Comparison of a 21G micropuncture needle and a regular 19G access needle for antegrade arterial access into the superficial femoral artery.

INTRODUCTION: The purpose of this prospective study was to compare a 21G micropuncture needle with a regular 19G access needle for direct superficial femoral artery (SFA) access. METHODS: A total of 100 consecutive patients were randomized to each group. Ultrasound-guided antegrade puncture of the SFA was performed using either a 21G or 19G needle. The time between injection of local anesthesia and flushing of the inserted sheath was measured. For hemostasis, either manual compression for 20 min or a closure device was used. All patients received an ultrasound exam 6 h after the procedure to assess the puncture site. RESULTS: Successful access was achieved in 49 of 50 (98%) in the 21G group and 50 of 50 (100%) in the 19G group. In one patient, access with the 21G failed due to severe calcification. Access was successful after switching to the 19G needle. Immediate hemostasis was achieved in all patients. Overall, 22 complications were observed: 10 pseudoaneurysms (4 using the 21G and 6 with the 19G) and 12 hematomas (9 with the 21G and 3 with the 19G). The differences were not statistically significant (p > 0.05). Time to access was significantly faster for the 19G needle (median time 205 s; range: 94-2,160 s) compared with the 21G needle (median time 330 s; range: 93-1,140 s; p = 0.002). CONCLUSIONS: The rate of pseudoaneurysms after SFA access was slightly lower using a 21G needle compared with a 19G needle; however, this was without statistical significance. On the other hand, there was an increase in access time and hematomas with the 21G needle.

ECG-triggered non-contrast-enhanced MR angiography (TRANCE) versus digital subtraction angiography (DSA) in patients with peripheral arterial occlusive disease of the lower extremities.

OBJECTIVE: To prospectively determine the diagnostic value of electrocardiography-triggered non-contrast-enhanced magnetic resonance angiography (TRANCE) of the lower extremities including the feet versus DSA. METHODS: All 43 patients with symptomatic peripheral arterial occlusive disease (PAOD) underwent TRANCE before DSA. Quality of MRA vessel depiction was rated by two independent radiologists on a 3-point scale. Arterial segments were graded for stenoses using a 4-point scale (grade 1: no stenosis; grade 2: moderate stenosis; grade 3: severe stenosis; grade 4: occlusion). Findings were compared with those of DSA. RESULTS: In the 731 vessel segments analysed, intra-arterial DSA revealed 283 stenoses: 33.6% moderate, 16.6% severe and 49.8% occlusions. TRANCE yielded a mean sensitivity, specificity, positive and negative predictive value and diagnostic accuracy to detect severe stenoses or occlusions of 95.6%, 97.4%, 87.2%, 99.2%, 97.1% for the thigh segments and 95.2%, 87.5%, 83.2%, 96.6%, 90.5% for the calf segments. Excellent overall image quality was observed for TRANCE in 91.4% versus 95.7% (DSA) for the thigh and in 60.7% versus 91.0% for the calves, while diagnostic quality of the pedal arteries was rated as insufficient. CONCLUSION: TRANCE achieves high diagnostic accuracy in the thigh and calf regions, whereas the pedal arteries showed limited quality.

Antegrade access to the superficial femoral artery with ultrasound guidance: feasibility and safety.

PURPOSE: To evaluate the feasibility and safety of antegrade superficial femoral artery (SFA) access with the use of ultrasound (US) guidance. MATERIALS AND METHODS: One hundred consecutive patients (56% men) were prospectively enrolled, with a median age of 76 years. The SFA was punctured in antegrade fashion with a 19-gauge needle with US guidance, followed by sheath placement. The time from local anesthesia until successful blood aspiration from the sheath was measured. At the end of the case, hemostasis was achieved with a closure device or by manual compression. All cases were followed with US for access complications. RESULTS: Antegrade arterial access was successful in all cases. The arterial sheath was successfully placed into the SFA in 98 of 100 patients. In 95 of 98, the sheath was inserted with US guidance only; additional fluoroscopy was needed in three cases. In two of 100 patients, the common femoral artery (CFA) was accessed, accidentally in one case and deliberately in the other because the SFA was considered too small. Both patients were excluded from further analysis. The median time for arterial access was 3.5 minutes (interquartile range, 3.1-6.2 min). All complications directly related to vascular access were minor (16; 15.68%): 10 pseudoaneurysms (10.2%; median diameter, 15 mm) and six hematomas (6.12%; median diameter, 31.5 mm). CONCLUSIONS: Antegrade puncture into the SFA with US guidance is feasible and fast. The rate of minor complications is similar to other reported series, but a direct comparison with other studies is difficult because study designs vary.

