scholarly journals Interventional Treatment of Access Site Complications During Transfemoral TAVI: A Single Center Experience

2021 ◽  
Vol 8 ◽  
Author(s):  
Marcus Thieme ◽  
Sven Moebius-Winkler ◽  
Marcus Franz ◽  
Laura Baez ◽  
Christian P. Schulze ◽  
...  
Keyword(s):  
Interventional Procedure ◽  
Vascular Complications ◽  
Common Femoral Artery ◽  
The Elderly ◽  
Interventional Therapy ◽  
Interventional Treatment ◽  
Heart Team ◽  
Transfemoral Approach ◽  
Iliac Arteries ◽  
Transfemoral Tavi

Introduction: Transcatheter aortic valve implantation (TAVI) has rapidly developed over the last decade and is nowadays the treatment of choice in the elderly patients irrespective of surgical risk. The outcome of these patients is mainly determined not only by the interventional procedure itself, but also by its complications.Material and Methods: We analyzed the outcome and procedural events of transfemoral TAVI procedures performed per year at our institution. The mean age of these patients is 79.2 years and 49% are female. All the patients underwent duplex ultrasonography of the iliac arteries and inguinal vessels before the procedure and CT of the aorta and iliac arteries.Results: Transfemoral access route is associated with a number of challenges and complications, especially in the patients suffering from peripheral artery disease (PAD). The rate of vascular complications at our center was 2.76% (19/689). Typical vascular complications (VC) include bleeding and pseudoaneurysms at the puncture site, acute or subacute occlusion of the access vessel, and dissection or perforation of the iliac vessels. In addition, there is the need for primary PTA of the access pathway in the presence of additional PAD of the common femoral artery (CFA) and iliac vessels. Balloon angioplasty, implantation of covered and uncovered stents, lithoplasty, and ultrasound-guided thrombin injection are available to treat the described issues.Conclusion: Interventional therapy of access vessels can preoperatively enable the transfemoral approach and successfully treat post-operative VC in most of the cases. Training the heart team to address these issues is a key focus, and an interventional vascular specialist should be part of this team.

scholarly journals Comparing traditional aortic valve surgery and transapical approach to transcatheter aortic valve implant

2020 ◽  
Vol 22 (Supplement_E) ◽  
pp. E7-E12
Author(s):  
Nicola Buzzatti ◽  
Alessandra Sala ◽  
Ottavio Alfieri
Keyword(s):  
Aortic Valve ◽  
Severe Aortic Stenosis ◽  
The Elderly ◽  
Heart Team ◽  
Surgical Aortic Valve Replacement ◽  
Transfemoral Approach ◽  
Transcatheter Aortic Valve ◽  
Technological Advances ◽  
Risk Patients ◽  
Alternative Routes

Abstract During the last 15 years, transcatheter aortic valve implant (TAVI) has become a valid alternative to surgical aortic valve replacement in symptomatic patients with severe aortic stenosis, and high or intermediate operative risk. Transcatheter aortic valve implant could be approached through various access sites, among which the transapical has long been one of the most popular. Through the years, this procedure has shown results similar to the standard surgical approach, but not as good as the same procedure via the transfemoral approach. For this reason, along with continuous technological advances, the transfemoral approach is used, presently, in 90% of the patient, while the transapical route has been limited, progressively, to a minority of patients. Currently the Heart Team should decide, in every single patient, between conventional surgery and TAVI. In clinical practice, TAVI is favoured in high-risk patients, and in the elderly at intermediate surgical risk with favourable anatomical features. In patients in whom TAVI is preferable to surgery, but have ‘non-usable’ femoral approach, alternative routes, such as transaxillary or transapical, could be considered.

