Vascular closure devices (VCDs) status post
|
|
- Jessica Jones
- 5 years ago
- Views:
Transcription
1 Vascular Closure Devices: Point-Counterpoint Argument for Use of Vascular Closure Devices Oliver G. Abela, MD 1, Jimmy Diep, MD 2, Chowdhury H. Ahsan, MD 3 From 1 University of Cincinnati College of Medicine, Cincinnati, Ohio; 2 University of Nevada School of Medicine, Las Vegas, Nevada; 3 Nevada Heart and Vascular Center, Las Vegas, Nevada Vascular closure devices (VCDs) status post femoral artery puncture are underutilized in the most benefitting population. The advantages of VCDs go beyond improved satisfaction and convenience for patients and staff, which are not insignificant benefits themselves. 1 However, for the right patients the benefits include reduction in significant complications. The key to realizing these net benefits is using them in the highest risk patients. It is true that the overall complication rate of percutaneous coronary intervention (PCI) has decreased in recent years with the advent of newer techniques and technology. Bleeding rate improvements have come in part from use of smaller catheters, less intense anticoagulation, avoidance of GPIIb/IIIa inhibitors, and transradial approach. Major femoral bleeding decreased from 8.4% ( ) to 5.3% ( ) to 3.5% ( ). 2 However, despite these improvements, bleeding complications remain a significant issue in the transfemoral approach. Adverse outcomes of major femoral bleeding include prolonged hospital stay (4.5 days vs 2.7 days), increased need for transfusion (39% vs 4.7%), and a statistically significant decrease in 30-day and long-term survival. 2 Still taking into consideration the increased complication rate with failure of deployment of a VCD, the incidence of Table 1 failure is low and the net impact remains positive. Moreover, when citing bleeding rates across different studies, it is extremely important to be familiar with the commonly used definitions, which are varied, and the shortcomings of each. One bleeding risk model used in the CathPCI registry was developed by Mehta et al and is described in Table 1 and Figure 1. 3 Previous data did not show benefit or as robust a benefit as is likely present because VCDs were not used in the highest risk population often enough. In another study from the CathPCI registry, Marso et al showed Vascular Disease Management November
2 Figure 1 bleeding reduction was statistically significant with the use of VCDs in high-risk patients (Table 2). 4 This registry includes approximately 1.5 million patients from 955 centers. Bleeding in manual compres- in PCI patients. 8 sion of high bleeding risk patients was 6.1% as compared to 4.6% with VCDs, 3.8% when bivalirudin was has a higher rate of bleeding: in one recent study, aortic balloon pump use had an incidence of severe bleeding at 11.4%. 5 This is at least due in part to the larger size catheter necessary for insertion. The intra-aortic balloon pump uses an 8 Fr catheter and the Impella 2.5 uses a 13 Fr catheter. 6,7 A large prospective study showed vascular complication rate was significantly lower with closure device use compared with manual compression. Benefit was seen in both diagnostic angiography (0.5% vs 1.1%, P=.01) and PCI (2.4% vs 4.9%, P<.001) groups. 8 In this study VCD use was associated with a 58% (95% CI 19%-88%) reduction in the risk of vascular complications in diagnostic procedures catheterization and a 42% (95% CI 17%-59%) reduction A large single-center study evaluating 7,718 consecutive patients who underwent PCI via femoral access used, and 2.3% when both bivalirudin and VCDs were from 2003 to 2009 for whom 1-year follow-up was used. 4 Paradoxically in the high-risk bleeding patients, available showed multiple findings supporting the use combined bivaluridin and VCDs were used least often of VCDs in PCI patients. The main findings were that (14.4%) and manual compression was used most often post-procedure vascular complications without severe (40.3%). 3 Mechanical circulatory support device use blood loss did not increase 1 year mortality. 5 However, Table 2. Bleeding Rates by Pre-Percutaneous Coronary Intervention Risk of Bleeding and Use of Bleeding Avoidance Strategies 4 Table 2 Vascular Disease Management November
3 regardless of the magnitude of hematocrit decrease, transfusion was associated with an increase in 1-year mortality. 5 Therefore, efforts to reduce significant bleeding with VCDs will yield benefits in the right patient. Vascular closure devices had a statistically significant lower incidence of transfusions in a large observational cohort study including 32 hospitals in Michigan with 85,048 PCI patients. 9 Bleeding, vascular perforation, or laceration requiring surgical repair did reduce 1-year survival. Age, female gender, higher levels of intraprocedural anticoagulation, and the use of glycoprotein IIb/ IIIa inhibitors were strongly associated with increased risk for postprocedural severe hematocrit decrease. Confirming previous findings the use of bivalirudin rather than heparin and the use of closure devices were independently associated with reduced risk for severe bleeding. 5 Larger dedicated randomized control trials are under way, including the ISAR-CLOSURE trial randomizing approximately 4,500 femoral artery puncture patients to 3 arms: manual compression and two separate types of closure devices. 8 This study is expected to give further insight into the use of VCDs in the contemporary practice of interventional cardiology. Like most decisions in medicine patient selection is paramount for ensuring the best patient outcomes, and in these appropriate high-risk patients, vascular closure devices should be used. n Editor s Note: Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no financial relationships or conflicts of interest regarding the content herein. REFERENCES 1. Behan MW, Large JK, Patel NR, Lloyd GW, Sulke AN. A randomised controlled trial comparing the routine use of an Angio-Seal STS device strategy with conventional femoral haemostasis methods in a district general hospital. Int J Clin Pract. 