Utilisation of Image Guidance to Enhance Safety of Deployment of the Mynx Control Vascular Closure Device

2021 ◽  
pp. 153857442110320
Author(s):  
Steven G. Dolan ◽  
Douglas Mulholland ◽  
Narayanan Thulasidasan ◽  
Athanasios Diamantopoulos
Keyword(s):  
Polyethylene Glycol ◽  
Vessel Wall ◽  
Image Guidance ◽  
Control Device ◽  
Closure Device ◽  
Vascular Closure Device ◽  
Imaging Guidance ◽  
Plaque Disruption ◽  
Device Deployment ◽  
Instructions For Use

The Mynx Control device (Cardinal Healthcare, Dublin, Ohio, USA) was recently licensed and allows for entirely extravascular arteriotomy closure. It uses a polyethylene glycol sealant plug which is absorbed fully within 30 days, alleviating concerns around difficulties with regaining access in future. The Mynx device uses a balloon, inflated within the artery and retracted against the arteriotomy to achieve haemostasis, with the extravascular sealant plug then deployed outside the vessel wall. While the manufacturer’s instructions for use do not include utilisation of imaging guidance, we routinely employ fluoroscopic and/or ultrasound to ensure safe use of the device. These techniques allow confirmation of balloon position against the arteriotomy, hence avoiding inadvertent deployment of the plug partially or fully intraluminally. Visualisation of the balloon within the lumen also eliminates risk of plaque disruption in diseased vessels on retraction of the device. Image guidance adds little time to device deployment, and the safety benefits are such that we recommend that practitioners elsewhere consider adopting our techniques. Here, we describe the process involved in both techniques.

scholarly journals Endovascular foreign body removal of a MynxGrip polyethylene glycol (PEG) sealant embolus using a cerebral stent retriever

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Mohammed Shamseldin ◽  
Hendrik Bergert ◽  
Axel Neumeister ◽  
Ralf Puls
Keyword(s):  
Polyethylene Glycol ◽  
Foreign Body ◽  
Femoral Artery ◽  
Superficial Femoral Artery ◽  
Rare Complication ◽  
Stent Retriever ◽  
Closure Device ◽  
Vascular Closure Device ◽  
Stent Retrievers ◽  
The Right

Abstract Background This is a rare case of removing an intra-arterial foreign body represented by MynxGrip polyethylene glycol (PEG) sealant as a rare complication of using the MynxGrip™ Vascular Closure Device (AccessClosure, Inc., Mountain View, CA) using a pRESET stent retriever (Phenox, Bochum, Germany) which is utilized mainly for treatment of endovascular stroke. Case presentation A 60-year-old female patient suffering from intermittent claudication in the right lower limb (stage IIb according to Fontaine) due to a peripheral arterial occlusive disease was presented for an elective revascularization using balloon angioplasty of a short chronic occlusion of the right superficial femoral artery. After a successful revascularization of the right superficial femoral artery using a retrograde femoral access from the left common femoral artery, the patient suffered from an acute limb ischemia in the left foot with distal popliteal embolization with involvement of BTK (below the knee) trifurcation. This is believed to be due to an intra-arterial foreign body embolism of MynxGrip polyethylene glycol sealant as a rare complication of using the MynxGrip™ Vascular Closure Device. Conclusions Stent retrievers have been used previously in removing dislocated coils especially in the cerebral vessels. This case report however proves a high efficacy and safety of using stent retrievers in removing different and rather unusual intra-arterial foreign bodies such as MynxGrip polyethylene glycol sealant.

scholarly journals Managing Unintentional Iatrogenic Triple Lumen Central Venous Catheter (TLCVC) Arterial Puncture

2021 ◽  
Vol 1 (2) ◽  
pp. 12-18
Author(s):  
Nurulfida’ Nusaiba M. Shukor ◽  
Ezamin Abdul Rahim ◽  
Ahmad Sobri Muda ◽  
Hariati Jamil ◽  
Heamn N Abduljabbar ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Venous Catheter ◽  
Arterial Puncture ◽  
Closure Device ◽  
Central Venous Catheter Insertion ◽  
Vascular Closure Device ◽  
Central Venous ◽  
External Compression ◽  
Alternative Strategies ◽  
Device Deployment

Unintentional arterial puncture by central venous catheter insertion/placing can result in destructive complications especially if a large bore (>7F) catheter was used. Unplanned immediate catheter ejection with manual external compression is hazardous due to potential torrential blood leakage or formation of a pseudoaneurysm. Endovascular removal with a vascular closure device deployment is preferred in this situation. The aim of this case report is to discuss the alternative strategies if the vascular closure device fails to secure hemostasis.