P917Transcatheter treatment of severe tricuspid regurgitation: first experiences with the edge-to-edge technique using the MitraClip

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Otto ◽  
M Velichkov ◽  
A Hamadanchi ◽  
L Baez ◽  
M Franz ◽  
...  
Keyword(s):  
High Risk ◽  
Tricuspid Regurgitation ◽  
Therapeutic Option ◽  
Nyha Class ◽  
Vascular Complications ◽  
Interventional Therapy ◽  
Interventional Treatment ◽  
Severe Tricuspid Regurgitation ◽  
High Risk Patients ◽  
Risk Patients

Abstract Background Due to increased operative mortality in high-risk patients treated for severe tricuspid regurgitation (TR), there is a growing interest in interventional therapy in these patients that are otherwise solely treated with medication. The edge-to edge technique with implantation of one or more MitraClips is an therapeutic interventional option for these patients. So far, data for transcatheter TR treatment are sparse. Purpose The present cohort study investigates safety, feasibility and effectiveness of the edge-to-edge technique treating severe TR after starting a transcatheter TR treatment program at our institution in 2017. Methods A total of 17 high-risk patients (79.18±8.76 years, EUROScore II 9.31±8.23%, table) with symptomatic, severe TR were treated using the MitraClip system from 12/2017 until 12/2018. All patients received pre-interventional clinical, echocardiographic and invasive evaluation and were entered into a database. Safety and feasibility of the procedure, reduction of TR grade and clinical outcomes were collected and analyzed at the day of discharge and at 30-day follow-up. Results MitraClip device was successfully implanted in 16 of 17 patients (94.1%). In one patient grasping of the leaflets was impossible due to bad echo conditions by abdominal air. 76.5% of the patients had severe or massive and 23.5% had a torrential TR (figure). A total of 25 Clips were used (22 in anteroseptal, 3 in posteroseptal commissure). No intraprocedural deaths, emergency surgery or major vascular complications occurred. Postprocedural TR was significantly reduced (TR reduction ≥1 grade) from a mean TR grade of 3.8±0.8 at baseline to 1.74±0.59 postprocedural (p<0.001, table and figure). One patient had device detachment before discharge. There was one death due to progressive cardiogenic shock 4 days after the procedure. However, the procedure was planned as a last therapeutic option in this terminally ill patient. Echocardiography at discharge showed reduction of TR in 82,4% of patients (mean TR grade at discharge 2.21±0.66, p<0.001). At 30 day f/u symptoms were significantly improved from inital mean NYHA class of 3.06±0.56 to a mean NYHA class of 2.55±0.52 (p=0.002) and patients presented with reduced TR (mean TR grade at 30 day f/u 2.58±0.57, p<0.001). Conclusion Interventional treatment of severe TR in high-risk and mostly inoperable patients using the MitraClip technique is safe and effectivly reduces TR grade leading to clinical improvement. However, further investigations are needed to identify clear parameters highly predictive for a favorable acute and midterm procedural success. Also, more data and clinical trials are needed to determine the long-term course in these patients.

scholarly journals Multivessel endovascular therapy for undiagnosed vascular type Ehlers-Danlos syndrome. Successful percutaneous transcatheter coil embolization of hepatic artery pseudoaneurysm with stenting of right renal and iliac arteries in emergency setting

2020 ◽  
Vol 6 (4) ◽  
pp. 20200025
Author(s):  
Lorenzo Paolo Moramarco ◽  
Carlo Alberto Capodaglio ◽  
Pietro Quaretti ◽  
Nicola Cionfoli ◽  
Ilaria Fiorina ◽  
...  
Keyword(s):  
Hepatic Artery ◽  
Vascular Complications ◽  
Transcatheter Embolization ◽  
Closure Device ◽  
Emergency Setting ◽  
Transfemoral Approach ◽  
Ehlers Danlos Syndrome ◽  
Artery Pseudoaneurysm ◽  
Iliac Arteries ◽  
Vascular Type

Among Ehlers-Danlos syndromes, the vascular type is the most severe because of its vascular complications. Transcatheter embolization of medium-sized arteries has become the first-line therapy for life-threatening hemorrhage. Ongoing multiple lesions causing hemorrhagic or ischemic complications in the acute phase can challenge patient management. Multivessel endovascular treatment has never been reported. In this study, we report successful single-session treatment by coiling of a ruptured pseudoaneurysm of the hepatic artery with stenting of dissected right renal and iliac arteries in a 46-year-old female. Percutaneous transfemoral approach was gained and sealed with a plug-based closure device. Genetic disease was subsequently confirmed by molecular analysis.

