The document discusses various vascular closure devices (VCDs), including:
1. Plug-based devices like Angio-Seal, Exoseal, and MynxGrip that use anchors, plugs, or polymers to seal the puncture site.
2. Suture-mediated devices like Perclose Proglide and Prostar that deploy sutures before sheath removal to close the arteriotomy.
3. Mechanical devices like StarClose that use clips, and compressive devices like Catalyst III that use disks, to facilitate hemostasis.
While VCDs can reduce time to hemostasis and ambulation compared to manual compression, meta-
Catheters used in Angiography & angioplastySatya Shukla
Guide catheters are essential tools for Pecutaneous
Coronary Intervention
• Understanding construction, design & performance
characteristics facilitate their appropriate selection
• Selection of Guide catheters seems elementary but
makes the difference between a successful and failed
PCI procedure
Optimize guide catheter support
Fabrice Leroy, Lille, France
11th Experts Live CTO
The annual Euro CTO meeting
September 13th –14th, 2019 - Berlin, Germany
This is a recreation of a presentation that I created in the early 2000s for a nursing inservice about femoral vascular access site complications. Post cardiac catheterization and post interventional radiology patients were a new patient population for these nurses.
Intraoperative Intrasac Thrombin Injection to Prevent Type II Endoleak After Endovascular Abdominal Aortic
Aneurysm Repair
(Chirurgia Vascolare-ULSS 15 Alta Padovana)
(Vascular Surgery -ULSS 15 Alta Padovana)
A Review of Atherectomy in Peripheral Arterial Diseaseasclepiuspdfs
Atherectomy involves exciting technology and offers expanded treatment options for PAD. Data are scant so far in most lower extremity territories to support its use over other interventions, but newer results are promising. There is still a financial benefit to choosing atherectomy in the outpatient setting that likely drives much of its popularity among interventionalists. Atherectomy is an exciting technology for peripheral vascular intervention. Its use has greatly increased over the last decade. Data on its superiority to angioplasty or angioplasty with stenting are scant. Here, we review atherectomy techniques and principles along with results and controversy surrounding its use.
Catheters used in Angiography & angioplastySatya Shukla
Guide catheters are essential tools for Pecutaneous
Coronary Intervention
• Understanding construction, design & performance
characteristics facilitate their appropriate selection
• Selection of Guide catheters seems elementary but
makes the difference between a successful and failed
PCI procedure
Optimize guide catheter support
Fabrice Leroy, Lille, France
11th Experts Live CTO
The annual Euro CTO meeting
September 13th –14th, 2019 - Berlin, Germany
This is a recreation of a presentation that I created in the early 2000s for a nursing inservice about femoral vascular access site complications. Post cardiac catheterization and post interventional radiology patients were a new patient population for these nurses.
Intraoperative Intrasac Thrombin Injection to Prevent Type II Endoleak After Endovascular Abdominal Aortic
Aneurysm Repair
(Chirurgia Vascolare-ULSS 15 Alta Padovana)
(Vascular Surgery -ULSS 15 Alta Padovana)
A Review of Atherectomy in Peripheral Arterial Diseaseasclepiuspdfs
Atherectomy involves exciting technology and offers expanded treatment options for PAD. Data are scant so far in most lower extremity territories to support its use over other interventions, but newer results are promising. There is still a financial benefit to choosing atherectomy in the outpatient setting that likely drives much of its popularity among interventionalists. Atherectomy is an exciting technology for peripheral vascular intervention. Its use has greatly increased over the last decade. Data on its superiority to angioplasty or angioplasty with stenting are scant. Here, we review atherectomy techniques and principles along with results and controversy surrounding its use.
Minimal access surgery is a routine surgical practice due to its minimal invasive and associated advantages. It has a lot of advantages but not devoid of complication, one of the major concerned complication is the trocar site herniation (TSH).
Example of an innovative clinical trial design for a group of medical devices (in this case absorbable hemostats) to support a particular clinically relevant claim
This presentation is about surgical drains and the techniques of draining the surgical wounds. Advancements in the surgical drains are also discussed and mentioned.
J ENDOVASC THER 2010;17:517–524-Clinical Investigation- Aneurysm Sac ‘‘Thrombization’’ and Stabilization
in EVAR: A Technique to Reduce the Risk of Type II Endoleak
(Chirurgia Vascolare-ULSS 15 Alta Padovana)
(Vascular Surgery -ULSS 15 Alta Padovana)
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
2. Overview..
Session divided into 2 presentations.
First a view on VCDs with their categories, uses, indications and complications.
Further for better understanding other presentation is based on videos of these
VCDs.
3. Manual Compression
Traditional Approach
Apply pressure for up to 10-20 mins.
Bed rest up to 4-24 hrs depending on sheath size and coagulation status.
Labor and time intensive with potential limitations ( Unable to comply with bed rest
and Obese)
Hemostasis by formation of fibrin and platelet plug after blood is exposed to collagen
at puncture site in the arterial wall.