Symptomatic vascular complications after vascular closure device use following diagnostic and interventional catheterisation

VASA ◽  
2004 ◽  
Vol 33 (2) ◽  
pp. 78-81 ◽  
Author(s):  
Thalhammer ◽  
Aschwanden ◽  
Jeanneret ◽  
Labs ◽  
Jäger
Keyword(s):  
Current Literature ◽  
Vascular Complications ◽  
University Hospital ◽  
Closure Device ◽  
Ultrasound Guided ◽  
Vascular Closure Device ◽  
Device Use ◽  
Arterial Stenoses ◽  
The University ◽  
Stenotic Lesions

Background: Haemostatic puncture closure devices for rapid and effective hemostasis after arterial catheterisation are a comfortable alternative to manual compression. Implanting a collagen plug against the vessel wall may become responsible for other kind of vascular injuries i.e. thrombotic or stenotic lesions and peripheral embolisation. The aim of this paper is to report our clinically relevant vascular complications after Angio-Seal® and to discuss the results in the light of the current literature. Patients and methods: We report the symptomatic vascular complications in 17 of 7376 patients undergoing diagnostic or therapeutic catheterisation between May 2000 and March 2003 at the University Hospital Basel. Results: Most patients presented with ischaemic symptoms, arterial stenoses or occlusions and thrombotic lesions (n = 14), whereas pseudoaneurysms were extremely rare (n = 3). Most patients with ischaemic lesions underwent vascular surgery and all patients with a pseudoaneurysm were successfully treated by ultrasound-guided compression. Conclusions: Severe vascular complications after Angio-Seal® are rare, consistent with the current literature. There may be a shift from pseudoaneurysms to ischaemic lesions.

Endovascular treatment of acute limb ischemia caused by an intravascularly deployed bioabsorbable plug of a vascular closure device

VASA ◽  
2013 ◽  
Vol 42 (2) ◽  
pp. 144-148 ◽  
Author(s):  
Daniel Maxien ◽  
Barbara Behrends ◽  
Karla M. Eberhardt ◽  
Tobias Saam ◽  
Sven F. Thieme ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Limb Ischemia ◽  
Closure Device ◽  
Acute Limb Ischemia ◽  
Vascular Closure Device

First Experiences with MANTA Vascular Closure Device in Minimally Invasive Valve Surgery

2020 ◽  
Author(s):  
A. El-Sayed Ahmad ◽  
S. Salamate ◽  
M. Amer ◽  
S. Sirat ◽  
Ö. Akhavuz ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Valve Surgery ◽  
Closure Device ◽  
Vascular Closure Device ◽  
Minimally Invasive Valve Surgery

397 Intra-tumor immunotherapy injections utilizing image guidance in interventional radiology: clinical trial experience at a tertiary care cancer center

2020 ◽  
Vol 8 (Suppl 3) ◽  
pp. A422-A422
Author(s):  
Ravi Murthy ◽  
Rahul Sheth ◽  
Alda Tam ◽  
Sanjay Gupta ◽  
Vivek Subbiah ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Interventional Radiology ◽  
Real Time ◽  
Image Guidance ◽  
Tertiary Care ◽  
Cancer Center ◽  
Imaging Guidance ◽  
Image Guided ◽  
Real Time Image ◽  
Time Image

