Vascular closure devices: Difference between revisions

Jump to navigation Jump to search
No edit summary
Line 17: Line 17:
'''Editor in Chief''': [[User:Msf2399|Michael S. Fenster, MD]] [mailto:msf@3giinc.com]  
'''Editor in Chief''': [[User:Msf2399|Michael S. Fenster, MD]] [mailto:msf@3giinc.com]  


 
==Overview==
 
==Background==
 
At the very heart of any successful endovascular procedure is successful arterial entry and exit. The first successful cardiac catheterization, according to Andre Cournand, was performed on an equine patient in 1844 utilizing a retrograde approach through both the jugular vein and carotid artery<sup>1</sup>. Human retrograde left heart catheterization was first reported by Zimmerman<sup>2</sup>  and Limon-Lason<sup>3</sup>.  in 1950. Shortly thereafter in 1953, Seldinger developed the percutaneous technique  and this technique was quickly adapted to left heart cardiac catheterizations. With the growth of Interventional Cardiology in the years following Grüntzig’s introduction of coronary angioplasty in 1977<sup>4</sup> ,  the percutaneous approach became, and today remains, by far the most common method of performing catheterization, angiography and endovascular intervention.
At the very heart of any successful endovascular procedure is successful arterial entry and exit. The first successful cardiac catheterization, according to Andre Cournand, was performed on an equine patient in 1844 utilizing a retrograde approach through both the jugular vein and carotid artery<sup>1</sup>. Human retrograde left heart catheterization was first reported by Zimmerman<sup>2</sup>  and Limon-Lason<sup>3</sup>.  in 1950. Shortly thereafter in 1953, Seldinger developed the percutaneous technique  and this technique was quickly adapted to left heart cardiac catheterizations. With the growth of Interventional Cardiology in the years following Grüntzig’s introduction of coronary angioplasty in 1977<sup>4</sup> ,  the percutaneous approach became, and today remains, by far the most common method of performing catheterization, angiography and endovascular intervention.
Within the realm of percutaneous approaches, the majority of the procedures are performed from the femoral approach, with a minority being done from a radial approach. Brachial and axillary are also used in a minority of procedures<sup>5</sup>. Reasons for the continued preference of the femoral route for access includes the vessel size, operator training and equipment, radiation exposure (operator), and the advent of vascular closure devices. Studies have suggested that between 8-10% of all patients selected for a transradial approach will convert to a transfemoral route<sup>6,7,8</sup>.
Within the realm of percutaneous approaches, the majority of the procedures are performed from the femoral approach, with a minority being done from a radial approach. Brachial and axillary are also used in a minority of procedures<sup>5</sup>. Reasons for the continued preference of the femoral route for access includes the vessel size, operator training and equipment, radiation exposure (operator), and the advent of vascular closure devices. Studies have suggested that between 8-10% of all patients selected for a transradial approach will convert to a transfemoral route<sup>6,7,8</sup>.

Revision as of 03:17, 9 October 2012

Vascular closure devices

WikiDoc Resources for Vascular closure devices

Articles

Most recent articles on Vascular closure devices

Most cited articles on Vascular closure devices

Review articles on Vascular closure devices

Articles on Vascular closure devices in N Eng J Med, Lancet, BMJ

Media

Powerpoint slides on Vascular closure devices

Images of Vascular closure devices

Photos of Vascular closure devices

Podcasts & MP3s on Vascular closure devices

Videos on Vascular closure devices

Evidence Based Medicine

Cochrane Collaboration on Vascular closure devices

Bandolier on Vascular closure devices

TRIP on Vascular closure devices

Clinical Trials

Ongoing Trials on Vascular closure devices at Clinical Trials.gov

Trial results on Vascular closure devices

Clinical Trials on Vascular closure devices at Google

Guidelines / Policies / Govt

US National Guidelines Clearinghouse on Vascular closure devices

NICE Guidance on Vascular closure devices

NHS PRODIGY Guidance

FDA on Vascular closure devices

CDC on Vascular closure devices

Books

Books on Vascular closure devices

News

Vascular closure devices in the news

Be alerted to news on Vascular closure devices

News trends on Vascular closure devices

Commentary

Blogs on Vascular closure devices

Definitions

Definitions of Vascular closure devices

Patient Resources / Community

Patient resources on Vascular closure devices

Discussion groups on Vascular closure devices

Patient Handouts on Vascular closure devices

Directions to Hospitals Treating Vascular closure devices

Risk calculators and risk factors for Vascular closure devices

Healthcare Provider Resources

Symptoms of Vascular closure devices

Causes & Risk Factors for Vascular closure devices

Diagnostic studies for Vascular closure devices

Treatment of Vascular closure devices

Continuing Medical Education (CME)

