Abstract 266: The Usefulness of a Collagen Plug Vascular Closure Device in Patients Undergoing Coronary and Peripheral Percutaneous Intervention

2013 ◽  
Vol 33 (suppl_1) ◽  
Author(s):  
John T Owens ◽  
Andrea Tordini ◽  
Shaun Bhatty ◽  
Peter Danyi ◽  
Kalpesh Patel ◽  
...  
Keyword(s):  
Medical Center ◽  
Veterans Administration ◽  
Closure Device ◽  
Minor Bleeding ◽  
Complication Rates ◽  
Manual Compression ◽  
Access Site ◽  
Percutaneous Coronary ◽  
Male Patients ◽  
The Mean

Background Vascular access site complications can follow coronary and peripheral angioplasty procedures and be associated with significant morbidity. We compared the complication rates of the Angioseal closure device with complication rates after manual compression in patients undergoing coronary and peripheral interventional procedures. Methods and Results We studied 553 predominantly male patients undergoing percutaneous coronary, peripheral interventions, FFR or IVUS at a Veterans Administration Medical Center. The mean age was 64.6 years. Angioseal closure devices were used in 388 (70%) patients and manual compression was used in 165 (30%) patients. Major groin complications such as arteriovenous fistula, pseudoaneurysm or hematoma greater than 5 cm occurred in 16 (4.16%) patients who had an Angioseal closure device and 11 (6.67%) patients in whom manual compression was used for hemostasis (odds ratio [OR] 0.63, 95% confidence interval [CI] 0.29-1.40; P=0.26). Other complications such as minor bleeding requiring additional manual compression, bruising, pain and swelling occurred in 32 (8.42%) patients who had an Angioseal closure device and 21 (12.4%) patients who had manual compression (OR 0.65, 95% CI 0.36-1.17; P=0.15). After adjustment for other comorbid factors such as age, type of anticoagulant used, peripheral vascular disease and chronic kidney disease, the association of major complications with the use of the Angioseal closure device remained similar to manual compression (OR 0.75, 95% CI 0.28-1.91; P=0.49). However, there was a trend for fewer minor complications with the closure device (OR 0.57, 95% CI 0.26-1.08; P=0.08). Conclusion In this cohort of predominantly male patients undergoing percutaneous coronary and peripheral intervention, the use of the Angioseal closure device was not associated with a decreased risk of major groin complications, but was associated with a trend for a decreased risk of minor complications compared to manual compression.

scholarly journals Usefulness of a Nonsuture Closure Device in Patients Undergoing Diagnostic Coronary and Peripheral Angiography

2017 ◽  
Vol 26 (04) ◽  
pp. 228-233
Author(s):  
John Owens ◽  
Shaun Bhatty ◽  
Robert Donovan ◽  
Andrea Tordini ◽  
Peter Danyi ◽  
...  
Keyword(s):  
Closure Device ◽  
Complication Rates ◽  
Manual Compression ◽  
Access Site ◽  
Femoral Access ◽  
Peripheral Angiography ◽  
Major Complications ◽  
Increased Risk ◽  
Male Patients ◽  
To Receive

AbstractVascular access site complications can follow diagnostic coronary and peripheral angiography. We compared the complication rates of the Catalyst vascular closure device, with the complication rates after manual compression in patients undergoing diagnostic angiographic procedures via femoral access. We studied 1,470 predominantly male patients undergoing diagnostic coronary and peripheral angiography. Catalyst closure devices were used in 436 (29.7%) patients and manual compression was used in 1,034 (70.3%) patients. The former were allowed to ambulate after 2 hours, while the latter were allowed to ambulate after 6 hours. Major complications occurred in 4 (0.9%) patients who had a Catalyst device and in 14 (1.4%) patients who had manual compression (odds ratio [OR]: 0.67, 95% confidence interval [CI]: 0.22–2.1, p = 0.49). Any complications occurred in 51 (11.7%) patients who had a Catalyst closure device and in 64 (6.2%) patients who had manual compression (OR: 2, CI: 1.4–3, p < 0.01). After adjustment for other variables and for a propensity score reflecting the probability to receive the closure device, the association of major complications with the use of the closure device remained not significant (OR: 0.54, 95% CI: 0.17–1.7, p = 0.29), while the association of any complications with the use of the Catalyst device remained significant (OR: 1.9, 95% CI: 1.3–2.9, p < 0.01). The Catalyst device was not associated with an increased risk of major groin complications but was associated with an increased risk of any complications compared with manual compression. Patients receiving the closure device ambulated sooner.

scholarly journals A Stopped Pilot Study of the ProGlide Closure Device After Transbrachial Endovascular Interventions

2019 ◽  
Vol 26 (5) ◽  
pp. 727-731 ◽  
Author(s):  
Max M. Meertens ◽  
Michiel W. de Haan ◽  
Geert W. H. Schurink ◽  
Barend M. E. Mees
Keyword(s):  
Pilot Study ◽  
Brachial Artery ◽  
Secondary Outcome ◽  
Control Group ◽  
Closure Device ◽  
Manual Compression ◽  
Access Site ◽  
Historical Cohort ◽  
Endovascular Interventions ◽  
High Incidence

