Femoral Artery Access Research Articles

Life over limb: Arterial access-related limb ischemic complications in 48-hour REBOA survivors.

Resuscitative endovascular balloon occlusion of the aorta (REBOA) is increasingly used in some trauma settings. Arterial access-related limb ischemic complications (ARLICs) resulting from the femoral arterial access required for REBOA are largely under reported. We sought to describe the incidence of these complications and the clinical, technical, and device factors associated with their development. This was a retrospective cohort study of records of adult trauma patients from the American Association for the Surgery of Trauma Aortic Occlusion for Resuscitation in Trauma and Acute care surgery registry between October 2013 and September 2020 who had REBOA and survived at least 48 hours. The primary outcome was ARLIC, defined as clinically relevant extremity ischemia or distal embolization. Relevant factors associated with ARLIC were also analyzed. Of 418 identified patients, 36 (8.6%) sustained at least one ARLIC; 22 with extremity ischemia, 25 with distal embolism, 11 with both. Patient demographics and injury characteristics were similar between ARLIC and no ARLIC groups. Access-related limb ischemic complication was associated with larger profile devices (p = 0.009), cutdown access technique (p = 0.02), and the presence of a pelvic external fixator/binder (p = 0.01). Patients with ARLIC had higher base deficit (p = 0.03) and lactate (p = 0.006). One hundred fifty-six patients received tranexamic acid (TXA), with 22 (14%) ARLICs. The rate of TXA use among ARLIC patients was 61% (vs. 35% TXA for non-ARLIC patients, p = 0.002). Access-related limb ischemic complication did not result in additional in-hospital mortality, however, ARLIC had prolonged hospital LOS (31 vs. 24 days, p = 0.02). Five ARLIC required surgical intervention, three patch angioplasty (and two with associated bypass), and four ARLIC limbs were amputated. Femoral artery REBOA access carries a risk of ARLIC, which is associated with unstable pelvis fractures, severe shock, and strongly with the administration of TXA. Use of lower-profile devices and close surveillance for these complications is warranted in these settings and caution should be exercised when using TXA in conjunction with REBOA. Prognostic and Epidemiologic, Level III.

TCT-362 Comparison of Radial Versus Femoral Arterial Access for Complex Percutaneous Coronary Intervention: A Systematic Review and Meta-analysis

TCT-362 Comparison of Radial Versus Femoral Arterial Access for Complex Percutaneous Coronary Intervention: A Systematic Review and Meta-analysis

Abstract 1122‐000067: Radial Versus Femoral Artery Access for Mechanical Thrombectomy Following IV tPA Administration

This meeting abstract was removed due to the OA licensing requirements of this journal. The full abstract is listed here : https://www.svin.org/files/SVIN_2021_Abstracts_for_Web.pdf

Vascular1: Evaluation of a Virtual Reality Ultrasound-Guided Femoral Artery Access Training Module

Khan, Suleman I. BA; Shenoy, Vishal BA; Nguyen, Elizabeth BS; Farooqui, Nabeel BS; Caraccio, William BS; Aalami, Oliver O. MD Author Information

Percutaneous Proximal Axillary Artery Versus Femoral Artery Access for Aortic and Peripheral Endovascular Interventions

We described and illustrated the technique of ultrasound-guided percutaneous proximal axillary artery (PAA) access and, secondarily, evaluated the versatility and safety of this approach in aortic and peripheral endovascular interventions.

581 Renal Arteriovenous Fistula Percutaneous Embolization Using the Amplatzer Vascular Plug II

Abstract Introduction Renal arteriovenous fistula (AVF) is not considered a common condition; however, it can occasionally complicate with renal impairment and heart failure secondary to high cardiac output. Recently, percutaneous embolization has overcome traditional surgery as the first line of its management, because of better success rates as well as less morbidity and mortality. Case report A 68-year-old male who presented with a renal AVF post left partial nephrectomy associated with a large pseudoaneurysm. This was found on a computed tomography angiography (CTA) scan, a routine follows up for his endovascular aortic aneurysm repair. Due to the patient’s co-morbidities and to avoid the potentially fatal pseudoaneurysm rupture, a minimal invasive approach was agreed in the multidisciplinary meeting. He was treated by percutaneous transcatheter embolization using the Amplatzer Vascular Plug II (AVP-II) through a right femoral arterial access. The patient recovery was uneventful, following an overnight stay he was discharged home. CTA done four and ten months later showed the AVP-II device inside the left renal artery branch feeder with no artifacts seen. There was absence of recanalization of the AVF. In the literature, adopting the transarterial route for the renal AVF treatment with AVP-II device as a single embolotherapy device has not been reported before. Conclusions Our report display the feasibleness of AVP-II in renal AVF treatment by arterial feeder embolization, specifically in fistulas with high flow and short communication as our case in which it showed offered multiple advantages over coils and is more cost effective.