Cardiovascular Imaging for Guiding Interventional Therapy in Structural Heart Diseases

2020 ◽  
Vol 16 (2) ◽  
pp. 111-122
Author(s):  
Nora Rat ◽  
Iolanda Muntean ◽  
Diana Opincariu ◽  
Liliana Gozar ◽  
Rodica Togănel ◽  
...  
Keyword(s):  
Heart Diseases ◽  
Interventional Procedure ◽  
Imaging Techniques ◽  
Ductus Arteriosus ◽  
Three Dimensional ◽  
High Specificity ◽  
Interventional Therapy ◽  
Structural Defects ◽  
Imaging Method ◽  
Three Dimensional Echocardiography

Development of interventional methods has revolutionized the treatment of structural cardiac diseases. Given the complexity of structural interventions and the anatomical variability of various structural defects, novel imaging techniques have been implemented in the current clinical practice for guiding the interventional procedure and for selection of the device to be used. Three– dimensional echocardiography is the most used imaging method that has improved the threedimensional assessment of cardiac structures, and it has considerably reduced the cost of complications derived from malalignment of interventional devices. Assessment of cardiac structures with the use of angiography holds the advantage of providing images in real time, but it does not allow an anatomical description. Transesophageal Echocardiography (TEE) and intracardiac ultrasonography play major roles in guiding Atrial Septal Defect (ASD) or Patent Foramen Ovale (PFO) closure and device follow-up, while TEE is the procedure of choice to assess the flow in the Left Atrial Appendage (LAA) and the embolic risk associated with a decreased flow. On the other hand, contrast CT and MRI have high specificity for providing a detailed description of structure, but cannot assess the flow through the shunt or the valvular mobility. This review aims to present the role of modern imaging techniques in pre-procedural assessment and intraprocedural guiding of structural percutaneous interventions performed to close an ASD, a PFO, an LAA or a patent ductus arteriosus.

A New Access Site Management Tool: The Angio-Seal™ Hemostatic Puncture Closure Device

1995 ◽  
Vol 2 (3) ◽  
pp. 289-296 ◽  
Author(s):  
Michel Henry ◽  
Max Amor ◽  
Mohamed Allaoui ◽  
Olivier Tricoche
Keyword(s):  
Arterial Wall ◽  
Bypass Graft ◽  
Vascular Complications ◽  
Common Femoral Artery ◽  
Management Tool ◽  
Closure Device ◽  
Manual Compression ◽  
Vascular Closure Device ◽  
Arterial Lumen ◽  
Manual Pressure

Purpose: Given the increasing number of percutaneously applied endovascular therapies, the incidence of access-related vascular complications can be expected to rise, particularly in association with those techniques requiring large sheaths or anticoagulation. The need exists for a safe, easy to use, and effective hemostatic technique to replace the labor-intensive method of manual compression. Methods: A bioabsorbable, sheath-delivered vascular closure device (Angio-Seal™) has been developed that deposits a small collagen plug within the arterial wall to mechanically seal the puncture defect. An anchor connected by suture to the plug is first deployed in the arterial lumen and pulled flush against the interior arterial wall to guard against intraluminal deposition of the collagen. Results: The Angio-Seal device was deployed successfully in 80 (96%) of 83 attempts involving common femoral arteries accessed for peripheral angioplasty (n = 30), coronary angiography (n = 30), and coronary angioplasty (n = 16). Three popliteal artery access sites and one femoropopliteal bypass graft were also treated. Hemostasis was immediate in 78 cases (98%); 2 sites required a 5-minute manual compression to effect a secure seal. Three devices failed to deploy, and manual pressure was used to close the puncture. Nondeployment did not cause any sequelae, and no complications were encountered with the technique. Conclusions: This novel vascular closure device is quick (< 1 minute application time) and simple to use, providing a positive seal of common femoral artery puncture sites for both peripheral and coronary interventions. It appears to be a reliable alternative to standard manual hemostasis.

Platypnoea-orthodeoxia syndrome in the elderly: A difficult-to-make diagnosis of intracardiac right-to-left shunt

2017 ◽  
Vol 62 (3) ◽  
pp. 122-125 ◽  
Author(s):  
Enrico M Zardi ◽  
Silvia Spoto ◽  
Luciana Locorriere ◽  
Giulio Cacioli ◽  
Silvia Mazzaroppi ◽  
...  
Keyword(s):  
Patent Foramen Ovale ◽  
Arteriovenous Malformations ◽  
Clinical Signs ◽  
Vascular Complications ◽  
The Elderly ◽  
Upright Position ◽  
Foramen Ovale ◽  
Case Presentation ◽  
Hepatic Diseases ◽  
Chronic Pulmonary Diseases

