The Experts below are selected from a list of 666 Experts worldwide ranked by ideXlab platform
Alik Farber - One of the best experts on this subject based on the ideXlab platform.
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routine use of ultrasound guidance in femoral arterial access for peripheral vascular intervention decreases Groin Hematoma rates in high volume surgeons
Annals of Vascular Surgery, 2018Co-Authors: Elica Inagaki, Alik Farber, Jeffrey J Siracuse, Matthew W Mell, Denis Rybin, Gheorghe Doros, Jeffrey A Kalish, Vascular Quality InitiativeAbstract:Background There is a documented learning curve when adopting ultrasound guidance (UG) to aid vascular access. In the Vascular Study Group of New England (VSGNE), routine UG during percutaneous femoral artery access was shown to protect against the complication of Groin Hematoma. We sought to confirm this finding in the Vascular Quality Initiative (VQI), a data set with a larger sample size and broader geographic distribution, and to evaluate the effects of ultrasound usage and interventionalist volume on Hematoma rates following peripheral vascular interventions (PVIs). Methods The VQI PVI database (2010–2014) was queried to identify the complication of Groin Hematoma after 43,947 PVIs performed via femoral artery access. Both procedure- and interventionalist-level analyses were performed. Multivariable logistic regression was used to assess factors associated with Hematoma. Multivariable Poisson regression analyses were used to compare Hematoma rates between routine (≥80% of PVIs) and selective ( 50 PVIs/year). Results The overall Groin Hematoma rate was 3.2%, and lower Hematoma rates correlated with increasing annual interventionalist volume (low vs. medium vs. high volume: 3.7% vs. 3.4% vs. 2.9%; P = 0.011). UG was associated with increased risk of Hematoma (odds ratio [OR] 1.29, 95% confidence interval [CI] 1.13–1.47, P Conclusions UG in percutaneous femoral artery access may decrease the complication rate of Groin Hematoma, especially as an interventionalist's volume increases and as selective use transforms into routine adoption. With repetition and practice, interventionalists likely overcome the learning curve associated with adoption of an unfamiliar technology and potentially improve patient outcomes.
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routine use of ultrasound guidance in femoral arterial access for peripheral vascular intervention decreases Groin Hematoma rates
Journal of Vascular Surgery, 2014Co-Authors: Jeffrey Kalish, Denis Rybin, Gheorghe Doros, Mohammad H Eslami, David L Gillespie, Marc L Schermerhorn, Alik FarberAbstract:Background Use of fluoroscopy and bone landmarks to guide percutaneous common femoral artery (CFA) access has decreased access site complications compared with palpation alone. However, only limited case series have examined the benefits of ultrasound to guide CFA access during peripheral vascular intervention (PVI). We evaluated the effect of routine vs selective use of ultrasound guidance (UG) on Groin Hematoma rates after PVI. Methods The Vascular Study Group of New England database (2010-2014) was queried to identify the complication of postprocedural Groin Hematoma after 7359 PVIs performed through CFA access. Hematoma (including pseudoaneurysms) was defined as minor (requiring compression or observation), moderate (requiring transfusion or thrombin injection), and major (requiring operation). Both procedure-level and interventionalist-level analyses were performed. Multivariable Poisson regression models were used to compare Hematoma rates of interventionalists based on routine (≥80% of PVIs) and selective ( Results The overall postprocedural Groin Hematoma rate after PVI was 4.5%, and the rate of combined moderate and major Hematoma was 0.8%. Among 114 interventionalists with ≥10 PVI procedures, routine and selective UG was used by 31 (27%) and 83 (73%) interventionalists, respectively. Routine UG was protective against Hematoma (rate ratio [RR], 0.62; 95% confidence interval [CI], 0.46-0.84; P 80 years (RR, 0.47; 95% CI, 0.27-0.85; P = .01), body mass index ≥30 (RR, 0.51; 95% CI, 0.29-0.90; P = .02), and sheath size >6F (RR, 0.43; 95% CI, 0.23-0.79; P Conclusions Routine UG may potentially protect against the complication of Hematoma for both modifiable and nonmodifiable patient and procedural characteristics. Encouraging routine UG is a feasible quality improvement opportunity to decrease patient morbidity after PVI.