Initial experience of subcutaneous nitroglycerin for distal transradial access in neurointerventions.

Background: Transradial access (TRA) for diagnostic and interventional neuroendovascular procedures has gained significant popularity in recent years due to its improved safety profile and appeal to patients compared with transfemoral access. However, risks of TRA include hand ischemia in cases of poor ulnar collateral circulation and inability to cannulate the radial artery due to its relatively small diameter. By accessing the radial artery distal to the superficial palmar arch where ulnar collateral blood flow arises, in the anatomic snuffbox, the risk of hand ischemia is theoretically eliminated. The use of subcutaneous nitroglycerin and lidocaine to improve rates of success in radial artery access has been reported in the cardiac literature, however, has yet to be described for neurointerventional procedures. We discuss our technique and report our initial experience using subcutaneous nitroglycerin and lidocaine cocktail for access to the distal transradial artery in a variety of neuroendovascular procedures.Methods: A retrospective review of our institution’s database of neurointerventional and diagnostic procedures performed using dTRA was conducted, and 64 patients were identified between February and December 2020. Patient demographics, clinical data, procedural details, and radiographic information were collected and analyzed.Results: A total of 64 patients underwent neurointerventional procedures using the subcutaneous injection for dTRA access. The procedures performed included diagnostic cerebral angiograms (n = 47), stent and balloon assisted aneurysm coiling (n = 5), flow diversion (n = 2), intra-saccular device placement (n = 1), mechanical thrombectomy (n = 1), tumor embolization (n = 1), middle meningeal artery embolization (n = 2), extracranial carotid stent placement (n = 2), and arteriovenous malformation embolization (n = 3). While no complications of hand ischemia were appreciated, the access site conversion rate was 3.1%; 2 cases required a switch to femoral artery access due to proximal vessel tortuosity and aortic anatomical variations, and not due to access site complication. Furthermore, on repeat angiograms by the same proceduralist, distal TRA (dTRA) was successful in 100% of the cases.Conclusion: dTRA using subcutaneous nitroglycerin and lidocaine is a safe and effective method for neurointerventional and diagnostic procedures.

Genicular Artery Embolization for the Treatment of Symptomatic Knee Osteoarthritis.

Background:Genicular artery embolization (GAE) is a novel therapy to treat patients with symptomatic knee osteoarthritis (OA) by reducing synovial arterial hypervascularity. This study evaluates the safety and efficacy of GAE for the treatment of symptomatic knee OA.Methods:A prospective, single-center, open-label U.S. Food and Drug Administration-approved investigational device exemption study was conducted. Patients enrolled in the study were 40 to 80 years old, with moderate or severe knee OA (Kellgren-Lawrence grade 2, 3, or 4), who previously had failure of conservative therapy. Baseline pain (visual analog scale [VAS]) and symptom scores (Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]) were assessed. After femoral arterial access was achieved, GAE of 1, 2, or 3 genicular arteries supplying the location of the subject’s pain, as determined by digital subtraction angiography and cone-beam computed tomography, was performed using 100-μm particles. Adverse events and symptoms scores were assessed at 1 week, 1 month, 3 months, 6 months, and 1 year after GAE.Results:Over a 10-month period, 40 subjects were enrolled. The median age was 69 years (range, 49 to 80 years). The median body mass index was 29 kg/m2 (range, 19 to 44 kg/m2). Knee OA severity was grade 2 in 18% of the patients, grade 3 in 43%, and grade 4 in 40%. Technical success was achieved in 100% of the subjects. Transient skin discoloration and transient mild knee pain after the procedure were common and expected. Treatment-related adverse events included a groin hematoma requiring overnight observation in 1 subject, self-resolving focal skin ulceration in 7 subjects, and an asymptomatic small bone infarct on magnetic resonance imaging at 3 months in 2 subjects. The WOMAC total and VAS pain scores decreased by 61% and 67% at 12 months from a median baseline of 52 (of 96) and 8 (of 10), respectively. Twenty-seven patients (68%) had a reduction of ≥50% in both WOMAC total and VAS pain scores.Conclusions:This prospective trial demonstrates that GAE is effective and durable in reducing pain symptoms from moderate or severe knee OA that is refractory to other conservative therapy, with an acceptable safety profile.Level of Evidence:Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Radial Artery Access is a Safe Alternative to Brachial Artery and Femoral Artery Access for Endovascular Lower Extremity Peripheral Arterial Disease

