Efficacy and Safety of Ultrasound-Guided Repeat Access and Repeat Closure With an ExoSeal Vascular Closure System in Patients With Peripheral Arterial Disease

2021 ◽  
pp. 153857442110455
Author(s):  
Taira Kobayashi ◽  
Masaki Hamamoto ◽  
Takanobu Okazaki ◽  
Mayu Tomota ◽  
Takashi Fujiwara ◽  
...  
Keyword(s):  
Success Rate ◽  
Complication Rates ◽  
Efficacy And Safety ◽  
Closure System ◽  
Technical Success ◽  
Ultrasound Guided ◽  
Access Site ◽  
Technical Success Rate ◽  
Significant Difference ◽  
Procedural Success

Objective The purpose of this study was to evaluate the efficacy and safety of ultrasound-guided repeat access and repeat closure with an ExoSeal vascular closure system. Methods A total of 123 endovascular therapy (EVT) procedures were performed in 59 patients (65 limbs) with ultrasound-guided repeat access and repeat implantation of an ExoSeal vascular closure system between January 2019 and March 2021. The procedural details and postprocedural outcomes of EVT with repeat access and use of ExoSeal (RE group) were compared with those of EVT with initial use of ExoSeal (IE group) in the same patients. In a subgroup analysis, these outcomes were also compared in early repeat (within 3 months) and late repeat (over 3 months) cases. Results The technical success rate of ultrasound-guided access in the RE group was 100%. The procedural success rate of EVT and deployment success rate of ExoSeal in the RE group were 93% and 94%, respectively, which were not significantly different to those in the IE group. Access site complications in the RE group occurred in 2 cases (2%), again with no significant difference with the IE group. The median puncture, procedural, and hemostasis times in the RE group were 3 [2-5], 36.5 [29-54], and 7 [5-10] min, respectively, which were not significantly longer than those in the IE group. In the RE group, early and late repeat closure was performed in 66 (54%) and 57 (46%) cases, respectively, and there were no significant differences in the technical success of ultrasound-guided access, procedural success of EVT, deployment success of ExoSeal, and access site complication rates in these cases. Conclusions Ultrasound-guided access facilitated higher technical success of repeat access and fewer access site complications in EVT with repeat use of ExoSeal, regardless of the interval between procedures.

scholarly journals A Newly Developed Variable Stiffness Duodenoscope for Diagnostic and Therapeutic Endoscopic Retrograde Cholangiopancreatography

2010 ◽  
Vol 2010 ◽  
pp. 1-4 ◽  
Author(s):  
Takao Itoi ◽  
Atsushi Sofuni ◽  
Fumihide Itokawa ◽  
Toshio Kurihara ◽  
Takayoshi Tsuchiya ◽  
...  
Keyword(s):  
Success Rate ◽  
New Technology ◽  
Variable Stiffness ◽  
Duodenal Stenosis ◽  
Technical Success ◽  
Endoscopic Retrograde ◽  
Technical Success Rate ◽  
Significant Difference ◽  
Therapeutic Ercp ◽  
Procedural Success

The aim of this study is to evaluate a prototype variable stiffness duodenoscope (VSD) for diagnostic and therapeutic ERCP in comparison with standard duodenoscopes. We performed retrospective analysis on the success rate of intubation of the second duodenum, overall procedural success rate, and comparative frequency of the necessity to change duodenoscopes from standard JF-260V and TJF 260V or to change stiffness using the VSD. A total of 213 nonconsecutive procedures in 196 patients with pancreaticobiliary diseases. There was no statistically significant difference in endoscope intubation rate or technical success rate between the different duodenoscopes. In one patient with severe duodenal stenosis, the VSD using the moderately stiff mode allowed the major papilla to be reached when the TJF-260V endoscope could not. There were no serious procedure-related adverse events. In conclusion, while the VSD performed well, the present models do not appear to offer obvious advantages over the standard duodenoscopes for routine diagnostic and therapeutic ERCP. Prospective studies may be warranted to identify those patients who would benefit from this new technology.

scholarly journals Modified percutaneous radiologic gastrostomy technique without endoscopic or nasogastric access

2019 ◽  
Vol 50 (1) ◽  
Author(s):  
Reda Tabashy ◽  
Amira Darwish ◽  
Ashraf Ibrahim ◽  
Mohamed Gad El-Mola
Keyword(s):  
Esophageal Cancer ◽  
Success Rate ◽  
Nasogastric Tube ◽  
Conventional Technique ◽  
Fluoroscopic Guidance ◽  
Efficacy And Safety ◽  
Technical Success ◽  
Technical Success Rate ◽  
Major Complications ◽  
Percutaneous Radiologic Gastrostomy

