Transfemoral Approach for Intraoperative Angiography in the Prone or Three-quarter Prone Position

Wang, Chi; Hsu, Szu-Kai; Chang, Chih‐Ju; Chen, Ming Hong; Huang, Chih-Ta; Huang, Jing-Shan; Su, I‐Chang

doi:10.1007/s00062-019-00783-3

Cited by 6 publications

(8 citation statements)

References 7 publications

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“…Twelve studies were conducted in Asia3 6 19–28, 11 studies in the United States7 8 29–37, and 3 in Europe38–40. The number of participants per study ranged from 1 to 30.…”

Section: Resultsmentioning

confidence: 99%

“…The most common intraoperative position was prone (85%), followed by three-quarters prone (8%), and park-bench (8%). IOA was performed with a portable C-arm in 18 studies3 6 7 19–22 24 25 29–32 34–38, in a hybrid operative room in 78 23 26–28 33 40, and in an adapted angiosuite in 139. Postoperative angiographic confirmation of the IOA findings was performed in seven studies3 20–22 29 32 39.…”

Section: Resultsmentioning

confidence: 99%

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Intraoperative angiography during neurosurgical procedures on patients in prone, three-quarters prone, and park-bench positions: tertiary single-center experience with systematic review and meta-analysis

Vivanco‐Suarez

Sioutas

Matache

et al. 2023

J NeuroIntervent Surg

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BackgroundThere is limited evidence about the role and effectiveness of intraoperative angiography (IOA) during neurosurgical procedures with patients in prone, three-quarters prone, and park-bench positions.ObjectiveTo carry out a systematic review and meta-analysis of the literature to evaluate the safety and efficacy of IOA during neurosurgical procedures.MethodsWe reviewed (between January 1960 and July 2022) all studies in which IOAs were performed during neurosurgical procedures with patients in either prone, three-quarters prone, or park-bench positions. Additionally, a cohort of patients from our institutional experience was included. Efficacy outcomes were the rate of successful angiography and the rate of surgical adjustment/revision after IOA. Safety outcomes were the rate of angiography-related complications and mortality. Data were analyzed using a random-effects meta-analysis of proportions, and statistical heterogeneity was assessed.ResultsA total of 26 studies with 142 patients plus 32 subjects from our institution were included in the analysis. The rate of successful intraoperative angiography was 98% (95% CI 94% to 99%; I2=0%). The rate of surgical adjustment/revision was 18% (95% CI 12% to 28%; I2=0%). The rate of complications related to the angiography was 1% (95% CI 0% to 5%; I2=0%). There were no deaths associated with IOA.ConclusionWe found that IOA performed with patients in prone, three-quarters prone, and park-bench positions is feasible and safe with a non-negligible rate of intraoperative post-angiographical surgical adjustment/revision. Our findings suggest that the performance of IOA to complement vascular neurosurgical procedures might have a valuable role in favoring patient outcomes.

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“…Twelve studies were conducted in Asia3 6 19–28, 11 studies in the United States7 8 29–37, and 3 in Europe38–40. The number of participants per study ranged from 1 to 30.…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Intraoperative angiography during neurosurgical procedures on patients in prone, three-quarters prone, and park-bench positions: tertiary single-center experience with systematic review and meta-analysis

Vivanco‐Suarez

Sioutas

Matache

et al. 2023

J NeuroIntervent Surg

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“…While femoral access is currently the mainstay of endovascular procedures, prone positioning causes inaccessibility to the femoral artery, lack of a sterile environment, and the possibility of the patient’s weight resting on the femoral sheath and tubing leading to skin injury, thrombus formation, or other catheter-related complications 7. Currently, transfemoral access is achieved using an extended femoral sheath approach whereby the patient is placed in the supine position and the sheath is inserted into the femoral artery using ultrasound guidance 6. The catheter is then stitched to the access site to prevent slipping, and the entire access site is wrapped with gauze padding and secured with transparent film dressing 6.…”

Section: Discussionmentioning

confidence: 99%

“…The most frequently used access point for endovascular procedures is the common femoral artery (CFA) 5. This involves securing CFA access in the supine position, securing the catheter sheath to the lower extremity, and then flipping the patient into the prone or semiprone position 6. Patients are often positioned prone for resection and obliteration of neurovascular lesions in the spine, posterior fossa, and other intracranial locations 4.…”

