Incidence Of Vessel Occlusion Research Articles

ULSOSEAL Technique: A Unique Technique to Achieve Hemostasis Using ExoSeal in High-Risk Patients after Common Femoral Artery Puncture.

This study aimed to assess the safety and feasibility of the ULtrasound-guided uSe Of exoSEAL technique (ULSOSEAL technique) in patients at a high risk of complications following the use of ExoSeal. ExoSeal is a novel, completely extravascular hemostatic device that can treat punctures of the common femoral artery; however, it is not preferable for use in cases that require hemostasis of complex puncture sites. From November 2019 to August 2020, the ULSOSEAL technique was performed in 35 patients with implanted stents (6 patients, 17%), severe calcification (32 patients, 91%), and plaque (7 patients, 20%) around the puncture site; the presence of these conditions is usually undesirable when using ExoSeal. The antegrade approach was used in 22 patients (71%). The size of the ExoSeal used was 5 Fr (13 patients, 37%), 6 Fr (21 patients, 60%), and 7 Fr (1 patient, 2%). Technical success was achieved in 34 patients (97%), while ExoSeal malfunction occurred in 1 patient. There was no incidence of vessel occlusion, pseudoaneurysm, arteriovenous fistula, infection, and secondary bleeding. One patient developed a hematoma (>5 cm in size); however, it occurred before the use of ExoSeal due to side leakage from the inserted sheath. The ULSOSEAL technique was safe and feasible for hemostasis in patients who were considered unsuitable for the ExoSeal device.

Vascular compromise in newborn infants.

With improved neonatal resuscitation techniques a number of infants are now surviving only to develop vascular problems secondary to intravascular catheterisation, repeated venepuncture, or arterial blood sampling. Spontaneous thromboses are also more common in early life than in later childhood.' 2 Guidelines for the prevention, diagnosis, and treatment of blocked vessels in adult patients are not automatically applicable to the newborn. The size of the delicate vessels, the immature haemostatic mechanism, and the background of relative polycythaemia pose special problems. Thromboembolic vessel obstruction may result in death or irreversible damage to an organ or limb. In addition to blockage of peripheral vessels,3 4thrombosis ofthe cerebral,5 pulmonary,6 7 coronary,8 9 renal,I0 and mesenteric arteries, is reported in the neonate. Peripheral artery occlusion usually presents with a cold, pulseless, mottled, and discoloured limb. Obstruction of the central veins or arteries may be more difficult to recognise. Renal vein thrombosis, for example, does not always present with haematuria and an enlarged kidney, and thrombosis of the aorta may not disclose itself with congestive cardiac failure and ischaemia of the lower limbs.' association with radial,'9 femoral,0 pulmonary, and temporal artery22 lines, as well as with catheters into the jugular7 23 or femoral24 veins. Thrombi are also found when catheters are not used. A review of consecutive necropsies revealed a 4-5% incidence of thrombosis in uncatheterised cases, and an 11% incidence when intravascular catheters were used.25 Even temporary catherisation can cause problems. In a prospective study of children undergoing cardiac catheterisation, 3-6% developed clinical symptoms of femoral artery thrombosis.26 An extensive literature review of 1045 cannulations of the radial artery in newborn infants showed that 6% of cases suffered transient ischaemia and 0-5% had permanent ischaemic damage.27 Even hand amputation after radial artery cannulation has been reported.28 The incidence of vessel occlusion without ischaemic changes, however, is as high as 63%,29 and in such cases, an adequate collateral circulation exists. Flow in the blocked vessel is often restored several days after catheter removal. The propensity to develop thrombosis is related to size of the infant. The risk of vessel obstruction after cardiac catheterisation is highest in infants of less than 10 kg.27 30 31

Selective use of heparin in aortic surgery.

The incidence of distal ischaemia following aortic reconstruction may be as high as 25%, despite the use of systemic heparin. As anticoagulation may be associated with excessive operative blood loss, a retrospective study was performed to assess the prevalence of these problems, in a consecutive series, during a 30-month period. Evaluation of reconstruction was possible in 161 patients with aneurysm and 38 patients with occlusive disease. The incidence of vessel occlusion was 21% in the occlusive and 4% in the aneurysm group (P less than 0.05). Four of seven patients who had major vessel occlusion had serious complications, and there were two resultant deaths. These problems occurred despite the administration of heparin. Blood loss and operating time were quantitated in the patients who had resection for aortic aneurysm. Both were significantly longer in patients who received heparin (P less than 0.05) and the differences were maintained when patients were stratified according to increments in dose or operating time, and according to whether woven tube or bifurcation grafts were performed. It was concluded that aneurysm surgery, in the absence of distal occlusive disease, could be safely performed without the use of systemic heparin, but surgery for occlusive disease still requires heparinization.