2007;61(3): Doyle BJ, Ting HH, Bell MR, et al. Major femoral bleeding complications after percutaneous coronary intervention. Incidence, predictors, and impact on longterm survival among 17,901 patients treated at the Mayo Clinic from 1994 to JACC Cardiovasc Interv. 2008;1(2): Mehta SK, Frutkin AD, Lindsey JB, et al; Bleeding in patients undergoing percutaneous coronary intervention: the development of a clinical risk algorithm from the National Cardiovascular Data Registry. Circ Cardiovasc Interv. 2009;2(3): Marso SP, Amin AP, House JA, et al. Association between use of bleeding avoidance strategies and risk of periprocedural bleeding among patients undergoing percutaneous coronary intervention. JAMA. 2010;303(21): Romaguera R, Wakabayashi K, Laynez-Carnicero A, et al. Association between bleeding severity and long-term mortality in patients experiencing vascular complications after percutaneous coronary intervention. Am J Cardiol. 2012;109(1): Cohen M, Ferguson JJ 3rd, Freedman RJ Jr., et al. Comparison of outcomes after 8 vs 9.5 French size intraaortic balloon counterpulsation catheters based on 9,332 patients in the prospective Benchmark Registry. Catheter Cardiovasc Interv. 2002;56(2): Sjauw KD, Konorza T, Erbel R, et al. Supported highrisk percutaneous coronary intervention with the Impella 2.5 device the Europella registry. J Am Coll Cardiol. 2009;54(25): Arora N, Matheny ME, Sepke C, Resnic F. A propensity analysis of the risk of vascular complications after cardiac catheterization procedures with the use of vascular closure devices. Am Heart J. 2007;153(4): Gurm HS, Hosman C, Share D, et al. Comparative safety of vascular closure devices and manual closure among patients having percutaneous coronary intervention. Ann Intern Med. 2013;159(10): Vascular Disease Management November
4 Minimizing Femoral Access Complications: Vascular Closure Devices Are Not Routinely Needed Ehrin J. Armstrong, MD, MSc From University of Colorado School of Medicine and Denver VA Medical Center, Denver, Colorado. Vascular closure devices (VCD) are frequently used to achieve hemostasis in patients undergoing percutaneous coronary or peripheral arterial intervention. Potential benefits of VCDs include a shorter time to ambulation and fewer staffing requirements to manage hemostasis after femoral arterial sheath removal. However, no definitive data support the use of VCDs specifically to decrease vascular access complications. Consistent with this, current society guidelines provide a class IIa recommendation for use of VCD to decrease the duration of bed rest, but a class III recommendation for use of VCD to reduce vascular access complications. 1 WHAT DO THE DATA SAY? The data are mixed on the outcomes of VCD use among patients undergoing PCI. Initial observational studies suggested an increased risk of bleeding complications with VCD, including an increased risk of retroperitoneal hematoma. 2,3 In contrast, more recent observational studies have suggested decreased rates of bleeding among patients treated with VCDs compared to manual compression. In one of the largest analyses, the NCDR registry reported a decreased rate of vascular complications among patients treated with VCDs after PCI, with the greatest benefit apparent among patients treated with both bivalirudin and a VCD. 4 While these data are encouraging, they are limited by the inclusion of multiple devices, the inherent biases of observational studies, and a lack of rigorously adjudicated endpoints. In addition, VCD failure is associated with an almost 5-fold risk of bleeding complications. 5 For these reasons, meticulous attention should be paid to the initial arterial access, which is likely a larger determinant of outcomes than the use of a VCD vs manual compression at the conclusion of the procedure. TECHNIQUES TO MINIMIZE COMPLICATIONS OF FEMORAL ARTERIAL ACCESS With current techniques, the major determinants of an access site complication are related to the technical aspects of obtaining femoral arterial access. Three major techniques can be used to reduce femoral arterial access complications: fluoroscopic landmarks, ultrasound guidance, and micropuncture needle access. Fluoroscopic landmarks provide a reference for the location of the femoral head, thereby identifying a compressible site for hemostasis. Multiple studies have shown that the inguinal crease does not reliably identify the femoral head; this is especially true in obese patients. 6 By using fluoroscopic landmarks, the needle access site can be reliably directed to the mid-femoral head, thereby also increasing the chances of common femoral artery cannulation. Use of fluoroscopic guidance has been associated with a decreased incidence of pseudoaneurysm and any arterial injury, but not overall Vascular Disease Management November
5 bleeding, in a cohort of unselected patients. 7 Fluoroscopic guidance may have an additional benefit among women, where use of fluoroscopy was associated with significantly lower rates of vascular complications. 8 Ultrasound-guided access can provide direct visualization of the common femoral artery and location of the profunda femoris/superficial femoral artery bifurcation. It also has the advantage of localizing calcium or other atherosclerotic disease, so that the access site can be optimized for a given vessel. The FAUST study was a multicenter randomized trial that compared fluoroscopic vs. ultrasound guided femoral access. 9 The overall study found no significant difference in rates of common femoral artery cannulation, although patients with a high bifurcation were more likely to have successful common femoral artery cannulation with ultrasound guidance (83% vs 70%). Vascular complications were also significantly lower in the ultrasound-guided group (1.4% vs 3.4%, P=.04). These results suggest that ultrasound-guided access has significant advantages in optimizing the results of femoral arterial access, even when compared to standard fluoroscopic guidance. Micropuncture access with a 21-gauge needle and an.018" wire is also frequently used to minimize vascular complications. An advantage of this technique includes minimal trauma to the vessel in the case of multiple arteriotomies. When using a micropuncture technique, it is imperative to visualize the wire under fluoroscopy prior to sheath insertion, because inadvertent cannulation of the circumflex branch of the femoral artery can lead to vessel perforation. The data supporting micropuncture use are based on observational studies that showed no benefit and a possible increased risk of retroperitoneal bleeding. 