A Catania - One of the best experts on this subject based on the ideXlab platform.
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meta analysis of randomized trials on the efficacy of vascular closure devices after diagnostic angiography and angioplasty
American Heart Journal, 2010Co-Authors: Fausto Biancari, Vito Dandrea, Carlo Di Marco, G Savino, Valentina Tiozzo, A CataniaAbstract:Background The aim of this meta-analysis was to evaluate the safety and efficacy of vascular closure devices (VCDs). Methods This meta-analysis was performed in accordance with the Cochrane Handbook for Systematic Reviews . Results The literature search yielded 31 prospective, randomized studies including 7,528 patients who were randomized to VCDs or manual/mechanical compression after diagnostic angiography and/or endovascular procedures. Most of these studies have excluded patients at high risk of puncture site complications. Meta-analysis showed similar results in the study groups in terms of Groin Hematoma, bleeding, pseudoaneurysm, and blood transfusion. Lower limb ischemia and other arterial ischemic complications (0.3% vs 0%, P = .07) as well as need of surgery for vascular complications (0.7% vs 0.4%, P = .10) were somewhat more frequent with arterial puncture closure devices. The incidence of Groin infection was significantly more frequent with VCDs (0.6% vs 0.2%, P = .02). The use of VCD was uniformly associated with a significantly shorter time to hemostasis. Such differences where more evident in patients undergoing percutaneous coronary intervention, whereas these methods were associated with similar rates of adverse events among patients undergoing diagnostic coronary angiography. Conclusions The use of VCDs is associated with a significantly shorter time to hemostasis and thus may shorten recovery. However, the use of VCDs is associated with a somewhat increased risk of infection, lower limb ischemia/arterial stenosis/device entrapment in the artery, and need of vascular surgery for arterial complications. Further studies are needed to get more conclusive results, particularly in patients at high risk of femoral puncture-related complications.
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Meta-analysis of randomized trials on the efficacy of vascular closure devices after diagnostic angiography and angioplasty
'Elsevier BV', 2010Co-Authors: Fausto Biancari, Carlo Di Marco, G Savino, Valentina Tiozzo, Vito D'andrea, A CataniaAbstract:Background The aim of this meta-analysis was to evaluate the safety and efficacy of vascular closure devices (VCDs). Methods This meta-analysis was performed in accordance with the Cochrane Handbook for Systematic Reviews. Results The literature search yielded 31 prospective, randomized studies including 7,528 patients who were randomized to VCDs or manual/mechanical compression after diagnostic angiography and/or endovascular procedures. Most of these studies have excluded patients at high risk of puncture site complications. Meta-analysis showed similar results in the study groups in terms of Groin Hematoma, bleeding, pseudoaneurysm, and blood transfusion. Lower limb ischemia and other arterial ischemic complications (0.3% vs 0%, P=.07) as well as need of surgery for vascular complications (0.7% vs 0.4%, P=.10) were somewhat more frequent with arterial puncture closure devices. The incidence of Groin infection was significantly more frequent with VCDs (0.6% vs 0.2%, P=.02). The use of VCD was uniformly associated with a significantly shorter time to hemostasis. Such differences where more evident in patients undergoing percutaneous coronary intervention, whereas these methods were associated with similar rates of adverse events among patients undergoing diagnostic coronary angiography. Conclusions The use of VCDs is associated with a significantly shorter time to hemostasis and thus may shorten recovery. However, the use of VCDs is associated with a somewhat increased risk of infection, lower limb ischemia/arterial stenosis/device entrapment in the artery, and need of vascular surgery for arterial complications. Further studies are needed to get more conclusive results, particularly in patients at high risk of femoral puncture-related complications. (Am Heart J 2010; 159: 518-31.
