Percutaneous Cardiac Catheterization Research Articles

Same wrist intervention via the cubital (ulnar) artery in case of radial puncture failure for percutaneous cardiac catheterization or intervention: The multicenter SWITCH registry

AimsThe radial approach is safer than the femoral for percutaneous coronary procedures. However its feasibility is lower, mainly for technical issues, often related to failure to puncture or cannulate the radial artery. The ulnar approach is a valid alternative to radial. We aimed to test the incidence, feasibility and safety of a direct homolateral ulnar approach in case of failed radial sheath insertion. Methods and resultsFive operators collected their 1-year activity (diagnostic and interventional) with focus on entry site. Entry site choice was left to operators' discretion. In case of failed radial sheath insertion, an attempt to cannulate the homolateral ulnar artery was mandated, if ulnar pulse was present. All patients in whom this attempt was performed were followed until discharge.Out of 2403 procedures (1271 interventions), the final successful entry site was radial in 66.5%, femoral in 31.0%, ulnar in 2.1% and brachial in 0.4%. Radial failure occurred in 117 patients (6.9%). In 75 patients, the radial failure was not due to sheath insertion (which was successful), but to lack of catheter support or to tortuosity of the subclavian/brachial arteries. In the remaining 42 (35.9% of all radial failures), a homolateral ulnar approach was attempted. A successful cannulation of the ulnar artery occurred in 36 patients (85.7%) with further performance of the complete procedure. Concerning local complications, 1 radial pseudo-aneurysm (treated with additional compression) occurred, while no cases of early hand ischemia were reported. ConclusionsIn this multicenter registry, in case of failed radial sheath insertion, switching directly to the homolateral ulnar artery for percutaneous coronary procedures is feasible and it appears to be safe, without cases of symptomatic hand ischemia.

Fetal cardiac catheterization using a percutaneous transhepatic access technique: preliminary experience in a lamb model

Human fetal cardiac intervention has hitherto typically involved a percutaneous transventricular approach. In fetal lambs, a transhepatic approach to access the fetal intra-abdominal veins after exteriorization of the uterus by laparotomy has been described. We aimed to develop a percutaneous transhepatic technique for catheterization of the fetal heart at mid-gestation that avoids maternal laparotomy. In 10 fetal lambs (90-97 days' gestation), access to the fetal venous system was attempted by percutaneous puncture with a 5-F sheath into the umbilical vein (n = 1) or a 16-gauge IV-catheter into the hepatic vein (n = 9). This was followed by cardiac catheterization using a 1.8-2.6-F tapered coronary catheter. Euthanasia and postmortem examination were performed immediately postprocedure in two cases, or after normal term delivery in the remaining cases that survived the procedure. In one case fetal position precluded procedural attempts, and in another, the fetus, accessed by a 5-F sheath, died from umbilical hemorrhage. In eight cases, access to the fetal hepatic vein was achieved. In seven of these cases, the access catheter was advanced into the inferior vena cava, followed by catheterization of the right atrium (all cases) and four cardiac chambers (three cases). One fetus died during cardiac catheterization owing to right ventricle perforation, and the other seven fetuses were alive at the end of the procedure (87.5% survival). Immediate postmortem after euthanasia in two of the fetuses that survived the procedure detected intraperitoneal bleeding (4 mL and 20 mL), while postnatal postmortem examination following uneventful delivery at term in the remaining five fetuses revealed no vascular or cardiac trauma. Ultrasound-guided percutaneous transhepatic cardiac catheterization is feasible in mid-gestational fetal sheep. This technique has the potential for translation into human fetal cardiac and circulatory interventions.

TCT-539: Same Wrist Intervention via The Cubital (ulnar) artery in case of radial puncture failure for percutaneous cardiac catheterization or intervention: the multicenter prospective SWITCH registry

TCT-539: Same Wrist Intervention via The Cubital (ulnar) artery in case of radial puncture failure for percutaneous cardiac catheterization or intervention: the multicenter prospective SWITCH registry

