Showing papers on "Femoral artery published in 2023"

Outcomes with plug‐based versus suture‐based vascular closure device after transfemoral transcatheter aortic valve replacement: A systematic review and meta‐analysis

Abstract: Studies comparing plug‐based (i.e., MANTA) with suture‐based (i.e., ProStar XL and ProGlide) vascular closure devices (VCDs) for large‐bore access closure after transcatheter aortic valve replacement (TAVR) have yielded mixed results.

Efficacy and Safety of Distal Radial Access for Transcatheter Arterial Chemoembolization (TACE) of the Liver

Abstract: Background: The distal radial artery has emerged as an alternative vascular-access site to conventional transfemoral and transradial approaches. The main advantage over the conventional transradial route is the reduced risk of radial artery occlusion, especially in those patients who, for various clinical reasons, have to undergo repeated endovascular procedures. This study aims to assess the efficacy and safety of distal radial access for transcatheter arterial chemoembolization of the liver. Methods: This investigation is a single-center retrospective analysis of 42 consecutive patients who had undergone, from January 2018 to December 2022, transcatheter arterial chemoembolization of the liver with distal radial access for intermediate-stage hepatocellular carcinoma. Outcome data were compared with a retrospectively constituted control group of 40 patients undergoing drug-eluting beads-transcatheter arterial chemoembolization with femoral access. Results: Technical success was achieved in all cases, with a 2.4% conversion rate for distal radial access. A superselective chemoembolization was performed in 35 (83.3%) cases of distal radial access. No episode of radial artery spasm or radial artery occlusion occurred. No significant differences in efficacy and safety were observed between the distal radial access group and the femoral access group. Conclusions: Distal radial access is effective, safe, and comparable to femoral access in patients undergoing transcatheter arterial chemoembolization of the liver.

Efficacy and Safety of Axiostat® Hemostatic Dressing in Aiding Manual Compression Closure of the Femoral Arterial Access Site in Patients Undergoing Endovascular Treatments: A Preliminary Clinical Experience in Two Centers

Abstract: Background: Hemostasis of the femoral arterial access site by manual compression or a vascular closure device is critical to the safe completion of any endovascular procedure. Previous investigations evaluated the hemostatic efficacy at the radial access site of some chitosan-based hemostatic pads. This study aims to assess the efficacy and safety of a new chitosan-based hemostatic dressing, namely Axiostat®, in aiding manual compression closure of the femoral arterial access site in patients undergoing endovascular treatments. Furthermore, the outcomes were compared with evidence on manual compression alone and vascular closure devices. Methods: This investigation is a two-center retrospective analysis of 120 consecutive patients who had undergone, from July 2022 to February 2023, manual compression closure of the femoral arterial access site aided by the Axiostat® hemostatic dressing. Endovascular procedures performed with introducer sheaths ranging from 4 Fr to 8 Fr were evaluated. Results: Primary technical success was achieved in 110 (91.7%) patients, with adequate hemostasis obtained in all cases of prolonged manual compression requirements. The mean time-to-hemostasis and time-to-ambulation were 8.9 (±3.9) and 462 (±199) minutes, respectively. Clinical success was achieved in 113 (94.2%) patients, with bleeding-related complications noted in 7 (5.8%) patients. Conclusions: Manual compression aided by the Axiostat® hemostatic dressing is effective and safe in achieving hemostasis of the femoral arterial access site in patients undergoing endovascular treatment with a 4–8 Fr introducer sheath.

Long term clinical and functional venous outcomes after endovascular transvenous femoro-popliteal bypass

Abstract: Peripheral artery disease is widespread in Western societies affecting around 13% of the population above 50 years of age. Despite recent improvements of endovascular treatment, open surgical bypass is still recommended as the treatment of choice for long segment TASC D lesions. The DETOUR procedure was introduced as an endovascular alternative in cases of long-segment superficial femoral artery occlusion. This unconventional technique raises several questions regarding the effect of the bypass graft on femoral venous physiology.We conducted a 3-year follow-up study of subjects enrolled and treated in the prospective, multicenter DETOUR study at the Pauls Stradins clinical university hospital, Riga, Latvia. In total, 52 consecutive patients (54 procedures) were enrolled in this study from 2015 until 2019. We performed Venous Clinical Severity Score (VCSS) and Villalta (VS) Score assessments, Duplex ultrasound measuring femoral and popliteal vein diameters, venous occlusion plethysmography and digital photoplethysmography to assess and compare venous physiology at baseline and at follow-up visits every 6 months.At baseline mean femoral vein diameter was 11.1 mm (SD=1.5). At 36-months following intraluminal stent-graft placement, mean femoral vein diameter was 11.1 mm (SD=1.7) with no evidence of enlargement of the femoral vein (P=0.2). Popliteal vein diameter was not significantly changed during 24-months of follow-up (P=0.12) but showed a small (0.02 mm) statistically significant decrease in diameter at 36-months compared to baseline. During the study period, only one patient (1.9%) developed clinically significant ipsilateral DVT 1-month after surgery. Clinically silent femoral venous thrombosis was documented in 8 legs during 36-month follow-up. In one case the thrombus was occlusive and in 7 cases the thrombus was non-occlusive. At baseline, 48 of 52 patients (92%) had no or minor venous symptoms ([VCSS 0-2] with clinically significant venous symptoms in only 4 patients [VCSS≥3]). At one-month follow-up, the venous clinical severity score increased in all patients compared to baseline. At 6-month follow-up, the VCSS had returned to baseline in the majority of patients with no significant changes during the 3-year follow-up period. At baseline, all patients had a VS of 0-2 indicating minor or no venous symptoms (mean 0.4 [SD 0.7]). At the 1-month follow-up visit 3 patients (5.8%) had a VS≥3 (two patients had a score of 3 and one patient a score of 4), indicating significant venous symptoms. At the 6-month visit and thereafter, all the VS in all patients had returned to baseline. Transvenous endovascular procedure did not significantly alter venous physiology in treated leg.Percutaneous transvenous femoropopliteal bypass provided safe and effective lower-extremity revascularization with minimal effect on long-term venous function. The femoral and popliteal vein remained patent with no compensatory enlargement in response to the presence of the bypass graft within the femoral vein. During 3-year follow-up there were no significant changes in venous symptom scores or physiologic function.

