Experiencia acumulada en el uso de Angio-Seal™ durante el procedimiento de retirada de balón de contrapulsación intraaórtico

ResumenEl dispositivo de cierre de punción femoral Angio-Seal™ (St. Jude Medical, St. Paul, Minnesota) es actualmente el más utilizado en nuestro medio para el cierre de las punciones femorales en los que se utilizan introductores hasta 8F, con excelentes resultados, sin apenas complicaciones, y que permite una movilización precoz del paciente (incluso a las 3h del procedimiento).Dada la amplia experiencia en nuestro medio con dicho dispositivo, decidimos el inicio de un protocolo de retirada de los dispositivos de contrapulsación intraaórtica mediante el uso del Angio-Seal™ para la hemostasia. Todos los procedimientos se llevan a cabo en la unidad de cuidados intensivos cardiológicos. Desde el inicio del protocolo (junio de 2014 hasta septiembre de 2015) hemos realizado un total de 33 procedimientos de retirada de balón de contrapulsación intraaórtica con el dispositivo Angio-Seal™ 8F.Hemos incluido un total de 33 pacientes consecutivos (19 varones y 12 mujeres) con una edad media de 64,1 años (rango: 50-83) a los que se les ha implantado un dispositivo de contrapulsación intraaórtica por distintas causas.Como objetivo primario del estudio se ha incluido la ausencia de complicaciones mayores y únicamente una complicación menor (hematoma > 10 cm), siendo la efectividad en la liberación del dispositivo del 100.La retirada de los dispositivos de contrapulsación intraaórtica mediante el uso de Angio-Seal™ 8F para la hemostasia se considera un dispositivo rápido, efectivo y seguro, por lo que podemos recomendar su uso, aunque sería necesario un estudio con más pacientes y aleatorizado con respecto a la compresión manual tradicional para recomendar su uso rutinario.AbstractDue to the big experience with Angio-Seal™ Device (St. Jude Medical) in our center to close femoral puncture during cardiac catheterization, we investigated whether the Angio-Seal™ could be used safely and could achieve hemostasis fastly when removing an IABP.We prospectely studied 33 consecutive patients (Age: mean 64,1 years [50-83 years]) in which the Angio-Seal™ 8F device was planned to be used to achieve vascular hemostasis after removal of an IABP between January to December of 2015 in the Cardiac Intensive care unit of Cruces University Hospital. IABP was implanted due to several causes (cardiogenic shock due to STEMI, after cardiac surgery, high risk PCI...).The primary endpoint was a composite of any type of major (retroperitoneal bleeding, vessel occlusion, loss of distal pulses, vascular surgery and death) and minor vascular complication (hematoma, AV fistula or pseudoaneurism).IABP was continued for 1-7 days (mean 4 days). The device was successfully deployed in all of the patients. There were no major and only 2 minor complications (hematoma >10 cm). No patients required additional compression although most of them were treated with antiplatelet drugs.Removal of IABP with the Angio-Seal™ 8F device is a fast, effective and safe procedure that could improve the hemostasis and the confort of the patients compared with the manual compression or other compression decides. We need further randomized studies comparing Angio-Seal™ with conventional methods of compression to recommend routine use

Un tipo especial de coartación compleja de aorta con oclusión total de la luz arterial tratada con radiofrecuencia

Coarctation of aorta (CoA) accounts for between 7% and 10% of cases of congenital heart disease1. Aortic atresia (complete aortic occlusion) is a special and very uncommon type characterized by the total abscence of distal flow, but with luminal continuity between the ascending and descending aorta. Normally occurs in cases of untreated long – standing CoA which progress to complete occlusion Diagnosis is usually established in the context of the study of HTA, stroke or heart failure. It´s usually accompained by extensive collateral circulation and degeneration of aortic wall which can trigger complication such as aneurysm and dissections or even aortic rupture. Surgical treatment is associated with a high rate of morbidity and mortality and for this reason percutaneous treatment has become relevant in recent years. It is performed  by dual arterial access, due to the lenght of the occlussion , it couldn´t be crossed by angioplasty guidewire and we used a radiofrecuency catheter so as to cross. Once the occlusion was crossed we stablished a radial-femoral loop and then we proceeded to a progressive dilatation and finally a covered stent implantation. The collateral circulation is usually highly developed, which confers special surgical difficulty and risk on the procedure. This has led to the development of the percutaneous approach, with techniques for crossing the occluded segment using coronary angioplasty or radiofrequency guidewires (in cases of long occluded segments) and implantation of a stent, which should preferably be covered with ePTFE, The ePTFE stents could be recommended in this type of complex intervention in calcified aortas with a loss of structure due to medial cystic necrosis, which can progress to the formation of aneurysms, dissections, or even rupture. The stent should be positioned correctly in the wall with its ePTFE covering in order to reduce the incidence of complication