Outcomes of Peripheral Vascular Interventions via Retrograde Pedal Access for Chronic Limb-Threatening Ischemia in a Multicenter Registry

2020 ◽  
Vol 27 (2) ◽  
pp. 205-210 ◽  
Author(s):  
Mark Perry ◽  
Peter W. Callas ◽  
Matthew J. Alef ◽  
Daniel J. Bertges
Keyword(s):  
Major Amputation ◽  
Technical Failure ◽  
Peripheral Vascular ◽  
Technical Success ◽  
Access Site ◽  
Femoral Access ◽  
Kaplan Meier ◽  
Hazard Ratios ◽  
Cox Proportional Hazard Models ◽  
Multicenter Registry

Purpose: To describe the use and 1-year outcomes of retrograde pedal access during peripheral vascular interventions (PVI) for chronic limb-threatening ischemia (CLTI). Materials and Methods: From October 2016 to September 2017, 159 patients (mean age 71±10 years; 112 men) undergoing PVI via retrograde pedal access were enrolled in the multicenter Vascular Quality Initiative (VQI) registry. The pedal access approach included retrograde femoral (40%), antegrade femoral (26%), retrograde to antegrade femoral (22%), and pedal only (11%). A comparator group of 1972 patients (mean age 69±12 years; 1129 men) having a contralateral retrograde femoral access was established for propensity matching, which resulted in 156 patients per group. Procedure characteristics, technical success, and access site complications were compared. Major adverse limb events (MALE) and amputation-free survival (AFS) at 1 year were analyzed using the Kaplan-Meier method and Cox proportional hazard models to calculate hazard ratios (HR) and 95% confidence intervals (CI). Results: Technical failure was similar for retrograde femoral and pedal access (7% vs 13%, p=0.07). Complications were rare and included access site hematoma (2 vs 5, p=0.32) and target artery thrombosis (0 vs 2) for the femoral vs pedal access groups, respectively. The rates of MALE at 1 year were significantly lower after retrograde femoral access (24%) compared with pedal access (38%; log-rank p=0.01; HR 1.95, 95% CI 1.15 to 3.30). AFS estimates at 1 year were similar: 86% for retrograde femoral and 83% for pedal access (log-rank p=0.37; HR 1.32, 95% CI 0.73 to 2.39), as were major amputation estimates: 10% for retrograde femoral access and 13% for pedal access group (log-rank p=0.21; HR 1.58, 95% CI 0.77 to 3.26). Conclusion: In this analysis of multicenter registry data, retrograde pedal access in patients with CLTI had similar technical success and early complications in comparison with traditional contralateral retrograde femoral access. The rates of MALE were higher after pedal access but AFS was similar, indicating a tradeoff between limb salvage and repeat interventions.

Flip Techniques: Obtaining Antegrade and Retrograde Femoral Access Through a Single Access Site

2018 ◽  
Author(s):  
S. Lowell Kahn
Keyword(s):  
Standard Of Care ◽  
Common Femoral Artery ◽  
Fogarty Catheter ◽  
Technical Success ◽  
Access Site ◽  
Femoral Access ◽  
Technical Success Rate ◽  
The Third ◽  
The Common ◽  
Buddy Wire

Retrograde access of the common femoral artery for ipsilateral iliac and up-and-over contralateral iliac-to-tibial interventions has been the standard of care for lower extremity procedures. However, ipsilateral antegrade access has gained popularity for infrainguinal occlusive disease. Proximity of the access site to the point of occlusion confers a higher technical success rate. Interestingly, there are times where conversion of a single femoral access from retrograde to antegrade or antegrade to retrograde may be desired. Three techniques are reviewed in this chapter: the first technique involves using a reverse curve catheter in conjunction with a Glidewire. The second technique is a “rebound” method whereby a Fogarty catheter is inflated just beyond the tip of a retrograde sheath to deflect a side-by-side Glidewire in the opposite direction. The third technique describes converting an antegrade sheath back to retrograde using a “buddy wire.”

scholarly journals Occupational Noise Exposure and Incidence of High Fasting Blood Glucose: A 3-Year, Multicenter, Retrospective Study

2021 ◽  
Vol 18 (17) ◽  
pp. 9388
Author(s):  
Seunghan Kim ◽  
Byungyoon Yun ◽  
Seunghyun Lee ◽  
Changyoung Kim ◽  
Juho Sim ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Noise Exposure ◽  
Fasting Blood Glucose ◽  
Common Data Model ◽  
Occupational Noise ◽  
Occupational Noise Exposure ◽  
Cox Proportional Hazard ◽  
Kaplan Meier ◽  
Hazard Ratios ◽  
Cox Proportional Hazard Models

