country in 2010. This paper contributes to the ongoing work on the economic impact of natural disasters and provides an argument for further study of how institutional regimes can be also understood as potential adaptation strategies.

How to perform extrathoracic venous access for cardiac implantable electronic device placement: Detailed description of techniques

Venous access is needed for implantation of cardiac implantable electronic devices (CIEDs) with endocardial leads. Extrathoracic venous access in the prepectoral region has become the standard of care for CIED implantation because of lower risks for pneumothorax and likely less lead malfunction due to subclavian crush syndrome. The most common extrathoracic venous access sites in the pectoral region are extrathoracic subclavian vein access, axillary vein access, and cephalic vein access. This review provides a detailed description of the anatomy, technical considerations, and relative advantages and disadvantages of each of these extrathoracic venous access sites.

Narrative strategy of "Red China" exhibitions:on the example of the exhibition celebrating the centenary of the founding of the communist party of China

Exhibitions dedicated to the theme of "Red China" occupy an important place in the dissemination of "red" culture, the continuity of the "red" gene and the intensification of "red" education. They reflect the political agenda, have a distinct content and the uniqueness of the text material. Being an important element of the spread of "red" culture, exhibitions on the theme of "Red China" integrate elements of this culture into people's daily lives and play an active role in preserving and multiplying the "red" gene. In this article, the systematization and generalization of knowledge in the field of narrative strategy of exhibitions on the theme of "Red China" is carried out from the point of view of ontology, structure and narrative carrier, which at the present stage is important for building a strong socialist ideology. Exhibitions on the theme of "Red China" are an important way of materialization, visualization and dissemination of "red" culture, as well as an effective means of its popularization. The study found that the "Red" exhibitions should have a "revolutionary content", have a "political character", be "mutually recognized by the authorities and the people", take on the main responsibility for providing people with common access to material and spiritual culture. From the point of view of the communication function of the "red" exhibitions, they are an important means of organizing ideological and political education by the Communist Party of China, strengthening social harmony and promoting basic values.

An Attribute-Based Encryption Method Using Outsourced Decryption and Hierarchical Access Structure

Cloud computing is being rapidly adopted by many organizations from different domains and large amounts of data is stored in the cloud. In order to ensure data security, the attribute-based access control mechanism has been emerging recently as a fine-grained access control model that grants access based on the data user’s attributes. In this model, the data owner builds the access policy using the attributes of the data users and access to the data is granted only if the requirements of such an access policy are satisfied. Ciphertext policy-based attribute-based encryption (CPABE) is one of the most widely used methods for providing encrypted access control. Complex, time consuming and costly paring operations are the major issue with the CPABE method. Hence, another efficient method is needed to reduce the data user’s overhead while decrypting data. This paper presents an efficient method consisting in outsourcing decryption operations to a third-party server, so that complex operations may be performed by that machine with only some simple calculations left on the data user’s side. The concept of a hierarchical access structure is also integrated with the traditional CPABE technique. The hierarchical approach enables the data owner to encrypt multiple data using a single common hierarchical access structure. This allows the user to decrypt only the relevant part of ciphertext, depending on which fragment of the hierarchical access structure is satisfied. The paper evaluates also the performance of the proposed model in terms of time and storage cost.

Calibrating joint attention and affective stances in young children's peer interactions

The present study addresses young children's (three-to five-year-olds’) peer interactions and explores a recurrent interactional genre, i.e. children's affectively heightened attention-organizing practices used when initiating an exchange in preschool interactions in Sweden. The data consists of 40 h of video recordings collected in two regular preschools in Sweden. By using Multimodal Interaction Analysis (Goodwin, 2000) of video-recordings from everyday activities, we examine the verbal, embodied and material features of children's interactions. The analysis shows that children exploited common access to objects or physical personal attributes within their socio-material environment and relied on them to secure the others’ attention, while using various methods for making the object ‘noteworthy’. By indexing their affective stance towards the referent, the children created the interpretative framework for the recipient's response. However, the recipients’ orientation and stance alignment were not to be presumed. The peer responses comprised a continuum of their affective engagement: the children aligned with or downplayed the prior speaker's stance through the affective quality of their response. In all, detailed interactional analysis reveals the young children's interactional repertoires and the communicative challenges associated with children's peer interactions.