10 Despite the lack of definitive data in support of micropuncture access, a combined technique using ultrasound and micropunture may provide optimal outcomes of femoral arterial access. Further clinical trials are necessary to evaluate the advantages of this combined technique. WHEN TO USE A VASCULAR CLOSURE DEVICE Although meticulous attention to femoral access is the best determinant of outcomes regardless of closure technique, a number of situations may warrant specific use of a closure device. The increasing development of percutaneous large sheath procedures including transcatheter aortic valve replacement and endovascular aortic aneurysm repair has necessitated novel approaches to vascular closure, as manual closure typically is not feasible for larger sheath sizes. Suture-mediated devices including the preclose technique may offer significant advantages for these applications. Even in these cases, however, fluoroscopic and ultrasound-guided access offer additional advantages of optimizing the access site. Editor s Note: Disclosure: The author has completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The author reports no financial relationships or conflicts of interest regarding the content herein. REFERENCES 1. Patel MR, Jneid H, Derdeyn CP, et al. Arteriotomy closure devices for cardiovascular procedures: a scientific statement from the American Heart Association. Circulation. 2010;122(18): Trimarchi S, Smith DE, Share D, et al. Retroperitoneal hematoma after percutaneous coronary intervention: prevalence, risk factors, management, outcomes, and predictors of mortality: a report from the BMC2 (Blue Cross Blue Shield of Michigan Cardiovascular Consortium) registry. JACC Cardiovasc Interv. 2010;3(8): Vascular Disease Management November
6 3. Doyle BJ, Ting HH, Bell MR, et al. Major femoral bleeding complications after percutaneous coronary intervention. Incidence, predictors, and impact on long-term survival among 17,901 patients treated at the Mayo Clinic from 1994 to JACC Cardiovasc Interv. 2008;1(2): Marso SP, Amin AP, House JA, et al. Association between use of bleeding avoidance strategies and risk of periprocedural bleeding among patients undergoing percutaneous coronary intervention. JAMA. 2010;303(21): Bangalore S, Arora N, Resnic FS. Vascular closure device failure: frequency and implications: a propensity-matched analysis. Circ Cardiovasc Interv. 2009;2(6): Garrett PD, Eckart RE, Bauch TD, Thompson CM, Stajduhar KC. Fluoroscopic localization of the femoral head as a landmark for common femoral artery cannulation. Catheter Cardiovasc Interv. 2005;65(2): Fitts J, Ver LP, Hofmaster P, Malenka D. Northern New England Cardiovascular Study Group. Fluoroscopy-guided femoral artery puncture reduces the risk of PCI-related vascular complications. J Interv Cardiol. 2008;21(3): Ahmed B, Piper WD, Malenka D, et al. Significantly improved vascular complications among women undergoing percutaneous coronary intervention: a report from the Northern New England Percutaneous Coronary Intervention Registry. Circ Cardiovasc Interv. 2009;2(5): Seto AH, Abu-Fadel MS, Sparling JM, et al. Real-time ultrasound guidance facilitates femoral arterial access and reduces vascular complications: FAUST (Femoral Arterial Access With Ultrasound Trial). JACC Cardiovasc Interv. 2010;3(7): Ben-Dor I, Maluenda G, Mahmoudi M, et al. A novel, minimally invasive access technique versus standard 18- gauge needle set for femoral access. Catheter Cardiovasc Interv. 2012;79(7): Vascular Disease Management November
Vascular Closure Techniques
Vascular Closure Techniques Femoral Approach Clifford J Kavinsky, MD, PHD Professor of Medicine and pediatrics Associate Director, Center for Congenital and Structural Heart Disease Rush University Medical
More informationUniversity of Witten/Herdecke, Department of Cardiology 2. University of Bochum, Department of Cardiology 3
Safety and efficacy of clip-based vs. suture mediated vascular closure for femoral access hemostasis: A prospective randomized single center study comparing the StarClose and the ProGlide device Oliver
More informationVascular Closure Techniques
Vascular Closure Techniques CLIFFORD J. KAVINSKY MD, PHD PROFESSOR OF MEDICINE AND PEDIATRICS DIRECTOR, CARDIOVASCULAR FELLOWSHIP TRAINING PROGRAM DIRECTOR, RUSH CENTER FOR ADULT STRUCTURAL HEART DISEASE
More informationA propensity analysis of the risk of vascular complications after cardiac catheterization procedures with the use of vascular closure devices
A propensity analysis of the risk of vascular complications after cardiac catheterization procedures with the use of vascular closure devices Nipun Arora, MD, a Michael E. Matheny, MD, b,c Carrie Sepke,
More informationREDUCE COMPLICATIONS WITH RADIAL AND FEMORAL
PROVEN AT THE POINT OF ACCESS Global leader in arterial access and closure REDUCE COMPLICATIONS WITH RADIAL AND FEMORAL RADIAL FEMORAL RECOGNIZE THE RATE OF VASCULAR ACCESS COMPLICATIONS REDUCE E COMPLICATIONS
More informationUltrasound User Demonstration
Ultrasound User Demonstration Disclaimer: This presentation is intended to be used as a demonstration educational device to showcase Terumo products. It is NOT intended to be used as a diagnostic device
More informationANGIOPLASTY SUMMIT 2004 Seoul, South Korea APRIL 29-MAY 2, 2004
ANGIOPLASTY SUMMIT 2004 Seoul, South Korea APRIL 29-MAY 2, 2004 RESULTS OF STUDIES COMPARING TRANSRADIAL AND FEMORAL ANGIOGRAPHY HOWARD A. COHEN, M.D. UNIVERSITY OF PITTSBURGH MEDICAL CENTER PRESBYTERIAN
More informationUltrasound Guidance during Arterial Access for Peripheral Vascular Intervention: A VSGNE Quality Improvement Project
Ultrasound Guidance during Arterial Access for Peripheral Vascular Intervention: A VSGNE Quality Improvement Project Jeffrey Kalish, David Gillespie, Marc Schermerhorn, Daniel Bertges, Chris Healey, Paul
More informationTransradial vs. Transfemoral Access in STEMI: Should We Randomize?