Lesion Characteristics Associated with Loss of Primary Patency After Endovascular Therapy for Common Femoral Artery Lesions

Abstract: To identify lesion characteristics associated with restenosis after endovascular therapy (EVT) for common femoral artery (CFA) lesions in patients with peripheral artery disease (PAD) in real-world practice.We included 751 Japanese patients with PAD who underwent CFA EVT. Data were from a large-scale retrospective multicenter registry study. The association of lesion characteristics with the risk of restenosis was investigated with the Cox proportional hazards regression model.Lesions extended to the external iliac artery in 10.0% of patients, were isolated in the CFA in 59.9%, and involved the bifurcation in 30.1%. Chronic total occlusion was noted in 21.1%, and 99% stenosis, in 19.9%. Among the limbs with CFA lesions, 16.4% had a history of CFA EVT. Mean total lesion length was 32 ± 15 mm, and reference vessel diameter, 7.3 ± 1.4 mm. Plain old balloon angioplasty, drug-coated balloon angioplasty, and stent implantation were performed in 56.3, 23.2, and 20.5% of patients, respectively. The mean follow-up period was 10.4 ± 9.5 months. Rates of freedom from restenosis and reintervention at 1 year were 78.2 and 86.6%, respectively. Lesion characteristics independently associated with restenosis were history of CFA EVT, reference vessel diameter less than 6 mm, and lesion length greater than or equal to 50 mm; adjusted hazard ratios were 1.63 (P = 0.007), 1.93 (P = 0.006), and 1.71 (P = 0.018), respectively.History of CFA EVT, smaller reference vessel diameter, and longer lesion length are independent risk factors for restenosis after CFA EVT.Level 3.

Routine use of percutaneous femoral cannulation in minimally invasive cardiac surgery.

Abstract: BACKGROUND Large series of percutaneous femoral access for extracorporeal circulation in minimally invasive cardiac surgery are scarcely reported. METHODS A single-center study describing the use of percutaneous femoral access in patients undergoing minimally invasive cardiac surgery via minithoracotomy. Femoral artery closure was performed with a plug-based closure device. To reduce the risk for vascular complications, intraoperative ultrasound assessment of correct deployment of the arterial closure device was done during the later period of the study. RESULTS During a 5-year period, 650 patients underwent percutaneous femoral cannulation and decannulation with device closure of the femoral artery puncture. Two hundred and seven patients (31.8%) were operated in the early phase of the experience (August 2017 to August 2019), without the use of intraoperative ultrasound-assessment of closure device deployment. During the later period of our experience (August 2019 to September 2022), 443 patients (68.2%) were operated, of whom all underwent intraoperative ultrasound-assessment of closure device deployment. Of the patients operated without intraoperative ultrasound-assessment, 6 patients (2.9%) experienced vascular complications compared with none of the patients in whom intraoperative ultrasound-assessment was used (p < 0.001). In total, 15 patients (2.3%) underwent conversion to surgical cutdown owing to incomplete hemostasis or femoral artery stenosis/occlusion and the mechanism was intravascular deployment of the closure device in all 15 cases. CONCLUSION Percutaneous femoral access in minimally invasive cardiac surgery is safe and need for surgical cutdown was infrequent. The risk for vascular complications is minimized with the use of intraoperative ultrasound-assessment of correct positioning of the vascular closure device. CLINICAL TRIAL REGISTRATION http://www.clinicaltrials.gov. Unique identifier: NCT05462769.

Totally percutaneous versus surgical cut-down femoral artery access for elective bifurcated abdominal endovascular aneurysm repair

