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Cardiology
Vascular Access for Percutaneous Interventions and Angiography
Built from Cardiovascular Catheterization and Intervention: A Textbook of Coronary, Peripheral, and Structural Heart Disease
What’s inside
7 sections · 117 slides
Overview
- Scope of this topic
Ultrasound-guided vascular access
- Rationale for ultrasound-guided access
- Learning curve for ultrasound-guided access
- FAUST trial: access success with ultrasound
- FAUST trial: attempts, venipuncture and complications
- RAUST trial: ultrasound for radial cannulation
- Equipment for ultrasound-guided puncture
- Ultrasound technique for femoral access
- Confirming the puncture site under fluoroscopy
- Ultrasound guidance for axillary access
- Sequence of ultrasound-guided femoral puncture
- Common femoral artery anatomy and the inguinal ligament
- Groin crease compared with the femoral head
Femoral access
- Role of common femoral artery access
- Anatomy of the common femoral artery
- Consequences of a high arterial puncture
- Consequences of a low arterial puncture
- Level of arterial puncture and its consequences
- Variation in bifurcation level
- Groin crease as an unreliable landmark
- What ultrasound adds at femoral puncture
- Ultrasound benefit in large-bore access
Access-site complications
- Bleeding as the leading cause of death
- Bleeding and mortality: GLOBAL LEADERS
- Clinical and economic burden of bleeding
- Mechanisms of harm from transfusion after PCI
- Anatomy-related causes of femoral complications
- Patient and operator causes of complications
- Caution with large-bore access
- Management of a high arteriotomy bleed
- Covered stent grafts for failed tamponade
- Confirming closure after a high bleed
- Retroperitoneal bleed from a high sheath and its rescue
- Management of a low arteriotomy bleed
- Persistent bleeding after a low puncture
- Pseudoaneurysm on duplex and thrombin injection equipment
- Femoral artery thrombosis
- Initial approach to femoral artery thrombosis
- Thrombectomy and adjuncts
- Vascular surgery and stenting considerations
- Common femoral occlusion after a closure device and its treatment
Haemostasis and vascular closure devices
- Manual compression after sheath removal
- Technique of obstructive manual compression
- Mechanical compression devices
- Haemostatic patches as an adjunct
- Uptake and evidence for vascular closure devices
- Prerequisites before using a closure device
- Complications of vascular closure devices
- Angio-Seal: design and performance
- Angio-Seal: sizes and combination use
- Perclose ProGlide and ProStyle mechanism
- Advantages of the Perclose platform
- ProStyle compared with ProGlide
- Snared knot pusher of the ProStyle device
- Device fracture and arterial avulsion
- Arterial avulsion after forceful removal of a closure device
- MANTA device: design
- MANTA device: clinical data
- CHOICE-CLOSURE: MANTA versus ProGlide
- Reading the closure device comparison
- Vascular closure devices: platform and puncture size
- Vascular closure devices: platform and puncture size (continued)
- Vascular closure devices: platform and puncture size (continued)
- Vascular closure devices: FDA indicated use
- Vascular closure devices: design and resorption
- Vascular closure devices: design and resorption (continued)
- Vascular closure devices: design and resorption (continued)
Radial access
- Adoption of transradial access
- Early objections and access site choice
- Patient selection for radial access
- Radial access and spontaneous coronary dissection
- Assessment of collateral circulation
- Landmarks and local anaesthesia for radial puncture
- Puncture technique and sheath insertion
- Wire behaviour and troubleshooting
- Sheath and specialty wire selection
- Failure of radial access and conversion
- Radial artery spasm and the sheath cocktail
- Composition and cautions of the radial cocktail
- Catheter advancement to the ascending aorta
- Pressure monitoring during catheter advancement
- Balloon-assisted tracking
- Alternative strategies for difficult radial anatomy
- Patent haemostasis at the radial arteriotomy
- Monitoring during radial band deflation
Trial evidence and radial complications
- RIVAL trial
- RIVAL STEMI subanalysis
- MATRIX trial
- RIFLE-STEACS trial
- STEMI-RADIAL trial
- Radial access outside the acute setting
- OCTOPUS trial in complex coronary lesions
- Radial artery spasm
- Radial artery occlusion
- Prevention of radial artery occlusion
- Forearm haematoma and compartment syndrome
- Management of forearm haematoma
- Radial access site infection
- Radial pseudoaneurysm and arteriovenous fistula
- Nerve injury after radial access
- Principles of safe femoral access
- Key points on access selection
- References
- References (continued)
- References (continued)
- References (continued)
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- References (continued)
- Cardiovascular Catheterization and Intervention: A Textbook of Coronary, Peripheral, and Structural Heart Disease
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