China
Africa
Explore chapters and articles related to this topic
Transfemoral Transcatheter Aortic Valve Implantation
Published in Theo Kofidis, Minimally Invasive Cardiac Surgery, 2021
The arterial access will allow passage of a pigtail catheter for aortic root angiogram. A cross-over angiogram is performed to delineate the ideal puncture site for the site of TAVI delivery sheath access. This can be done using a pigtail, Judkins right (JR) or internal mammary artery (IMA) catheter. In our unit we usually place a 0.018” V-18 ControlWire Guidewire (Boston Scientific, Marlborough, MA, USA) from the contralateral side to act as a safety wire (Figure 8.2.3), which allows ease of intervention for vascular complications. The wire also helps localize the femoral artery and assists in cannulation of the femoral artery site chosen for TAVI access. Once arterial access is obtained, a 6F sheath is inserted, then the access is “pre-closed” with two Perclose ProGlide® (Abbott, Chicago, IL, USA) or Prostar (Abbott, Chicago, IL, USA) vascular closure devices. For larger-size artery with no significant calcification or tortuosity, the access site can be alternatively closed with a Manta® vascular closure device.
Introduction to the Endovascular Suite and Basic Principles of Angiography
Published in Vikram S. Kashyap, Matthew Janko, Justin A. Smith, Endovascular Tools & Techniques Made Easy, 2020
Jason Ty Turner, Virginia L. Wong
After procedural completion, all devices are withdrawn from the patient using the appropriate closure technique. Techniques include manual compression of soft tissue over the puncture site (typically 5 minutes per sheath French size, followed by several hours of bed rest with the limb immobilized) or the utilization of a vascular closure device (see Chapter 14, “Post-Procedural Hemostasis and Closure Devices”). Open exposure of a vessel must be closed in standard surgical fashion. The most common complications after endovascular procedures involve the access point; including hematoma, arterial pseudoaneurysm, infection, dissection, and vessel thrombosis.
Complex lower extremity revascularization
Published in Peter A. Schneider, Endovascular Skills: Guidewire and Catheter Skills for Endovascular Surgery, 2019
Frequently, when dealing with aortoiliac occlusion, there is an access site ipsilateral to and distal to the reconstruction. In this case, closure devices have the advantage of continued flow beyond the access site immediately after performing closure. This helps to prevent access site thrombosis. However, if the artery is quite small (<5 or 6 mm), closure devices may be a set up for a complication such as thrombosis. In addition, if there is a stent that ends near the access site, it may influence the choice of closure device. Suture-mediated closure devices must be passed a significant distance into the artery, and this must be done blindly and not over a wire, and this is not optimal in the setting of a recently placed stent. The local collagen plug approach is probably best in this setting. The Mynx® Vascular Closure Device permits closure with the plug material deposited external to the artery. If the access is simply for passage of the catheter and guidewire, and the access site is limited in size, such as a 4-Fr sheath, manual compression should be considered.
From the Evolut Pro to the Evolut FX self-expanding transcatheter aortic valve replacement systems: current status and future perspectives
Published in Expert Review of Medical Devices, 2022
Vassili Panagides, Jules Mesnier, Jorge Nuche, Robert Delarochellière, Jean-Michel Paradis, Dimitri Kalavrouziotis, Eric Dumont, Siamak Mohammadi, Josep Rodes-Cabau
The rate of major vascular complications reported with the Evolut Pro system ranges from 2.8% to 10% (Table 1). These complications seem to be mainly determined by patients’ characteristics, sheath size, and vascular closure device failure. Surprisingly, major vascular complications were not higher in the trials comparing the Evolut R and Evolut Pro systems despite that the Evolut Pro system required a larger sheath (16Fr equivalent vs. 14Fr). This finding may be related to the extensive experience of operators with femoral access management and the low sheath size difference that doesn’t seem to have an impact on access site complications. Consistently, the risk of major complications may not differ between the Evolut Pro and Pro+ systems. However, there are no data available comparing these two devices yet.
Wading Through the Data for an Optimal Vascular Closure Device Strategy
Published in Structural Heart, 2021
There is a proverb, “a river cuts through rock not because of its power, but its persistence.” We might reframe this in the context of retrospective analyses to say that their power typically rests in their patient volume and continuity. In the associated manuscript by Dr. Patel et al. in this volume of the journal,1 the authors compare three up-front strategies for vascular hemostasis: an 18 F MANTA alone (86 patients), two ProGlides (46 patients), or a single ProGlide and an 8 F Angio-Seal (40 patients). While very well conceived, unfortunately this analysis lacks the power to draw any significant conclusions with regard to the optimal choice of vascular closure device (VCD) following transcatheter aortic valve replacement (TAVR). In fact, using standard parameters for a retrospective analysis—an 80% power to detect a difference and an alpha of 0.05—if we generously assumed an 8% major vascular complication rate among the study population and that the MANTA device was wildly successful and resulted in a 50% reduction in this endpoint (and that there were only 2 comparator arms), the authors would still require 1104 patients to confidently detect this difference. Many more patients would be needed if the MANTA wasn’t as successful or the baseline complication rate was less.
Saccular or dissecting aneurysms involving the basilar trunk: Endovascular treatment and clinical outcome
Published in Neurological Research, 2019
Kwang-Chun Cho, Pyoung Jeon, Byung Moon Kim, Soo Mee Lim, Woo Sang Jung, Jung-Jae Kim, Sang Hyun Suh
In the procedure, a 5F or 6F guiding catheter system (Envoy; Codman Neurovascular, Raynham, MA, USA) was introduced via the femoral artery. Through the vertebral artery, a microcatheter (Prowler 14 microcatheter, Codman Neurovascular; Excelsior SL-10 microcatheter, Boston Scientific, Natick, Massachusetts) was carefully guided into the aneurysm sac of the BA. Using the jailing technique, a self-expandable intracranial stent (Neuroform stent, Boston Scientific; Enterprise stent, Codman Neurovascular; Solitaire AB stent, ev3 neurovascular, Irvine, CA, USA) or balloon occlusion catheter (Hyperglide, ev3 neurovascular) was inserted in the BA itself or from the posterior cerebral artery (PCA) to the BA in order to protect the parent artery from coil protrusion. Afterward, a detachable coil was delivered into the aneurysm sac via a jailed microcatheter, and this process was repeated until coil embolization was achieved with preservation of the incorporated arteries. In small aneurysms less than 2 mm in size, two stents overlapped in the BA without coiling. A vascular closure device (Perclose; Abbott Vascular Devices, Redwood City, California) was used to seal off the femoral artery puncture. All treated patients were maintained with heparin for 24 h after the procedure; clopidogrel, 75 mg/day, and aspirin, 150 mg/day, were also administered for 6 months in cases of stent implantation. After the procedure, external ventricular drainage (EVD) was performed if hydrocephalus was detected.