Transradial vs. Transfemoral Access in STEMI: Should We Randomize? Ajay J. Kirtane, MD, SM Center for Interventional Vascular Therapy Columbia University Medical Center / New York Presbyterian Hospital
More informationVascular Closure Techniques
Vascular Closure Techniques Femoral Approach Clifford J Kavinsky, MD, PHD Professor of Medicine and pediatrics Associate Director, Center for Congenital and Structural Heart Disease Rush University Medical
More informationArterial Access for Diagnosis and Intervention T-Woei Tan, MD, FACS
Arterial Access for Diagnosis and Intervention T-Woei Tan, MD, FACS Assistant Professor of Surgery Vascular Endovascular Surgery Louisiana State University Health - Shreveport Disclosures None Objective
More informationFemoral Basics. Zoltan G. Turi, M.D. Rutgers Robert Wood Johnson Medical School New Brunswick, NJ
Femoral Basics Zoltan G. Turi, M.D. Rutgers Robert Wood Johnson Medical School New Brunswick, NJ Vascular Access in the New Percutaneous Technologies Era is: Taken for Granted Under-investigated but Way
More informationFemoral Access is Safer Under Ultrasound Guidance. Complications of Femoral Artery Access
Femoral Access is Safer Under Ultrasound Guidance Jennifer Baker, MD November 9, 2018 Complications of Femoral Artery Access Hematomas: 2-12% 2 Pseudoaneurysms 0.2-9% 1 Arteriovenous fistulas 0.2-2.1%
More informationPuncture Ultrasound Guidance: Decrease Access Site Complications. Peter A. Schneider, MD Kaiser Foundation Hospital Honolulu, Hawaii
Puncture Ultrasound Guidance: Decrease Access Site Complications Peter A. Schneider, MD Kaiser Foundation Hospital Honolulu, Hawaii Disclosure Speaker name: Peter A. Schneider... I have the following potential
More informationMynx Vascular Closure Device Early Ambulation Study
Mynx Vascular Closure Device Early Ambulation Study The safety and benefits of 1-hour ambulation with the Mynx 5-F Vascular Closure Device. By Vikranth R. GongidI, DO; Ahsan Jafir, DO; and Vijay Verma,
More informationPourquoi j utilise le STARCLOSE. P.Commeau Cardiologie et Radiologie Vasculaire Interventionnelles Polyclinique Les Fleurs Ollioules, Fr
Pourquoi j utilise le STARCLOSE P.Commeau Cardiologie et Radiologie Vasculaire Interventionnelles Polyclinique Les Fleurs Ollioules, Fr Consultant Abbott Medtronic Boston Scientific Braun Medical Biotronik
More informationAccess Site Complications. Nick Cheshire MD FRCS, Professor of Vascular Surgery Imperial College Healthcare St Mary s Hospital Campus
Access Site Complications Nick Cheshire MD FRCS, Professor of Vascular Surgery Imperial College Healthcare St Mary s Hospital Campus Surgeons & Cardiologists Interventional Cardiology 2008 Eye of a Hawk,
More informationAccess Closure: Manual vs. Device
Access Closure: Manual vs. Device Herbert D. Aronow, MD, MPH, FACC, FSCAI, FSVM Director, Interventional Cardiology, Cardiovascular Institute Director, Cardiac Cath Labs, Rhode Island &The Miriam Hospitals
More informationVascular Access: Management of Complications. Chris Burrell, South West Cardiothoracic Centre, Plymouth
Vascular Access: Management of Complications Chris Burrell, South West Cardiothoracic Centre, Plymouth Alternative Vascular Access Sites Femoral Axillary Brachial Radial Ulnar Femoral v Radial Vascular
More informationCordis EXOSEAL Vascular Closure Device
to receive our latest news and key activities. Cordis EXOSEAL Vascular Closure Device A Guide to Good Access and Closure Transfemoral Access Closure Pocket Guide LinkedIn page Follow us on CORDIS EMEA
More informationReal-Time Ultrasound Guidance Facilitates Femoral Arterial Access and Reduces Vascular Complications: FAUST (Femoral Arterial Access With
Real-Time Ultrasound Guidance Facilitates Femoral Arterial Access and Reduces Vascular Complications: FAUST (Femoral Arterial Access With Ultrasound Trial) Arnold H. Seto, Mazen S. Abu-Fadel, Jeffrey M.
More informationTRANSRADIAL CARDIAC CATHETERIZATION. Amanda Ryan, DO, Interventional Cardiologist Heart Care Centers of Florida April 13, 2013
TRANSRADIAL CARDIAC CATHETERIZATION Amanda Ryan, DO, Interventional Cardiologist Heart Care Centers of Florida April 13, 2013 TOPICS Historical perspective and current trends Rationale Bleeding for the
More informationCopyright HMP Communications
Treatment of Angioseal-Related Femoral Artery Occlusion Using TurboHawk Directional Atherectomy Anvar Babaev, MD, PhD; David W. Lee, MD; Anna Kurayev, MD; Heather Yang, PA From the Division of Cardiology,
More informationPre-Procedural Estimate of Individualized Bleeding Risk Impacts Physicians Utilization of Bivalirudin During Percutaneous Coronary Intervention
Journal of the American College of Cardiology Vol. 61, No. 18, 2013 2013 by the American College of Cardiology Foundation ISSN 0735-1097/$36.00 Published by Elsevier Inc. http://dx.doi.org/10.1016/j.jacc.2013.02.017
More informationCLOSES WITH SECURITY. LEAVES WITHOUT A TRACE.
