Improved Hybrid Technique for Vascular Access and Closure

Abstract

To present a technique for vascular access that features minimal surgical visualization of the target vessel, fast and safe access using an open Seldinger technique under tactile and visual control, and suture closure. Technique: After minimal surgical access to the target vessel, exposing only the anterior wall, 4 preliminary 5-0 polypropylene transmural single sutures are placed in the horizontal plane, 2 on either side of the proposed entry point. If the anterior wall is calcified, the sutures are placed more laterally or medially in a suitable plaque-free area. The vessel is then accessed via an open Seldinger technique in the midline between the 4 sutures, and the corresponding sheaths are inserted over the wire. At the end of the procedure, the sheath and wire are removed, and with digital pressure on the vessel distally, the access site is washed out in antegrade fashion. All 4 sutures are then pulled tight by an assistant, and the surgeon ties all the sutures sequentially.Over a 4-year period, this technique has been used in 536 accesses involving the common femoral (n5500) and iliac (n532) arteries and the abdominal aorta (n54). Up to 24-F sheaths were introduced. Mean time for vascular access was 9.063.3 minutes. There were no access-related early complications detected in routine postprocedural imaging and clinical evaluation. Conclusion:The ''Surgiclose'' technique, which is easy to learn and applicable to all vessels, provides a fast, easy, and reliable remote vascular access. It combines the best of both surgical and interventional access techniques, affording minimal surgical access and maximal safety.

Debate: Whether endovascular repair offers a survival advantage over open repair for ruptured abdominal aortic aneurysms

“…The Zurich group has published numerous scientific and technologic papers on the performance of REVAR since 1998, with excellent outcomes and low turn down rates. 9,19,20,[37][38][39][40][41][42][43][44][45][46][47][48][49][50][51] From the beginning, a detailed protocol was established that has been refined over the years. This "Zurich algorithm" 20,42,52 focuses attention on five key points: hemodynamics, imaging, procedure, abdominal compartment syndrome (ACS), and teamwork.…”

Periscope Endograft Technique to Revascularize the Left Subclavian Artery During Thoracic Endovascular Aortic Repair

“…Remote access to the LSA was achieved percutaneously through the left common femoral artery using a preclose technique 9 with Proglide (Abbott Vascular, Redwood City, CA, USA) in 10 patients and through a surgical exposure and surgiclose technique 10 in the other 4. After introducing a 12-F sheath (Cook Medical, Inc., Bloomington, IN, USA), the LSA was catheterized typically using a Chuang reversed visceral (Cook Medical, Inc.) or JV1 (Cook Medical, Inc.) catheter and a soft J-wire guide (Cordis, Miami Lakes, FL, USA) or a Glidewire (Terumo Medical, Tokyo, Japan).…”

CT Angiography at 24 Months Demonstrates Durability of EVAR With the Use of Chimney Grafts for Pararenal Aortic Pathologies

“…At Site 2, the chimney technique was performed in similar fashion in a hybrid operating room under fluoroscopic control (Philips Medical Systems, Inc., Shelton, CT, USA) or an angiographic suite (Artiszeego; Siemens AG). Access to the aorta was obtained with a femoral cutdown and either a surgiclose technique 5 or by using one or several ProGlide Suture-Mediated Closure devices (Abbott Vascular, Redwood City, CA, USA). The renovisceral arteries were accessed through the axillary and femoral routes with a 45-cm Arrow sheath (Arrow International Inc., Reading, PA, USA), a 5-F Chuang visceral reverse curve catheter (Cook Inc.), and a Rosen wire.…”