scholarly journals Complication rates of percutaneous brachial artery puncture: effect of live ultrasound guidance

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
K. Appelt ◽  
M. Takes ◽  
C. J. Zech ◽  
KA Blackham ◽  
T. Schubert
Keyword(s):  
Upper Extremity ◽  
Brachial Artery ◽  
Complication Rates ◽  
Puncture Site ◽  
Access Site ◽  
Femoral Access ◽  
Technical Success Rate ◽  
Us Guidance ◽  
Major Complications ◽  
The Impact

Abstract Purpose The current literature on the use of brachial artery access is controversial. Some studies found increased puncture site complications. Others found no higher complication rates than in patients with femoral or radial access. The purpose of this study was to determine the impact of ultrasound (US)-guidance on access site complications. Materials and methods This is a single-center retrospective study of all consecutive patients with brachial arterial access for interventional procedures. Complications were classified into minor complications (conservative treatment only) and major complications (requiring surgical intervention). The brachial artery was cannulated in the antecubital fossa under US-guidance. After the intervention, manual compression or closure devices, both followed by a compression bandage for 3 h, either achieved hemostasis. Results Seventy-five procedures in seventy-one patients were performed in the study period using brachial access. Access was successful in all cases (100%). Procedures in different vascular territories were performed: neurovascular (10/13.5%), upper extremity (32/43.2%), visceral (20/27.0%), and lower extremity (12/16.3%). Sheath size ranged from 3.2F to 8F (mean: 5F). Closure devices were used in 17 cases (22.7%). In total, six complications were observed (8.0%), four minor complications (5.3%, mostly puncture site hematomas), and two major complications, that needed surgical treatment (2.7%). No brachial artery thrombosis or upper extremity ischemia occurred. Conclusion Exclusive use of US-guidance resulted in a low risk of brachial artery access site complications in our study compared to the literature. US-guidance has been proven to reduce the risk of access site complications in several studies in femoral access. In addition, brachial artery access yields a high technical success rate and requires no additional injection of spasmolytic medication. Sheath size was the single significant predictor for complications.

scholarly journals Complication Rates of Percutaneous Brachial Artery Puncture: Effect of Live Ultrasound Guidance

2021 ◽  
Author(s):  
Konrad Appelt ◽  
Martin Takes ◽  
Christoph J Zech ◽  
Tilman Schubert
Keyword(s):  
Upper Extremity ◽  
Brachial Artery ◽  
Complication Rates ◽  
Puncture Site ◽  
Access Site ◽  
Femoral Access ◽  
Technical Success Rate ◽  
Us Guidance ◽  
Major Complications ◽  
The Impact

Abstract PurposeThe current literature on the use of brachial artery access is controversial. Some studies found increased puncture site complications. Others found no higher complication rates than in patients with femoral or radial access. The purpose of this study was to determine the impact of ultrasound (US)-guidance on access site complications.Materials and MethodsThis is a single-center retrospective study of all consecutive patients with brachial arterial access for interventional procedures. Complications were classified into minor complications (conservative treatment only) and major complications (requiring surgical intervention). The brachial artery was cannulated in the antecubital fossa under US-guidance. After the intervention, manual compression or closure devices, both followed by a compression bandage for 3 hours, either achieved hemostasis.Results75 procedures in 71 patients were performed in the study period using brachial access. Access was successful in all cases (100%). Procedures in different vascular territories were performed: neurovascular (11/14.7%), upper extremity (36/48%), visceral (20/26.7%), and lower extremity (12/16%). Sheath size ranged from 3.2F to 8F (mean: 5F). Closure devices were used in 17 cases (22.7%). In total, six complications were observed (8.0%), four minor complications (5.3%, mostly puncture site hematomas), and two major complications, that needed surgical treatment (2.7%). No brachial artery thrombosis or upper extremity ischemia occurred.ConclusionExclusive use of US-guidance resulted in a low risk of brachial artery access site complications in our study compared to the literature. US-guidance has been proven to reduce the risk of access site complications in several studies in femoral access. In addition, brachial artery access yields a high technical success rate and requires no additional injection of spasmolytic medication. Sheath size was the single significant predictor for complications.

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.

TRIACCESS Study: Randomized Comparison Between Radial, Femoral, and Pedal Access for Percutaneous Femoro-popliteal Artery Angioplasty

2021 ◽  
pp. 152660282110385
Author(s):  
Zoltán Ruzsa ◽  
Ádám Csavajda ◽  
István Hizoh ◽  
Mónika Deák ◽  
Péter Sótonyi ◽  
...  
Keyword(s):  
Femoral Artery ◽  
Cumulative Incidence ◽  
Randomized Study ◽  
Artery Stenosis ◽  
Complication Rates ◽  
Access Site ◽  
Total Occlusion ◽  
Femoral Access ◽  
X Ray ◽  
Access Site Complication