Purpose: To evaluate the feasibility and safety of the suture-mediated ProGlide device in closure of the brachial artery after endovascular interventions. Materials and Methods: From 2016 to 2017, a pilot study was performed using the ProGlide to achieve hemostasis after percutaneous access of distal brachial arteries >4 mm in diameter. In an interim analysis, the results were compared to a matched control group taken from a 60-patient historical cohort who underwent brachial artery access and manual compression to achieve hemostasis between 2014 and 2017. The primary outcome was access-related reintervention and the secondary outcome was the incidence of access-site complications. Results: Seven patients (mean age 67.9 years; 6 men) were enrolled in the study before it was stopped in 2017. Four patients experienced 6 access-site complications (neuropathy, hematoma, occlusion, and pseudoaneurysm). These resulted in 3 access-related reinterventions: surgical evacuation of a hematoma, thrombectomy of the occluded brachial artery, and surgical repair of the pseudoaneurysm. In the interim comparison to the 19 matched patients (mean age 61.9 years; 6 men), the ProGlide group had proportionally more patients experiencing access-related complications (57% vs 16% for manual compression, p=0.035) and resultant reinterventions (43% vs 11%, p=0.064). Based on this data the trial was stopped. Conclusion: Considering this experience, it is not advisable to use the ProGlide in transbrachial endovascular interventions due to the high incidence of complications and access-related reinterventions.

scholarly journals Feasibility and Safety of Chronic Total Occlusion Percutaneous Coronary Intervention via Distal Transradial Access

2021 ◽  
Vol 8 ◽  
Author(s):  
Cheng-Jui Lin ◽  
Wei-Chieh Lee ◽  
Chieh-Ho Lee ◽  
Wen-Jung Chung ◽  
Shu-Kai Hsueh ◽  
...  
Keyword(s):  
Radial Artery ◽  
Chronic Total Occlusion ◽  
Vascular Complications ◽  
Coronary Intervention ◽  
Artery Occlusion ◽  
Access Site ◽  
Total Occlusion ◽  
Percutaneous Coronary ◽  
The Mean ◽  
Procedural Success

Aims: The current study aims to verify the feasibility and safety of chronic total occlusion (CTO)-percutaneous coronary intervention (PCI) via the distal transradial access (dTRA).Methods: Between April 2017 and December 2019, 298 patients who underwent CTO PCI via dTRA were enrolled in this study. The baseline demographic and procedural characteristics were listed and compared between groups. The incidences of access-site vascular complications and procedural complications and mortality were recorded.Results: The mean J-CTO (Japanese chronic total occlusion) score was 2.6 ± 0.9 points. The mean access time was 4.6 ± 2.9 min, and the mean procedure time was 115.9 ± 55.6 min. Left radial snuffbox access was performed successfully in 286 patients (96.5%), and right radial snuffbox access was performed successfully in 133 patients (97.7%). Bilateral radial snuffbox access was performed in 107 patients (35.9%). 400 dTRA (95.5%) received glidesheath for CTO intervention. Two patients (0.7%) developed severe access-site vascular complications. None of the patients experienced severe radial artery spasm and only 2 patients (0.5%) developed radial artery occlusion during the follow-up period. The overall procedural success rate was 93.5%. The procedural success rate was 96.5% in patients with antegrade approach and 87.7% in patients with retrograde approach.Conclusions: It is both safe and feasible to use dTRA plus Glidesheath for complex CTO intervention. The incidences of procedure-related complications and severe access-site vascular complications, and distal radial artery occlusion were low.

scholarly journals Testicular Doses of Patients Undergoing Radiological Examination of the Chest at Federal Medical Centre Makurdi, Nigeria

2014 ◽  
Vol 1 (1) ◽  
pp. 1-5
Author(s):  
L Alumuku ◽  
J.T Iortile ◽  
E.H Agba
Keyword(s):  
Dose Level ◽  
Adult Male ◽  
Medical Center ◽  
Medical Centre ◽  
Radiological Examination ◽  
Radiation Measurement ◽  
X Ray ◽  
Tube Potential ◽  
Male Patients ◽  
The Mean

The testicular dose of eight adult male patients undergoing radiological examination of the chest were investigated at the radiological department of the Federal Medical Center (FMC) Makurdi using themoluminescent dosimetry technique. The investigation was carried out using LiF TLD discs Reader, TLD model 4500 (Harshaw Radiation measurement product USA), 3-phase diagnostic X-ray machine and single a phase X-ray machine. The Mean testicular dose of the male patients investigated was found to be 0.0662±0.0034mGy. There is also a significant correlation between testicular dose and tube potential, in which higher tube potential delivered higher values of testicular doses. Results showed that, testicular doses are within acceptable limits, which is approximately 6.6% of the 1mGy reference dose level.