Abstract: Background Abdominal aortic aneurysms (AAAs) are a vascular condition with significant risk attached, particularly if they rupture. Therefore, it is critical to identify and repair these as an elective procedure before they rupture and require emergency surgery. Repair has traditionally been an open surgical technique that required a large incision across the abdomen. Endovascular abdominal aortic aneurysm repairs (EVARs) are now a common alternative. In this procedure, the common femoral artery is exposed via a cut‐down approach and a graft is introduced to the aneurysm in this way. This Cochrane Review examines a totally percutaneous approach to EVAR. This technique gives a minimally invasive approach to femoral artery access that may reduce groin wound complication rates and improve recovery time. However, the technique may be less applicable in people with, for example, groin scarring or arterial calcification. This is an update of the previous Cochrane Review published in 2017. Objectives To evaluate the benefits and harms of totally percutaneous access compared to cut‐down femoral artery access in people undergoing elective bifurcated abdominal endovascular aneurysm repair (EVAR). Search methods We used standard, extensive Cochrane search methods The latest search was 8 April 2022. Selection criteria We included randomised controlled trials in people diagnosed with an AAA comparing totally percutaneous versus surgical cut‐down access endovascular repair. We considered all device types. We only considered studies investigating elective repairs. We excluded studies reporting emergency surgery for ruptured AAAs and those reporting aorto‐uni‐iliac repairs. Data collection and analysis We used standard Cochrane methods. Our primary outcomes were 1. short‐term mortality, 2. failure of aneurysm exclusion and 3. wound infection. Secondary outcomes were 4. major complications (30‐day or in‐hospital); 5. medium‐ to long‐term (6 and 12 months) complications and mortality; 6. bleeding complications and haematoma; and 7. operating time, duration of intensive treatment unit (ITU) stay and hospital stay. We used GRADE to assess the certainty of evidence for the seven most clinically relevant primary and secondary outcomes. Main results Three studies with 318 participants met the inclusion criteria, 189 undergoing the percutaneous technique and 129 treated by cut‐down femoral artery access. One study had a small sample size and did not adequately report the method of randomisation, allocation concealment or preselected outcomes. The other two larger studies had few sources of bias and good methodology; although one study had a high risk of bias in selective reporting. We observed no clear difference in short‐term mortality between groups, with only one death occurring overall, in the totally percutaneous group (risk ratio (RR) 1.50, 95% confidence interval (CI) 0.06 to 36.18; 2 studies, 181 participants; low‐certainty evidence). One study reported failure of aneurysm exclusion. There was one failure of aneurysm exclusion in the surgical cut‐down femoral artery access group (RR 0.17, 95% CI 0.01 to 4.02; 1 study, 151 participants; moderate‐certainty evidence). For wound infection, there was no clear difference between groups (RR 0.18, 95% CI 0.01 to 3.59; 3 studies, 318 participants; moderate‐certainty evidence). There was no clear difference between percutaneous and cut‐down femoral artery access groups in major complications (RR 1.21, 95% CI 0.61 to 2.41; 3 studies, 318 participants; moderate‐certainty evidence), bleeding complications (RR 1.02, 95% CI 0.29 to 3.64; 2 studies, 181 participants; moderate‐certainty evidence) or haematoma (RR 0.88, 95% CI 0.13 to 6.05; 2 studies, 288 participants). One study reported medium‐ to long‐term complications at six months, with no clear differences between the percutaneous and cut‐down femoral artery access groups (RR 0.82, 95% CI 0.25 to 2.65; 1 study, 135 participants; moderate‐certainty evidence). We detected differences in operating time, with the percutaneous approach being faster than cut‐down femoral artery access (mean difference (MD) −21.13 minutes, 95% CI −41.74 to −0.53 minutes; 3 studies, 318 participants; low‐certainty evidence). One study reported the duration of ITU stay and hospital stay, with no clear difference between groups. Authors' conclusions Skin puncture may make little to no difference to short‐term mortality. There is probably little or no difference in failure of aneurysm exclusion (failure to seal the aneurysms), wound infection, major complications within 30 days or while in hospital, medium‐ to long‐term (six months) complications and bleeding complications between the two groups. Compared with exposing the femoral artery, skin puncture may reduce the operating time slightly. We downgraded the certainty of the evidence to moderate and low as a result of imprecision due to the small number of participants, low event rates and wide CIs, and inconsistency due to clinical heterogeneity. As the number of included studies was limited, further research into this technique would be beneficial.

Ultrasound-guided femoral access in patients with vascular closure devices: a prespecified analysis of the randomised UNIVERSAL trial

Abstract: Whether ultrasound (US)-guided femoral access compared to femoral access without US guidance decreases access site complications in patients receiving a vascular closure device (VCD) is unclear.We aimed to compare the safety of VCD in patients undergoing US-guided versus non-US-guided femoral arterial access for coronary procedures.We performed a prespecified subgroup analysis of the UNIVERSAL trial, a multicentre randomised controlled trial of 1:1 US-guided femoral access versus non-US-guided femoral access, stratified for planned VCD use, for coronary procedures on a background of fluoroscopic landmarking. The primary endpoint was a composite of major Bleeding Academic Research Consortium 2, 3 or 5 bleeding and vascular complications at 30 days.Of 621 patients, 328 (52.8%) received a VCD (86% ANGIO-SEAL, 14% ProGlide). In patients who received a VCD, those randomised to US-guided femoral access compared to non-US-guided femoral access experienced a reduction in major bleeding or vascular complications (20/170 [11.8%] vs 37/158 [23.4%], odds ratio [OR] 0.44, 95% confidence interval [CI]: 0.23-0.82). In patients who did not receive a VCD, there was no difference between the US- and non-US-guided femoral access groups, respectively (20/141 [14.2%] vs 13/152 [8.6%], OR 1.76, 95% CI: 0.80-4.03; interaction p=0.004).In patients receiving a VCD after coronary procedures, US-guided femoral access was associated with fewer bleeding and vascular complications compared to femoral access without US guidance. US guidance for femoral access may be particularly beneficial when VCD are used.

Learning Curve of Perclose ProGlide Utilization During Percutaneous Coronary Intervention

Abstract: Objective: This study aimed to investigate the learning curve (LC) of Perclose ProGlide (Chicago, IL: Abbott Laboratories) utilization for percutaneous coronary intervention (PCI) for the first time. Methods: The study was conducted in a prospective manner and the final sample of the study was determined as 80 patients. Patients’ characteristics, diameter of common femoral artery (CFA), distance from skin to CFA, degree of calcification (<50% or ≥50%), procedure-related parameters, complications, and success of procedures were recorded. Patients were equally divided into four groups and groups were compared according to patient demographic properties, procedure-related parameters, complications, and success. Results: The mean age and mean BMI of the study population were 55.5 years and 27.5 kg/m2, respectively. The mean procedure time was 144.8 minutes (min) in group 1, 138.9 min in group 2, 122.2 min in group 3, and 101.1 min in group 4, and the difference was statistically shorter in favor of group 3 and group 4 (p=0.023). Moreover, mean fluoroscopy time significantly decreased after 20 cases (p=0.030). Hospitalization period was significantly shortened following 40 procedures (p=0.031). Complications were detected in five patients in group 1, four patients in group 2, and one patient in group 4 (p=0.044). Success was significantly higher in group 3 and group 4 in comparison to group 1 and group 2 (p=0.040). Conclusion: This study showed that procedure time and hospitalization time significantly decreased after 40 cases and fluoroscopy time significantly decreased after 20 cases. Moreover, after 40 procedures, the success of Perclose ProGlide utilization during PCI significantly increased and complications of the procedure significantly decreased.