The role of hazardous occupational noise exposure on the development of prediabetes is not well researched. We aimed to elucidate exposure to hazardous occupational noise as an independent risk factor for high fasting blood glucose (FBG). Participants exposed/non-exposed to occupational noise were recruited from the Common Data Model cohorts of 2013/2014 from two centers and were followed-up for 3 years. Multivariate time-dependent Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) and were adjusted for various covariates. Pooled HRs were calculated. Among the 43,858 participants of this retrospective cohort study, 37.64% developed high FBG. The mean (standard deviation) age in the cohort was 40.91 (9.71) years. In the fully adjusted models, the HRs of high FBG in the two centers were 1.35 (95% CI: 1.24–1.48) and 1.22 (95% CI: 1.17–1.28), and the pooled HR was 1.28 (95% CI: 1.16–1.41). A Kaplan–Meier plot of high FBG incidence by occupational noise exposure showed significant results (p < 0.001). We found that occupational noise exposure is significantly associated with high FBG. Preventing exposure to hazardous noise in the work environment may help reduce the risk for prediabetes among workers.

Physical Activity, Function, and Mortality in Advanced Age: A Longitudinal Follow-Up (LiLACS NZ)

2018 ◽  
Vol 26 (4) ◽  
pp. 583-588
Author(s):  
Casey Mace Firebaugh ◽  
Simon Moyes ◽  
Santosh Jatrana ◽  
Anna Rolleston ◽  
Ngaire Kerse
Keyword(s):  
Physical Activity ◽  
Advanced Age ◽  
Linear Regression Models ◽  
Cox Proportional Hazard ◽  
Kaplan Meier ◽  
Hazard Ratios ◽  
Cox Proportional Hazard Models ◽  
The Relationship ◽  
Lower Hazard

The relationship between physical activity, function, and mortality is not established in advanced age. Physical activity, function, and mortality were followed in a cohort of Māori and non-Māori adults living in advanced age for a period of 6 years. Generalized linear regression models were used to analyze the association between physical activity and Nottingham Extended Activities of Daily Living scale, whereas Kaplan–Meier survival analysis and Cox proportional hazard models were used to assess the association between the physical activity and mortality. The hazard ratio for mortality for those in the least active physical activity quartile was 4.1 for Māori and 1.8 for non-Māori compared with the most active physical activity quartile. There was an inverse relationship between physical activity and mortality, with lower hazard ratios for mortality at all levels of physical activity. Higher levels of physical activity were associated with lower mortality and higher functional status in advanced-aged adults.

TRIACCESS study: randomized comparison between radial, femoral and transpedal access for for percutanous supertfitial femoral artery angioplasty

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
Z Ruzsa ◽  
A Csavajda ◽  
M Deak ◽  
P Sotonyi ◽  
O.F Bertrand ◽  
...  
Keyword(s):  
Success Rate ◽  
Femoral Artery ◽  
Complication Rate ◽  
Randomized Study ◽  
Technical Success ◽  
Access Site ◽  
Femoral Access ◽  
X Ray ◽  
Technical Success Rate ◽  
Access Site Complication

Abstract Background Traditional access for the treatment of femoral artery lesions is the femoral artery (FA) approach, but radial (RA) and pedal access (PA) is an alternative access site. The aim of the study was to compare the success rate, complication rate of different access sites for the treatment of superfitial artery stenosis in a randomized study Methods 180 consecutive patients were randomized in a prospective study to treat symptomatic superficial femoral stenosis, via RA, FA and PA. Primary endpoint: technical success, rate of major and minor access site complications. Secondary endpoints: major adverse events (MAE), procedural factors, cross-over rate, and duration of hospitalization. Results Technical success was achieved in 96.6%, 100% and 100% patients in RA, FA and PA group (p=ns). Secondary access site was used in 30%, 3.3% and 30% in the RA, FA and PA access group (p&lt;0.01). Stent implantation was done in the femoral artery in 26.6%, 58.3% and 71.6% cases in RA, FA and PA group (p&lt;0.01). CTO recanalization was performed in 34/36 (100%), 30/30 (100%) and 45/45 (100%) cases successfully in RA, FA and PA group (p=ns). Contrast consumption, fluoroscopy and procedure time was not statistically different, but the X Ray dose was significantly lower in PA than in the RA and FA access group (63.1 vs 162 vs 153 Dyn). The cumulative rate of access site complications in the RA, FA and PA group was 3.3% (0% major and 3.3% minor), 15% (3.3% major and 11.6% minor) and 3.3% (0% major and 3.3% minor) (p&lt;0.01), respectively. The cumulative incidence of MAE's at 6 months in the RA, FA and PA group was 8.3% vs 13.3% and 18.3%. (p&lt;0.05) Conclusion Femoral artery intervention can be safely and effectively performed using radial, femoral and pedal access, but radial and pedal access is associated with less access site complication rate. Pedal access is associated with less X Ray dose than radial and femoral access. Funding Acknowledgement Type of funding source: None