CME Programs on Vascular closure devices

International

Vascular closure devices en Espanol

Vascular closure devices en Francais

Business

Vascular closure devices in the Marketplace

Patents on Vascular closure devices

Experimental / Informatics

List of terms related to Vascular closure devices

Editor in Chief: Michael S. Fenster, MD [1]

Overview

At the very heart of any successful endovascular procedure is successful arterial entry and exit. The first successful cardiac catheterization, according to Andre Cournand, was performed on an equine patient in 1844 utilizing a retrograde approach through both the jugular vein and carotid artery1. Human retrograde left heart catheterization was first reported by Zimmerman2 and Limon-Lason3. in 1950. Shortly thereafter in 1953, Seldinger developed the percutaneous technique and this technique was quickly adapted to left heart cardiac catheterizations. With the growth of Interventional Cardiology in the years following Grüntzig’s introduction of coronary angioplasty in 19774 , the percutaneous approach became, and today remains, by far the most common method of performing catheterization, angiography and endovascular intervention. Within the realm of percutaneous approaches, the majority of the procedures are performed from the femoral approach, with a minority being done from a radial approach. Brachial and axillary are also used in a minority of procedures5. Reasons for the continued preference of the femoral route for access includes the vessel size, operator training and equipment, radiation exposure (operator), and the advent of vascular closure devices. Studies have suggested that between 8-10% of all patients selected for a transradial approach will convert to a transfemoral route6,7,8.


Current Limitations of Vascular Closure Devices

  • Require long learning curve
  • Small vessel size (<4.0–5.0mm); a contraindication to use
  • Non-common femoral artery ‘sticks’; a contraindication to use
  • Peripheral vascular disease; a contraindication to use (very common problem)
  • Significant endoluminal device components (prone to thrombosis)
  • High costs
  • Require bed rest post closure
  • Impaired or delayed common femoral artery re-entry (re-access concerns)
  • Non-inert, very reactive, permanent and absorbable device components (therefore may be prone to infection and common femoral artery scarring)
  • Catastrophic complications (1–2%, but may be underreported)
  • Poorly compatible with anticoagulated patients (increased bleeding)

Complications

Infection

  • After an incubation period of 2 to 29 days (average of 8 days) a vascular closure device infection can occur.
  • Sympotms include local pain and fever. The pain may improve and then worsen.
  • Blood cultures are positive
  • Most common pathogen is staphylococcus aureus infecting a myoctic aneurysm
  • Medical and surgical treatment are both required

References

1. Cournand, A. (1975). Cardiac Catheterization. Development of the technique and its contribution to experimental medicine, and its initial application in man. Acta Med Scand Suppl , 579:1-32.

2. Zimmerman, H., & Scott, R. B. (1950). Catheterization of the left side of the heart in man. Circulation , 1:357.

3. Limon-Lason, R., & Bouchard, A. (1950). El Caterismo Intracardico; Cateterizacion de la Cavidades Izquierdas en el Hombre. Registro Simultaneo de presion y Electrocardiograma Intracavetarios. Arch Inst Cardiol Mexico , 21:271.

4. Grüntzig, A., et al. (1977). Coronary transluminal angioplasty (abstract). Circulation , 56:II-319.

5. Agostoni, P. et al. (2004). Radial versus femoral apporach for percutaneous coronary diagnostic and interventional procedures-Systematic overview and meta-analysis of randomized trials. J Am Coll Cardiol , 44:349-356.

6. Guillard, N. et al. (1997). Coronary angiography by left radial approach. A bi-center prospective pilot study. Arch Mal Coeur Vaiss, 90:1349-1355.

7. Hildick-Smith, DJ. et al. (2004). Transradial coronary angiography in patients with contraindications to the femoral approach: An analysis of 500 cases. Catheter Cardiovasc Interv, 61:60-66.

8. Achenbach, S. et al. (2008). Transradial versus Tarnsfemoral approach for Coronary Angiography and Intervention in patients above 75 years of age. Catheter Cardiovasc Interv, 72:629-635.

Template:WikiDoc Sources