Retrograde Trans-Amputation Embolectomy of Common, Superficial and Deep Femoral Arteries for Inflow Revascularisation During Above-Knee Amputation: A Case Report and Review of the Literature.

Abstract: BACKGROUND Primary above-knee amputation (AKA) may at times be the only option for unsalvageable acute lower limb ischemia. However, occlusion of the femoral arteries may result in poor inflow and contribute to wound complications such as stump gangrene and sepsis. Previously attempted inflow revascularisation techniques include surgical bypass and percutaneous angioplasty and/or stenting. CASE PRESENTATION We present a case of a 77-year-old lady with unsalvageable acute right lower limb ischemia secondary to cardioembolic occlusion of the common (CFA), superficial (SFA) and deep (PFA) femoral arteries. We performed a primary AKA with inflow revascularisation using a novel surgical technique involving endovascular retrograde embolectomy of the CFA, SFA and PFA via the SFA stump. The patient made an uneventful recovery without any wound complications. Detailed description of the procedure is followed by a discussion of the literature on inflow revascularisation in the treatment and prevention of stump ischemia.

Clinical advantage of drug-coated balloon in treatment of restenosis in superficial femoral artery stents.

Abstract: This investigation probed the clinical effectiveness of drug-coated balloon (DCB) and common balloon (CB) for treating restenosis in superficial femoral artery stents.We retrospectively analyzed 295 patients with lower extremity arteriosclerosis obliterans with superficial femoral artery stenting restenosis admitted to Shaanxi Provincial People's Hospital from March 2017 to March 2020. Cases were segregated within two cohorts adopting different treatment methods (cohort 1, DCB and cohort 2, CB). The restenosis and clinical outcomes were evaluated by Doppler ultrasound, computed tomography angiography, or digital subtraction angiography at 1 week, 6, and 12 months.Following six months, the restenosis rate on angiography was 4.2% within cohort 1, and 26% within cohort 2 (P<0.05); at 12 months the rates on duplex ultrasonography were 18% and 84%, respectively (P<0.001). ABI and MDL of cohort 1 (P<0.05) were higher than those of cohort 2, 6 and 12 months post-operation; late lumen loss (LLL) and peak systolic velocity ratio (PSVR) of cohort 1 (P<0.05) were lower than those of Cohort 2. Cohort 1 cases demonstrated increased mobility upon treadmill at 12 months compared to within cohort 2.Medium-/long-term clinical effectiveness for drug-coated balloon treating restenosis in a superficial femoral artery stent is significantly higher than that of an ordinary balloon.

Anesthetic management of external iliac artery transection in a morbidly obese patient with Klippel-Trenaunay-Weber syndrome: a case report

Abstract: Abstract Background We report the anesthetic management of an external iliac artery transection in a morbidly obese patient with Klippel-Trenaunay-Weber syndrome (KTWS). Case presentation A 47-year-old man with KTWS was scheduled for a right external iliac artery transection. Preoperative CT showed a right external iliac artery aneurysm, a right superficial femoral artery aneurysm, and developed collateral vessels. General anesthesia was maintained with desflurane, remifentanil, and rocuronium bromide. After the transection of the right external iliac artery, the regional saturation of oxygen (rSO 2 ) value of the right femoral did not decrease. There was no significant hemodynamic change before or after the transection. A non-ultrasound-guided rectus abdominis sheath block was performed due to the many collateral vessels. After extubation, the patient did not complain of postoperative pain. Conclusions In the transection of lower-extremity blood arteries under laparotomy in patients with KTWS, rSO 2 monitoring, hemodynamic monitoring, and combined regional anesthesia could be useful.

Vascular Closure Devices after Femoral Arteriotomy: Insight in High‐Risk Patients