CLOSES WITH SECURITY. LEAVES WITHOUT A TRACE. Close with Confidence. Leave Nothing Behind. The innovative design and predictable deployment of MYNX CONTROL Vascular Closure Device (VCD) delivers outstanding
More informationCurtiss T. Stinis, M.D., F.A.C.C., F.S.C.A.I. SCRIPPS CLINIC
Avoiding and Managing Femoral Access Site Complications Curtiss T. Stinis, M.D., F.A.C.C., F.S.C.A.I. Director, Peripheral Interventions Program Director, Interventional Cardiology Fellowship Division
More informationHow to manage TAVI related vascular complications. Paul TL Chiam MBBS, FRCP, FESC, FACC, FSCAI
How to manage TAVI related vascular complications Paul TL Chiam MBBS, FRCP, FESC, FACC, FSCAI Definition VARC-2 consensus statement Complications caused by: Wire Catheter Anything related to vascular access
More informationAccess Issues and Bleeding Complications
Cardiovascular Trends 2011: Nursing and Cath Lab Symposia ITS 2011 Access Issues and Bleeding Complications Mauricio G. Cohen, MD, FACC, FSCAI Director, Cardiac Catheterization Lab Associate Professor
More informationThe advent of transcatheter aortic valve implantation. Vascular Complications Among Patients. cover story
Vascular Complications Among Patients Undergoing TAVR Contemporary concepts facing operators in this challenging patient population. By Stefan Stortecky, MD, and Peter Wenaweser, MD The advent of transcatheter
More informationOptimal Techniques for Obtaining Large Caliber Arterial Access
Optimal Techniques for Obtaining Large Caliber Arterial Access Gerald Yong MBBS (Hons) FRACP FSCAI Interventional Cardiologist Royal Perth Hospital Western Australia APCASH 11 October 2014 Disclosure Statement
More informationExperience with percutaneous suture system for larger caliber vascular access Bruno Freitas, Prof., MD
Experience with percutaneous suture system for larger caliber vascular access Bruno Freitas, Prof., MD Department of Interventional Angiology, University Hospital Leipzig, Germany Division of Vascular
More informationVascular Closure Device Failure in Contemporary Practice
JACC: CARDIOVASCULAR INTERVENTIONS VOL. 5, NO. 8, 2012 2012 BY THE AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION ISSN 1936-8798/$36.00 PUBLISHED BY ELSEVIER INC. http://dx.doi.org/10.1016/j.jcin.2012.05.005
More informationFor Personal Use. Copyright HMP 2013
Original Contribution Use of a Novel Access Technology for Femoral Artery Catheterization: Results of the RECITAL Trial Zoltan G. Turi, MD 1, Dale C. Wortham, MD 2*, Gregory C. Sampognaro, MD 3, Frank
More informationVascular Closure Device: A to Z. Owayed M Al Shammeri, MD, FSCAI Interventional Cardiologist AlRayyan Hospital, HMG Riyadh
Vascular Closure Device: A to Z Owayed M Al Shammeri, MD, FSCAI Interventional Cardiologist AlRayyan Hospital, HMG Riyadh Femoral artery Anatomy Disparities still exist Vascular Closure Devices Suture
More informationNo Diclosures. M. Uhlemann, S. Gielen, G.C. Schuler Department of Internal Medicine/Cardiology University of Leipzig, Heart Center, Germany
Routine vascular ultrasound after radial artery catheterization detects clinically silent access site complications: Prospective registry of 425 consecutive patients M. Uhlemann, S. Gielen, G.C. Schuler
More informationAlthough vascular closure devices (VCDs) have
The Two Sides of Vascular Access and Closure Part 1: Debating the pros and cons of manual compression versus vascular closure devices. BY ZOLTAN G. TURI, MD Although vascular closure devices (VCDs) have
More informationRadial Access Just another artery? Keith G Oldroyd Department of Cardiology Western Infirmary Glasgow
Radial Access Just another artery? Keith G Oldroyd Department of Cardiology Western Infirmary Glasgow Brachial access Not just another artery! Femoral access Not just another artery! Incidence of femoral
More informationPrevention and Management of Vascular Complications Related to Transcatheter Aortic Valve Implantation
Prevention and Management of Vascular Complications Related to Transcatheter Aortic Valve Implantation Marco Roffi Division of Cardiology University Hospital Geneva, Switzerland Disclosure Speaker name:...marco
More informationOverview of Trasradial Approach for Coronary Angiography and Intervention. A/Prof. Phạm Mạnh Hùng, MD.FACC., FESC
Overview of Trasradial Approach for Coronary Angiography and Intervention A/Prof. Phạm Mạnh Hùng, MD.FACC., FESC Outline Historical perspective and current trends Rationale for the radial approach Bleeding
More informationTransradial Artery Approach for Coronary Intervention: Maharat Nakhonratchasima Hospital Experience of The First 20 Cases
Transradial Artery Approach for Coronary Intervention: Maharat Nakhonratchasima Hospital Experience of The First 20 Cases Pinij Kaewsuwanna M.D. Tongprakob Siriwanij M.D. Cardiovascular Disease Center,
More informationΆγγελος Παπανικολάου MD, Ειδικευόμενος Καρδιολογίας, A Πανεπιστημιακή Καρδιολογική Κλινική, ΓΝΑ Ιπποκράτειο
Άγγελος Παπανικολάου MD, Ειδικευόμενος Καρδιολογίας, A Πανεπιστημιακή Καρδιολογική Κλινική, ΓΝΑ Ιπποκράτειο Endovascular access & closure Seldinger SI. Catheter replacement of the needle in percutaneous
More informationClosure Devices. Peter F Ludman Advanced Angioplasty 2003
Closure Devices Peter F Ludman Advanced Angioplasty 2003 Where Radials fear to tread Male, 46 yrs, ACS (CK to 792) Diabetes Morbid obesity Wheel chair bound Moderate LV dysfunction, LMS and RCA disease
More informationZiyad M. Hijazi, M.D., MPH, FSCAI, FACC
Ziyad M. Hijazi, M.D., MPH, FSCAI, FACC Professor of Pediatrics & Internal Medicine Rush University Medical Center Chicago Traditional Venous & arterial Access! 1. Umbilical vein/artery 2. Femoral Veins/arteries
More informationZiyad M. Hijazi, MD, FSCAI, FACC
Ziyad M. Hijazi, MD, FSCAI, FACC The James A. Hunter, MD, University Chair Professor of Pediatrics & Internal Medicine Rush Center for Congenital & Structural Heart Disease Rush University Medical Center
More informationJun-Won Lee, Sang Wook Park, Jung-Woo Son, Young Jin Youn, Min-Soo Ahn, Sung Gyun Ahn, Jang-Young Kim, Byung-Soo Yoo, Junghan Yoon, Seung-Hwan Lee
The procedural success and complication rate of the left distal radial approach for coronary angiography and percutaneous coronary intervention. Prospective observational study (LeDRA) Jun-Won Lee, Sang
More informationClinical Lessons from BMC2-PCI
Clinical Lessons from BMC2-PCI The Blue Cross Blue Shield of Michigan Cardiovascular Consortium Hitinder Gurm, M.D. University of Michigan Overview 32 papers since inception 10 papers published this year
More informationComplicaciones de Acceso Radial Cómo se Manejan?