scholarly journals Comparison of Radial and Femoral Approaches for Coronary Angiography with or without Percutaneous Coronary Intervention in Relation to Vascular Access Site Complications

2021 ◽  
Author(s):  
◽  
Jonele Maree Woodhead
Keyword(s):  
Cardiovascular Disease ◽  
Percutaneous Coronary Intervention ◽  
Coronary Angiography ◽  
Vascular Access ◽  
Coronary Intervention ◽  
P Value ◽  
Complication Rates ◽  
Access Site ◽  
Radial Approach ◽  
Percutaneous Coronary

<p>Background A major population health objective in New Zealand is to reduce the incidence and impact of cardiovascular disease. Cardiovascular disease (CVD) remains New Zealand's leading cause of death (41%). This high demand on health services indicates the need for improved therapies and treatment. Significant advances in percutaneous coronary intervention (PCI) offers many patients who would not typically be eligible for treatment, the chance for a better quality of life living with coronary artery disease (CAD). At present femoral access is primarily used for coronary angiography and or PCI procedures, however more recently there has been a gradual shift to using the radial access approach. Study objective The study's objective was to look at comparing the different access sites used for coronary angiography (CA) and/or percutaneous coronary intervention (PCI) and the significance of the rates of vascular access site complications. The research question considered was; "Is there a significant difference in the vascular access site complication rates when comparing radial to femoral approaches for coronary angiography?"  Methodology and design A cohort study design used observational prospective data on radial approaches and compared this with historical retrospective data on femoral approaches. The secondary (comparative) data was extracted from historical records, from earlier research I had completed. The collection of the secondary data involved strict criteria so that the observational study participants had similar baseline characteristics to ensure validity of this study. One hundred participants were recruited for each (prospective and retrospective) database and then compared and analysed. Findings The use of a radial approach for CA and PCI has a significant decrease in combined vascular access site complications (haematoma, vasovagal and arterial bleed), (p value 0.001), OR 0.28 (0.13-0.62). Haematoma is the main vascular complication (p value 0.009), OR 0.29 (0.11-0.74). Conclusion This study, although small, can be used as a pilot study for a more detailed and bigger national study within New Zealand. From the results it is clear there is a significant decrease in the vascular site complication rates when a radial approach is undertaken for CA and/or PCI. Through education and clinical practice, the radial approach would ensure better patient safety, satisfaction and comfort which would help reduce the patients length of stay and increase patients treated with timely discharges. It could also help decrease the nurses' workload caring for the patient with the radial approach due to the lesser complication rates. More extensive use of radial approaches for CA and or PCI would ensure the above benefits for the patients, staff and the organisation.</p>

scholarly journals Safety and Efficacy of a Novel “Hybrid Closure” Technique in Large-Bore Arteriotomies

2017 ◽  
Vol 26 (02) ◽  
pp. 116-120 ◽  
Author(s):  
Michael Amponsah ◽  
Rajiv Tayal ◽  
Zain Khakwani ◽  
Michael Sinclair ◽  
Najam Wasty
Keyword(s):  
Common Femoral Artery ◽  
Coronary Intervention ◽  
Arterial Calcification ◽  
Closure Device ◽  
Manual Compression ◽  
Closure Technique ◽  
Safe Alternative ◽  
Combined Use ◽  
Percutaneous Coronary ◽  
Balloon Technique

AbstractThe “preclose” technique employing two Perclose (P) devices is well established for large-bore artery (LBA) hemostasis. Occasionally, only one Perclose deploys successfully during the initial preclose because of arterial calcification necessitating the use of the crossover balloon technique to achieve hemostasis at the LBA. We sought to determine if the combined use of one Perclose and either one Angioseal or one Mynx vascular closure device (VCD) is a safe alternative closure technique large-bore arteriotomy closure.In total, 40 patients underwent high-risk percutaneous coronary intervention (HRPCI) with Impella support, of whom 38 had common femoral artery (CFA) arteriotomies and 2 underwent percutaneous axillary arteriotomy (AA). Prior to Impella insertion, one Perclose device was predeployed. At the end of HRPCI, Impella was removed and a 0.035″ wire was inserted through the Impella sheath. This sheath was then withdrawn over the wire, and partially deployed Perclose was fully deployed. A 6-Fr sheath was advanced over a 0.035″ wire into the CFA or AA, achieving hemostasis and reducing the LBA to a 6-Fr size. The 6-Fr arteriotomy was closed with a 6-Fr Mynx or Angioseal VCD. Patients were followed at day 1 and day 30.Hybrid closure was successful in 38 of 40 cases. In one case of Mynx balloon rupture, hemostasis was achieved with heparin reversal and manual compression. In the case of Perclose failure, crossover balloon tamponade at arteriotomy site and external manual compression achieved hemostasis. Patients were free of complications at day 1 and day 30.Hybrid closure with one Perclose and either one Mynx or one Angioseal VCD is safe and effective for LBA closure.

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