Safety and efficacy of Mynx vascular closure device for the closure of common femoral artery access after ipsilateral stent placement

2020 ◽  
pp. 112972982096694
Author(s):  
Jin Ho Hwang ◽  
Sang Woo Park ◽  
Woo Young Yang ◽  
Yong Wonn Kwon ◽  
Jeeyoung Min ◽  
...  
Keyword(s):  
Femoral Artery ◽  
Stent Placement ◽  
Common Femoral Artery ◽  
Bleeding Complications ◽  
Closure Device ◽  
Technical Failure ◽  
Technical Success ◽  
Vascular Closure Device ◽  
Access Site ◽  
Low Bmi

Introduction: To evaluate the feasibility and safety of the Mynx vascular closure device (VCD) for arteriotomy closure after stent placement near the common femoral artery (CFA) access site. Methods: A total of 88 patients (73 men; mean age, 72 ± 9.2 years; 136 procedures) who underwent closure of CFA arteriotomy using the Mynx VCD after stent placement in proximal superficial femoral artery (SFA) with antegrade approach, or in common or external iliac artery with retrograde approach were retrospectively studied. Technical success and access site complication were evaluated. Body mass index (BMI), platelet count, international normalized ratio, prior history of ipsilateral CFA access, access direction, degree of CFA calcification, stent location and diameter, total procedure time, and sheath size were analyzed to evaluate their relationship with technical failure and development of bleeding complications. Results: Technical success was achieved in 94.9% (129/136) patients. The mean time to hemostasis was 0.7 ± 1.8 min. Technical failure was significantly associated with low BMI ( p = 0.001). Other variables presented no significant relationship with technical failure and development of complications. Ultrasonography on the day after the procedure revealed that 8 (5.9%) patients had hematoma. Conclusions: Mynx VCD for arteriotomy closure is feasible and provides hemostatic safety after stent placement near antegrade or retrograde CFA access. However, Mynx VCD may have a poor technical success rate among patients with low BMI.

scholarly journals Title: Lung-molGPA in EGFR-mutated Adenocarcinoma: Prognostic Implications of Molecular Subtypes and Targeted Therapies

2020 ◽  
Author(s):  
Feng-Che Kuan ◽  
Chung-Sheng Shi ◽  
Wei-Hsun Yang ◽  
Meng-Hung Lin ◽  
Hung-Yi Lai ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Molecular Subtypes ◽  
Egfr Mutations ◽  
Rare Mutations ◽  
Kaplan Meier ◽  
Hazard Ratios ◽  
Cox Proportional Hazard Models ◽  
Prognostic Implications ◽  
Egfr Mutated ◽  
Exon 19

EGFR mutations are heterogenous but all carry the same weighting in the Lung-molGPA. The aim of this study was to elucidate the different prognostic implications of molecular subtypes and frontline TKIs in EGFR-mutated lung adenocarcinoma with synchronous brain metastases (BM) using the Lung-molGPA. Medical records were searched in hospital databases from 2011 to 2015. Patients with EGFR-mutated adenocarcinoma and brain metastases who received TKIs were included. The Kaplan-Meier method was used to estimate survival, and multivariate Cox proportional hazard models were used to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs). A total of 256 patients were included with a median overall survival (OS) of 17.2 months. In multivariate analysis of OS, only age (70 versus &amp;lt;70 years, HR:1.71, 95% CI:1.25-2.35, p&amp;lt;0.001), KPS (&amp;lt;70 versus 70, HR:1.71, 95% CI:1.26-2.31, p&amp;lt;0.001), and rare mutations (other versus exon 19 deletions, HR:1.78, 95% CI:1.04-3.05, p=0.037) remained statistically significant. In patients with a Lung-molGPA score 2.5, EGFR molecular subtypes had different median OS (exon 19 deletions versus Leu858Arg versus other, 18.8 vs 12.4 vs 12.1 months, p=0.021). In conclusion, different molecular subtypes treated with frontline TKIs have different prognostic implications in the Lung-molGPA. Further prospective studies are warranted to validate these findings.

scholarly journals Clinical Outcomes of Ambulatory Endovascular Treatment Using 4-French and 6-French Femoral Access Strategies: The Bio4amb Multicentre Trial