Clinical experience in timed arterial compression contrast-enhanced magnetic resonance angiography of the hand.

PURPOSE: A retrospective analysis of the diagnostic performance of the timed arterial compression (TAC) technique, which allows freezing of the contrast bolus during first-pass contrast-enhanced (CE) magnetic resonance angiography (MRA) to diagnose vascular pathologies in the hand. MATERIAL AND METHODS: A total of 14 consecutive CE-MRAs of the hand were acquired by using the TAC technique. By inflating a blood pressure cuff up to 200 mm Hg triggered to the arterial contrast filling of the hand, prolonged measurement times up to 144 seconds, with a spatial resolution of 0.59 × 0.59 × 0.8 mm(3), could be realized. Overall image qualities, arterial signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and vessel conspicuity besides the final diagnosis were evaluated. RESULTS: All 14 TAC-CE-MRAs of the hand were successfully accomplished without any adverse events and yielded, in all cases, a final diagnosis with a high total number of vascular pathologies (57). High arterial SNR and CNR values exceeding the soil of 85 and 60, respectively, resulted. Thus, overall vessel visibility (>90%), vessel conspicuity (mean Δ signal intensity [SI]/mm = 1,193) and image quality on a per patient level (>60%) were rated as excellent or good. CONCLUSIONS: TAC-CE-MRA of the hand offers high diagnostic performance because of its increased spatial resolution while preserving contrast, which allowed detection of tiny stenoses of the digital arteries.

Recanalization of acute and subacute femoropopliteal artery occlusions with the rotarex catheter: one year follow-up, single center experience.

PURPOSE: To assess the efficacy and safety of a new rotational catheter for percutaneous removal of fresh and organized thrombi in the femoropopliteal artery. METHODS: Forty-one limbs in 38 patients (age 56--90 years, mean 75.6 years) with acute, subacute or chronic femoropopliteal occlusions of 1--180 days' duration (mean 31.6 days) were treated with the Rotarex device. The Fontaine stage was mainly IIB (Rutherford 2--3, 22 patients) or III (Rutherford 4, 14 patients). The length of occlusion varied from 2 to 35 cm (mean 13.1 cm). After recanalization percutaneous transluminal angioplasty (PTA) was performed if there was a residual stenosis of >25%. Patients were followed up with color Doppler ultrasound at 48 hr and clinically with Doppler pressures and oscillometry at 3, 6, and 12 months. RESULTS: After an average of two passages with the Rotarex catheter all but two limbs required PTA for residual stenosis >25%. Five patients needed additional stenting. Major complications were one groin hematoma requiring blood transfusion and one arteriovenous fistula spontaneously thrombosing after unsuccessful primary prolonged balloon dilation. Distal embolizations occurred in 10 patients; 6 clinically relevant emboli were aspirated. All occlusions were technically successfully recanalised there were 2 early reocclusions after 1 day and two at 2 weeks. Brachial-ankle indices improved from an average of 0.41 before to 0.93 after recanalization. Primary and secondary patency rates were 62% / 84% after 6 months and 39% / 68% after 1 year. The amputation-free survival at 12 months was 100%. CONCLUSION: The Rotarex mechanical thrombectomy device is an efficient, quick, easy to handle, and safe tool for the treatment of acute, subacute or even chronic peripheral arterial thromboembolic occlusions. It can be used for short or long occlusions with equal success, provided the obstruction is not heavily calcified and has been safely passed with a guidewire first.

High-resolution magnetic resonance angiography of hands with timed arterial compression (tac-MRA).

Timed arterial compression (tac) of blood flow can be achieved by inflation of a blood-pressure cuff. We postulated that this technique might improve contrast-enhanced magnetic resonance angiography (MRA) of the arteries of the hands. We studied eight volunteers and six patients with occlusive arterial disease of the hands with standard MRA and tac-MRA. Compared with standard MRA, acquisition time was extended with the blood-pressure cuff by a factor of four, leading to quadrupled image resolution (512x1024). Furthermore, flow-related artifacts were not seen. Tac-MRA permits visualisation of the peripheral arterial system in finer detail than that achieved with standard MRA.