Complications:
Hematomas
Retroperitoneal Hemorrhage
Pseudo aneurysm
Vessel Occlusion
AV fistula formation
4. Vascular Closure Devices
First introduced in 1995
Decrease the time to hemostasis and ambulation.
Reduce access site complications.
The theoretical ideal VCD:
Easy to use with minimal training
Comfortable for patient and operator.
Offers secure hemostasis regardless of vessel quality.
Allows immediate ambulation with no short or long-term risks
But there is no ideal device at present, and indeed this theoretical ideal may be
unattainable.
The devices can be divided into groups as intravascular and extravascular plugs,
suture mediated/mechanical, and compressive assistance
5. 1)Plug-Based VCDs
A)Angio-Seal Evolution- VIP, and STS Plus (St. Jude Medical, St.
Paul, Minn)
Devices create a mechanical seal by sandwiching the arteriotomy between
a bio absorbable anchor and a collagen sponge.
Dissolve within 60 to 90 days.
Should not be used in small arteries (<5 mm) or arteries
with significant occlusive disease as the anchor can
catch on the side walls.
Leading to failure with continued bleeding or vessel
occlusion.
The device comes in 6F and 8F versions.
RCT of 435 patients:[1]
High deployment success rate (96 %)
Shorter time to hemostasis with 76 % of patients having immediate haemostasis
(within 1 min).
Reduced number of complications for patients with AngioSeal compared to MC.
1. Kussmaul WG, Buchbinder M, Whitlow PL, et al. Rapid arterial hemostasis and decreased access site complications after cardiac catheterization and angioplasty: results of a
randomized trial of a novel hemostatic device. J Am Coll Cardiol. 1995;25:1685–92
6. B)Exoseal (Cordis Corp., NJ, USA)
Places a polyglycolic acid plug outside the arteriotomy and is held in place by femoral
fascia.
This plug hydrolyze and resorbed within 60 to 90 days.
Available in 5F, 6F, and 7F sizes.
Potential advantage:
Do not have an intravascular implant thereby diminishing the risks of anchor-
related luminal narrowing, occlusion or embolism.
Two minutes of non-occlusive MC is advised following deployment, and ambulation
is proposed by the manufacturers at 6 h or later.
The ECLIPSE trial (multicenter RCT of 401 patients) randomized to closure with
Exoseal or MC.[2]
Mean time to hemostasis and time to ambulation were significantly shorter in the Exoseal
arm of the study (4.4 vs 20.1 min and 2.5 vs 6.2 h, respectively).
There were no major complications reported in this study.
2. Wong SC, Bachinsky W, Cambier P, et al. A randomized comparison of a novel bioabsorbable vascular closure device versus manual compression in the achievement of hemostasis
after percutaneous femoral procedures: the ECLIPSE (Ensure’s Vascular Closure Device Speeds Hemostasis Trial). JACC Cardiovasc Interv. 2009;2:785–93.
7.
8. C)MynxGrip (AccessClosure, Santa Clara, Calif)
Use extravascular polyethylene glycol, a water-soluble, bioinert, nonthrombogenic polymer, to
seal the tissue track.
The device comes in a 5F and 6F version.
The Mynx Sealant consists of freeze-dried polyethylene glycol.
On placement blood infiltrates the porous structure and the sealant expands to three to four
times its size, expanding and filling the tissue track to provide effective hemostasis.
When it is fully expanded, the sealant consists of 95% blood and fluids and 5% polyethylene
glycol sealant.
As blood collects within the porous matrix, the coagulation produces hemostasis and a
platform for vessel healing.
9. Sealant is absorbed within 30 days.
A non-randomised single-arm prospective trial of 190 patients (Mynx device) [3]
Successful deployment in 93 % of cases.
Mean time to haemostasis and time to ambulation of 1.3 min and 2.6 hours.
The primary advantage of the Mynx VCD:
Absence of intraluminal material, thereby reducing the risks of luminal narrowing,
vessel occlusion or distal embolisation.
However, there are reports of distal embolisation occurring with the Mynx VCD
3.Scheinert D, Sievert H, Turco MA, et al. The safety and efficacy of an extravascular, water-soluble sealant for vascular closure: initial clinical results for Mynx. Cathet
Cardiovasc Interv. 2007;70:627–33.
10. D)FISH (femoral introducer sheath and hemostasis) device (Morris
Innovative, Bloomington, Ind)
Indicated for diagnostic procedures with 5F to 8F procedural sheaths.
Bioabsorbable extracellular matrix made from porcine small intestinal submucosa.
The patch resembles a roll of wrapping paper and is
inserted through the arteriotomy so that it straddles
the arterial wall.
A wire is pulled to release the patch from the device,
followed by a compression suture that incorporates the
patch firmly in place in the artery wall.
The intravascular plug is absorbed in 30 days.
11. The intravascular component is very flexible, potentially allowing for closure in small
or diseased vessels.
