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THE JOURNAL OF CARDIOVASCULAR SURGERY

Rivista di Chirurgia Cardiaca, Vascolare e Toracica


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PERIPHERAL ARTERIES  20 YEARS EVC: MANAGEMENT OF ARTERIAL DISEASES


The Journal of Cardiovascular Surgery 2016 April;57(2):311-21

lingua: Inglese

Vascular access complications in endovascular procedures with large sheaths

Anne LEJAY 1, Thibault CASPAR 2, Mickaël OHANA 3, Charline DELAY 1, Elie GIRSOWICZ 1, Patrick OHLMANN 2, Fabien THAVEAU 1, Bernard GENY 4, Yannick GEORG 1, Nabil CHAKFE 1

1 Department of Vascular Surgery and Kidney Transplantation, University Hospital of Strasbourg, France, 2 Department of Cardiology, University Hospital of Strasbourg, France, 3 Department of Radiology, University Hospital of Strasbourg, France, 4 Department of Physiology, University of Strasbourg, France


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Endovascular procedures, such as transcatheter aortic valve implantation (TAVI), thoracic endovascular aortic repair (TEVAR), and endovascular abdominal aortic repair (EVAR) have been established as promising less invasive therapeutic options. However, despite continuous advances and device improvements, the use of large-sheaths still remains an important challenge, since significant coexisting arterial disease may be encountered in patients undergoing such procedures. Identification of coexisting arterial diseases by optimal preoperative imaging assessment is essential to anticipate these difficulties and avoid the complications by using adequate access options. Should a vascular complication such as iliac rupture occur, vascular interventionists must be aware of salvage procedures to control and treat major complications, such as maintaining wire access across the rupture for occlusion balloon placement and vessel control, while disruption is addressed either through an endovascular or an open approach. The aims of this review are to describe how to prevent vascular complications by optimal preoperative imaging assessment, to detail intraoperative options available for addressing difficult access issues and to discuss how to manage intraoperative major vascular complications.

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anne-catherine.lejay@orange.fr