TCT-760 Retrograde Tibio-Pedal Access For Revascularization Of Lower Extremity Peripheral Artery Disease Using 6 Fr Slender Sheath: The “Pedal First” Pilot Project

Sanghvi, Kintur; Kusick, Joseph

doi:10.1016/j.jacc.2017.09.999

Cited by 7 publications

(10 citation statements)

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“…Transpedal access through the tibial, dorsalis pedis, and peroneal arteries was not associated with increased time to hemostasis or complication rate relative to radial or ulnar access. While rare events of access site pseudoaneurysm have been previously documented in the use of the TR Band and VasoStat devices for transpedal access [25], no pseudoaneurysms were observed in this series.…”

Section: Discussioncontrasting

confidence: 50%

“…Retrospective analysis of TR Band placement following transpedal access has indicated this application appears safe and effective, but times to hemostasis were not documented; additionally, tibioperoneal utilization of the TR Band is not cleared by the Food and Drug Administration [25]. The current series observed a mean time to hemostasis of 55 min with the VasoStat, with low rates of hematoma (2%), oozing after removal (2.8%), early access artery occlusion (0.8%), and late access artery occlusion (0%) following both radial, distal radial (anatomic snuffbox), brachial, ulnar, and tibioperoneal access.…”

Section: Discussionmentioning

confidence: 99%

“…1). The VasoStat device is FDA-cleared and CE-marked for hemostasis after both upper extremity and transpedal access, and its focused compression mechanism may lead to more rapid hemostasis compared to larger compression surfaces by band devices such as the TR Band [24][25][26]. This study investigated the use of the focused compression device following upper and lower extremity arterial access and assessed patient and operative variables influencing times to hemostasis.…”

Section: Introductionmentioning

confidence: 99%

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Nonfemoral Arterial Hemostasis Following Percutaneous Intervention Using a Focused Compression Device

Barrette

Vance

Shamimi-Noori

et al. 2020

Cardiovasc Intervent Radiol

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Purpose Upper extremity and tibiopedal arterial access are increasingly used during endovascular therapies. Balloon compression hemostasis devices in these anatomic locations have been described, but most utilize a compression surface extending well beyond the puncture site. We report single-center experience with an arterial puncture-focused compression device following upper extremity and tibiopedal access. Patients and Methods A series of 249 focused compression hemostasis devices (VasoStat, Forge Medical, Bethlehem, Pennsylvania, USA) were used in 209 patients following lower extremity (n = 63) and upper extremity (n = 186; radial: 90%) arterial access procedures using 4-7 French sheaths. Demographic, operative, and follow-up data were collected. Logistic regression was used to evaluate potential association between patient/operative variables and time to hemostasis. Results Primary hemostasis was achieved in 97.2% (242/ 249) following sheath removal; in 7 cases (2.8%) puncture site oozing occurred after initial device removal and required reapplication. Secondary hemostasis was 100% (249/249). Seven complications (2.8%) were recorded: 5 minor hematomas (2%) and 2 transient access artery occlusions (0.8%). Mean time to hemostasis enabling device removal was 55 ± 28 min. Elevated body mass index (BMI) was not associated with increased time to hemostasis (p = 0.31). Accessed artery, sheath size, and heparin dose were also not associated with time to hemostasis (p = 0.64; p = 0.74; p = 0.75, respectively). Conclusions The focused compression hemostasis device enabled rapid hemostasis with a low complication rate. Time to hemostasis was independent of BMI, access site, sheath size, or heparin dose.

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Section: Discussioncontrasting

confidence: 50%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Nonfemoral Arterial Hemostasis Following Percutaneous Intervention Using a Focused Compression Device

Barrette

Vance

Shamimi-Noori

et al. 2020

Cardiovasc Intervent Radiol

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“…One of the challenges in endovascular interventions is lack of a real‐time hemodynamic measure, similar to FFR or iFR, to give functional and hemodynamic information of the severity. We and others have recently published several studies demonstrating that tibio‐pedal access for retrograde peripheral angiography and intervention is feasible, safe, and portend a low complication rate . Measuring pedal pressure from the tibio‐pedal access should be straightforward.…”

Section: Introductionmentioning

confidence: 99%

“…We and others have recently published several studies demonstrating that tibio-pedal access for retrograde peripheral angiography and intervention is feasible, safe, and portend a low complication rate. [11][12][13][14][15][16][17] Measuring pedal pressure from the tibio-pedal access should be straightforward. Using the similar concept of ABI, we have developed a novel hemodynamic index, pedal-brachial index (PBI) which was obtained from the pedal and brachial pressures during transpedal retrograde PAD intervention.…”

Section: Introductionmentioning

confidence: 99%

Functional hemodynamics assessment during endovascular Tibio‐pedal retrograde intervention of peripheral arterial disease

Kwan

Parikh

Patel

et al. 2019

Cathet Cardio Intervent

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Objective We sought to use a novel technique to measure the functional hemodynamics of peripheral arterial lesions during endovascular interventions. Background Functional hemodynamics has not been thoroughly evaluated during endovascular interventions. The aim of our study is to evaluate the feasibility and the potential benefits of pedal pressures measurements from tibio‐pedal access. Methods We retrospectively reviewed 100 consecutive patients who underwent endovascular interventions via tibio‐pedal artery access between October 3, 2018 and December 15, 2018. Baseline and postintervention pedal pressures from the pedal sheaths were measured. We also evaluated the pedal‐brachial index (PBI) which is defined as the pedal sheath pressure divided by the simultaneously brachial cuff pressure. We compared baseline pedal pressures, postintervention pedal pressures, baseline PBI, postintervention PBI, % change of PBI ([postintervention PBI minus baseline PBI]/baseline PBI), and resting ankle‐brachial index (ABI) versus baseline PBI in this cohort of patients. Results All 100 patients had successful tibio‐pedal artery access. Baseline pedal pressure was 70 + 30 mmHg with post intervention pedal pressure of 133 + 27 mmHg (p < .001). Baseline PBI was 0.75 + 0.24 with post intervention PBI of 1.09 + 0.19 (p < .001). The correlation coefficient of resting ABI vs. baseline PBI was 0.55. The % change of PBI was 63.2 + 52.4%. There was significant improvement of postintervention PBI when compared to baseline PBI in the majority of patients. Conclusions Obtaining pedal pressures and PBI from tibio‐pedal access can be a feasible tool for endovascular interventions. This simple technique can provide us important functional hemodynamics information before and after peripheral revascularization.

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Principles, Sites and Techniques of Vascular Access

Manoharan,

Karunanithy

2024

Mastering Endovascular Techniques

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TCT-760 Retrograde Tibio-Pedal Access For Revascularization Of Lower Extremity Peripheral Artery Disease Using 6 Fr Slender Sheath: The “Pedal First” Pilot Project

Cited by 7 publications

References 0 publications

Nonfemoral Arterial Hemostasis Following Percutaneous Intervention Using a Focused Compression Device

Nonfemoral Arterial Hemostasis Following Percutaneous Intervention Using a Focused Compression Device

Functional hemodynamics assessment during endovascular Tibio‐pedal retrograde intervention of peripheral arterial disease

Principles, Sites and Techniques of Vascular Access

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