Direct Measurement of Blood Flow in Microvessels Grown in Matrigel In Vivo

The Matrigel assay provides a versatile platform to examine vessel growth. Similarly, the microsphere method is used extensively in laboratory animals to measure tissue-specific blood flow. However, microsphere models have not been used with Matrigel to study angiogenesis in live animals. The goal of this study was to develop a novel technique to directly measure blood flow with microspheres in vessels grown in Matrigel invivo. In calves (n = 10, 110 ± 5 kg), 5 mL of Matrigel was injected subcutaneously. After 10 d, a percutaneous cardiac catheterization was performed. Fluorescent-labeled 15 μm microspheres were injected into the left ventricular chamber to distribute throughout the body based on systemic blood flow patterns. Afterwards, Matrigel plugs were removed, and animals were recovered. Flow cytometry was used to count microspheres and quantify blood flow within the plug. FITC-conjugated isolectin-B4 staining was performed to quantify Matrigel capillary density. Flow cytometry was performed to quantify circulating plasma CD34(+) cells. Linear regressions were used to determine relationships between Matrigel blood flow, Matrigel capillary density, and plasma CD34(+) cells. Over 10 d, small-caliber vessels grew into subcutaneous Matrigel plugs. Microspheres lodged throughout the plug and indicated that newly grown vessels in the Matrigel were functional and able to accommodate blood flow. Modest associations between Matrigel blood flow, Matrigel capillary density, and circulating plasma CD34(+) cells were noted. This method provides a novel and cost-effective technique to measure blood flow within vessels grown in Matrigel invivo.

Occlusion of Venous Femoropopliteal Bypass by a Starclose Device After Endovascular Cardiac Catheterization

More than 1 million patients undergo percutaneous cardiac catheterization worldwide every year. Overall vascular complications occur in 0.5% to 1.7% of patients undergoing diagnostic catheterization and in B5% of patients undergoing percutaneous interventions [1]. Major vascular complications seem to have diminished over time and have reached 2% in some studies [2]. They are, however, followed by surgery in a high percentage of patients (B40%) [3]. Vascular closure devices (VCDs) have been on the market for nearly 15 years. They permit early patient ambulation and discharge. Up until now, however, they failed to prove cost-effectiveness and a lower rate of vascular complications. The Starclose device was approved by the United States Food and Drug Administration in 2005. At least one randomized trial [4] has proven the safety and adequacy of this device. This is a case report of a major vascular complication of the puncture site after closure using the Starclose device.

Femoral Artery Complications after Cardiac Catheterization: A Study of Patient Profile

Femoral artery complications after cardiac catheterization range from simple events to severe complications requiring invasive techniques or surgery with significant economic costs. This study evaluated early femoral arterial complications from percutaneous arterial access during diagnostic and interventional cardiac catheterizations in an era of widespread use of closure devices and intense anticoagulation. Patients undergoing percutaneous cardiac catheterization via the femoral artery between August 2005 and December 2005 were identified using an ICD-9 patient database. Forty-six data points were extracted by retrospective chart review, including demographics, comorbidities, type of anticoagulation, procedural details, and postprocedural complications. Univariable analysis and binary logistic regression were used to determine factors associated with complications. Eighty-two of 579 patients (14%) suffered complications. The most common complications were hematomas (51 patients, 10%) and active bleeding (14 patients, 2.4%). Closure devices were used in 470 patients. After multivariable correction, use of preprocedural (odds ratio [OR]=5.65, 95% confidence interval [CI] 2.58-12.3, p<0.001) and intraprocedural (OR=4.88, 95% CI 1.95-12.3, p<0.001) antithrombotic agents (antiplatelet and/or anticoagulants), intraprocedural clopidogrel (OR=2.98, 95% CI 1.21-7.30, p=0.017), and postprocedural heparin (OR=29.4, 95% CI 3.56-250, p=0.002) were associated with increased risk. Coronary artery disease was associated with increased risk (OR=11.1, 95% CI 4.78-25.6, p<0.001), while use of a closure device (OR=0.263, 95% CI 0.125-0.553, p<0.001), male gender (OR=0.421, 95% CI 0.220-0.805, p=0.009), and prior catheterization (OR=0.033, 95% CI 0.012-0.095, p<0.001) were protective. With increasing numbers of complex coronary endovascular procedures and widespread use of high-dose multidrug antithrombotic therapy, femoral artery injuries will continue to be a significant risk for patients. Postprocedural monitoring with a high level of suspicion and use of vascular closure devices in high-risk patients may decrease the incidence of femoral artery complications. The use of vascular closure devices after low-risk procedures in male patients or those with previous ipsilateral catheterization might not be warranted but needs further study.