Alexander Battler - One of the best experts on this subject based on the ideXlab platform.
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short term triple therapy with aspirin warfarin and a thienopyridine among patients undergoing percutaneous coronary intervention
Catheterization and Cardiovascular Interventions, 2006Co-Authors: Avital Porter, Yuval Konstantino, Zaza Iakobishvili, Leeor Shachar, Alexander BattlerAbstract:Objectives: To assess bleeding complications among patients undergoing percutaneous coronary intervention (PCI) and receiving triple therapy of warfarin, aspirin, and a thienopyridine. Background: Triple therapy of warfarin, aspirin, and a thienopyridine is strongly discouraged, given the potential risk of bleeding complications. Methods and Results: Post-PCI patients receiving triple therapy thereafter underwent assessment for bleeding complications. Continuous variables are presented as median (25th–75th percentiles). The study group included 180 patients (80% males; age 65 (52, 75.5)). PCI was on an urgent/emergent basis in 86.6%. The main indications for warfarin use were left ventricular mural thrombus and atrial fibrillation (46.9 and 36.9% respectively). Glycoprotein IIb/IIIa receptor antagonists were used in 47.7%. Post-PCI triple therapy duration was 30 days (30, 30). During the post-triple therapy, 104 patients (57.8%) continued treatment with warfarin and aspirin for 376 days (150, 775). During the triple therapy period, 20 patients developed bleeding complications, (mean INR 2.1 ± 0.7 at 7 (6, 8.5) days post-PCI): 2 major Groin Hematoma (initial phase of warfarin treatment during overlap with heparin) and 18 minor. During post-triple therapy, primarily under warfarin and aspirin, 19 patients developed bleeding complications: 1 major and 18 minor. Conclusion: Short-term triple therapy after PCI was not associated with prohibitively high bleeding complication rates, and thus should be favorably considered in patients with a clear indication for warfarin use. © 2006 Wiley-Liss, Inc.
Christos A. Athanasoulis - One of the best experts on this subject based on the ideXlab platform.
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trapease vena cava filter experience in 751 patients
Journal of Endovascular Therapy, 2006Co-Authors: Sanjeeva P Kalva, Arthur C Waltman, Stephan Wicky, Christos A. AthanasoulisAbstract:PURPOSE: To evaluate the clinical safety and efficacy of the TrapEase vena cava filter in a 4-year single-center experience. METHODS: The clinical and imaging data of 751 patients (384 men; mean age 64 years, range 16-99) who had a TrapEase inferior vena cava (IVC) filter placed between January 1, 2001, and December 31, 2004, were reviewed retrospectively. More than a third of patients (297, 39.5%) presented with pulmonary embolism (PE), 188 (25.0%) had deep vein thrombosis (DVT), 40 (5.3%) had both PE and DVT, and the rest (226, 30.1%) had other symptoms. Indications for filter placement were contraindication to anticoagulation (461, 61.4%), complication of anticoagulation (42, 5.6%), failure of anticoagulation (39, 5.2%), and prophylaxis (209, 27.8%). Filters were placed in the infrarenal (n=738) or suprarenal (n=13) position through a femoral (n=729) or jugular vein (n=22) approach. Follow-up computed tomographic (CT) scans of the chest and abdomen were evaluated for recurrent PE and filter-related complications, respectively. RESULTS: Three (0.4%) patients developed Groin Hematoma. During a mean 295-day clinical follow-up (range 1-1677), 55 (7.5%) patients developed symptoms of PE, and 1 (0.1%) death was attributed to PE. Chest CT performed for various clinical indications in 219 patients at a mean 192 days (range 1-1346) showed PE in 15 (6.8%) patients; 10 were symptomatic and 5 asymptomatic, but there were no fatalities. Follow-up abdominal CT (n=270) at a mean 189 days (range 1-1415) showed fracture of filter components in 8 (3.0%), thrombus within the filter in 68 (25.2%), thrombus extending beyond the filter in 4 (1.5%), near total caval occlusion in 2 (0.7%), and no cases of migration. CONCLUSION: The TrapEase vena cava filter is effective in the prevention of pulmonary embolism, with minimal complications.