BackgroundImage guided intra-tumor administration of investigational immunotherapeutic agents represents an expanding field of interest. We present a retrospective review of the safety, feasibility & technical nuances of real-time image guidance for injection & biopsy across a spectrum of extracranial solid malignancies utilizing the discipline of Interventional Radiology.MethodsPatients who were enrolled in image guided intratumoral immunotherapy injection (ITITI) clinical trials over a 6 year period (2013–19) at a single tertiary care cancer center were included in this analysis. Malignancy, location, imaging guidance utilized for ITITI & biopsy for injected (adscopal) & non-injected (abscopal) lesions were determined and categorized. Peri-procedural adverse events were noted.Results262 pts (146 female, 61 yrs median) participating in 29 immunotherapeutic clinical trials (TLR & STING agonists, gene therapy, anti CD-40, viral/bacterial/metabolic oncolytics) met study criteria. Malignancies included melanoma 88, sarcoma 32, colorectal 29, breast 23, lung 17, head & neck 15, ovarian 8, neuroendocrine 7, pancreatic adenocarcinoma 6, 3 each (cholangioCA, endometrial, bladder, GI tract), 2 each (RCC, thymicCA, lymphoma, merkel cell, prostate) & others 1 each (CUP, GIST, dermatofibrosarcoma, DSRT, neuroblastoma, thyroid). All 169 & 93 patients received the intended 1371 ITITI in parietal (abdominal/chest wall, extremity, neck, pelvis) or visceral (liver, lung, peritoneum, adrenal) locations respectively; 83 patients received lymph node injections within either location. Imaging guidance was US in 68% of the cohort (US 161, CT+US 19); CT was used in 30% (81) & MRI in 1 patient. Median diameter of the ITITI lesion was 32 mm (8–230 mm). Median volume of the ITITI therapeutic material/session was 2 ml (1–6.9 ml). Lesions were accessed using a coaxial technique. ITITI delivery needles used at operator preference & tailored to lesion characteristics were either a 21G/22G Chiba, 21G Profusion (Cook Medical), 22G Morrison (AprioMed), 25G hypodermic (BD) & 18G Quadrafuse (Rex Medical). 2840 core biopsies (>18G Tru-cut core, Mission, Bard Medical) were performed in 237 patients during 690 procedures; biopsy sessions were often concurrent & of the ITITI site. 137 patients also underwent biopsy of a non-ITITI site (89 parietal location). Dimensions of the non-ITITI lesion were median 10 mm (7–113 mm); US image guidance was used in 97 patients (72%) to obtain a total of 1257, >18G Tru-core samples. 1.3% of injections resulted in SAE (NCI CTC AE >3) and 0.5% of 4097 biopsies developed major complications (SIR Criteria); both categories were manageable.ConclusionsUtilizing real time image guidance, ITITI to the administration of a myriad of investigational immunotherapeutic agents with concomitant biopsy procedures to date are associated with a high technical success rate & favorable safety profile.AcknowledgementsJoshua Hein, Mara Castaneda, Jyotsna Pera, Yunfang Jiang,Shuang Liu, Holly Liu and Anna LuiTrial RegistrationN/AEthics ApprovalThe study was approved by Institution’s Ethics Board, approval number 2020-0536: A retrospective study to determine the safety, feasibility and technical challenges of real-time image guidance for intra-tumor injection and biopsy across multiple solid tumors.Consent2020-0536 Waiver of Informed ConsentReferenceSheth RA, Murthy R, Hong DS, et al. Assessment of image-guided intratumoral delivery of immunotherapeutics in patients with cancer. JAMA Netw Open 2020;3(7):e207911. doi:10.1001/jamanetworkopen.2020.7911

scholarly journals Limitations of closing percutaneous transthoracic ventricular access ports using a commercial collagen vascular closure device

2011 ◽  
Vol 77 (7) ◽  
pp. 1079-1085 ◽  
Author(s):  
Israel M. Barbash ◽  
Christina E. Saikus ◽  
Kanishka Ratnayaka ◽  
Anthony Z. Faranesh ◽  
Ozgur Kocaturk ◽  
...  
Keyword(s):  
Closure Device ◽  
Vascular Closure Device

scholarly journals Treatment of Infected Pseudoaneurysm of Femoral Artery after Vascular Closure Device Deployment: A Practical Solution

2012 ◽  
Vol 2012 ◽  
pp. 1-4
Author(s):  
Predrag Matic ◽  
Srdjan Babic ◽  
Slobodan Tanaskovic ◽  
Dario Jocic ◽  
Djordje Radak
Keyword(s):  
Femoral Artery ◽  
Arterial Occlusion ◽  
Surgical Excision ◽  
Common Femoral Artery ◽  
Coronary Intervention ◽  
Closure Device ◽  
Arteriovenous Fistulas ◽  
Percutaneous Coronary ◽  
Infected Pseudoaneurysm ◽  
Device Deployment

Like other invasive procedures, percutaneous coronary interventions are associated with complications. Most common access site for these procedures is common femoral artery. Complications such as groin and retroperitoneal hematoma can be encountered as well as pseudoaneurysms, arteriovenous fistulas, acute arterial occlusion, and infection. When infected pseudoaneurysm occurs, surgical treatment can be extremely difficult. We present a case of the patient in whom infected pseudoaneurysm of common femoral artery developed after percutaneous coronary intervention and was successfully treated by surgical excision and autoarterial graft insertion.

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