In-Hospital Outcomes Associated With Fibrinolytic and Thienopyridine Use in Patients With ST-Segment Elevation Acute Myocardial Infarction. The Global Registry of Acute Coronary Events

To investigate how thienopyridine treatment, with or without associated fibrinolysis, affects the rates of major bleeding and inhospital death in patients with ST-elevation myocardial infarction (STEMI). The rates of major bleeding and in-hospital death were studied in 14,259 consecutive patients with STEMI. During hospitalization, 5340 (38%) received thienopyridines, 3007 (21%) received fibrinolytic drugs, and 2044 (14%) received both. Major bleeding occurred more frequently in patients who received thienopyridines with or without fibrinolytics, in 4.6% and 4.1%, respectively, compared with 2.3% in those who received fibrinolytics alone and 2.8% in those who received neither (P< .001). Multivariate analysis, which included adjustments for risk factors for bleeding, percutaneous coronary intervention and cardiac catheterization, showed that thienopyridine treatment was an independent risk factor for bleeding (odds ratio=1.68; 95% confidence interval, 1.23-2.31). In-hospital mortality was lower in patients who received a thienopyridine, and such treatment was an independent predictor of lower mortality (odds ratio=0.50; 95% confidence interval, 0.39-0.60). Thienopyridine treatment was associated with an increased risk of major bleeding but also with a better in-hospital prognosis. These findings in unselected patients with STEMI, who are representative of those seen in daily clinical practice, complement, but do not replace, the data obtained in randomized clinical trails of selected patients.

Renal perforation and retroperitoneal hematoma: an unusual complication following cardiac catheterization

Retroperitoneal hematoma (RPH) is a well-recognised, albeit rare complication of percutaneous transfemoral cardiac catheterization. We describe an unusual case of renal perforation and RPH following transfemoral cardiac catheterization for endomyocardial biopsy. Diagnosis was made based on multidetector computed tomography (MDCT) which clearly depicted active renal hemorrhage in short acquisition time. The case expands the spectrum of possible complications of percutaneous transfemoral cardiac catheterization and illustrates the usefulness MDCT in quickly and adequately detecting RPH.

Vascular ultrasound imaging to study immediate postcatheterization vascular complications in children

Vascular occlusion is the major complication of percutaneous cardiac catheterization in children. This is a prospective study to evaluate post catheterization vascular complications in 120 consecutive children with the help of vascular ultrasound and Doppler imaging. Ultrasound imaging of both iliac and femoral veins and arteries was done one hour prior and 24 hours after cardiac catheterization. Patients with prior thrombus or occlusion of femoral/iliac vein or artery due to previous cardiac catheterization were excluded from the study. Age of the patients ranged from 22 days to 12 years with a mean of 56 months and weight ranged from 3 to 57 kg with a mean of 14.3 kg. Procedure time was less than 60 minutes in 74 patients (61.66%) and more than 60 minutes in 46 patients (38.33%). 4F sized arterial sheath was used in 108 patients. 5F or bigger sized arterial sheath was used in remaining 12 patients. Incidence of arterial occlusion was higher in patients weighing less than 10 kg (16%) as compared with patients weighing more than 10 kg (5.5%) {P = 0.031}. Arterial thrombosis was more in infants (16%) as compared with older children (7%) {P = 0.203} Prolonged procedure time or use of larger sized sheath did not have higher incidence of arterial occlusion. Venous thrombosis was found in 2 patients (1.66%) who had 5F venous sheath. One patient had arterio venous fistula. Our study shows vascular ultrasound imaging can provide anatomical details of femoral and iliac vessels and is a easier and accurate method of assessing post-catheterization vascular complications in children.

Macroscopic assessment of porcine coronary vessel wall trauma after percutaneous cardiac catheterization and intervention

A macroscopic pathological assessment of the coronary arteries of a pig's heart, in which stent implantation and intra-vascular ultrasound and thermography pullbacks were performed, shows that during percutaneous coronary catheterization and intervention, one of the major vessel traumas occurs in the very proximal part of the coronary arteries, where the guiding catheter tip is manipulated to adequately engage the vessels.

¿Se puede mejorar la eficiencia en procedimientos cardiológicos percutáneos? Dispositivos hemostáticos vasculares femorales

ObjectiveTo demonstrate that the use of hemostatic closure devices for the closure of femoral puncture sites after cardiac catheterization improves the quality of patient care and reduces hospital cost by decreasing length of hospital stay. MethodIn this descriptive study, two series of consecutive patients underwent cardiac catheterization: a study group of 103 patients in which the device was used (2002) and a control group of 116 patients in which the device was not used (2001). The effect of these hemostatic devices on reduction of mean length of hospital stay (through early ambulation and reduction in major vascular adverse events), as well as the subsequent decrease in hospital costs, were analyzed. ResultsMajor vascular adverse events in the puncture site after the procedure decreased (occurring in only three patients and these events were unrelated to the device). The mean length of hospital stay was markedly reduced in patients in whom the collagen hemostatic vascular closure device was used: 2.3 days vs 3.1 days, representing a 33% decrease with a saving of 72.51 e per patient (332.83 e in the case of an interventional procedure). ConclusionsThe use of this hemostatic closure device improves efficiency in percutaneous cardiac catheterization and reduces costs in both diagnostic and interventional procedures.