Abstract: HomeJournal of the American Heart AssociationAhead of PrintVascular Closure Devices after Femoral Arteriotomy: Insight in High‐Risk Patients Open AccessEditorialPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citations ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toOpen AccessEditorialPDF/EPUBVascular Closure Devices after Femoral Arteriotomy: Insight in High‐Risk Patients Ravi Thakker, MD, Jose C. Iturrizaga, MD and Tareq Abu Sharifeh, MD Ravi ThakkerRavi Thakker *Correspondence to: Ravi Thakker, MD, Division of Cardiovascular Disease, University of Texas Medical Branch, Galveston, TX 77555. Email: E-mail Address: [email protected] https://orcid.org/0000-0001-7214-3439 , Division of Cardiovascular Disease, , University of Texas Medical Branch, , Galveston, , TX, Search for more papers by this author , Jose C. IturrizagaJose C. Iturrizaga , Division of Cardiovascular Disease, , University of Texas Medical Branch, , Galveston, , TX, Search for more papers by this author and Tareq Abu SharifehTareq Abu Sharifeh , Division of Cardiovascular Disease, , University of Texas Medical Branch, , Galveston, , TX, Search for more papers by this author Originally published30 Dec 2022https://doi.org/10.1161/JAHA.122.028501Journal of the American Heart Association. 2022;0:e028501Femoral arteriotomy has been appreciated to be one of the most commonly used access sites for cardiac catheterization.1 Although transradial arterial access use is increasing and becoming the predominant access site, femoral arterial access is still needed for large‐bore access procedures.2 Complications associated with femoral arteriotomy include groin hematomas, pseudoaneurysms, arteriovenous fistulas, cholesterol plaque embolization, and infection.3 Femoral artery access is also associated with an increased risk of bleeding compared with radial artery access.4 Proposed ways to overcome these access site complications have included the use of ultrasound access, which allows for visualization of landmarks in addition to fluoroscopy,5 as well as, micropuncture technique.6 Although manual compression is appreciated as the main stay of hemostasis after femoral arteriotomy, vascular closure devices (VCD) have been noted to be a tool in the interventionalist armament. VCDs have been shown to decrease bed rest time and decrease time to hemostasis.7It is in this context that the study by Marquis‐Gravel et al8 in this issue of the Journal of the American Heart Association (JAHA) should be viewed. The authors are to be commended on their post hoc study of 1580 patients from the REGULATE‐PCI (A Study to Determine the Efficacy and Safety of REG1 Compared to Bivalirudin in Patients Undergoing PCI [Percutaneous Coronary Intervention]) trial,9 which occurred across 225 sites in North America and Europe from 2013 to 2014. In the original trial, Lincoff et al9 compared REG1 versus bivalirudin in patients undergoing PCI. The primary efficacy end point was the composite of all‐cause death, myocardial infarction, stroke, and unplanned target lesion revascularization by day 3. The safety end point was bleeding. The study was stopped prematurely because of medication allergy. In this analysis8 the authors evaluated the efficacy of VCDs in reducing bleeding after transfemoral PCI. The patient population compared were those undergoing VCD versus manual compression. Patients presenting with ST‐segment–elevation myocardial infarction within 48 hours, clinical instability, inability to tolerate anticoagulation, recent use of bivalirudin, fibrinolysis, or glycoprotein IIb/IIIa inhibitors were excluded. The primary efficacy end point was type 2, 3, or 5 Bleeding Academic Research Consortium (BARC) access site bleeding on day 3. There are several baseline characteristics to appreciate from this study, although they may not all be statistically significant: Women accounted for approximately 30% of the patient population in the VCD group and 25% in the manual compression group (P=0.05).A creatine clearance of <60 mL/min was present in 14.2% of the VCD group and 13.4% of the manual compression group (P=0.63).Clopidogrel was used in 57.8% of the VCD group and 51.6% of the manual compression group (P=0.02). Ticagrelor was used in 7.7% of the VCD group and 8.5% of the manual compression group (P=0.55). Prasugrel was used in 9.9% of the VCD group and 9.5% of the manual compression group (P=0.84).Peripheral artery disease was present in 21.7% of the VCD group and 11.3% of the manual compression group (P=<0.01).The authors reported the following findings: Bleeding Academic Research Consortium 2, 3, or 5 bleeding through day 3 was present in 6.4% of the VCD group and 6.6% of the manual compression group. This was not statistically significant (P=0.89). At day 3 through day 30 there was no Bleeding Academic Research Consortium 3 or 5 bleeding. Ultimately, multivariate analysis showed no difference in the primary end point of bleeding (P=0.79).Median time to hemostasis (P<0.01) and ambulation (P<0.01) were shorter in the VCD group compared with the manual compression group.Secondary bleeding end points were not significantly different between either group (P>0.05).Interestingly, the authors found lower bleeding rates in patients with high‐risk features such as female sex (P=0.005), chronic kidney disease (P=0.0004), and on ticagrelor or prasugrel who underwent VCD (P=0.038).The overall design of this study is well done. We know from prior trials such as the ISAR‐CLOSURE (Instrumental Sealing of Arterial Puncture Site Closure Device Versus Manual Compression Trial)10 and CLOSE‐UP (Comparison of the FemoSeal Arterial Closure Device to Manual Compression After Coronary Angiography)11 studies, as the authors point out, that VCD is noninferior to manual compression in terms of access site complications and hematoma formation. On the contrary, Tavris et al12 in their analysis of the CathPCI Registry found VCDs to lower bleeding risk or vascular complications compared with manual compression alone. This analysis raises important questions such as the need for studies in high‐risk groups that include women, patients with renal insufficiency, and those on P2Y12 inhibition therapy. In the Northern New England PCI Registry, Ahmed et al13 noted that older age, poor renal function, cardiogenic shock, and use of large sheaths were all indicators for increased bleeding in women undergoing PCI. Aside from the aforementioned, lower body mass index, anatomy of the vessel such as smaller vessel size, in vivo platelet function, and pharmacodynamics of antiplatelet therapy have also been identified as female‐specific factors relating to increase bleeding risk.14 The diathesis for bleeding in patients with renal insufficiency is multifold