Abstract Background The aim of this study is to evaluate the efficacy and safety of a modified percutaneous radiologic gastrostomy (MPRG) technique under ultrasound and fluoroscopic guidance without endoscopic or nasogastric access. Results The study included 24 patients: 10 males and 14 females whose ages ranged from 44 to 80 years old. Ten patients had esophageal cancer and 14 patients had neck cancer. Technical success was achieved in 23 out of the 25 procedures (92%). Two procedures failed (8%) and were converted to the conventional technique by using the nasogastric tube. No major complications were reported. Minor complications were observed in 5 patients (20%): intraperitoneal air and contrast leakage in 4 patients and focal mucosal dissection by the contrast in 1 patient. Conclusion The MPRG has high technical success rate, is safe with no major complications, and is most feasible when endoscopic or nasogastric access cannot be performed.

scholarly journals Tibiopedal and distal femoral retrograde vascular access for challenging chronic total occlusions: predictors for technical success, and complication rates in a large single-center cohort

2020 ◽  
Vol 31 (1) ◽  
pp. 535-542
Author(s):  
Gerd Grözinger ◽  
Jan Hallecker ◽  
Ulrich Grosse ◽  
Roland Syha ◽  
Dominik Ketelsen ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Success Rate ◽  
Vascular Access ◽  
Chronic Total Occlusion ◽  
Lesion Length ◽  
Complication Rates ◽  
Technical Success ◽  
Total Occlusion ◽  
Femoral Access ◽  
Technical Success Rate

Abstract Objective To evaluate the safety and effectiveness of tibiopedal and distal femoral access for retrograde crossing of chronic total occlusion (CTO) in Rutherford stage III to VI peripheral arterial occlusive disease, and to determine factors that correlate with technical success. Material and methods One hundred seventy-one consecutive patients were included in this retrospective study. Rutherford stages were III, IV, and V/VI in 24%, 8%, and 67% of patients. Inclusion criteria were CTO at the superficial femoral (SFA), popliteal (PA), and/or below-the-knee (BTK) level, and a failed antegrade treatment followed by a distal retrograde approach. The numbers of occluded vascular levels (OVL), lesion length, degree of calcification, technical success rate, complications, and clinical outcome were noted. Results OVL were 1 in 72%, 2 in 20%, and 3 in 8% of patients. CTOs were longer than 20 cm in 45.6% of cases and showed severe calcifications in 50.3%. Target vessels for distal access were the distal SFA/PA in 17% and BTK in 83%. The overall technical success rate was 82%. Severe calcification decreased technical success (p = 0.01) despite lesion length and Rutherford stage. Clinical outcome improved in 123/152 patients with a significant increase of the median ABI (N = 158) from 0.53 (interquartile range 0.39 to 0.61) to 0.85 (0.59 to 1.03; p < 0.001). Complications were reported in 7.6% cases with 2.3% related to the distal vascular access. Conclusion The tibiopedal and distal femoral retrograde access presents a safe and effective treatment option of CTOs at the thigh and/or BTK after a failed antegrade attempt improving clinical outcome. Technical success decreased with lesion’s degree of calcification. Key Points • Safety and effectiveness of the tibiopedal and distal femoral access for retrograde crossing of chronic total occlusion. • Target lesion’s degree of calcification decreases technical success. • Complications related to the distal vascular access were rare.

scholarly journals Long-term outcomes of tracheal stents removal under fluoroscopy guidance: comparison of tracheal fistulas with tracheal stenosis

2020 ◽  
Author(s):  
Yonghua Bi ◽  
Jianzhuang Li ◽  
Liangliang Bai ◽  
Gang Wu ◽  
Xinwei Han ◽  
...  
Keyword(s):  
Success Rate ◽  
Tracheal Stenosis ◽  
Survival Rates ◽  
Technical Success ◽  
Technical Success Rate ◽  
Stent Removal ◽  
Total Incidence ◽  
Significant Difference ◽  
Routine Removal ◽  
Fluoroscopy Guidance