Occasional-operator percutaneous brachial coronary angiography: first, do no arm.

The percutaneous brachial approach to coronary angiography is perceived, rightly or wrongly, to be the easiest of the arm approaches. Predominantly femoral operators may therefore be encouraged to use the percutaneous brachial approach as an occasional procedure. We decided to investigate prospectively whether this was a reasonable strategy by examining outcome in patients who underwent percutaneous brachial cardiac catheterization by occasional brachial operators. Between October 1997 and 2000, 55 patients underwent percutaneous brachial coronary angiography (0.6% of coronary angiographies), aged 66 +/- 10 years, of whom 40 (73%) were male. Chief indications for a brachial approach were peripheral vascular disease in 35 (64%), failed femoral approach in 10 (18%), and orthopnoea in 5 (9%). The procedure was completed successfully in 46 patients (84%). Reasons for failure were failure of access (two), brachial artery spasm (one), inability to negotiate brachial/subclavian tortuosity (two), dissection of the brachial artery (two), and inability to intubate a vein graft (two). Six patients required catheterization from an alternative site (brachial arteriotomy in two, percutaneous transradial in two, femoral in two), with success in all. There were complications of varying severity in 20 patients (36%). Major complications were false aneurysm requiring surgical repair (one), large brachial hematoma requiring surgical exploration and arterial repair (one), and hematoma with clinical median nerve dysfunction for one month. Minor complications included need for repeat coronary angiography via alternative approach (six), weakness of radial pulse < 24 hr (two), brachial artery dissection without clinical sequelae (two), brachial artery spasm terminating procedure (one), and wound oozing (three). Percutaneous brachial coronary angiography is a hazardous procedure when undertaken by occasional brachial operators. Complications are unacceptably frequent. As with all practical procedures, complication rates are likely to be inversely proportional to operator volumes. Patients requiring an arm approach should be referred to operators with high-volume brachial or radial experience.

Percutaneous management of access site complications.

Percutaneous cardiac catheterization and endovascular procedures are associated with complications at the vascular access site. While surgery has been the traditional treatment for vascular access complications, the current state of the art permits percutaneous management of many access site complications. Surgical repair may be required only when percutaneous methods fail, are not available, or are unsuitable.

Circulatory support with a direct cardiac compression device: A less invasive approach with the AbioBooster device

TX R efractory cardiogenic shock is an important cause of death in patients after acute myocardial infarction (AMI), therapeutic percutaneous cardiac catheterization, and cardiac surgery. Of the 1.1 million AMI cases annually, 7% to 10% have cardiogenic shock, which has a 50% to 60% in-hospital mortality.1 The value of short-term circulatory support with currently available assist devices is drastically reduced by thromboembolic, hemorrhagic, and infectious devicerelated complications.2 The concept of direct cardiac compression (DCC), first introduced in 1965,3 is simple and elegant, with several advantages over intravascular ventricular assist devices (VAD) in current use. Use of non-blood contacting DCC systems would avoid cardiopulmonary bypass and bleeding complications and would be technically simpler to institute, allowing more widespread use. We evaluated a pneumatic DCC device, the AbioBooster, designed and fabricated by ABIOMED, Inc (Danvers, Mass). This device consists of inflatable polyurethane cylinders wrapped within a silicone-coated polytetrafluoroethylene fabric. Air pumped into and out of the wrap causes contraction and dilatation of its circumference (Figure 1). Twelve sheep studies were performed in nine short-term and three 4-week survival experiments. The effects of the wrap after induced cardiogenic shock (esmolol β-blockade with norepinephrine) and ventricular fibrillation were characterized. To create a reproducible model of heart failure, we used a continuous infusion of a short-acting β-blocker, esmolol. An esmolol drip was started at 10 mg/min and titrated to maintain a descending aortic blood flow at 1.0 L/min or less. We evaluated the impact of the device on underlying coronary artery bypass grafts (CABGs) by performing bypasses from the left internal thoracic artery to the left anterior descending artery (n = 1) or first diagonal artery (n = 2) and from the innominate artery to the first obtuse marginal artery (n = 3) using a reversed saphenous vein graft before device application.

Percutaneous translumbar cardiac catheterization and central venous line insertion: An alternative approach in children with congenital heart disease

Percutaneous translumbar cardiac catheterization and central venous line insertion: An alternative approach in children with congenital heart disease

Pulsating varicose veins

A 64-year-old woman visited her general practitioner in January, 1997, with large bilateral varicose veins that were visibly pulsating. She was otherwise well, but 20 years before had had a mitral-valve replacement for rheumatic valve disease. As part of her preoperative assessment for that procedure she had had a percutaneous cardiac catheterisation via her femoral artery. This had been an uncomplicated procedure and she had no symptoms in her legs after it. 10 years previously, she had pain in the right hypochondrium, which was thought to be due to gallstones.