Radial artery access is a technique proved to be safe for percutaneous cardiac interventions. It has been used with increasing frequency in the treatment of lower extremity peripheral arterial disease. However, the overall safety has not yet been well described in the vascular surgery literature. We sought to evaluate the safety of this technique compared with retrograde femoral artery access and brachial artery access in the treatment of peripheral arterial disease.

Outcomes after endovascular reintervention for aortic interventions

ObjectiveEndovascular reinterventions are often performed after previous open or endovascular aortic procedures. We used the GREAT (Global Registry for Endovascular Aortic Treatment) database to compare the outcomes between these groups. We also compared reintervention of any type with a group of patients who had undergone primary endovascular abdominal aortic aneurysm repair (EVAR). MethodsAll patients enrolled in GREAT were grouped according to a previous EVAR or open abdominal aortic procedure (OAP). Univariate analysis was performed using the χ2, Wilcoxon rank sum, and Fisher exact tests. Cox proportional analysis was used to test the predictors for all-cause and aorta-related mortality. ResultsA total of 3974 subjects who had undergone EVAR with follow-up data available were included in the GREAT. Of the 3974 procedures, 196 (4.9%) were reinterventions (49 after OAP and 147 after previous EVAR). Reintervention after previous EVAR showed a trend toward a greater endoleak rate through 2 years (13.6% vs 4.1%; P = .07), although no difference was found in the occurrence of the intervention (12.2% vs 17.7%; P = .37). Reintervention after OAP resulted in higher all-cause mortality through 2 years of follow-up (32.7% vs 17.7%; P = .0.03). The predictors of mortality included prior OAP, renal insufficiency, and the use of cutdown for access. Compared with the patients who had undergone primary endovascular repair, patients in the reintervention cohort were older (75.3 years vs 73.3 years; P = .0005), had had only femoral artery access used (95.8% vs 90.3%; P < .0001), and were more likely to have undergone aortic branch vessel procedures (32.3% vs 13.3%; P < .0001). Both all-cause and aorta-related mortality through 2 years was higher in the reintervention group than in the primary EVAR group (21.4% vs 12.5% [P = .0003; and 4.6% vs 1% [P < .0001], respectively). On multivariate analysis, the predictors of aortic-related mortality included reintervention, renal insufficiency, chronic obstructive pulmonary disease, underweight body mass index, increasing aortic diameter, and the use of brachial artery or other arterial access sites. ConclusionsEndovascular reintervention for aortic pathology was associated with higher mortality than was primary EVAR. Reinterventions after prior OAPs were associated with higher mortality than were prior EVARs.

Safety and efficacy of dedicated guidewire, microcatheter, and guide catheter extension technologies for chronic total coronary occlusion revascularization: Primary results of the Teleflex Chronic Total Occlusion Study.

Description of procedural outcomes using contemporary techniques that apply specialized coronary guidewires, microcatheters, and guide catheter extensions designed for chronic total occlusion (CTO) percutaneous revascularization is limited. A prospective, multicenter, single-arm study was conducted to evaluate procedural and in-hospital outcomes among 150 patients undergoing attempted CTO revascularization utilizing specialized guidewires, microcatheters and guide extensions. The primary endpoint was defined as successful guidewire recanalization and absence of in-hospital cardiac death, myocardial infarction (MI), or repeat target lesion revascularization (major adverse cardiac events, MACE). The prevalence of diabetes was 32.7%; prior MI, 48.0%; and previous bypass surgery, 32.7%. Average (mean ± standard deviation) CTO length was 46.9 ± 20.5 mm, and mean J-CTO score was 1.9 ± 0.9. Combined radial and femoral arterial access was performed in 50.0% of cases. Device utilization included: support microcatheter, 100%; guide catheter extension, 64.0%; and mean number of study guidewires/procedure was 4.8 ± 2.6. Overall, procedural success was achieved in 75.3% of patients. The rate of successful guidewire recanalization was 94.7%, and in-hospital MACE was 19.3%. Achievement of TIMI grade 2 or 3 flow was observed in 93.3% of patients. Crossing strategies included antegrade (54.0%), retrograde (1.3%) and combined antegrade/retrograde techniques (44.7%). Clinically significant perforation resulting in hemodynamic instability and/or requiring intervention occurred in 16 (10.7%) patients. In a multicenter, prospective registration study, favorable procedural success was achieved despite high lesion complexity using antegrade and retrograde guidewire maneuvers and with acceptable safety, yet with comparably higher risk than conventional non-CTO PCI.