In a multi-center RCT of 297 patients randomized to FISH or MC:[4]
Mean time to hemostasis and mean time to ambulation were reduced for the FISH
cohort compared to MC (8.9 vs 17.2 min and 2.4 vs 4.3 hours)
There were no significant differences in the rates of adverse events between the two
cohorts in this study
4. Bavry AA, Raymond RE, Bhatt DL, et al. Efficacy of a novel procedure sheath and closure device during diagnostic catheterization: the multicenter randomized clinical trial
of the FISH device. J Invasive Cardiol. 2008;20(4):152–6.
12. 2) Suture Mediated
Allow closure by deploying the device before dilatation of the vessel with a larger sheath,
so-called preclose technique.
A) Perclose Proglide (Abbott Vascular, IL, USA)
Delivers a single pretied non-biodegradable monofilament polypropylene suture to close
the arteriotomy.
Licensed in the closure of sheath sizes from 5-French to 21-French.
Sheath sizes greater then 8-French require at least two devices using the pre-close
technique particularly in the setting of endovascular aneurysm repair.
Following completion of the procedure, the sheath is removed over a wire, whilst the pre-
deployed sutures are tensioned.
13. The advantage of this pre-close technique:
Large sheath sizes can be closed percutaneously.
A guide wire can be retained during tensioning of the sutures to allow insertion of a
further VCD or temporary sheath to stop bleeding.
14. B) Prostar (Abbott Vascular):
Is a 10F and places two braided sutures at 90-degree angles to each other to close the
arteriotomy.
Indicated for the closure of 8.5 to 10-French sheath common femoral artery access sites.
As with the Perclose Proglide, larger sheath sizes up to 24-French have been closed
successfully using the pre-close technique.
Although only one Prostar XL device is required as each Prostar XL delivers two sutures.
The drawbacks of this device and SMCDs:
There are a greater number of procedural steps which increase the complexity of the
VCD
Introduce a potentially longer learning curve
There is a potential risk of infection related to the implanted suture material, and in
one series, the infection rate was 0.5 %
15. 2) Mechanical Closure
A) StarClose SE (Abbott Vascular)
Delivers an extravascular flexible nitinol clip to the adventitial surface of the vessel
wall to complete a circumferential arteriotomy closure.
The StarClose is designed for closure of 5- to 6-French sheath sizes.
The main advantage of the StarClose is that there is no implanted intraluminal material.
A theoretical disadvantage is that there is a residual permanent metal implant
The CLIP trial (RCT of 596 patients) randomized to closure with StarClose or MC
Reduced times to hemostasis and ambulation (1.5 vs 15.5 and 163 vs 269 min)
With no significant differences in the rates of complications compared to MC
16.
17. 3) Compressive Assistance
A) Catalyst III (Cardiva Medical, Inc., Sunny- vale, Calif)
Facilitates hemostasis by downsizing the arteriotomy while re-establishing flow distally
Although manual compression is still required.
The device is inserted through the existing sheath.
Once the tip is within the arterial lumen, a conformable
nitinol 6.5-mm disk is deployed.
The sheath is removed and the disk is gently pulled against the arterial wall, where it is held in
place by a tension clip.
The disk, which is coated with protamine sulfate, provides temporary intravascular tamponade,
facilitating physiologic vessel contraction and thrombosis.
After the device is allowed to sit in the artery for 15 to 120 minutes, depending on the
anticoagulation status, the disk is collapsed, the device is withdrawn, and light manual
pressure is held for 5 minutes.
18. B) FemoStop.
The FemoStop plus Compression System take the place of manual external
compression.
These devices are placed over the puncture site and adjusted with a circumferential
strap, followed by pressure bag inflation.
19. Topical Hemostatic Aids
There are also topical hemostatic aids that promote coagulation independent of
compression.
Several hemostasis pads exists:
Chito-Seal (Abbott Vascular)
Clo-Sur PAD (Scion Cardio-Vascular, Miami, Fla)
Syvek patch (Marine Polymer Technologies, Inc., Dankers, Mass)
Neptune Pad (Biotronik, Berlin, Germany)
D-Stat Dry (Vascular Solutions, Minneapolis, Minn).
Syvek patches contain poly- N-acetyl glucosamine fibers derived from microalgae that
activate platelets and promote red blood cell aggregation.
The D-Stat product consists of thrombin on a cellulose scaffold or suspended in a
collagen gel, both of which work by initiating the extrinsic coagulation cascade.
21. Complications
Two meta-analyses of randomized trials compared the incidence of individual
complications in patients treated with manual compression versus closure devices.[5]
Closure devices tended to increase the incidence of local bleeding and did not appear
to significantly influence hematoma, pseudo- aneurysm, or arteriovenous fistula
formation.
Closure devices also increased the risk of groin infection and tended to increase the
risk of leg ischemia and a complication requiring surgical repair.
5.Vaitkus PT: A meta-analysis of percutaneous vascular closure devices after diagnostic catheterization and
percutaneous coronary intervention. J Invasive Cardiol 16:243–246, 2004.