Section: Introductionmentioning

confidence: 99%

Intraoperative angiography via popliteal artery access for spinal neurovascular lesions: an institutional experience and systematic review

Muhammad

Sioutas

Gajjar

et al. 2023

J NeuroIntervent Surg

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BackgroundIntraoperative DSA is used to confirm complete obliteration of neurovascular pathologies. For spinal neurovascular lesions, femoral access can be challenging given the need to flip the patient after sheath placement. Similarly, radial access can be complicated by arch navigation difficulties. Vascular access via the popliteal artery represents an appealing alternative option; however, data regarding its utility and efficacy in these cases are limited.MethodsA retrospective series of four consecutive patients between July 2016 and August 2022 who underwent intraoperative spinal DSA via the popliteal artery was analyzed. Additionally, a systematic review was conducted to collect previously reported such cases. Collective patient demographics and operative details are presented to consolidate the available evidence supporting popliteal access.ResultsFour patients met the inclusion criteria from our institution. The systematic review yielded six previously published studies reporting 16 additional transpopliteal access cases. Of the 20 total cases (mean±SD age 60.8±17.2 years), 60% were men. Most treated lesions were dural arteriovenous fistulas (80%) located in the thoracic spine (55%) or cervical spine (25%). The left popliteal artery was most accessed and the highest visualized level was the craniocervical junction. All outcomes were either stable or improving after surgery, and no complications were observed.ConclusionsWe report the safety and feasibility of transpopliteal access for intraoperative DSA in the prone position in four cases in addition to 16 previously reported cases in the literature. Our case series highlights popliteal artery access as an alternative to transfemoral or transradial access in this setting.

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“…Intraoperative sDSA is irreplaceable, but femoral access is difficult due to the position of the patient. A protocol for femoral access is reported in said cases, and another option is the use of the radial approach, which opens the possibility of a hybrid treatment of this pathology [ 54 , 55 ]. In the absence of sDSA, the use of indocyanine green video angiography should be considered to assess the degree of resection [ 39 , 42 , 56 ].…”

Section: Discussionmentioning

confidence: 99%

Spinal Vascular Shunts: Single-Center Series and Review of the Literature of Their Classification

Lizana

Aliaga

Marani

et al. 2022

Neurology International

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Spinal arteriovenous shunts (sAVSs) are an uncommon disease, constituting 3 to 4% of intradural lesions; 70% of these lesions are spinal arteriovenous fistulas (sAVFs), whereas spinal arteriovenous malformations (sAVMs) are rarer. Both share the problem of their classification due to the heterogeneity of their angioarchitecture. The aim of this study is to report a series of sAVSs treated in the neurosurgery department of the Hospital Nacional Guillermo Almenara during the 2018–2020 period and to present an overview of the current literature on sAVS classification. We reviewed all medical records of patients diagnosed with sAVFs and sAVMs during the 2018–2020 period, and then we analyzed images with Horos v4.0.0, illustrated some cases with Clip Studio Paint v1.10.5, and performed a descriptive statistical analysis with SPSS v25. Twelve patients were included in this study, eight of which were women (67%) and four of which were men (33%); the age range was from 3 to 74 years. Eight sAVSs were sAVFs, whereas four were sAVMs. The most frequent clinical manifestation was chronic myelopathy in seven patients (58%). Of those treated only by embolization, seven (70%) resulted in complete occlusion (five sAVFs and two sAVMs), while three (30%) remained with a residual lesion. At last follow-up, five patients (42%) improved clinically, and the seven remaining (58%) maintained the same neurological state. sAVSs require a detailed study of their angioarchitecture for proper management. The endovascular treatment is safe with acceptable cure rates. The surgical option should not be set aside.

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Transfemoral Approach for Intraoperative Angiography in the Prone or Three-quarter Prone Position

Cited by 6 publications

References 7 publications

Intraoperative angiography during neurosurgical procedures on patients in prone, three-quarters prone, and park-bench positions: tertiary single-center experience with systematic review and meta-analysis

Intraoperative angiography during neurosurgical procedures on patients in prone, three-quarters prone, and park-bench positions: tertiary single-center experience with systematic review and meta-analysis

Intraoperative angiography via popliteal artery access for spinal neurovascular lesions: an institutional experience and systematic review

Spinal Vascular Shunts: Single-Center Series and Review of the Literature of Their Classification

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