Radiographic Relationships of the Femoral Head, Inguinal Ligament, and Common Femoral Artery Bifurcation for Optimal Vascular Access

Common femoral artery (CFA) access is often used for endovascular interventions. Access site complications contribute to significant morbidity and mortality. We characterized the radiographic variability of the femoral head, inguinal ligament, and the CFA bifurcation to identify the optimal CFA access zone.

Percutaneous Proximal Axillary Artery Access Versus Femoral Artery Access for Aortic and Peripheral Endovascular Interventions

We have described and illustrated the technique of ultrasound-guided percutaneous proximal axillary artery access (AA) and, secondly, evaluated the versatility and safety of this approach in endovascular interventions.

A comparison of radial versus femoral artery access for acute stroke interventions.

In this study, the authors aimed to investigate procedural and clinical outcomes between radial and femoral artery access in patients undergoing thrombectomy for acute stroke. The authors conducted a single-institution retrospective analysis of 104 patients who underwent mechanical thrombectomy, 52 via transradial access and 52 via traditional transfemoral access. They analyzed various procedural and clinical metrics between the two patient cohorts. There was no difference between patient demographics or presenting symptoms of stroke severity between patients treated via transradial or transfemoral access. The mean procedural time was similar between the two treatment cohorts: 60.35 ± 36.81 minutes for the transradial group versus 65.50 ± 29.92 minutes for the transfemoral group (p = 0.451). The mean total fluoroscopy time for the procedure was similar between the two patient cohorts (20.31 ± 11.68 for radial vs 18.49 ± 11.78 minutes for femoral, p = 0.898). The majority of patients underwent thrombolysis in cerebral infarction score 2b/3 revascularization, regardless of access site (92.3% for radial vs 94.2% for femoral, p = 0.696). There was no significant difference in the incidence of access site or periprocedural complications between the transradial and transfemoral cohorts. Acute stroke intervention performed via transradial access is feasible and effective, with no significant difference in procedural and clinical outcomes compared with traditional transfemoral access. Larger studies are required to further validate the efficacy and limitations of transradial access for neurointerventional procedures.

TRIACCESS Study: Randomized Comparison Between Radial, Femoral, and Pedal Access for Percutaneous Femoro-popliteal Artery Angioplasty

Background The aim of this randomized study was to compare the success and complication rates of different access sites for the treatment of superficial artery stenosis. Methods and Results A total of 180 consecutive patients were randomized in a prospective study to treat symptomatic superficial femoral artery stenosis via radial (RA), femoral (FA), or pedal artery (PA) access. Technical success was achieved in 96.7%, 100%, and 100% of the patients in the RA, FA, and PA groups, respectively (p=0.33). Secondary access sites were used in 30%, 3.3%, and 30% of the patients in the RA, FA, and PA access groups, respectively (p=0.0002). Recanalization for chronic total occlusion was performed in 34/36 (94.4%), 30/30 (100%), and 46/46 (100%) patients in the RA, FA, and PA groups, respectively (p=0.17). The X-ray dose was significantly lower in the PA group than that in the RA and FA access groups (63.1 vs 162 vs 153 Dyn, p=0.0004). The cumulative rates of access site complications in the RA, FA, and PA groups were 3.3% (0% major and 3.3% minor), 16.7% (3.3% major and 13.3% minor), and 3.3% (3.3% major and 0% minor) (p=0.0085), respectively. The cumulative incidence of MACEs at 6 months in the RA, FA, and PA groups was 5%, 6.7%, and 1.7%, respectively. The cumulative incidence of MALEs at 6 months in the RA, FA, and PA groups was 20%, 16.7%, and 9.2%, respectively (p=0.54). Conclusion Femoral artery intervention can be safely and effectively performed using radial, femoral, and pedal access, but radial and pedal access is associated with a lower access site complication rate and hospitalization. Pedal access is associated with a lower X-ray dose than that with radial and femoral access.