Coronary Revascularization and Cardiac Catheterization in the United States: Trends in Racial Differences

Objectives. We sought to determine whether racial differences in rates of coronary artery bypass graft surgery (CABG), percutaneous transluminal coronary angioplasty (PTCA) and cardiac catheterization decreased after 1980.Background. Many reports of racial differences in utilization of CABG have been published since 1982. However, changes in the relative utilization of revascularization over time have received little attention.Methods. Data from the National Hospital Discharge Survey were examined for the years 1980 through 1993. Estimated numbers of procedures performed in nonfederal U.S. hospitals were used to compute age-adjusted rates per 100,000 population by year and race for patients 35 to 84 years old.Results. In patients 35 to 84 years old, the rate of CABG increased in blacks and whites between 1980 and 1993. Between 1986 and 1993, there was little change in the black/white ratio of age-adjusted rates (0.23 in 1980 through 1985 combined, 0.38 in 1986 and 0.43 in 1993). An apparent increase from 0.23 in 1980 through 1985 combined may have been due to sampling variation. Despite rapid increases in rates of PTCA in both races, no increase in the black/white ratio was noted (0.57 in 1993). However, the rate of inpatient cardiac catheterization increased more rapidly in blacks than in whites. This resulted in an increase in the black/white ratio of age-adjusted rates from 0.42 in 1980 to 0.91 in 1993.Conclusions. Rates of CABG, cardiac catheterization and especially PTCA increased between 1980 and 1993, a period during which racial disparities in the procedures became widely known. Despite apparent increases in the black/white ratio for inpatient cardiac catheterization, large racial disparities in the utilization of CABG and PTCA persist and require further evaluation and possible intervention.(J Am Coll Cardiol 1997;29:1557–62)

Enhanced soluble thrombomodulin, t-PA and u-PA concentrations caused by short-term endothelial damage during percutaneous cardiac catheterisation

Summary Objective : circulating plasma thrombomodulin (TM), tissue-type plasminogen activator (t-PA) and urokinase-type plasminogen activator (u-PA) are endothelial cell markers which may reflect endothelial injury. To find out to what extent diagnostic cardiac percutaneous catheterisation irritates vascular endothelium we conducted a prospective study in 114 children. Results : compared to starting values TM, t-PA and u-PA concentrations show a clearly significant increase at the end of cardiac catheterisation. TM and u-PA returned to pretreatment values 24 hours later, t-PA remained elevated. Four of 114 children developed vascular occlusion near the puncture sites within 48 hours of cardiac catheterisation. Two patients Conclusions : data of this study indicate that increased TM, t-PA and u-PA concentrations after percutaneous cardiac catheterisation in children are signs of endothelial damage.

A comparison of the treatment of acute myocardial infarction between St. Petersburg, Russia and Seattle, Washington

This study compared the baseline demographics, time to treatment and types of treatment of patients presenting with acute myocardial infarction in St. Petersburg, Russia and Seattle, WA. The study included 63 consecutive patients admitted to City Hospital #1 in St. Petersburg in July 1993. Comparative data for Seattle patients was obtained from the multi-year Myocardial Infarction Triage and Intervention project, a registry of all acute myocardial infarction patients hospitalized in the Seattle area. The results show a significantly prolonged time from symptom onset to presentation in Russia (51.8 h vs. 8.0 h; P < 0.001). Aspirin was used slightly more often in Seattle (78.9% vs. 74.6%; P = 0.40) while thrombolysis was used much more often in Seattle (22.5% vs. 6.3%; P = 0.002). There was also much less use of percutaneous transluminal coronary angioplasty (0% vs. 26.9%; P < 0.001), heparin (12.7% vs. 79.1%; P < 0.001), or cardiac catheterization (4.8% vs. 64.3%; P < 0.001). Also, the length of hospitalization was longer in St. Petersburg (23.8 ± 10.8 vs. 7.5 ± 5.1 days; P < 0.001). The findings in this study are an impetus for us all in understanding the magnitude of differences currently existing and the challenges for improving health care delivery in Russia.

European Survey on Cardiac Interventions: Open-Heart Surgery, Percutaneous Transluminal Coronary Angioplasty and Cardiac Catheterization in 1993

European Survey on Cardiac Interventions: Open-Heart Surgery, Percutaneous Transluminal Coronary Angioplasty and Cardiac Catheterization in 1993