Abstract Background: No study compared the techniques and complications of stent removal under fluoroscopy guidance for tracheal fistula and tracheal stenosis.Methods: We conducted a retrospective analysis of 152 patients who underwent fluoroscopy-guided stent removal from January 2011 to June 2017. Eighty-five patients underwent stent removal for tracheal fistula (TF group), and 67 patients for tracheal stenosis (TS group). All patients underwent tracheal CT scans before stent removal and during follow up. The technical success rate, complications, survival rate were compared between the two groups.Results: The technical success rate of stent removal was 98.9% and 97.4% for tracheal fistula and tracheal stenosis, respectively. Except for the routine removal for half of patients, excessive granulation tissue was the common indications for stent removal, which was found 142.1±25.9 days later for tracheal fistula, and 89.9±15.0 day for tracheal stenosis. The total incidence of complications was 21.1% and 22.4% for tracheal fistula and tracheal stenosis, respectively. One perioperative death of asphyxia was found in TF group, and 2 deaths in TS group. Recurrence of fistula or stenosis requiring stenting was the most comment complication in both groups. The 0.5-, 3-, 6-year survival rates were 90.3%, 59.6%, and 36.1% for TF group, and 80.4%, 75.7%, 75.7% for TS group.Conclusions: Fluoroscopic removal of tracheal stent is safe and effective for both tracheal fistula and tracheal stenosis, with no significant difference. Recurrence of fistula or stenosis requiring stenting was the most comment complication.

scholarly journals Ultrasound-guided lung biopsy with coaxial technique: pleural contact length affects the occurrence of pneumothorax after first puncture

2021 ◽  
Author(s):  
Rinpei Imamine ◽  
Takeshi Kubo ◽  
Keizo Akuta ◽  
Hisato Kobayashi ◽  
Yoshiharu Yamamoto ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Success Rate ◽  
Lung Biopsy ◽  
Regression Tree ◽  
Contact Length ◽  
Classification And Regression Tree ◽  
Technical Success ◽  
Technical Success Rate ◽  
Significant Difference ◽  
Pleural Contact

Abstract Purpose To assess prebiopsy characteristics influencing the occurrence of pneumothorax after first puncture of ultrasound (US)-guided lung biopsy with coaxial technique. Materials and methods From January 2007 to September 2018, 180 peripheral lung lesions in 174 patients who underwent B-mode US-guided lung biopsy with coaxial technique at single institution were included in this study. Technical success was defined as the ability to make a diagnosis using the acquired sample with/without an adverse event of pneumothorax. Statistical analyses of prebiopsy characteristics were performed to identify the most important cutpoint and to evaluate the effect on diagnostic accuracy. Results Of the 180 lesions (mean size, 37 mm ± 26.2; mean pleural contact length, 38.2 mm ± 34.4), technical success rate was 97.2% (175/180 lesions) and diagnostic accuracy rate was 91.6% (165/180 lesions). Pneumothorax occurred immediately after first puncture for seven of 180 lesions. Classification and regression tree analysis and Fisher’s exact test showed the proportion of the pneumothorax immediately after first puncture was higher in lesions with pleural contact length less than 9.78 mm (p = 0.002). No significant difference was shown between the pneumothorax and non-pneumothorax after first puncture in technical success and final diagnosis success rate. Conclusion Pleural contact length affects the occurrence of pneumothorax after first puncture of US-guided lung biopsy with coaxial technique.

scholarly journals Long-term outcomes of fluoroscopy-guided tracheal stents removal under fluoroscopy guidance: comparison of tracheal fistulas and tracheal stenosis

2020 ◽  
Author(s):  
Yonghua Bi ◽  
Jindong Li ◽  
Liangliang Bai ◽  
Xinwei Han ◽  
Jianzhuang Ren
Keyword(s):  
Success Rate ◽  
Tracheal Stenosis ◽  
Survival Rates ◽  
Technical Success ◽  
Technical Success Rate ◽  
Stent Removal ◽  
Total Incidence ◽  
Significant Difference