An End-to-End Automatic Cache Replacement Policy Using Deep Reinforcement Learning

In the past few decades, much research has been conducted on the design of cache replacement policies. Prior work frequently relies on manually-engineered heuristics to capture the most common cache access patterns, or predict the reuse distance and try to identify the blocks that are either cache-friendly or cache-averse. Researchers are now applying recent advances in machine learning to guide cache replacement policy, augmenting or replacing traditional heuristics and data structures. However, most existing approaches depend on the certain environment which restricted their application, e.g, most of the approaches only consider the on-chip cache consisting of program counters (PCs). Moreover, those approaches with attractive hit rates are usually unable to deal with modern irregular workloads, due to the limited feature used. In contrast, we propose a pervasive cache replacement framework to automatically learn the relationship between the probability distribution of different replacement policies and workload distribution by using deep reinforcement learning. We train an end-to-end cache replacement policy only on the past requested address through two simple and stable cache replacement policies. Furthermore, the overall framework can be easily plugged into any scenario that requires cache. Our simulation results on 8 production storage traces run against 3 different cache configurations confirm that the proposed cache replacement policy is effective and outperforms several state-of-the-art approaches.

Complication of tunneled dialysis catheter of chronic ulcer in the site of vascular access entry leading to suspected squamous cell carcinoma (SCC): a case report

Introduction: Catheter-related infection (CRI) is one of the most common vascular access complications in dialysis catheter-related procedures. However, repeated chronic infected ulcer that leads to suspected malignancy in a tunneled dialysis catheter (TDC) insertion site and its risk factor have not been reported. Case description: A 37 years-old woman presented with a chronic exudative ulcer in the right breast at the entry site of a tunneled dialysis catheter. The past medical history included type 2 diabetes mellitus, chronic kidney disease, hepatitis C, and obesity. The patient had routine hemodialysis with TDC for the last 2 years and had changed the TDC access 3 times due to recurrent CRI. At first, the lesion appeared as a small pustule and enlarged recurrently. Later, the lesion progressed into an 82x80 mm raised crateriform exudative ulcer with a raw surface similar to Marjolin’s ulcer squamous cell carcinoma. The patient was referred to oncology due to limited facilities in our hospital. Conclusion: CRI is one of the most common long-term complications of TDC. In out of the case, this led to chronic infection and change in TDC, chronic inflammation then became Marjolin’s Ulcer. Risk factors for suspected SCC in our patient were immunosuppressive state from diabetes, hepatitis C, CKD, and chronic inflammation from a repeated chronic infected ulcer. SCC can be considered a long-term complication of TDC. Early prevention of CRI and risk factor controlling should be considered to prevent such complications.

The Relationship Between Adequacy of Hemodialysis and Anemia in Chronic Kidney Diseases (Ckd) Patients Undergoing Hemodialysis in Dialysis Unit, Fatmawati Hospital

Background: Anemia is a common problem that often occurs in patients with CKD undergoing hemodialysis. 56.5% of hemodialysis patients were still have anemia, while on the other hand, the achievement of hemodialysis. adequacy only reached 52.7%. Disparity that data is the basis for this research. The aim of this study is to analysis the relationship between the achievement of hemodialysis adequacy with the incidence of anemia in patients with CKD undergoing hemodialysis.Methods: This study uses a descriptive correlation with a cross sectional approach to the analysis of the independent variable (HD Adequacy) and the dependent variable (Anemia). The relationship between these variables was tested using the Chi Square test.Result: The study was conducted on 134 hemodialysis patients aged 13-86 years, the most common vascular access was AV fistula (68.7%), and women were the most respondents (55.2%). The Kt / V value in this study was 1.67 (1.03-2.75) and an adequate one was 54.5%. Adequate URR reached 80.6% with a mean of 75.13 ± 6.38. The incidence of anemia reached 53.7% with the Hb value at 8.93 ± 2.82 mg / dl. The results of the Chi Square test showed that HD adequacy (Kt / V and URR) with the incidence of anemia had P values of 0.670 and 0.217.Conclusion: There is no significant relationship between HD adequacy and the incidence of anemia