Background The aim of this randomized study was to compare the success and complication rates of different access sites for the treatment of superficial artery stenosis. Methods and Results A total of 180 consecutive patients were randomized in a prospective study to treat symptomatic superficial femoral artery stenosis via radial (RA), femoral (FA), or pedal artery (PA) access. Technical success was achieved in 96.7%, 100%, and 100% of the patients in the RA, FA, and PA groups, respectively (p=0.33). Secondary access sites were used in 30%, 3.3%, and 30% of the patients in the RA, FA, and PA access groups, respectively (p=0.0002). Recanalization for chronic total occlusion was performed in 34/36 (94.4%), 30/30 (100%), and 46/46 (100%) patients in the RA, FA, and PA groups, respectively (p=0.17). The X-ray dose was significantly lower in the PA group than that in the RA and FA access groups (63.1 vs 162 vs 153 Dyn, p=0.0004). The cumulative rates of access site complications in the RA, FA, and PA groups were 3.3% (0% major and 3.3% minor), 16.7% (3.3% major and 13.3% minor), and 3.3% (3.3% major and 0% minor) (p=0.0085), respectively. The cumulative incidence of MACEs at 6 months in the RA, FA, and PA groups was 5%, 6.7%, and 1.7%, respectively. The cumulative incidence of MALEs at 6 months in the RA, FA, and PA groups was 20%, 16.7%, and 9.2%, respectively (p=0.54). Conclusion Femoral artery intervention can be safely and effectively performed using radial, femoral, and pedal access, but radial and pedal access is associated with a lower access site complication rate and hospitalization. Pedal access is associated with a lower X-ray dose than that with radial and femoral access.

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 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.

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

scholarly journals Incidence of major complication following embolo-sclerotherapy for upper and lower extremity vascular malformations

Vascular ◽  
2020 ◽  
pp. 170853812093761
Author(s):  
Chung Sim Lim ◽  
Nicholas Evans ◽  
Ishapreet Kaur ◽  
Anthie Papadopoulou ◽  
Mohamed Khalifa ◽  
...  
Keyword(s):  
Informed Consent ◽  
Lower Extremity ◽  
Upper Extremity ◽  
Vascular Malformation ◽  
Vascular Malformations ◽  
Direct Injection ◽  
Major Complication ◽  
Complication Rates ◽  
Major Complications ◽  
Skin Ulcerations

Objective The current literature on the major complications of embolo-sclerotherapy of upper and lower extremity vascular malformations is scarce. Evaluating and understanding the rates and types of potential major complications of embolo-sclerotherapy of vascular malformations help treatment planning and informed consent. Therefore, this study reviewed major complications following embolo-sclerotherapy of all upper and lower extremity vascular malformations in a single specialized multidisciplinary vascular malformation center over a 5-year period. Methods All patients with vascular malformations underwent multidisciplinary directed intervention. Demographic, procedural, follow-up, and complication data were collected prospectively in a dedicated database, and reviewed retrospectively. Major complications for upper and lower extremity vascular malformations from 1 January 2013 to 31 December 2017 were analyzed. All embolo-sclerotherapies of high-flow vascular malformations (HFVMs) were performed under selective catheter angiography and direct injection, but low-flow vascular malformations (LFVM) with direct injection only. Major complications were defined as any tissue or functional damage caused by direct injection, distal embolization, or tissue reaction. Results Seventy patients (median age of 25 years; 44 males and 26 females) had 150 embolo-sclerotherapy procedures for upper extremity vascular malformation. Of these, 28 patients had embolo-sclerotherapy for HFVM and 42 patients for LFVM; total 78 and 72 procedures, respectively. A total of 107 patients (median age of 26 years; 42 males and 65 females) had 160 embolo-sclerotherapy interventions for lower extremity vascular malformations. Of these, 18 patients had embolo-sclerotherapy for HFVM and 89 patients for LFVM; total of 30 and 130 procedures, respectively. The overall major complication rates following embolo-sclerotherapy of upper and lower extremity vascular malformations were 14.3% and 4.7%, respectively ( P = 0.030). In the upper extremity HFVM group, major complications from embolo-sclerotherapy occurred in five patients; three ischemic fingers requiring amputation and two skin ulcerations. Meanwhile, in the upper extremity LFVM group, major complications occurred in five patients; one median nerve injury requiring nerve grafting and hand therapy, one hand contracture requiring tendon release, and three skin ulcerations. There was only one major complication, which was cellulitis in the lower extremity HFVM group. In the lower extremity LFVM group, major complications occurred in four patients; two skin ulcerations, one cellulitis, and one deep vein thrombosis. Conclusions Embolo-sclerotherapy is relatively safe for upper and lower extremity vascular malformations in a high-volume experienced center where our major complication rates were 14.3% and 4.7%, respectively, which compare favorably or similar to those reported in most recent literature. These outcomes will direct treatment strategies to avoid local and systemic toxic complications in the upper and lower extremity, for both HFVM and LFVM, and to improve informed consent.