2020 ◽  
Author(s):  
Marianne Brodmann ◽  
◽  
Koen Deloose ◽  
Eric Steinmetz ◽  
Olivier Regnard ◽  
...  
Keyword(s):  
Closure Device ◽  
Peripheral Vascular ◽  
Primary Analysis ◽  
Access Site ◽  
Femoral Access ◽  
Vascular Closure Devices ◽  
Total Procedure Time ◽  
American Society ◽  
Device Use ◽  
Ambulatory Procedures

Abstract Purpose Ambulatory peripheral vascular interventions have been steadily increasing. In ambulatory procedures, 4F devices might be particularly useful having the potential to reduce access-site complications; however, further evidence on their safety and efficacy is needed. Materials and Methods BIO4AMB is a prospective, non-randomized mulitcentre, non-inferiority trial conducted in 35 centres in Europe and Australia comparing the use of 4F- and 6F-compatible devices. The main exclusion criteria included an American Society of Anaesthesiologists class ≥ 4, coagulation disorders, or social isolation. The primary endpoint was access-site complications within 30 days. Results The 4F group enrolled 390 patients and the 6F group 404 patients. Baseline characteristics were similar between the groups. Vascular closure devices were used in 7.7% (4F group) and 87.6% (6F group) of patients. Patients with vascular closure device use in the 4F group were subsequently excluded from the primary analysis, resulting in 361 patients in the 4F group. Time to haemostasis was longer for the 4F group, but the total procedure time was shorter (13.2 ± 18.8 vs. 6.4 ± 8.9 min, p < 0.0001, and 39.1 ± 25.2 vs. 46.4 ± 27.6 min, p < 0.0001). Discharge on the day of the procedure was possible in 95.0% (4F group) and 94.6% (6F group) of patients. Access-site complications were similar between the groups (2.8% and 3.2%) and included predominantly groin haematomas and pseudoaneurysms. Major adverse events through 30 days occurred in 1.7% and 2.0%, respectively. Conclusions Ambulatory peripheral vascular interventions are feasible and safe. The use of 4F devices resulted in similar outcomes compared to that of 6F devices.

scholarly journals Distal Radial Artery Access for Superficial Femoral Artery Interventions

2020 ◽  
pp. 152660282096302
Author(s):  
Zoltán Ruzsa ◽  
Ádám Csavajda ◽  
Balázs Nemes ◽  
Mónika Deák ◽  
Péter Sótonyi ◽  
...  
Keyword(s):  
Radiation Dose ◽  
Femoral Artery ◽  
Superficial Femoral Artery ◽  
Fluoroscopy Time ◽  
Complication Rates ◽  
Procedure Time ◽  
Technical Success ◽  
Access Site ◽  
Femoral Access ◽  
Crossover Rate

Purpose: To compare the acute success and complication rates of distal radial (DR) vs proximal radial (PR) artery access for superficial femoral artery (SFA) interventions. Materials and Methods: Between 2016 and 2019, 195 consecutive patients with symptomatic SFA stenosis were treated via DR (n=38) or PR (n=157) access using a sheathless guide. Secondary access was achieved through the pedal artery when necessary. The main outcomes were technical success, major adverse events (MAEs), and access site complications. Secondary outcomes were treatment success, fluoroscopy time, radiation dose, procedure time, and crossover rate to another puncture site. Results: Overall technical success was achieved in 188 patients (96.4%): 37 of 38 patients (97.3%) in the DR group and 151 of 157 patients (96.2%) in the PR group (p=0.9). Dual (transradial and transpedal) access was used in 14 patients (36.8%) in the DR group and 28 patients (18.9%) in the PR group (p<0.01). Chronic total occlusions were recanalized in 25 of 26 DR patients (96.1%) and in 79 of 81 PR patients (92.6%) (p=0.57). The crossover rate to femoral access was 0% in the DR group vs 3.2% in the PR group (p=0.59). Stents were implanted in the SFA in 15 DR patients (39.4%) and in 39 patients (24.8%) in the PR group (p=0.1). The contrast volume, fluoroscopy time, radiation dose, and procedure time were not statistically different between the DR and PR groups, nor were the rates of access site complications (2.6% and 7.0%, respectively). The cumulative incidences of MAE at 6 months in the DR and PR groups were 15.7% vs 14.6%, respectively (p=0.8). Conclusion: SFA interventions can be safely and effectively performed using PR or DR access with acceptable morbidity and a high technical success rate. DR access is associated with few access site complications.

