Endovascular management of an unusual troubling femoral access complication: common femoral artery thrombotic occlusion precipitated by sheath occlusive effect and low cardiac output

2011 ◽  
Vol 12 (3) ◽  
pp. 199-200
Author(s):  
Gianluca Rigatelli ◽  
Fabio DellʼAvvocata ◽  
Federico Ronco ◽  
Paolo Cardaioli
Keyword(s):  
Cardiac Output ◽  
Femoral Artery ◽  
Common Femoral Artery ◽  
Endovascular Management ◽  
Thrombotic Occlusion ◽  
Femoral Access ◽  
Low Cardiac Output

scholarly journals Kissing Balloon Technique for Angioplasty of Tibioperoneal Arteries Bifurcation Using Pedal Arterial Retrograde Revascularization

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Ahmed Amro ◽  
Obadah Aqtash ◽  
Adee Elhamdani ◽  
Mehiar El-Hamdani
Keyword(s):  
Femoral Artery ◽  
Clinical Success ◽  
Common Femoral Artery ◽  
Severity Index ◽  
Femoral Access ◽  
Infrapopliteal Artery ◽  
Kissing Balloon Technique ◽  
Balloon Technique ◽  
Bifurcation Lesions ◽  
Procedural Success

Background. Kissing Balloon Technique using retrograde pedal approach together with anterograde common femoral artery (CFA) approach could be the treatment of choice in patients with diseased infrapopliteal artery bifurcation. We report seven cases where the KBT was utilized for the treatment of diseased infrapopliteal artery bifurcation using retrograde pedal access in conjunction with the conventional common femoral artery (CFA) access. Methods. We reviewed all seven cases that underwent KBT with the combination of pedal and common femoral access in a single-center study from 2014 to 2015 utilizing Rutherford classification severity index; all cases were deemed stage 3 (severe claudication) to stage 6 (severe ischemic ulcers or frank gangrene). With the exception of two cases, contralateral femoral access was obtained, with sheath sizes varying from 4 to 6 French for both CFA and pedal access. Ultrasound was utilized for ipsilateral pedal access in all seven cases. Results. Arterial revascularization was successfully achieved by the KBT in all patients without any complications. All patients achieved procedural success, which is defined as residual stenosis of less than 30% with no dissection or thrombosis and clinical success that is defined as resolution of symptoms (absence of intermittent claudication and healing of the ulcer) as well as improvement in the arterial brachial index (ABI). During follow-up, out of the seven cases, repeat angiogram was performed for one case, which showed patent arteries with no residual lesions. Conclusions. In patients with popliteal and tibioperoneal trunk bifurcation lesions, Kissing Balloon Technique using retrograde pedal access in conjunction with the conventional anterograde access appeared to be successful, safe, and effective technique with lower access site complications and shorter procedure time.

Use of a Steerable Sheath for Retrograde Access to Antegrade Branches in Branched Stent-Graft Repair of Complex Aortic Aneurysms

2018 ◽  
Vol 25 (5) ◽  
pp. 566-570 ◽  
Author(s):  
Vladimir Makaloski ◽  
Nikolaos Tsilimparis ◽  
Fiona Rohlffs ◽  
Konstantinos Spanos ◽  
E. Sebastian Debus ◽  
...  
Keyword(s):  
Upper Extremity ◽  
Stent Graft ◽  
Femoral Artery ◽  
Common Femoral Artery ◽  
Aortic Aneurysms ◽  
Femoral Access ◽  
Aortic Stent Graft ◽  
Stent Graft Repair ◽  
The Common ◽  
Steerable Sheath

Purpose: To describe how to use a steerable sheath from a femoral access to catheterize antegrade branches in a branched aortic stent-graft. Technique: Following femoral cutdown, a stent-graft with antegrade branches destined for renovisceral target vessels was deployed in the desired position. A steerable sheath with a tip that rotates up to 180° was introduced from the common femoral artery and navigated to the antegrade branches for consecutive catheterization of the target vessels and deployment of one or more bridging stents per branch. The technique is demonstrated in 4 patients who underwent successful complex abdominal and thoracoabdominal branched endovascular repairs with 1, 2, and 4 antegrade branches. Conclusion: Retrograde access for complex aortic endografts with antegrade branches using a steerable sheath appears feasible and effective and may serve as an alternative to upper extremity access.