Use of a Novel Simulator and Simulation-based Mastery Learning to Improve Femoral Arterial Access Skills

Femoral artery access (FAA) is a fundamental clinical skill across multiple specialties. Simulation-based mastery learning (SBML) is a rigorous form of competency-based education that improves procedural skills and clinical outcomes. We assessed the impact of a FAA SBML curriculum on procedural competency among cardiology fellows (CFs) and vascular surgery trainees (VSTs).

Radial Artery Access Is a Safe Alternative to Brachial Artery and Femoral Artery Access for Endovascular Lower Extremity Peripheral Arterial Disease

Radial artery access is a well-described technique that has proven to be safe and efficacious in percutaneous cardiac intervention. This technique has been used with increased frequency in the treatment of lower extremity peripheral arterial disease (LE-PAD); however, the overall safety has not yet been well described in vascular surgery literature. We sought to evaluate the safety of this technique compared with retrograde femoral artery access and brachial artery access in the treatment of PAD.

Vascular1: Evaluation of a Virtual Reality Ultrasound Guided Femoral Artery Access Training Module

Ultrasound guided vascular access (UGVA) has become standard of care when performing arterial/venous access to minimize puncture-related complications. Training remains limited, and trainees often learn on patients. Current simulation modules are limited by price and accessibility. Recent advances in virtual reality (VR) technology enable high fidelity simulations of real-life environments, are cost-effective, and do not require computer or WiFi connectivity. We built Vascular1 as a VR module to train landmark recognition and essential hand-eye coordination skills for safe and effective UGVA on a scalable platform.

Comparison of Success Rate and Complications of Totally Percutaneous Decannulation in Patients With Veno-Arterial Extracorporeal Membrane Oxygenation and Endovascular Aneurysm Repair.

Background: Total percutaneous closure for the site of femoral arterial puncture using Perclose ProGlide (PP) has become prevalent post-percutaneous endovascular aortic repair (EVAR) and veno-arterial extracorporeal membrane oxygenation (VA-ECMO).Objective: To evaluate the safety and efficacy of total percutaneous closure of the femoral artery access site post-EVAR compared with VA-ECMO.Methods: This was a retrospective observational study conducted over 4 years, including 88 patients who underwent EVAR (64 patients) and VA-ECMO (24 patients). Perclose ProGlide devices were used in the femoral artery puncture sites closed percutaneously. In this study, technical success was defined as successful arterial closure of the common femoral artery (CFA) without additional surgical or endovascular procedures to prevent vessel leaking. Access site complications, including overt bleeding requiring transfusion or surgical intervention, minor bleeding, tinea cruris, pseudoaneurysm, and lymphocele, were recorded 24 h and 30 days after arterial closure.Results: Each group's technical success rates were 95.8% (VA-ECMO) and 92.2% EVAR, respectively. There were no differences in the periprocedural complications of major bleeding, pseudoaneurysm, minor bleeding, acute limb ischemia, and groin infection. Furthermore, we did not observe any complications such as arterial thrombosis, dissection, stenosis, arteriovenous fistula, hematoma, groin infection, or lymphocele at the access site by following-up an ultrasound examination. There was no significant difference in the technical success rate of percutaneous closure by the PP device in the EVAR and VA-ECMO oxygenation groups. Also, no periprocedural or 30-day complications were observed at the access site of the EVAR and VA-ECMO patients.

Axillary arterial access for balloon dilatation of coarctation of aorta in newborns: a case series.

Balloon dilatation of coarctation of aorta is a standard of care for the patients presenting with severe left ventricular dysfunction. It can be performed through femoral, carotid, and axillary arterial access. Very few case series were available in the literature through axillary arterial access, despite being its advantage as non-end artery and easily palpable in coarctation of aorta. We present our experience with five cases of neonatal coarctation of aorta with severe left ventricular dysfunction where successful balloon dilatation of coarctation of aorta was performed via axillary approach without adverse events.