Introduction Platypnea-orthodeoxia syndrome is a combination of positional dyspnoea and hypoxemia; it is caused by several cardiac, pulmonary and hepatic diseases. Case presentation In this study, we describe a 77-year-old female affected by unexplained dizziness and hypoxia that exacerbated in upright position. After diagnosing platypnea-orthodeoxia syndrome and excluding all possible causes (liver cirrhosis, acute and chronic pulmonary diseases and arteriovenous malformations), the origin of the syndrome was individuated in the presence of a patent foramen ovale with right-to-left shunt. Endovascular patent foramen ovale closure permitted the resolution of symptoms and disappearance of platypnea-orthodeoxia syndrome. Conclusion Although patent foramen ovale may be present since birth without giving clinical signs, it may represent a common enough cause of platypnea-orthodeoxia syndrome and other vascular complications in the elderly.

Anomalous High Bifurcation of the Common Femoral Artery at the Groin: Management of Gsv Incompetence with Endovenous Laser Ablation

2012 ◽  
Vol 28 (5) ◽  
pp. 264-267 ◽  
Author(s):  
C Lekich ◽  
W Campbell ◽  
S Walton ◽  
P Hannah
Keyword(s):  
Laser Ablation ◽  
Femoral Artery ◽  
Vascular Complications ◽  
Common Femoral Artery ◽  
Vascular Anomalies ◽  
Endovenous Laser Ablation ◽  
Safe Treatment ◽  
Complications Of Surgery ◽  
The Common ◽  
Saphenofemoral Junction

Objectives: To discuss safety of EVLA in anomalies of the GSV anatomy. To review and discuss complications of surgery involving anomalous anatomy. Method: We report a case of high bifurcation of the common femoral artery wrapping around the saphenofemoral junction. Results: Successful ablation was achieved with no adverse consequences. Conclusion: EVLA is a safe treatment for SFJ/GSV incompetence in the presence of vascular anomalies that have historically resulted in serious vascular complications from surgery.

scholarly journals Comparison of In-Hospital Outcomes of ST Elevation Myocardial Infarction in Patients Undergoing Transradial and Transfemoral Primary Percutaneous Coronary Intervention

2019 ◽  
Vol 11 (2) ◽  
pp. 98-104
Author(s):  
Fahdia Afroz ◽  
Mir Jamal Uddin ◽  
Md Khalquzzaman ◽  
Mohammad Ullah ◽  
Mohammad Khalilur Rahman Siddiqui ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Vascular Complications ◽  
Coronary Intervention ◽  
Adverse Outcomes ◽  
Transfemoral Approach ◽  
Transradial Approach ◽  
Group I ◽  
Percutaneous Coronary ◽  
St Elevation ◽  
Group Ii

Background: Primary percutaneous coronary intervention (PPCI) has been performed traditionally by using femoral approach. Transradial approach has become increasingly popular as it is likely to be less complicating, more comfortable and relatively cost effective having mortality and morbidity benefits. The aim of the study was to compare the in-hospital outcomes of transradial PPCI with that of transfemoral route. Methods: A total of 80 patients with ST elevation myocardial infarction (STEMI) who underwent PPCI were enrolled in the study. Patients were divided in two groups. Group-I: transradial PPCI; and Group-II: transfemoral PPCI. All patients were followed up during the period of hospital stay and adverse outcomes were observed and compared between the groups. Results: The result showed that bleeding took place in 2.5% patient of Group-I and 15% patients of Group- II. Vascular complications occurred in 2.5% and 12.5% patients of Group-I and Group-II, respectively. In Group-II, 7.5% patients died with none in Group-I. In Group-II, 37.5% patients experienced some sort of adverse outcomes whereas only 15% of the patients of Group-I did have such experiences (p<0.05). Bleeding and vascular complications were significantly more in Group-II (p<0.05). The mean hospital stay time was significantly lower in Group-I (p<0.001). Conclusions: Transradial PPCI is safer than transfemoral approach in respect of procedural and post procedural complications including bleeding, vascular complications and mortality. So, transradial approach may be an attractive alternative to conventional transfemoral approach and can be practiced routinely for PPCI. Cardiovasc. j. 2019; 11(2): 98-104

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