Safety and Ease of Sheath Insertion During Endovascular Treatment Via the Common Femoral Artery After Endarterectomy With Autologous Repair: A Retrospective Cohort Study

2021 ◽  
pp. 153857442110619
Author(s):  
Sotaro Katsui ◽  
Kimihiro Igari ◽  
Masato Nishizawa ◽  
Toshifumi Kudo
Keyword(s):  
Endovascular Treatment ◽  
Femoral Artery ◽  
Common Femoral Artery ◽  
Arterial Disease ◽  
Scar Tissue ◽  
Patch Repair ◽  
Simple Closure ◽  
The Common ◽  
Sheath Insertion ◽  
Stiff Guidewire

Background Endovascular treatment (EVT) using the common femoral artery (CFA) for access after endarterectomy (EA) may result in sheath insertion difficulties because of subcutaneous scar tissue, as well as difficulties with hemostasis. We evaluated the safety of CFA access and the ease of sheath insertion over time after EA. Method We included 19 patients (21 limbs, 40 cases) in whom the CFA was used after EA with autologous repair as an access route in EVT for peripheral arterial disease in our institution from January 2013 to December 2020. Nine limbs underwent simple closure repair and 12 underwent autologous patch repair. Difficult sheath insertions were defined as those in which additional devices (stiff guidewire or a smaller diameter sheath for dilation) were used for scheduled sheath insertion. The inability to insert a sheath with the scheduled diameter was defined as a failed sheath insertion. We evaluated the EVT timing after EA for difficult sheath insertions, and whether the CFA was repaired with simple closure or autologous patch repair during EA surgery. Results There were 10 (25%) difficult sheath insertions, with one (2.5%) failure. The rate of difficult sheath insertions peaked from 6 months to 1 year after EA and gradually decreased (47% from 6 months to 3 years, 14% thereafter). There were more statistically significant difficult sheath insertions with simple closure repair (50%) than with autologous patch repair (12%) (P = 0.018). Hemostasis devices were used in 90% of EVT cases. The median maximum sheath diameter was 6 Fr (mean = 5.8 Fr). None of the cases required surgical procedures to achieve hemostasis after EVT. Conclusion EVT may be performed safely using the CFA after EA. The difficulty of sheath insertion may differ depending on the EVT timing after EA; it was more difficult with simple closure than with autologous patch repair, possibly related to scar formation.

scholarly journals A case of picking calcified plaque in the common femoral artery with a long needle: the “calc-pick technique”

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Yoshihiro Iwasaki ◽  
Shojiro Hirano ◽  
Atsushi Funatsu ◽  
Tomoko Kobayashi ◽  
Takanori Ikeda ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Intermittent Claudication ◽  
Femoral Artery ◽  
Balloon Dilatation ◽  
Common Femoral Artery ◽  
Contralateral Approach ◽  
Calcified Plaque ◽  
The Common ◽  
Stiff Guidewire

AbstractAn 88-year-old man had intermittent claudication of his right leg. Angiography revealed severely calcified plaque in the common femoral artery. Endovascular treatment was performed by contralateral approach. We attempted to penetrate the center of the calcified plaque and perform balloon dilatation. However, a 0.014-inch stiff guidewire could not enter the center of the lesion. Thus, we used an inner cylinder of 15-cm 20G long needle directly through the retrograde femoral sheath and successfully introduced the guidewire into the calcified plaque. Crosser and balloon dilatation resulted in 50 % stenosis. To cross the center of calcified plaque, it is important to obtain sufficient lumen gain at the non-stenting zone.

scholarly journals A Case of Picking Calcified Plaque In The Common Femoral Artery With A Long Needle: The “Calc-Pick Technique”

2021 ◽  
Author(s):  
Yoshihiro Iwasaki ◽  
Shojiro Hirano ◽  
Atsushi Funatsu ◽  
Tomoko Kobayashi ◽  
Shigeru Nakamura ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Intermittent Claudication ◽  
Femoral Artery ◽  
Balloon Dilatation ◽  
Common Femoral Artery ◽  
Contralateral Approach ◽  
Calcified Plaque ◽  
The Common ◽  
Stiff Guidewire

