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Formation of the Platelet Plug01:22

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The platelet phase, the second stage of hemostasis, commences around 15-20 seconds after an injury. It follows and overlaps with the vascular phase, during which blood vessels constrict to minimize blood loss.
As the injured blood vessel contracts, endothelial cells undergo contraction, revealing collagen fibers in the basement membrane and underlying connective tissue. Furthermore, the plasma membrane of endothelial cells becomes adhesive, preparing the site for platelet adhesion. Platelets...
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Fully Endoscopic Mitral Valve Repair with Percutaneous Cannulation of Groin Vessels
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Collagen plug-based vascular closure devices do not decrease vascular and bleeding complications occurring after

Florence Leclercq1, Delphine Delseny1, Richard Gervasoni1

  • 1Department of Cardiology, University of Montpellier, Montpellier, France.

Archives of Cardiovascular Diseases
|March 11, 2015
PubMed
Summary

Collagen plug-based vascular closure devices (VCDs) did not reduce, but rather increased, femoral access complications after balloon aortic valvuloplasty. Their routine use in elderly patients undergoing this procedure is questionable.

Keywords:
Balloon aortic valvuloplastyComplications vasculairesFermeture vasculaire percutanéeValvuloplastie aortique au ballonVascular closure devicesVascular complications

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Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Vascular Surgery

Background:

  • The efficacy of vascular closure devices (VCDs) in preventing vascular complications post-femoral intervention is debated.
  • Balloon aortic valvuloplasty (BAV) frequently involves femoral access, carrying risks of complications.

Purpose of the Study:

  • To assess the effectiveness of collagen plug-based VCDs in mitigating femoral access complications after BAV.
  • To compare complication rates between VCDs and manual/mechanical compression in BAV patients.

Main Methods:

  • A prospective study analyzed 180 patients undergoing BAV via femoral retrograde technique.
  • Group 1 (75 patients) used 8F collagen plug-based VCDs; Group 2 (105 patients) used manual/mechanical compression.
  • Data collected included major adverse events, bleeding (BARC ≥3), and vascular access complications; no heparin was used.

Main Results:

  • No significant reduction in vascular and bleeding complications was observed with VCD use (RR 2.60, CI 1.10-3.09; P=0.05).
  • Complication rates were similar across subgroups, and hospital stay duration was not improved by VCDs.
  • Collagen plug-based VCDs were associated with an increased risk of femoral access complications in this cohort.

Conclusions:

  • Collagen plug-based VCDs may increase femoral access complications after BAV, particularly when small sheaths and no heparin are used.
  • The routine application of VCDs in elderly patients with potential limb atherosclerosis undergoing BAV warrants careful consideration.
  • Further research is needed to clarify the role of VCDs in specific patient populations and procedural contexts.