Appropriate hemostasis by routine use of ultrasound echo-guided transfemoral access and vascular closure devices after lower extremity percutaneous revascularization

Abstract

To assess the safety and efficacy of routine use of ultrasound-guided puncture and the use of vascular closure device (VCD) in patients undergoing endovascular therapy (EVT) through femoral access. This was a single-center, non-randomized clinical study that enrolled 513 patients undergoing EVT via femoral artery access in which hemostasis was achieved using VCDs (406-patient EXOSEAL arm and 107-patient PROGLIDE arm). All cases were performed by routine use of ultrasound-guided access. The primary endpoint was the achievement of hemostasis without periprocedural and 30-day incidence of major or minor access site-related complications. The primary endpoint was achieved in 91.6 % of the cases (470/513) with a higher success rate in the EXOSEAL arm (93.6). Major complications were observed in 5 patients (0.9 %) in total cohort and 3 patients (0.7 %) treated with EXOSEAL arm vs. 2 patients (1.8 %) with PROGLIDE arm (p = 0.32). Combined treatment two VCDs with the routine ultrasound guidance access for patients who underwent the EVT procedure showed high efficacy and safety outcomes.

The novel echo‐guided ProGlide technique during percutaneous transfemoral transcatheter aortic valve implantation

“…Echo‐guided femoral artery access is reportedly related with a lower rate of access site complications during peripheral vascular intervention . We could visualize the femoral artery bifurcation or arterial wall calcification using echography.…”

“…Visualization Echo-guided femoral artery access is reportedly related with a lower rate of access site complications during peripheral vascular intervention. 16,17 We could visualize the femoral artery bifurcation or arterial wall calcification using echography. Therefore, echo-guided puncture enables detection of the optimal femoral arteriotomy site or avoidance of puncture at the calcified site to prevent complications.…”

Intravascular Ultrasound–Guided Interventions for Below-the-Knee Disease in Patients With Chronic Limb-Threatening Ischemia

“…For a BTK intervention, the operator inserted a 3.5-F to 6-F sheath or guiding sheath from the ipsilateral common femoral artery after antegrade ultrasound-guided puncture. 18 Digital subtraction angiography was performed with an Azurion 7C20 system (Philips Healthcare, Best, the Netherlands). Infrapopliteal angiography was performed via the diagnostic catheter or guiding sheath placed at the popliteal artery to accurately evaluate the tibioperoneal trunk (TPT), anterior tibial artery (ATA), posterior tibial artery (PTA), peroneal artery (PA), dorsal pedis artery (DPA), and the medial and lateral plantar arteries.…”

The ARAHKEY technique: A novel method for the management of access site bleeding during percutaneous transfemoral transcatheter aortic valve replacement

“…Arterial puncture of the CFA, guided by echography or digital subtraction angiography, is helpful for optimal puncture and reduction of vascular complications. 13,14 A unique technique for ProGlide application was reported and associated with reduced access site complications. 15,16 When access site bleeding occurs, the ARAHKEY technique is applicable as long as…”