Endovascular Treatment of Severely Calcified Femoropopliteal Lesions Using the “Pave-and-Crack” Technique: Technical Description and 12-Month Results

2018 ◽  
Vol 25 (3) ◽  
pp. 334-342 ◽  
Author(s):  
Marina Dias-Neto ◽  
Manuela Matschuck ◽  
Yvonne Bausback ◽  
Ursula Banning-Eichenseher ◽  
Sabine Steiner ◽  
...  
Keyword(s):  
Limb Ischemia ◽  
Target Lesion ◽  
Major Amputation ◽  
Lesion Length ◽  
Secondary Patency ◽  
Technical Success ◽  
Stent Patency ◽  
Kaplan Meier ◽  
The Mean ◽  
Peripheral Arterial

Purpose: To report midterm results of the “pave-and-crack” technique to facilitate safe and effective scaffolding of heavily calcified femoropopliteal lesions in preparation for delivery of a Supera interwoven stent. Methods: Data were collected retrospectively on 67 consecutive patients (mean age 71±8 years; 54 men) treated with this technique between November 2011 and February 2017 at a single center. A third (22/64, 34%) of the patients had critical limb ischemia (CLI). Most lesions were TASC D (52/67, 78%), and the majority were occlusions (61/66, 92%). The mean lesion length was 26.9±11.2 cm. Nearly two-thirds (40/64, 62%) had grade 4 calcification (Peripheral Arterial Calcium Scoring System). To prepare for Supera stenting, the most heavily calcified segments of the lesion were predilated aggressively to obliterate recoil. A Viabahn stent-graft was then implanted to “pave” the lesion and protect from vessel rupture as aggressive predilation continued until the calcified plaque was “cracked” before lining the entire lesion with a Supera stent. Patency and target lesion revascularization (TLR) rates were estimated using the Kaplan-Meier method. Results: Procedural success was achieved in 100% and technical success (residual stenosis <30%) in 98% (66/67). The mean cumulative stent lengths were 16±9 cm for the Viabahn and 23±12 cm for the Supera. Only 2 complications occurred (distal embolization and access-site pseudoaneurysm). Two CLI patients died within 30 days, and 3 patients (all claudicants) underwent a TLR. Patients were followed for a mean 19±18 months, during which another 2 CLI patients died and 1 patient had a major amputation. One-year primary and secondary patency estimates were 79% and 91%, respectively; freedom from TLR was 85%. Conclusion: Despite severe lesion calcification, patients experienced high technical success and a safe and durable therapy at midterm follow-up with the femoropopliteal “pave-and-crack” technique.

P1710Risk of Mortality associated with use of mechanical support devices among comatose cardiac arrest patients

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Dutta ◽  
K Hari ◽  
W Qureshi
Keyword(s):  
Cardiac Arrest ◽  
Short Term ◽  
Circulatory Assist Devices ◽  
Kaplan Meier ◽  
Hazard Ratios ◽  
Short Term Mortality ◽  
Future Prospective Study ◽  
Cox Proportional Hazard Models ◽  
The Impact ◽  
Early Benefit

Abstract Background The impact of mechanical circulatory assist devices (MCS) has not been well studied in cardiac arrest survivors. We examined that association of MCS with risk of mortality among comatose cardiac arrest survivors Purpose Compare the survival between different MCS and non MCS groups Methods This is a retrospective cohort study of 1417 comatose adult cardiac arrest survivors that survived for at least 1 day post cardiopulmonary resuscitation. Cox proportional hazard models adjusted for demographics, resuscitation parameters, comorbidities and medications were used to compute hazard ratios for extracorporeal membrane oxygenation (ECMO), ECMO + Impella/intraaortic balloon pump (IABP), IABP and Impella associated with risk of short term 60 day mortality. Kaplan meier's curves were used to demonstrate cumulative survival rate. Results Among 1417 cardiac arrest survivors, MCS was used among 553 (39.1%) patients. After 60 days of follow up, mortality rate was 49.4% in non MCS group, 58.6% in IABP group, 22.9% in Impella group, 40.0% in ECMO only group, 50.0% in ECMO + Impella/IABP group. When compared with no MCS use, only Impella use was associated with decrease risk of short term mortality (HR 0.37; 95% CI 0.16–0.83, p=0.02) while there was no significant association of other forms of MCS with short term mortality. There was no significant association of any MCS with long term mortality. Kaplan-Meier curves demonstrate early benefit of Impella and very early benefit of ECMO (figure 1). Conclusions This is the first large study to report various types of MCS use among comatose cardiac arrest survivors and has shown an indication of benefit with Impella use only in first 60 days post cardiac arrest. Future prospective study may be needed to validate this association Acknowledgement/Funding None

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