Abstract An 88-year-old male had intermittent claudication of his right leg. Angiography revealed severely calcified plaque in the common femoral artery. Endovascular treatment was performed by contralateral approach. We attempted to penetrate the center of the calcified plaque and perform balloon dilatation. However, a 0.014-inch stiff guidewire could not enter center of the lesion. Thus, we used a inner cylinder of 15-cm 20G long needle directly through the retrograde femoral sheath and successfully introduce the guidewire into the calcified plaque. Crosser and balloon dilatation resulted 50% stenosis. To cross the center of calcified plaque is important to get sufficient lumen gain at the nonstenting zone.

Endovascular Treatment of the Common Femoral Artery for Limb Ischemia

2013 ◽  
Vol 47 (8) ◽  
pp. 639-644 ◽  
Author(s):  
Robert S. M. Davies ◽  
William Adair ◽  
Amman Bolia ◽  
Guy Fishwick ◽  
Robert D. Sayers ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Femoral Artery ◽  
Limb Ischemia ◽  
Common Femoral Artery ◽  
The Common

scholarly journals Endovascular treatment of the common femoral artery in the Vascular Quality Initiative

2017 ◽  
Vol 65 (4) ◽  
pp. 1039-1046 ◽  
Author(s):  
Jeffrey J. Siracuse ◽  
Kathryn Van Orden ◽  
Jeffrey A. Kalish ◽  
Mohammad H. Eslami ◽  
Marc L. Schermerhorn ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Femoral Artery ◽  
Common Femoral Artery ◽  
The Common

scholarly journals Endovascular Treatment of Common Femoral Artery Atherosclerotic Disease

2018 ◽  
Vol 1 (1) ◽  
pp. 12-16 ◽  
Author(s):  
Omar Jawaid ◽  
Ehrin Armstrong
Keyword(s):  
Endovascular Treatment ◽  
Femoral Artery ◽  
Common Femoral Artery ◽  
Critical Limb Ischaemia ◽  
Limb Ischaemia ◽  
Long Term Outcomes ◽  
Patch Angioplasty ◽  
The Common ◽  
Artery Disease

Common femoral artery atherosclerosis is a common cause of claudication and critical limb ischaemia. Surgical endarterectomy with or without patch angioplasty has been considered the gold standard for the treatment of common femoral peripheral artery disease. Endovascular intervention to the common femoral artery has gained popularity in recent years as devices and technical skills have advanced. A systematic review of the literature from 1987 to 2018 for endovascular treatment of common femoral artery disease was conducted. This article summarises the data on acute and long-term outcomes for endovascular treatment of common femoral artery disease.

scholarly journals Ultrasound-guided puncture reduces bleeding-associated complications, regardless of calcified plaque, after endovascular treatment of femoropopliteal lesions, especially using the antegrade procedure: A single-center study

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0248416
Author(s):  
Kentaro Fukuda ◽  
Shinya Okazaki ◽  
Masayuki Shiozaki ◽  
Iwao Okai ◽  
Akihisa Nishino ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Limb Ischemia ◽  
Common Femoral Artery ◽  
Arterial Disease ◽  
Ultrasound Guided ◽  
Calcified Plaque ◽  
The Common ◽  
Ultrasound Guided Puncture ◽  
Peripheral Arterial ◽  
Guided Puncture

