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      Vascular Closure Devices For Axillary Artery Access: A Systematic Review and Meta-Analysis

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          Abstract

          Purpose:

          To evaluate the technical success and complication rates of vascular closure devices (VCDs) in the axillary artery.

          Materials and Methods:

          MEDLINE and Embase were searched independently by two reviewers to identify observational studies from inception through October 2021. The following outcomes were meta-analyzed: technical success, hematoma, dissection, pseudoaneurysm, infection, and local neurological complications. Complications were also graded as mild, moderate, and severe. A logistic regression evaluating the influence of sheath size for the outcome of technical success rate was performed using individual patient–level data.

          Results:

          Of 1496 unique records, 20 observational studies were included, totaling 915 unique arterial access sites. Pooled estimates were as follows: technical success 84.8% (95% confidence interval [CI]: 78%–89.7%, I 2=60.4%), hematoma 7.9% (95% CI: 5.8%–10.6%, I 2=0%), dissection 3.1% (95% CI: 1.3%–7.3%, I 2=0%), pseudoaneurysm 2.7% (95% CI: 1.3%–5.7%, I 2=0%), infection <1% (95% CI: 0%–5.7%, I 2=20.5%), and local neurological complications 2.7% (95% CI: 1.7%–4.4%, I 2=0%). There was a significant negative association between sheath size and technical success rate (odds ratio [OR]: 0.87 per 1 French (Fr) increase in sheath size, 95% CI: 0.80–0.94, p=0.0005). Larger sheath sizes were associated with a greater number of access-site complications (adjusted odds ratio [aOR]: 1.21 per 1 Fr increase sheath size, 95% CI: 1.04–1.40, p=0.013).

          Conclusions:

          Off-label use of VCDs in the axillary artery provides an 85% successful closure rate and variable complication rate, depending on the primary procedure and sheath size. Larger sheaths were associated with a lower technical success and greater rate of access-related complications.

          Clinical Impact

          Safe arterial access is the foundation for arterial intervention. While the common femoral artery is a well established access site, alternative arterial access sites capable of larger sheath sizes are needed in the modern endovascular era. This article provides the largest synthesis to date on the use of vascular closure devices for percutaneous axillary artery access in endovascular intervention. It should serve clinicians with added confidence around this approach in terms of providing a reference for technical success and complications. Clinically, this data is relevant for patient consent purposes as well as for practice quality improvement in setting safety standards for this access site.

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          Most cited references36

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          Quantifying heterogeneity in a meta-analysis.

          The extent of heterogeneity in a meta-analysis partly determines the difficulty in drawing overall conclusions. This extent may be measured by estimating a between-study variance, but interpretation is then specific to a particular treatment effect metric. A test for the existence of heterogeneity exists, but depends on the number of studies in the meta-analysis. We develop measures of the impact of heterogeneity on a meta-analysis, from mathematical criteria, that are independent of the number of studies and the treatment effect metric. We derive and propose three suitable statistics: H is the square root of the chi2 heterogeneity statistic divided by its degrees of freedom; R is the ratio of the standard error of the underlying mean from a random effects meta-analysis to the standard error of a fixed effect meta-analytic estimate, and I2 is a transformation of (H) that describes the proportion of total variation in study estimates that is due to heterogeneity. We discuss interpretation, interval estimates and other properties of these measures and examine them in five example data sets showing different amounts of heterogeneity. We conclude that H and I2, which can usually be calculated for published meta-analyses, are particularly useful summaries of the impact of heterogeneity. One or both should be presented in published meta-analyses in preference to the test for heterogeneity. Copyright 2002 John Wiley & Sons, Ltd.
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            • Article: not found

            Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses.

              Bookmark
              • Record: found
              • Abstract: not found
              • Article: not found

              Meta-analysis in clinical trials

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                Author and article information

                Journal
                J Endovasc Ther
                J Endovasc Ther
                JET
                spjet
                Journal of Endovascular Therapy
                SAGE Publications (Sage CA: Los Angeles, CA )
                1526-6028
                1545-1550
                10 January 2023
                October 2024
                : 31
                : 5
                : 763-771
                Affiliations
                [1 ]Department of Radiology, McMaster University, Hamilton, ON, Canada
                [2 ]Division of Vascular and Interventional Radiology, Department of Medical Imaging, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
                [3 ]Division of Vascular Surgery, University Health Network, Toronto, ON, Canada
                [4 ]Peter Munk Cardiac Centre, Toronto General Hospital, University Health Network, Toronto, ON, Canada
                [5 ]Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany
                Author notes
                [*]Sebastian Mafeld, Division of Vascular and Interventional Radiology, Department of Medical Imaging, Toronto General Hospital, University of Toronto, 585 University Avenue, Toronto, ON M5G 2N2, Canada. Email: sebastiancharles.mafeld@ 123456uhn.ca
                Author information
                https://orcid.org/0000-0002-3914-4373
                https://orcid.org/0000-0002-3468-1313
                Article
                10.1177_15266028221147451
                10.1177/15266028221147451
                11408977
                36625294
                9bdae726-89e8-46b9-aeda-5a462a114f57
                © The Author(s) 2023

                This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ( https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages ( https://us.sagepub.com/en-us/nam/open-access-at-sage).

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                axillary artery,interventional radiology,vascular closure device

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