Complicaciones de Acceso Radial Cómo se Manejan? Mauricio G. Cohen, MD, FACC, FSCAI Associate Professor of Medicine Director, Cardiac Catheterization Laboratory University of Miami Miller School of Medicine
More informationPercutaneous Aortic Valve Replacement
Journal of the American College of Cardiology Vol. 59, No. 2, 2012 2012 by the American College of Cardiology Foundation ISSN 0735-1097/$36.00 Published by Elsevier Inc. doi:10.1016/j.jacc.2011.08.069
More informationRadial Artery Access Improving Outcomes and Decreasing Costs
Howard A. Cohen, MD, FACC, FSCAI Director, Division of Cardiac Intervention Co-Director, Cardiac Catheterization Laboratories Lenox Hill Heart & Vascular Institute Institute DISCLOSURE Nothing to disclose
More informationRadRx Your Prescription for Accurate Coding & Reimbursement Copyright All Rights Reserved.
Interventional Radiology Coding Case Studies Prepared by Stacie L. Buck, RHIA, CCS-P, RCC, CIRCC, AAPC Fellow President & Senior Consultant INDICATION: Abdominal aortic aneurysm. INTERVENTIONAL RADIOLOGIST:
More informationJournal of Patient-Centered Research and Reviews. Volume 3 Issue 1 Article
Journal of Patient-Centered Research and Reviews Volume 3 Issue 1 Article 3 1-25-2016 Development and Validation of a Preprocedural Risk Score to Predict Access Site Complications After Peripheral Vascular
More informationI Was Too Late With Device Placement
SCAI SHOCK 2018 A Team-Based Course On Cardiogenic Shock General Session # 2 Saturday, October 13, 2018 8:39 8:51 AM Boston Park Plaza - Boston, MA I Was Too Late With Device Placement M Chadi Alraies,
More informationBridging With Percutaneous Devices: Tandem Heart and Impella
Bridging With Percutaneous Devices: Tandem Heart and Impella DAVID A. BARAN, MD, FACC, FSCAI SYSTEM DIRECTOR, ADVANCED HEART FAILURE, TX AND MCS SENTARA HEART HOSPITAL NORFOLK, VA PROFESSOR OF MEDICINE
More informationInternational Journal of Collaborative Research on Internal Medicine & Public Health (IJCRIMPH)
Same-day discharge after percutaneous coronary intervention in light of the society for cardiovascular angiography and intervention's proposed guidelines: A single-center experience Yazan Khouri, Sachin
More informationTransradial access compared with femoral puncture closure devices in percutaneous coronary procedures
International Journal of Cardiology 137 (2009) 199 205 www.elsevier.com/locate/ijcard Transradial access compared with femoral puncture closure devices in percutaneous coronary procedures Alessandro Sciahbasi
More informationPercutaneous Axillary Artery Access For Branch Grafting for complex TAAAs and pararenal AAAs: How to do it safely
Percutaneous Axillary Artery Access For Branch Grafting for complex TAAAs and pararenal AAAs: How to do it safely Daniela Branzan, MD, Department of Vascular Surgery University Hospital Leipzig Disclosure
More informationInterventional Cardiology
Interventional Cardiology Retrograde approach to successfully treat antegrade failure due to subintimal hematoma of a right coronary artery chronic total occlusion Use of antegrade dissection re-entry
More informationRhondalyn C. McLean. 2 ND YEAR RESEARCH ELECTIVE RESIDENT S JOURNAL Volume VII, A. Study Purpose and Rationale
A Randomized Clinical Study To Compare The Intra-Aortic Balloon Pump To A Percutaneous Left Atrial-To-Femoral Arterial Bypass Device For Treatment Of Cardiogenic Shock Following Acute Myocardial Infarction.