and focused on anemia and nitric oxide production with a concern for poor platelet adhesion.15 Owing to the variation in bleeding potential among various P2Y12 inhibitors, it is imperative that the right antiplatelet be chosen. Prasugrel has been associated with increased thrombolysis in myocardial infarction major and minor bleeding compared with clopidogrel and ticagrelor.16This study8 demonstrates 2 major important points that the interventionalist must keep in mind. VCDs may not reduce major bleeding but play an important role in time to hemostasis and ambulation, which we feel may help reduce patient down‐time and time to discharge. Furthermore, in high‐risk patients such as women, patients with history of chronic kidney disease, and those who are on antiplatelet therapy, VCDs should be considered as a primary method of hemostasis.DisclosuresNone.Footnotes*Correspondence to: Ravi Thakker, MD, Division of Cardiovascular Disease, University of Texas Medical Branch, Galveston, TX 77555. Email: ravi.a.[email protected]comThe opinions expressed in this article are not necessarily those of the editors or of the American Heart Association.See Article by Povsic et al.For Disclosures, see page 2.References1 Rao SV, Ou FS, Wang TY. Trends in the prevalence and outcomes of radial and femoral approaches to percutaneous coronary intervention: a report from the National Cardiovascular Data Registry. JACC Cardiovasc Interv. 2008; 1:379–386. doi: 10.1016/j.jcin.2008.05.007CrossrefMedlineGoogle Scholar2 Sandoval Y, Burke MN, Lobo AS, Lips DL, Seto AH, Chavez I, Sorajja P, Abu‐Fadel MS, Wang Y, Poulouse A, et al. Contemporary arterial access in the cardiac catheterization laboratory. JACC Cardiovasc Interv. 2017; 10:2233–2241. doi: 10.1016/j.jcin.2017.08.058CrossrefMedlineGoogle Scholar3 Nasser TK, Mohler ER, Wilensky RL, Hathaway DR. Peripheral vascular complications following coronary interventional procedures. Clin Cardiol. 1995; 18:609–614. doi: 10.1002/clc.4960181105CrossrefMedlineGoogle Scholar4 Gargiulo G, Giacoppo D, Jolly SS, Cairns J, Le May M, Bernat I, Romagnoli E, Rao SV, van Leeuwen MAH, Mehta SR, et al. Effects on mortality and major bleeding of radial versus femoral artery access for coronary angiography or percutaneous coronary intervention: meta‐analysis of individual patient data from 7 multicenter randomized clinical trials. Circulation. 2022; 146:1329–1343. doi: 10.1161/CIRCULATIONAHA.122.061527LinkGoogle Scholar5 Fanaroff AC, Giri J. Fluoroscopic guidance for femoral artery access‐pushing patients out of the plane without a parachute?JAMA Cardiol. 2022; 7:1118–1120. doi: 10.1001/jamacardio.2022.3413CrossrefMedlineGoogle Scholar6 Ben‐Dor I, Sharma A, Rogers T, Yerasi C, Case BC, Chezar‐Azerrad C, Musallam A, Forrestal BJ, Zhang C, Hashim H, et al. Micropuncture technique for femoral access is associated with lower vascular complications compared to standard needle. Catheter Cardiovasc Interv. 2021; 97:1379–1385. doi: 10.1002/ccd.29330CrossrefMedlineGoogle Scholar7 Patel MR, Jneid H, Derdeyn CP, Klein LW, Levine GN, Lookstein RA, White CJ, Yeghiazarians Y, Rosenfield K; American Heart Association Diagnostic and Interventional Cardiac Catheterization Committee of the Council on Clinical Cardiology, Council on Cardiovascular Radiology and Intervention, Council on Peripheral Vascular Disease, Council on Cardiovascular Surgery and Anesthesia, and Stroke Council . Arteriotomy closure devices for cardiovascular procedures: a scientific statement from the American Heart Association. Circulation. 2010; 122:1882–1893. doi: 10.1161/CIR.0b013e3181f9b345LinkGoogle Scholar8 Marquis‐Gravel G, Boivin Proulx L‐A, Huang Z, Zelenkofske SL, Lincoff AM, Mehran R, Steg PG, Bode C, Alexander JH, Povsic TJ. Femoral vascular closure devices and bleeding, hemostasis, and ambulation following percutaneous coronary intervention. J Am Heart Assoc. 2022. doi: 10.1161/JAHA.122.025666LinkGoogle Scholar9 Lincoff AM, Mehran R, Povsic TJ, Zelenkofske SL, Huang Z, Armstrong PW, Steg PG, Bode C, Cohen MG, Buller C, et al. Effect of the REG1 anticoagulation system versus bivalirudin on outcomes after percutaneous coronary intervention (REGULATE‐PCI): a randomised clinical trial. Lancet. 2016; 387:349–356. doi: 10.1016/S0140-6736(15)00515-2CrossrefMedlineGoogle Scholar10 Schulz‐Schüpke S, Helde S, Gewalt S, Ibrahim T, Linhardt M, Haas K, Hoppe K, Bottiger C, Groha P, Bradaric C, et al. Comparison of vascular closure devices vs manual compression after femoral artery puncture: the ISAR‐CLOSURE randomized clinical trial. JAMA. 2014; 312:1981–1987. doi: 10.1001/jama.2014.15305CrossrefMedlineGoogle Scholar11 Holm NR, Sindberg B, Schou M, Maeng M, Kaltoft A, Bottcher M, Krusell LR, Hjort J, Thuesen L, Terkelsen CJ, et al. Randomised comparison of manual compression and FemoSeal™vascular closure device for closure after femoral artery access coronary angiography: the CLOSuredEvices used in everyday practice (CLOSE‐UP) study. EuroIntervention. 2014; 10:183–190. doi: 10.4244/EIJV10I2A31CrossrefMedlineGoogle Scholar12 Tavris DR, Wang Y, Jacobs S, Gallauresi B, Curtis J, Messenger J, Resnic FS, Fitzgerald S. Bleeding and vascular complications at the femoral access site following percutaneous coronary intervention (PCI): an evaluation of hemostasis strategies. J Invasive Cardiol. 2012; 24:328–334.MedlineGoogle Scholar13 Ahmed B, Piper WD, Malenka D, VerLee P, Robb J, Ryan T, Herne M, Phillips W, Dauerman HL. 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; 2:423–429. doi: 10.1161/CIRCINTERVENTIONS.109.860494LinkGoogle Scholar14 Ahmed B, Dauerman HL. Women, bleeding, and coronary intervention. Circulation. 2013; 127:641–649. doi: 10.1161/CIRCULATIONAHA.112.108290 PMID: 23381962LinkGoogle Scholar15 Portolés J, Martín L, Broseta JJ, Cases A. Anemia in chronic kidney disease: from pathophysiology and current treatments, to future agents. Front Med (Lausanne). 2021; 8:642296. doi: 10.3389/fmed.2021.642296CrossrefMedlineGoogle Scholar16 Fei Y, Lam CK, Cheung BMY. Efficacy and safety of newer P2Y12 inhibitors for acute coronary syndrome: a network meta‐analysis. Sci Rep. 2020; 10:16794. doi: 10.1038/s41598-020-73871-xCrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetails Article InformationMetrics Copyright © 2022 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley BlackwellThis is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.https://doi.org/10.1161/JAHA.122.028501PMID: 36583433 Originally publishedDecember 30, 2022 KeywordsEditorialsfemoral artery access site complicationsvascular closure devicesfemoral arteriotomyPDF download SubjectsCatheter-Based Coronary and Valvular InterventionsPercutaneous Coronary InterventionPeripheral Vascular DiseaseQuality and OutcomesVascular Disease