Energy-Efficient Coexistence of LiFi Users and Light Enabled IoT Devices

Owing to power limitations and hardware constraints of the Internet of Things (IoT) device, it requires simple, low power, low complex, energy-efficient communication technology. In contrast, LiFi users require high data rates and reliable connectivity. Motivated by the diverse requirements of these heterogeneous users, this paper proposes novel green communication schemes that can be used for the coexistence of LiFi users and light communication (LC) enabled IoT devices under a common LiFi access point. The proposed coexistence schemes utilize the amalgamation of wavelength division multiplexing, OFDMA, Hartley transform based DCO-OFDM (DCO-OFDM <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">$^{\mathrm {H}}$ </tex-math></inline-formula> ), null DC element, interleaved subcarrier mapping, modified data sequence to achieve concurrent interference-free, low complex and reliable communication. Additionally, as the multiple access (MA) techniques affect the choice of modulation techniques and overall performance in the system. Therefore, this paper includes an analytical delay and throughput framework to corroborate the decision of an appropriate combination of MA and modulation techniques in the coexistence scheme. This paper presents a comprehensive analysis of the proposed coexistence schemes against conventional DCO-OFDM <inline-formula xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink"> <tex-math notation="LaTeX">$^{\mathrm {H}}$ </tex-math></inline-formula> coexistence schemes based on various performance metrics. The results suggest that the proposed DL and UL coexistence schemes reduce the complexity and increase the energy efficiency at the user’s and device’s terminals.

Numerical study of the characteristics of smoke spread in tunnel fires during construction and method for improvement of smoke control

In this study, the characteristics of smoke spread in tunnel fires during construction were investigated using numerical modelling. Besides, the method for improvement of smoke control was investigated. The results indicate that the smoke still maintains a good layered structure after hitting the excavation face when the fire is very close to the excavation face. In contrast, the stratification of smoke is destroyed after hitting the excavation face, after which the smoke seems to spread over the entire cross-section of the tunnel when the fire is far away from the excavation face. The construction shaft becomes a common access for natural ventilation and smoke exhaust, which causes the smoke to fill the tunnel quickly because of the large vortex produced by the interaction between the airflow and smoke flow. A drainage device was placed in the middle of the construction shaft to divide the accesses for natural ventilation and smoke exhaust, after which the temperature rise in the tunnel decreases significantly and the mass flow rate of smoke through the construction shaft increases. This study is useful for tunnel fire protection engineering, providing a theoretical basis and technical support for fire detection, early warning, and control in tunnels during construction.

A Preliminary Study on The Chemical Structure of Vicia sativa L. Accessions Collected From Natural Flora of European Part of Turkey

The objective of this study was to determine chemical composition of 24 common vetch (Vicia sativa L.) accessions, collected from natural flora in European part of Turkey. The field experiment was carried out in the 2015-2016 growing season at field experimental area of Tekirdag Namık Kemal University, Agricultural Faculty, Field Crops Department in Tekirdag/Turkey. In this study, chemical structure (nitrogen (N), phosphorus (P), potassium (K), calcium (Ca), magnesium (Mg), copper (Cu), zinc (Zn), iron (Fe), and manganese (Mn) content) of common vetch accessions were determined on hay. Chemical composition content were statistically significantly different (P≤0.01) between accessions. According to the results obtained from field experiments, N, P, K, Ca, Mg, Cu, Zn, Fe, and Mn content of common vetch accessions varied between 0.95–3.14 %, 0.84–3.65 %, 0.22–2.44 %, 0.89–2.85 %, 0.23–0.74 %, 0.15–7.80 ppm, 0.10–5.30 ppm, 43.00–2295.20 ppm, 3.08–17.50 ppm, respectively. A wide variation was observed among common vetch accessions used in the study for N, P, K, Ca, Mg, Cu, Zn, Fe, and Mn content. Tetany and Ca/P rates of accessions changed from 0.13 - 1.54 and 0.28 - 2.19, respectively. The tetany and Ca/P rates of common vetch accessions are within suitable values for animal feeding. Ca/P ratio is above the limit value only in accessions 15-2 and 14O04. According to the correlation analysis, N was positively and significantly correlated with P, K, Mg, Cu and Fe. Similarly, P was positively and significantly correlated with N, K and Fe. Magnesium was positively and significantly correlated with N, Ca, Cu, Fe and Mn. Iron was positively and significantly correlated with N, P, Ca, Mg and Cu. As a result, accession 15K17 and 33 were identified as common vetch accessions with high mineral nutrition content.