Valentina Tiozzo - One of the best experts on this subject based on the ideXlab platform.
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meta analysis of randomized trials on the efficacy of vascular closure devices after diagnostic angiography and angioplasty
American Heart Journal, 2010Co-Authors: Fausto Biancari, Vito Dandrea, Carlo Di Marco, G Savino, Valentina Tiozzo, A CataniaAbstract:Background The aim of this meta-analysis was to evaluate the safety and efficacy of vascular closure devices (VCDs). Methods This meta-analysis was performed in accordance with the Cochrane Handbook for Systematic Reviews . Results The literature search yielded 31 prospective, randomized studies including 7,528 patients who were randomized to VCDs or manual/mechanical compression after diagnostic angiography and/or endovascular procedures. Most of these studies have excluded patients at high risk of puncture site complications. Meta-analysis showed similar results in the study groups in terms of Groin Hematoma, bleeding, pseudoaneurysm, and blood transfusion. Lower limb ischemia and other arterial ischemic complications (0.3% vs 0%, P = .07) as well as need of surgery for vascular complications (0.7% vs 0.4%, P = .10) were somewhat more frequent with arterial puncture closure devices. The incidence of Groin infection was significantly more frequent with VCDs (0.6% vs 0.2%, P = .02). The use of VCD was uniformly associated with a significantly shorter time to hemostasis. Such differences where more evident in patients undergoing percutaneous coronary intervention, whereas these methods were associated with similar rates of adverse events among patients undergoing diagnostic coronary angiography. Conclusions The use of VCDs is associated with a significantly shorter time to hemostasis and thus may shorten recovery. However, the use of VCDs is associated with a somewhat increased risk of infection, lower limb ischemia/arterial stenosis/device entrapment in the artery, and need of vascular surgery for arterial complications. Further studies are needed to get more conclusive results, particularly in patients at high risk of femoral puncture-related complications.
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Meta-analysis of randomized trials on the efficacy of vascular closure devices after diagnostic angiography and angioplasty
'Elsevier BV', 2010Co-Authors: Fausto Biancari, Carlo Di Marco, G Savino, Valentina Tiozzo, Vito D'andrea, A CataniaAbstract:Background The aim of this meta-analysis was to evaluate the safety and efficacy of vascular closure devices (VCDs). Methods This meta-analysis was performed in accordance with the Cochrane Handbook for Systematic Reviews. Results The literature search yielded 31 prospective, randomized studies including 7,528 patients who were randomized to VCDs or manual/mechanical compression after diagnostic angiography and/or endovascular procedures. Most of these studies have excluded patients at high risk of puncture site complications. Meta-analysis showed similar results in the study groups in terms of Groin Hematoma, bleeding, pseudoaneurysm, and blood transfusion. Lower limb ischemia and other arterial ischemic complications (0.3% vs 0%, P=.07) as well as need of surgery for vascular complications (0.7% vs 0.4%, P=.10) were somewhat more frequent with arterial puncture closure devices. The incidence of Groin infection was significantly more frequent with VCDs (0.6% vs 0.2%, P=.02). The use of VCD was uniformly associated with a significantly shorter time to hemostasis. Such differences where more evident in patients undergoing percutaneous coronary intervention, whereas these methods were associated with similar rates of adverse events among patients undergoing diagnostic coronary angiography. Conclusions The use of VCDs is associated with a significantly shorter time to hemostasis and thus may shorten recovery. However, the use of VCDs is associated with a somewhat increased risk of infection, lower limb ischemia/arterial stenosis/device entrapment in the artery, and need of vascular surgery for arterial complications. Further studies are needed to get more conclusive results, particularly in patients at high risk of femoral puncture-related complications. (Am Heart J 2010; 159: 518-31.