Deep femoral artery branching by MDCT in a Turkish population and its potential clinical implications

Abstract: The deep femoral artery and its branches are vital for the arterial circulation of the lower extremity. The aim of the current study is to obtain morphometric and morphological data on the deep femoral artery and its branches and to investigate their clinical importance in the Turkish population. Morphometric measurements of the deep femoral artery and femoral artery were performed. The diameters of the femoral artery and deep femoral artery were measured in the axial plane. Classification was made according to the size of these diameters. A morphological classification was obtained by examining the variations of the deep femoral artery branches. The distance from the origin of the deep femoral artery to the midpoint of the inguinal ligament was 39.56 ± 8.52 mm, and the distances from the origin of the lateral circumflex femoral artery to the medial circumflex femoral artery were 17.15 ± 4.79 mm and 12.52 ± 4.58 mm, respectively. The study results show that there was a significant difference between genders in terms of the diameters measured. In the classification made by using the diameters, Type D (39%) had the highest rate, whereas Type C had the lowest rate (7.3%). According to the morphological classification, Type I (52.1%) was the most common in all individuals, and Type V and Type VII (2.3%) were the least common. Our study includes both morphometric and morphological information about the femoral artery and deep femoral artery of the Turkish population. We consider that the current study will be useful for cardiologists, interventional radiologists, orthopedists, and regional surgeons in clinical practice.

Surgical, Endovascular, and Multimodal Approaches to the Management of Atherosclerotic Common Femoral Artery Disease

Abstract: Abstract Common femoral artery disease is at the heart of nearly all treatment algorithms and decisions for patients with symptomatic peripheral arterial disease. Surgical endarterectomy has been the mainstay of common femoral treatment with a wealth of data supporting its safety, efficacy, and durability. Advances in endovascular technology and techniques for the management of iliac and superficial femoral artery disease has resulted in a paradigm shift in management. The common femoral artery has been aptly named a “no stent zone” due to anatomic and disease-specific challenges that have limited the role for endovascular techniques. New technology and techniques in the endovascular management of common femoral disease seek to change our treatment strategies. A multimodal approach utilizing a combination of angioplasty, atherectomy, and stenting has been shown most beneficial, although limited long-term data leave durability an unanswered question. While surgical treatment remains the gold standard, advances in the endovascular approach will certainly continue to improve outcomes. As truly isolated common femoral disease is a rarity, a collaborative approach combining all benefits of open and endovascular techniques in the treatment of peripheral arterial disease is essential.

Untangling a Knotted Angiographic Catheter Using a Balloon Catheter: A Case Report

Abstract: When a 66-year-old man with hepatocellular carcinoma underwent an angiographic examination, a 4-Fr catheter was inserted from the right femoral artery. It became tightly knotted in the descending aorta. To untangle the knotted catheter, a noncompliant balloon catheter was delivered into the knotted loop from the contralateral femoral artery. After the balloon catheter was inflated from the inside of the knotted loop, the knot became loose. Finally, the knotted catheter was untangled. Subsequently, the remainder of the examination was performed as initially planned.

Impact of aortoceliac angle in implantation of subcutaneous hepatic artery port-catheter system for hepatic arterial infusion chemotherapy via femoral approach.

Abstract: BACKGROUND In patients with an acute aortoceliac angle, the diagnostic catheter often fails to enter the common hepatic artery. PURPOSE To retrospectively evaluate the impact of aortoceliac angle on the implantation of a port-catheter system via a femoral approach for hepatic arterial infusion chemotherapy (HAIC) in patients with advanced hepatocellular carcinoma (HCC). MATERIAL AND METHODS A total of 399 patients with advanced HCC underwent percutaneous implantation of a port-catheter system for HAIC. Among these patients, 383 underwent successful implantation via a femoral artery approach (success group). In 16 patients, port-catheter systems were implanted via a subclavian artery approach (failure group) after failure of the initial attempt via the femoral artery due to failed catheter tip fixation to the gastroduodenal artery. We statistically analyzed aortoceliac angle, ostial celiac stenosis, sex, age, weight, height, and body mass index (BMI) between groups. RESULTS The average aortoceliac angle, weight, and BMI were significantly different between the two groups (P < 0.001, P = 0.02, P < 0.001, respectively). Among them, only the aortoceliac angle was a significant risk factor in logistic regression analysis. The smaller the aortoceliac angle, the more often the femoral approach failed (P < 0.001, odds ratio = 0.817, 95% confidence interval = 0.752-0.887). There were no significant differences in ostial celiac stenosis, sex, or age between the two groups (P = 0.549, 0.056, 0.173, and 0.773, respectively). CONCLUSION For patients with an acute aortoceliac angle, the femoral approach is likely to fail. A subclavian artery approach should be preferentially considered for percutaneous implantation of a port-catheter system in such patients.

The Safety and Effectiveness of the Prostar XL Closure Device Compared to Open Groin Cutdown for Endovascular Aneurysm Repair.