Abstract No. 519 Using the Angio-Seal closure device to treat iatrogenic common femoral artery pseudoaneurysms

The rate of femoral artery access complication ranges from 0.2% to 4.6% and includes hematoma, arteriovenous fistula, arterial occlusion, and pseudoaneurysm. This case series evaluates off-label use of the Angio-Seal closure device (St. Jude Medical, St. Paul, MN) to treat patients with PSA after common femoral access that were either not responsive or not amenable to more traditional methods.

Effectiveness of Standardized Nursing Care Protocol Post Cardiac Catheterization to Reduce Hematoma Development

Background: Hematoma development is the most common vascular access complication among post-cardiac catheterization patients. It requires safe and standardized nursing care protocol, as well as qualified and skilled health providers to obtain good outcomes of management. The vascular complications were severe and increased the length of stay in the hospital. Timely recognition and management can diminish their burden.&#x0D; Objectives&#x0D; &#x0D; To evaluate the effectiveness of Standardized Nursing Care Protocol Post cardiac catheterization to reduce hematoma development.&#x0D; To assess the association of hematoma development between procedure site (radial and femoral) and comorbidities (diabetes, hypertension, and obesity) among post-cardiac catheterized patients.&#x0D; &#x0D; Methodology: This quasi-experimental (post) study was conducted at Coronary Care Units at tertiary care hospitals in Karachi. In this study, a total of 108 post-cardiac catheterized patients participated. The patients were divided into two groups; the interventional group and the control group. In the control group, 54 post-cardiac catheterized patients were selected and data were taken based on inclusion criteria who received routine holistic nursing care post-procedure and have been discharged. Besides 54 patients participated in the interventional group who received Standardized Nursing Care Protocol post-cardiac catheterization including proper patient assessment, compression techniques, interventions pre, during and post sheath and TR-band removal to discharge instruction by the principal investigator (PI). The data was collected through patients’ assessment sheets and hematoma scales for the identification of hematoma development rate among post-cardiac catheterized patients. The non-probability consecutive sampling technique was accomplished for the collection of data.&#x0D; Findings: The rate of hematoma development in the (control) group was reflected at 18 (33.3 %) while after the implementation of the standardized nursing care protocol the rate of hematoma development was 9 (16.6%) in the (interventional) group out of 54 (50%) post-cardiac catheterized patients. There was a significant difference between the (control) and (interventional) groups regarding the rates of hematoma development post-cardiac catheterization i.e. the P values were 0.037 ˂ 0.05. Thus, the standardized nursing care protocol post-cardiac catheterization was effective in the reduction of hematoma development. Furthermore, the radial site procedure reflected fewer rates of hematoma development 8 (14.81%) as compared to the femoral site procedure 19 (35.1%) among post-cardiac catheterized out of 54 (50%). The P-value was 0.058 &gt; 0.05 there was no association between hematoma development and procedure site in the (interventional and control) groups post-cardiac catheterization. Similarly, the P-value was greater than 0.05 hence there was no association between hematoma development and comorbidities (diabetes, hypertension, and obesity) post-cardiac catheterization.&#x0D; Conclusion: The implementation of Standardized Nursing Care Protocol post-cardiac catheterization was effective for the reduction of hematoma development in the (intervention) group while there was an association of hematoma development between the (control and interventional) groups. However, there was no association between hematoma development and site procedure (radial and femoral) and comorbidities (diabetes, hypertension, and obesity) post-cardiac catheterization.

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.

Safety and Efficacy of the CELT ACD Femoral Arteriotomy Closure Device in the Office-based Laboratory

Manual compression remains the gold standard for achieving hemostasis for percutaneous common femoral artery access. However, it requires prolonged bed rest and 20-30 minutes or more of compression for hemostasis. Current arterial closure devices have emerged in recent years, but they are still associated with significant access device complications, including hematoma, retroperitoneal bleeding, transfusion requirement, pseudoaneurysm, arteriovenous fistula, and arterial thrombosis. A novel femoral access closure device, the CELT ACD (Vasorum Ltd), has been previously shown to reduce these complication rates and allow rapid hemostasis and time to ambulation and discharge.