Abstract Background: Endoscopic removal is the most common method for removal of tracheal stents. Few studies have reported the technique of fluoroscopy-guided stent removal for tracheal fistula and tracheal stenosis. We aimed to study the safety and efficacy of fluoroscopy-guided stent removal as well as the optimal duration for stent usage.Methods: We conducted a retrospective analysis of 152 patients who underwent fluoroscopy-guided stent removal from January 2011 to June 2017. Reasons for stent implantation were tracheal fistula in 85 patients (TF group), and tracheal stenosis in 67 patients (TS group). All patients underwent tracheal CT scans before stent removal and during follow up. The technical success rate, complications, and survival rate were compared between the two groups.Results: The technical success rate of stent removal was 98.9% and 97.4%, respectively for the TF and TS group. Removal was routine for half of patients, and in the remainder, excessive granulation tissue was the common indications for stent removal, which was found after stenting at 142.1±25.9 days in the TF group, and at 89.9±15.0 day in the TS group. The total incidence of complications was 21.1% and 22.4%, respectively, for the TF and TS groups. Perioperative death occurred in one patient in the TF group, and two patients in the TS group. Recurrence of fistula or stenosis requiring re-stenting was the most comment complication in both groups. The 0.5-, 3-, 6-year survival rates were 90.3%, 59.6%, and 36.1% for TF group, and 80.4%, 75.7%, 75.7% for TS group.Conclusions: Fluoroscopic removal of tracheal stents is safe and effective for both tracheal fistula and tracheal stenosis, with no significant difference in outcomes. Recurrence of fistula or stenosis requiring re-stenting was the most common complication.

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

P975Safety and clinical outcomes of rotational atherectomy: an eleven-year centre experience

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A R Pereira ◽  
R Cale ◽  
P Santos ◽  
A R Almeida ◽  
A Marques ◽  
...  
Keyword(s):  
Success Rate ◽  
Clinical Outcomes ◽  
Rotational Atherectomy ◽  
Safe Procedure ◽  
Access Site ◽  
Significant Difference ◽  
Coronary Lesions ◽  
Procedural Success ◽  
Calcified Coronary Lesions

Abstract Introduction Rotational atherectomy (RA) is an adjunctive tool for the management of heavily calcified coronary lesions during percutaneous coronary intervention (PCI), but the clinical outcomes remain unclear. Access site choice is also poorly defined and there is growing evidence that transradial approach (TRA) is associated with lower complications and lower mortality. Objectives To assess the safety and long-term outcomes of RA for calcified coronary lesions and to investigate the influence of vascular access site in the efficacy and safety of the procedure. Methods Retrospective single-centre study that included consecutive PCI with RA performed from January 2006 to December 2017. Endpoint was a composite of major adverse cardiac events (MACE), defined as cardiovascular death, nonfatal myocardial infarction, nonfatal stroke and target vessel revascularization, at 1- and 5-year. Results 246 procedures were included in a total of 236 patients (pts): mean age 70.1±9.7 years, 73.6% male; 36.2% had previous PCI, 12.2% vascular peripheral disease (VPD), 24% reduced left ventricle ejection fraction (LVEF) and 6.9% were under hemodialysis. PCI with RA was mostly performed due to stable angina (48.9%) and via TRA (55.3%), with a total of 371 treated segments and a median number of 1 vessel treated per intervention. The left anterior descending artery was the most frequently treated artery (67.5%). Single burr was used in 76% of cases (mean number of burrs 1.23; mean burr size 1.5 mm). Procedural success rate was 94.7%. Complications were recorded in 9.3%, with no procedure related death. Clinical follow-up was complete in 98.8% of pts at 1-year and 81.3% at 5-year (mean time 62.3±41.8 months). Survival free of MACE at 1- and 5-year were 83.7% and 73.2%, respectively. Multivariate Cox regression identified 6 independent predictors (only 1 protector) for 1-year MACE (Fig. A) and 6 independent predictors (all of increased risk) for 5-year MACE (Fig. B). TRA was protector of 1-year MACE and Kaplan-Meier curves showed benefit for both 1- and 5-year MACE occurrence (Fig. C and D), without significant difference in procedural success (p=0.92) and complications (p=0.45) rate comparing to transfemoral approach. Conclusions RA followed by stenting was a safe procedure with a high immediate success rate but an increased number of long-term cardiovascular events. Some clinical conditions, such as previous PCI, VPD and reduced LVEF, seems to adversely influence the long-term outcome while TRA appears to be protective.

scholarly journals Comparison of the Effects of TIPS versus BRTO on Bleeding Gastric Varices: A Meta-Analysis

2020 ◽  
Vol 2020 ◽  
pp. 1-9 ◽  
Author(s):  
Zi Wen Wang ◽  
Jin Chao Liu ◽  
Fang Zhao ◽  
Wen Guang Zhang ◽  
Xu Hua Duan ◽  
...  
Keyword(s):  
Hepatic Encephalopathy ◽  
Cohort Studies ◽  
Success Rate ◽  
Meta Analysis ◽  
Gastric Varices ◽  
Cochrane Library ◽  
Technical Success ◽  
Technical Success Rate ◽  
Significant Difference ◽  
Rebleeding Rate