Abstract: OBJECTIVE The aim of this study is to compare the outcomes of percutaneous femoral closure with the Prostar XL for endovascular aneurysm repair (EVAR) to those of open femoral cutdown, and to evaluate factors which may predict the failure of percutaneous closure. METHODS Patients undergoing endovascular aneurysm repair for an infrarenal abdominal aortic aneurysm between 2005 and 2013 were included. Patient characteristics, anatomic femoral artery measurements, and postoperative complications were recorded retrospectively. Operator experience was defined with a cut-off point of >30 Prostar XL closures performed. Comparisons were made per access site. RESULTS A total of 443 access sites were included, with percutaneous closure used in 257 cases (58.0%) and open cutdown in 186 cases (42.0%). The complication rate was 2.7% for the percutaneous and 4.3% for the open cutdown group (P = .482). No significant differences between groups were found with respect to 30-day mortality, wound infections, thrombosis, seromas, or bleeding complications. Fourteen failures (5.4%) of percutaneous closure occurred. The success rates were similar for experienced and unexperienced operators (94.2% vs 95.5%, P = .768). Renal insufficiency was more common in the failed than in the successful percutaneous closure group (64.3% vs 24.7%, P = .003). Common femoral artery calcification or diameter, BMI, sheath size, or operator experience did not predict failure. No further complications were seen in follow-up CT at 1-3 years postoperatively. CONCLUSION The use of the Prostar XL is safe compared to open cutdown. The success rate is 94.6%. Operator experience, sheath size, obesity, or femoral artery diameter or calcification do not appear to predict a failure of percutaneous closure. Complications seem to occur perioperatively, and late complications are rare.

Temporary arterial shunting following a complete transection of femoral artery in a resource-limited setting

Abstract: The aim of a surgeon managing vascular trauma in an extremity is to save the life, limb, and function of the patient. The use of temporary intravascular shunting has been shown to be a successful damage control strategy in patients who present with hemodynamic instability. We present the first reported case of a penetrating arterial injury of the lower limb causing a large defect that was successfully treated with temporary intravascular shunting before definitive repair in the country of Liberia. In a low-resource setting such as ours, the surgeon often opts to amputate limbs with vascular injuries that are not believed to be candidates for primary repair. Using a pediatric feeding tube with good postoperative results, we demonstrated that temporary arterial shunting in damage control situations before definitive repair was not only feasible but also cost-effective and ultimately resulted in the preservation of the patient's limb.

Place the Sheath: Emergent 7 French Femoral Sheath Placement is Low Risk During Initial Trauma Resuscitation

Abstract: Background: We hypothesized that emergent placement of 7 French (Fr) common femoral artery (CFA) sheathsduring trauma resuscitation for potential resuscitative endovascular balloon occlusion of the aorta (REBOA) carries alow complication rate.Methods: Trauma patients at a Level I trauma center with emergent CFA access from January 2016 through toDecember 2020 were reviewed. CFA access was categorized as (1) 7 Fr sheath plus REBOA (REBOA) and (2) 7 Fr sheathwithout REBOA (Sheath). Outcomes included mortality and vascular complications.Results: 157 patients underwent emergent CFA access. Sixty-nine (43.9%) patients had a 7 Fr CFA sheath, and 88(56.1%) progressed to REBOA. The mortality rate was similar (Sheath 30.4% vs. REBOA 34.1%, p = 0.63). The REBOAcohort had a significantly higher complication rate (22.7%) compared to the Sheath cohort (4.3%, p = 0.001).Conclusions: Emergent 7 Fr CFA sheath placement during trauma resuscitation is low risk, suggesting empiricsheath placement is warranted in potential REBOA candidates.

Open surgical repair of common femoral artery aneurysm: Case report and literature review

Abstract: Common femoral artery (CFA) aneurysms are rare with an unknown exact incidence and often found in elderly males with chronic diseases. Early recommendations are to repair aneurysms with a maximum diameter of ≥2.5cm. We present the case of a 37-year-old male with a right CFA aneurysm. Open surgical repair (OSR) consisting of aneurysmectomy and reconstruction of the femoral artery with a bifurcated prosthetic graft was applied. Our study details this case and thoroughly reviews on the treatment of femoral artery aneurysms in the literature. OSR and vascular reconstruction with interposition prosthetic graft were durable and associated with favorable outcomes.

Alternative Arterial Access Routes for Endovascular Thrombectomy in Patients with Acute Ischemic Stroke: A Study from the MR CLEAN Registry

Abstract: Background: Endovascular thrombectomy (EVT) through femoral access is difficult to perform in some patients with acute ischemic stroke due to challenging vasculature. We compared outcomes of EVT through femoral versus alternative arterial access. Methods: In this observational study, we included patients from the MR CLEAN Registry who underwent EVT for acute ischemic stroke in the anterior circulation between 2014 and 2019 in the Netherlands. Patients who underwent EVT through alternative and femoral access were matched on propensity scores in a 1:3 ratio. The primary endpoint was favorable functional outcome (modified Rankin Scale score ≤ 2) at 90 days. Secondary endpoints were early neurologic recovery, mortality, successful intracranial reperfusion and puncture related complications. Results: Of the 5197 included patients, 17 patients underwent EVT through alternative access and were matched to 48 patients who underwent EVT through femoral access. Alternative access was obtained through the common carotid artery (n = 15/17) and brachial artery (n = 2/17). Favorable functional outcome was less often observed after EVT through alternative than femoral access (18% versus 27%; aOR, 0.36; 95% CI, 0.05–2.74). The rate of successful intracranial reperfusion was higher for alternative than femoral access (88% versus 58%), although mortality (59% versus 31%) and puncture related complications (29% versus 0%) were more common after alternative access. Conclusions: EVT through alternative arterial access is rarely performed in the Netherlands and seems to be associated with worse outcomes than standard femoral access. A next step would be to compare the additional value of EVT through alternative arterial access after failure of femoral access.