More informationCARDIOLOGY GRAND ROUNDS
Presentation: Speakers: Presentation: Speakers: Presentation: Speakers: CARDIOLOGY GRAND ROUNDS Date: Case Review: Open thoracoabdominal aortic aneurysm repair Timothy M. Sullivan, MD, Minneapolis Heart
More informatione Corrado Tamburino, MD, PhD
Transcatheter Aortic Valve Implantation Stroke: etiology ogy and prevention e Corrado Tamburino, MD, PhD Full Professor of Cardiology, Director of Postgraduate School of Cardiology Chief Cardiovascular
More informationPost-Procedure Care and Same-Day PCI. Arnold Seto, MD, MPA
Post-Procedure Care and Same-Day PCI Arnold Seto, MD, MPA Post-Procedure Care Success of radial program depends upon effective access site management Training of staff critical to increase comfort with
More information(EU), FACC (USA), FSCAI (USA)
How to reduce vascular complications of TAVI Paul TL Chiam MBBS (S pore), MMed, MRCP (UK), FAMS FRCP (Edin), FESC (EU), FACC (USA), FSCAI (USA) Cardiologist Mount Elizabeth Hospital Singapore Definition
More informationThis is the seventh year that I have had the privilege
Overview of Vascular Closure The Endovascular Today annual review. BY ZOLTAN G. TURI, MD This is the seventh year that I have had the privilege of writing the annual review of vascular closure for Endovascular
More informationCase Report Rapid Switch from Intra-Aortic Balloon Pumping to Percutaneous Cardiopulmonary Support Using Perclose ProGlide
Hindawi Publishing Corporation Case Reports in Cardiology Volume 2015, Article ID 407059, 5 pages http://dx.doi.org/10.1155/2015/407059 Case Report Rapid Switch from Intra-Aortic Balloon Pumping to Percutaneous
More informationCTO Re vascularization in 2013
CTO Re vascularization in 2013 Is it safe to use/stent the sub intimal space? Dimitri Karmpaliotis, MD, FACC, FSCAI Interventional Cardiology Piedmont Heart Institute Atlanta, Georgia Dimitri.karmpaliotis@piedmont.org
More informationAccepted Manuscript. Improving Survival in Cardiogenic shock: Is Impella the Answer?,, James J Glazier MD, Amir Kaki MD S (18)
Accepted Manuscript Improving Survival in Cardiogenic shock: Is Impella the Answer?,, James J Glazier MD, Amir Kaki MD PII: S0002-9343(18)30496-0 DOI: 10.1016/j.amjmed.2018.04.045 Reference: AJM 14684
More informationAudit on the Complication Rates of Angioseal Vascular Closure Devices
Audit on the Complication Rates of Angioseal Vascular Closure Devices Poster No.: C-1359 Congress: ECR 2014 Type: Authors: Keywords: DOI: Scientific Exhibit S. Abdulla, H. Rafiee, M. Crawford; Norwich/UK
More informationCover Page. The handle holds various files of this Leiden University dissertation
Cover Page The handle http://hdl.handle.net/1887/21543 holds various files of this Leiden University dissertation Author: Dharma, Surya Title: Perspectives in the treatment of cardiovascular disease :
More informationSwitching from femoral to radial access for coronary angiography in ACS
ORIGINAL ARTICLE 169 Feasability, bleeding events and impact on door-to-balloon times Switching from femoral to radial access for coronary angiography in ACS Ivano Reho, Martin Sprenger, David Tueller,
More informationStreamlining a TAVR Procedure From screening to post TAVR care Hatim Al Lawati
Streamlining a TAVR Procedure From screening to post TAVR care Hatim Al Lawati Consultant Interventional Cardiology Sultan Qaboos University Hospital Muscat Oman Speaker's name: Hatim Al Lawati, SQUH -
More informationSuccessful percutaneous treatment of late-onset femoral pseudoaneurysm after transcatheter, aortic valve implantation procedure
Case Report Page 1 of 5 Successful percutaneous treatment of late-onset femoral pseudoaneurysm after transcatheter, aortic valve implantation procedure Murat Celik, Uygar Cagdas Yuksel Correspondence to:
More informationComparison of transradial and transfemoral approach for carotid artery stenting: RADCAR study
Comparison of transradial and transfemoral approach for carotid artery stenting: RADCAR study (RADial access for CARotide artery stenting) Zoltán Ruzsa MD PhD et al. TCT 2013 Disclosure Statement of Financial
More informationRadial Basics. Samir B. Pancholy, MD, FACP, FACC, FSCAI. Program Director, Cardiology Fellowship, The Wright Center for Graduate Medical Center
Radial Basics Samir B. Pancholy, MD, FACP, FACC, FSCAI Program Director, Cardiology Fellowship, The Wright Center for Graduate Medical Center Associate Professor of Medicine, The Commonwealth Medical College,
More informationPERFORMANCE YOU CAN TRUST. EverFlex Self-expanding Peripheral Stent with Entrust Delivery System
PERFORMANCE YOU CAN TRUST EverFlex Self-expanding Peripheral Stent with Entrust Delivery System The Entrust Delivery System is designed to provide improved patient outcomes and procedural efficiency. The
More informationHybrid Muscular VSD Closure in Small Weight Children
Hybrid Muscular VSD Closure in Small Weight Children Shakeel A Qureshi, on behalf of: John P. Cheatham, MD George H. Dunlap Endowed Chair in Interventional Cardiology Director Cardiac Catheterization &
More informationTAVR in Intermediate Risk Populations /Optimizing Systems for TAVR
TAVR in Intermediate Risk Populations /Optimizing Systems for TAVR Saibal Kar, MD, FACC, FAHA, FSCAI Professor of Medicine Director of Interventional Cardiac Research Smidt Heart Institute, Cedars-Sinai
More informationDECLARATION OF CONFLICT OF INTEREST
DECLARATION OF CONFLICT OF INTEREST Cardiogenic Shock Mechanical Support Eulàlia Roig FESC Heart Failure and HT Unit Hospital Sant Pau - UAB Barcelona. Spain No conflics of interest Mechanical Circulatory
More informationFemoral Closure Devices: Good, Bad and Ugly. Zoltan G. Turi, M.D. Rutgers Robert Wood Johnson Medical School New Brunswick, NJ
Femoral Closure Devices: Good, Bad and Ugly Zoltan G. Turi, M.D. Rutgers Robert Wood Johnson Medical School New Brunswick, NJ Disclosure Statement of Financial Interest Affiliation/Financial Relationship
More informationVascular Access Safety Training: The VAST Agenda
Vascular Access Safety Training: The VAST Agenda Mitchell W. Krucoff MD, FACC Professor of Medicine / Cardiology Duke University Medical Center Director, Cardiovascular Devices Unit Duke Clinical Research
More informationCath Lab Essentials : Transradial Cardiac Catheterization
Cath Lab Essentials : Transradial Cardiac Catheterization Pranav M. Patel, MD, FACC, FSCAI Interim Chief, Division of Cardiology Director, Cardiac Catheterization Lab Associate Professor of Medicine University
More informationAcute dissections of the descending thoracic aorta (Debakey
Endovascular Treatment of Acute Descending Thoracic Aortic Dissections Nimesh D. Desai, MD, PhD, and Joseph E. Bavaria, MD Acute dissections of the descending thoracic aorta (Debakey type III or Stanford
More informationMitigating Operator Risk in Complex Interventional Procedures. Tanveer Rab, MD, FACC Ajay Kirtane, MD, FACC Prashant Kaul, MD, FACC
Mitigating Operator Risk in Complex Interventional Procedures Tanveer Rab, MD, FACC Ajay Kirtane, MD, FACC Prashant Kaul, MD, FACC Risk assessment Documentation Informed consent Public reporting Steps
More informationPercutaneous Coronary Intervention Complications and Guide Catheter Size
JACC: CARDIOVASCULAR INTERVENTIONS VOL. 2, NO. 7, 2009 2009 BY THE AMERICAN COLLEGE OF CARDIOLOGY FOUNDATION ISSN 1936-8798/09/$36.00 PUBLISHED BY ELSEVIER INC. DOI: 10.1016/j.jcin.2009.05.012 Percutaneous
More informationDiagnosis and Management of Femoral Access Site Complications IV: Novel Techniques for Endovascular Rescue
Diagnosis and Management of Femoral Access Site Complications IV: Novel Techniques for Endovascular Rescue Robert M. Bersin, M.D. Director, Endovascular Services Seattle Cardiology and the Cardiovascular
More informationWatchman. Left Atrial Appendage Closure Device. Uniquely engineered for the LAA 1-3 with proven safety and longterm efficacy. 4-8
TM Watchman Left Atrial Appendage Closure Device PROOF OFLEADERSHIP Uniquely engineered for the LAA 1-3 with proven safety and longterm efficacy. 4-8 Patients with AF have a 5x increased risk of stroke.