Background and Aim. Upper gastrointestinal bleeding is a threat to patients with gastric varices (GVs). Previous studies have concluded that both transjugular intrahepatic portosystemic shunt (TIPS) and balloon-occluded retrograde transvenous obliteration (BRTO) are effective treatments for patients with GV. We aimed to compare the efficiency and outcomes of these two procedures in GV patients through meta-analysis. Methods. The PubMed, Cochrane Library, EMBASE, and Web of Science databases were searched using the keywords: GV, bleeding, TIPS, and BRTO to identify relevant randomized controlled trials and cohort studies. The overall survival (OS) rate, imminent haemostasis rate, rebleeding rate, technical success rate, procedure complication rate (hepatic encephalopathy and aggravated ascites), and Child-Pugh score were evaluated. Randomized clinical trials and cohort studies comparing TIPS and BRTO for GV due to portal hypertension were included in our meta-analysis. Two independent reviewers performed data extraction and assessed the study quality. A meta-analysis was performed to calculate risk ratios (RRs), mean differences (MDs), and 95% CIs using random effects models. Results. A total of nine studies fulfilled the inclusion criteria. There was a significant difference between TIPS and BRTO in the OS rate (RR, 0.81 (95% CI, 0.66 to 0.98); P=0.03) and rebleeding rate (RR, 2.61 (95% CI, 1.75 to 3.90); P<0.00001). TIPS had a higher incidence rate of hepatic encephalopathy (RR, 16.11 (95% CI, 7.13 to 36.37); P<0.00001). There was no significant difference between TIPS and BRTO in the immediate haemostasis rate (RR, 0.99 (95% CI, 0.89 to 1.10); P=0.84), technical success rate (RR, 1.06 (95% CI, 0.98 to 1.16); P=0.16), aggravated ascites rate (RR, 0.60 (95% CI, 0.33 to 1.09); P=0.10), or Child-Pugh change (MD, 0.22 (95% CI, −0.21 to 0.65); P=0.31). Conclusions. In this meta-analysis, BRTO brought more benefits to patients, with a higher OS rate and lower rebleeding rate. BRTO is a feasible method for GVB.

Single-center comparison of the efficacy and complications of arterial vascular closure devices in interventional radiology

2017 ◽  
Vol 18 (4) ◽  
pp. 339-344 ◽  
Author(s):  
Matthew A. Elmasri ◽  
Stephen T. Kee ◽  
John M. Moriarty ◽  
Antoinette Gomes ◽  
Edward W. Lee ◽  
...  
Keyword(s):  
Interventional Radiology ◽  
Success Rate ◽  
Complication Rates ◽  
Manual Compression ◽  
Single Center ◽  
Technical Success ◽  
Laboratory Parameters ◽  
Technical Success Rate ◽  
Major Complications ◽  
Vascular Closure Devices

Introduction Vascular closure devices (VCDs) are commonly used to achieve hemostasis of arterial access sites, but there is little comparative data on the variety of VCDs currently in clinical use. We reviewed the VCD experience at our institution to determine the safest and most effective VCD. Materials and Methods Retrospective analysis of 907 consecutive arterial procedures in interventional radiology from June 2012 to June 2014 was performed. Five VCDs were used: Angio-Seal (n = 478), FISH (n = 56), Mynx (n = 56), Perclose (n = 61), and Starclose (n = 68). Patients who underwent manual compression (n = 188) without use of VCDs were also studied as a comparison group. Patient demographics and pre-procedural laboratory parameters were recorded. The technical success rate for achievement of hemostasis and complication rates were noted. Results Complete hemostasis rate (aka technical success rate) was 93.5% for Angio-Seal, 83.9% for FISH, 53.6% for Mynx, 73.7% for Perclose, 76.5% for Starclose, and 91.5% for manual compression. The differences among the devices were statistically significant (p<0.001). Fourteen major complications (1.5%) were encountered: nine with Angio-Seal (1.9%), one with Mynx (1.8%), one with Starclose (1.5%), and three with manual compression (1.6%); these differences were not statistically significant. Of the demographic and laboratory parameters studied, none were significantly correlated with hemostasis failure or development of complications. Conclusions In our single-center institutional experience, Angio-Seal is the device with the best technical success rate. Major complications of VCDs were rare, with no statistically significant difference between devices.

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