scholarly journals Initial experience with the AXERA 2 Femoral Access System in neurovascular procedures

2015 ◽  
Vol 21 (3) ◽  
pp. 412-417 ◽  
Author(s):  
Ramesh Grandhi ◽  
Nathan T Zwagerman ◽  
Xiaoran Zhang ◽  
Stephanie H Chen ◽  
Ashutosh P Jadhav ◽  
...  
Keyword(s):  
Femoral Artery ◽  
Common Femoral Artery ◽  
Manual Compression ◽  
Femoral Access ◽  
Device Failure ◽  
Arterial Access ◽  
Access System ◽  
Small Series ◽  
Vascular Closure Devices ◽  
Groin Hematoma

Introduction Conventional cerebral angiography is a commonly performed procedure in medicine. Vascular closure devices have been developed as alternatives to manual compression at the arteriotomy site and prolonged bed rest. The risks of using these devices include arterial dissection, groin hematoma, and device failure. Herein, we describe our experience with the use of a novel device used for arterial access and closure, the AXERA 2 Access System. Methods A total of 13 patients underwent vascular access and closure with the AXERA 2 Access System. Results Arterial access using the AXERA 2 Access System was achieved in 11 of 13 patients. Amongst the patients with successful access, one patient experienced a groin hematoma requiring manual compression and two patients suffered occlusions of the common femoral artery due to dissections, with both patients requiring femoral artery thromboendarterectomies. Conclusions This small series highlights a heretofore underreported serious complication rate of the AXERA 2 Access System. Additional studies are warranted to provide further insight into risk factors for device failure and complication development.

scholarly journals Emergency endovascular management of the common femoral artery rupture due to radiotherapy for scrotal carcinoma

2015 ◽  
Vol 4 (2) ◽  
pp. 204798161454515 ◽  
Author(s):  
Umberto Marcello Bracale ◽  
Giovanni Merola ◽  
Luca del Guercio ◽  
Maurizio Sodo ◽  
Anna Maria Giribono ◽  
...  
Keyword(s):  
Femoral Artery ◽  
Common Femoral Artery ◽  
Endovascular Management ◽  
The Common

scholarly journals Localization of the femoral artery bifurcation: hips don't lie – in at least 97% of cases

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
S Uehlein ◽  
S Smolka ◽  
M Arnold ◽  
M Marwan ◽  
S Achenbach
Keyword(s):  
Femoral Head ◽  
Femoral Artery ◽  
Hip Replacement ◽  
Age Groups ◽  
Vascular Complications ◽  
Common Femoral Artery ◽  
Femoral Access ◽  
Funding Sources ◽  
Transcatheter Aortic Valve ◽  
Upper Third

Abstract Background The most common vascular access for structural cardiac interventions such as transcatheter aortic valve implantation (TAVI) is the common femoral artery (CFA). Depending on the procedure CFA puncture has to be performed not only unilaterally, but also bilaterally. Since incorrect localization of femoral access can lead to severe vascular complications, specific knowledge about the exact position of the CFA bifuraction is helpful. Such information might be systematically obtained from pre-TAVI CT scans. Methods We performed a retroperspective analysis of consecutive contrast-enhanced pre-TAVI CT angiography data sets (n=1000) to determine the CFA bifurcation localization relative to the femoral head and the correlation to contralateral CFA bifurcation location. Results The site of the CFA bifurcation was in 67.2% below the femoral head (−−), in 24.3% within the lower third of the femoral head (−), in 7.4% in the mid (0) and in 1.2% within the upper third (+) of the femoral head. Bifurcations above (++) the femoral head were not detected. CFA bifurcations below the femoral head showed the highest prevalence within men and women in all age groups (50–59, 60–69, 70–79, 80–89, 90–99 years). Bilateral agreement of CFA bifurcations was observed in only 69.3% and was independent of one-sided hip replacement (agreement 72.7%) or two-sided hip replacement (agreement 78.7%). A congruent contralateral left CFA bifurcation below the femoral head could be predicted in 80.6%, whereas CFA bifurcations within the lower and upper margins of the femoral head were congruent in only 65.7% (of these, 49.2% for the lower third, 29.7% for the mid and 36.4% for the upper third). Conclusion In conclusion, punctures within the upper third of the femoral head will provide an ideal puncture site in at least 97% of cases, independent of age, sex, or previous hip replacement. FUNDunding Acknowledgement Type of funding sources: None.