Transradial intraoperative cerebral angiography: a multicenter case series and technical report

2019 ◽  
Vol 12 (2) ◽  
pp. 170-175
Author(s):  
Joshua W Osbun ◽  
Bhuvic Patel ◽  
Michael R Levitt ◽  
Alexander T Yahanda ◽  
Amar Shah ◽  
...  
Keyword(s):  
Radial Artery ◽  
Cerebral Angiography ◽  
Carotid Arteries ◽  
Case Series ◽  
Patient Positioning ◽  
Interventional Cardiology ◽  
Access Site ◽  
Femoral Access ◽  
Technical Success Rate ◽  
Access Site Complication

BackgroundUse of the radial artery as an access site for neurointerventional procedures is gaining popularity after several studies in interventional cardiology have demonstrated superior patient safety, decreased length of stay, and patient preference compared with femoral artery access. The transradial approach has yet to be characterized for intraoperative cerebral angiography.ObjectiveTo report a multicenter experience on the use of radial artery access in intraoperative cerebral angiography, including case series and discussion of technical nuances.Methods27 patients underwent attempted transradial cerebral angiography betweenMay 2017 and May 2019. Data were collected regarding technique, patient positioning, vessels selected, technical success rate, and access site complications.Results24 of the 27 patients (88.8%) underwent successful transradial intraoperative cerebral angiography. 18 patients (66.7%) were positioned supine, 6 patients (22.2%) were positioned prone, 1 patient (3.7%) was positioned lateral, and 2 patients (7.4%) were positioned three-quarters prone. A total of 31 vessels were selected including 13 right carotid arteries (8 common, 1 external, 4 internal), 11 left carotid arteries (9 common and 2 internal), and 6 vertebral arteries (5 right and 1 left). Two patients (7.4%) required conversion to femoral access in order to complete the intraoperative angiogram (1 due to arterial vasospasm and 1 due to inadvertent venous catheterization). One procedure (3.7%) was aborted because of inability to obtain the appropriate fluoroscopic views due to patient positioning. No patient experienced stroke, arterial dissection, or access site complication.ConclusionsTransradial intraoperative cerebral angiography is safe and feasible with potential for improved operating room workflow ergonomics, faster patient mobility in the postoperative period, and reduced costs.

Arterial vascular access complication in osteogenesis imperfecta

2021 ◽  
pp. 112972982110099
Author(s):  
Asim Chughtai ◽  
Ramita Dey ◽  
Sudipta Chattopadhyay
Keyword(s):  
Osteogenesis Imperfecta ◽  
Rare Complication ◽  
Covered Stent ◽  
Coronary Angiogram ◽  
Puncture Site ◽  
Access Site ◽  
Femoral Access ◽  
Femoral Route ◽  
Catheterisation Laboratory

We present a case of the catastrophic bleeding from the femoral access site after an uncomplicated puncture in a patient with Type 1 osteogenesis imperfecta (OI) undergoing coronary angiogram via the femoral route. This had to be treated with a covered stent at the puncture site. This is an extremely rare complication in OI. The potential pathological mechanisms of this complication are discussed. An interventionist will rarely encounter such a patient in the catheterisation laboratory but would do well to be aware of this potential complication.

scholarly journals Safety profile of an 8F femoral arteriotomy closure using the Angio-Seal device in thrombolysed acute stroke patients undergoing thrombectomy

2018 ◽  
Vol 24 (5) ◽  
pp. 540-545
Author(s):  
James Wareham ◽  
Sebastian Luppe ◽  
Adam Youssef ◽  
Robert Crossley ◽  
Alex Mortimer
Keyword(s):  
Acute Stroke ◽  
Complication Rate ◽  
Intravenous Thrombolysis ◽  
Bleeding Complications ◽  
Closure Device ◽  
Stroke Patients ◽  
Access Site ◽  
Femoral Access ◽  
Access Site Complication ◽  
The Impact

Background The relationship between bridging thrombolysis and femoral access site complications after mechanical thrombectomy remains contested. Use of a closure device could minimise bleeding complications. This study aimed to elucidate the rate of access site complications in a cohort of patients treated using an 8F groin sheath with subsequent closure using the Angio-Seal to assess safety and the impact of bridging thrombolysis on access site complication rate. Methods All patients with large vessel occlusive stroke treated between 2014 and 2017 with thrombectomy with or without bridging thrombolysis were reviewed. A prospectively acquired departmental database was used to obtain baseline data, and the radiology information and haematology reporting systems were used to record imaging or transfusion relating to subsequent access site complications. Results Seventy-five patients treated with thrombectomy alone were compared to 70 patients treated with prior intravenous thrombolysis. All had an 8F femoral sheath placed for arterial access, and all underwent attempted haemostasis with an 8F Angio-Seal. Two patients (1.14%) suffered Angio-Seal device failure necessitating manual pressure. One patient (0.6%) suffered a small femoral pseudo-aneurysm. No retroperitoneal haemorrhage, haematoma requiring transfusion, ipsilateral deep-vein thrombosis or ipsilateral acute limb ischaemia was encountered. There was no significant difference in the rate of haemorrhagic, ischaemic or infective complications between those treated with bridging thrombolysis or thrombectomy alone. Conclusion Use of the Angio-Seal closure device for 8F femoral access is safe in acute stroke patients. Intravenous thrombolysis prior to endovascular thrombectomy does not significantly alter femoral access site complication rate if this approach is used.

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