Background A common complication of endovascular treatment for femoropopliteal lesions is bleeding at the vascular access site. Although risk factors of bleeding-associated complications at the approach site have been reported, the results have been inconclusive. Hence, this study aimed to assess the predictors of bleeding-associated complications at the approach site in patients undergoing endovascular treatment for femoropopliteal lesions. Methods This retrospective, single-center, observational study included consecutive patients who underwent endovascular treatment (n = 366, 75% male, 72.4±9.9 year) for peripheral arterial disease with claudication and critical limb ischemia in our hospital from January 2010 to December 2017. We divided the patients into bleeding and non-bleeding groups, depending on whether bleeding-associated complications occurred at the approach site. Bleeding-associated complications were defined according to the Bleeding Academic Research Consortium criteria types 2, 3, and 5. Results Altogether, 366 endovascular treatment procedures and 404 arterial accesses were performed for femoropopliteal lesions in 335 peripheral arterial disease patients with claudication and 69 critical limb ischemia patients. We recorded 35 postprocedural bleeding-associated complications at the approach site (9%), all of which were hematomas. The predictors of increased bleeding-associated complications were age ≥ 80 years (bleeding vs. non-bleeding group, 43% vs. 25%, p<0.05) and antegrade cannulation of the common femoral artery (48% vs. 69%, p<0.05). Ultrasound-guided puncture reduced bleeding-associated complications (odds ratio, 0.28; 95% confidence interval, 0.004–0.21; p<0.05). In contrast, there was no significant difference in puncture site calcification between the groups (bleeding vs. non-bleeding groups, 29% vs. 21%, p = 0.29). Conclusion Ultrasound-guided puncture is associated with a decrease in bleeding-associated complications at the approach site, regardless of the presence of calcified plaque. It is particularly effective and should be more actively used in patients aged ≥80 years and for antegrade cannulation of the common femoral artery.

scholarly journals Experience of endovascular treatment of common femoral artery pseudoaneurysm with usage Angio-Seal Closure Device

2020 ◽  
Vol 29 (3) ◽  
pp. 71-79
Author(s):  
Yu.V. Cherednichenko
Keyword(s):  
Endovascular Treatment ◽  
Femoral Artery ◽  
Common Femoral Artery ◽  
Left Vertebral Artery ◽  
Closure Device ◽  
Severe Stenosis ◽  
Femoral Access ◽  
Artery Pseudoaneurysm ◽  
The Common ◽  
The Right

One case of successful treatment of the common femoral artery pseudoaneurysm with usage of modified technique of pseudoaneurysm neck sealing with Angio-Seal with retrograde access percutaneously is presented.A 52-year-old man was admitted in the recovery period of ischemic stroke in the left carotid basin. A total subtraction cerebral angiography was performed, which revealed severe stenosis in the bulb of the left internal carotid artery with ulcerated contour and severe stenosis in the ostium of the left vertebral artery. Hemostasis was performed by compression. A pressure dressing was applied for a day. The puncture site was without any problems on the next day. The patient received double antiplatelet therapy 5 days before endovascular surgery. Before surgery, palpation in the right inguinal region determines a rounded painful compaction. Carotid stenting on the left side, stenting of the left vertebral artery and control angiography of arteries of the right lower limb were performed by left-side femoral access. Pseudoaneurysm in the bifurcation of the right common femoral artery with a narrow neck was verified. Attempts to cure it by manual compression under angiographic control and ultrasound control were unsuccessful.After 6 days, endovascular treatment of pseudoaneurysms of the right common femoral artery with closure of the pseudoaneurysm neck was performed. The right common femoral artery was catheterized with left radial access with diagnostic catheter on a hydrophilic wire 0.035ʺ. This wire was carefully advanced into pseudoaneurysm through a defect in the common femoral artery and subsequently served as a marker. The pseudoaneurysm was punctured with miniaccess needle, then the 0.018ʺ wire passed through the pseudoaneurysm neck into the femoral artery retrogradly, focusing on the “marker” wire. A 6F radial introducer is introduced along 0.018ʺ wire. Further, this access was used to close the pseudoaneurysm neck with the Angio-Seal Closure Device 6F according to the standard method. In a control angiograms, a pseudoaneurysm did not contrast, arteries are passable without stenosis and signs of dissection. Hemostasis at the site of puncture of the radial artery was performed with a hemostatic bracelet. The patient was discharged from the clinic to continue treatment in a rehabilitation neurological center.This technique of endovascular treatment of postcatheterization pseudoaneurysms of the common femoral artery is quite simple, causing minimal discomfort for the patient. The closure is immediate and angiographically controled. The use of radial access instead of contralateral femoral access for introducing of a “marker” wire and angiographic control reduces the risk of local complications at the access site.

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