Femoral Vascular Access – Approaches and Available Devices

2012 ◽  
Vol 7 (2) ◽  
pp. 108
Author(s):  
Benjamin H Holland ◽  
Robert J Applegate ◽  
◽  
Keyword(s):  
Vascular Access ◽  
Femoral Artery ◽  
Healthcare Costs ◽  
Common Femoral Artery ◽  
Delivery Systems ◽  
Manual Compression ◽  
Femoral Access ◽  
Cardiac Procedures ◽  
The Common

Femoral access remains a vital route for many cardiac and non-cardiac procedures, including those involving the use of large delivery systems. In the common femoral artery access is extremely important to minimise complications and optimise use of closure devices. Dissatisfaction with haemostasis achieved by manual compression stimulated development of VCDs that provide quick and effective haemostasis after sheath removal. Despite shortening time to haemostasis and ambulation, a debate still rages regarding their overall contribution to reducing complications and healthcare costs.

On-Site–Modified Sheath to Overcome the Undesirable Catheterization of the Profunda Femoris Artery During Antegrade Femoral Access

2020 ◽  
Vol 27 (3) ◽  
pp. 505-508 ◽  
Author(s):  
August Ysa ◽  
Marta Lobato ◽  
Amaia Arruabarrena ◽  
Ana M. Quintana ◽  
Roberto Gómez ◽  
...  
Keyword(s):  
Femoral Artery ◽  
Superficial Femoral Artery ◽  
Common Femoral Artery ◽  
Simple Method ◽  
Femoral Access ◽  
Profunda Femoris Artery ◽  
Distal Marker ◽  
Antegrade Puncture ◽  
Repeated Passage ◽  
Profunda Femoris

Purpose: To present a simple method to avoid favored passage of a guidewire into the profunda femoris artery (PFA) after antegrade puncture of the common femoral artery. Technique: A 6-F conventional introducer sheath with a radiopaque distal marker is placed on the nurse’s table with its side port orientated to the 12 o’clock position. A small (2–2.5 mm) oval fenestration is created on the superior aspect of the sheath about 3 cm from its tip with a size 11 surgical blade. The modified introducer is passed over the angled 0.035-inch guidewire into the PFA and gently retrieved until the tip marker is ~3 cm from the femoral bifurcation. The dilator is removed, and the guidewire is withdrawn to the level of the fenestration, manipulated through it, and advanced further into the superficial femoral artery under fluoroscopic guidance. Conclusion: When repeated passage of the guidewire down the PFA persists despite conventional manipulation of the wire or needle, an on-site modification of the sheath is an easy alternative approach for the catheterization of the superficial femoral artery.

Tunneled Ipsilateral Sheath: A Novel Technique in Endovascular Management of Superficial Femoral Artery Ostial Lesions

2019 ◽  
Vol 53 (4) ◽  
pp. 337-340
Author(s):  
Mohamed I. EL-Maadawy ◽  
Ahmed M. Balboula ◽  
Hossam Zaghloul
Keyword(s):  
Femoral Artery ◽  
Superficial Femoral Artery ◽  
Common Femoral Artery ◽  
Endovascular Management ◽  
Novel Technique ◽  
Antegrade Approach ◽  
Technical Details ◽  
Subcutaneous Tunnel ◽  
The Common ◽  
Ostial Lesion

Ostial lesions of the superficial femoral artery preclude the use of ipsilateral common femoral artery antegrade approach. Access via either the contralateral common femoral or the brachial arteries are the 2 alternative classical approaches. Conversely, using an ipsilateral antegrade approach, through a partially inserted sheath, usually leaves the sheath insecure and frequently hits ostial lesion itself during insertion. Dislodgment from the artery frequently occurs, resulting in loss of access. We describe a technique whereby we insert 2 to 3 cm of the sheath into the common femoral artery and the remaining part of the sheath resides in a fashioned subcutaneous tunnel of the lowermost abdomen. Technical details are provided as well as the results of using this technique on 37 patients. The technique is safe, easy to perform, and reproducible.

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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