More informationSupplementary Online Content
Supplementary Online Content Schulz Schüpke S, Helde S, Gewalt S; et al. Comparison of vascular closure devices vs manual compression after femoral artery puncture: the ISAR-CLOSURE randomized clinical
More informationThrombin injection vs Conventional Surgical Repair in Treatment of Iatrogenic Post-cath Femoral Artery Pseudoaneurysm (IFAP)
Kasr El Aini Journal of Surgery VOL., 11, NO 3 September 2010 31 Thrombin injection vs Conventional Surgical Repair in Treatment of Iatrogenic Post-cath Femoral Artery Pseudoaneurysm (IFAP) Farghaly A,
More informationPercutaneous Access for TEVAR
Percutaneous Access for TEVAR The Preclose technique and the Proglide device offer safe and effective percutaneous access for thoracic endovascular aortic repair. BY W. ANTHONY LEE, MD Suture-mediated
More informationWe are IntechOpen, the world s leading publisher of Open Access books Built by scientists, for scientists. International authors and editors
We are IntechOpen, the world s leading publisher of Open Access books Built by scientists, for scientists 3,500 108,000 1.7 M Open access books available International authors and editors Downloads Our
More informationState of the Art of PEVAR
State of the Art of PEVAR Zvonimir Krajcer, MD Program Director- Peripheral Vascular Interventions Department of Cardiology, St. Luke s Episcopal Hospital and Texas Heart Institute, Houston, TX Disclosures
More informationTRI update Joint Meeting of Coronary Revascularization Dec , 2008 Busan, Korea
TRI update 2008 Joint Meeting of Coronary Revascularization Dec. 12-13, 2008 Busan, Korea Junghan Yoon, MD Yonsei University Wonju College of Medicine Wonju, KOREA Our history is... Do you agree that radial
More informationINTRODUCTION. Key Words:
Original Article Acta Cardiol Sin 2013;29:531 538 Interventional Cardiology Short-Term Safety and Efficacy of Femoral Vascular Closure after Percutaneous Coronary Intervention with Combination of the Boomerang
More informationCurrent Non-Surgical Cardiac Interventions. By Pam Bayles, RN, BSN
Current Non-Surgical Cardiac Interventions By Pam Bayles, RN, BSN Balloon Angioplasty & DES A balloon-tipped catheter was first used in 1964 to treat a cause of atherosclerotic disease in a patient s leg
More informationEvaluating the economic value of 5F systems for outpatients
Evaluating the economic value of 5F systems for outpatients Pr Yann Gouëffic, MD, PhD Department of vascular surgery - University Hospital of Nantes, France Disclosure Speaker's name: Yann Goueffic I have
More informationParadigm Shift Updates on improving outcomes and reducing complications.
From Femoral to Radial: An Ongoing Paradigm Shift Updates on improving outcomes and reducing complications. By Rohan R. Wagle, MD, and Ralph Brindis, MD, MPH, MACC, FSCAI Percutaneous coronary intervention
More informationMethods. Statistical analysis
Gender differences in adverse outcomes after contemporary percutaneous coronary intervention: An analysis from the Blue Cross Blue Shield of Michigan Cardiovascular Consortium (BMC2) percutaneous coronary
More informationFor Personal Use. Copyright HMP 2013
Case Report J INVASIVE CARDIOL 2013;25(2):E39-E41 A Case With Successful Retrograde Stent Delivery via AC Branch for Tortuous Right Coronary Artery Yoshiki Uehara, MD, PhD, Mitsuyuki Shimizu, MD, PhD,
More informationVascular Closure Devices Versus Manual Compression After Femoral Artery Access
Vascular Closure Devices Versus Manual Compression After Femoral Artery Access the ISAR-CLOSURE Randomized Trial Stefanie Schüpke (Schulz) 1, Sandra Helde 1, Senta Gewalt 1, Tareq Ibrahim 2, Roland Schmidt
More informationThe Role of Mechanical Circulatory Support in Cardiogenic Shock: When to Utilize
The Role of Mechanical Circulatory Support in Cardiogenic Shock: Presented by Nancy Scroggins ACNP, CNS-CC CV Surgery ACNP Bayshore Medical Center The Role of Mechanical Circulatory Support in Cardiogenic
More informationProfessional Society Roles in Drug-Device Cardiac Safety
Professional Society Roles in Drug-Device Cardiac Safety TREATT II Thinktank Silver Spring, MD March 7, 2011 Ralph Brindis, MD MPH FACC President, American College of Cardiology Senior Advisor for CV Disease
More information