title: Safety and efficacy of combined micropuncture and shallow angle femoral artery access for neurovascular angiography.
abstract: BACKGROUND
  The AXERA 2 low-angle vascular access device utilizes a dual arteriotomy mechanism in which the standard access tract is compressed by a vascular sheath inserted over the second, low-angle tract. It is unknown whether this device could be effectively used with 21-gauge micropuncture access, as the micropuncture introducer makes a larger arteriotomy than the 19-gauge needle provided with the AXERA 2 system.
  
  
  METHODS
  A retrospective review was performed on 189 patients who underwent common femoral artery access for diagnostic cerebrovascular angiography using either combined micropuncture and AXERA 2 access or standard access with manual pressure hemostasis. Demographic and procedural data were reviewed along with complications related to vascular access and times to bed elevation, ambulation and discharge.
  
  
  RESULTS
  Combined micropuncture and AXERA 2 access was performed on 110 patients and 79 patients had standard access. The AXERA device was successfully used in 91.8% of the cases. Demographic data, anticoagulant use and sheath sizes were similar between both subsets. Use of the AXERA 2 was associated with two bleeding complications (1.8%) compared with 10 (12.7%) with manual pressure hemostasis alone. Institution-specific protocol allowed shorter mean manual compression time, as well as shorter times to ambulation and discharge with the AXERA 2.
  
  
  CONCLUSIONS
  Use of the AXERA 2 device with micropuncture access did not infer increased bleeding risk than standard arterial access in this patient series. The considerable incidence of device use failures suggests a learning curve associated with its use.
authors.affiliation: University of Tennessee Graduate School of Medical Education, Knoxville, TN - USA.
authors.forename: Austin C
authors.initials: AC
authors.lastname: Bourgeois
authors.affiliation: University of Tennessee Graduate School of Medical Education, Knoxville, TN - USA.
authors.forename: Chris T
authors.initials: CT
authors.lastname: Kolze
authors.affiliation: Department of Radiology, Medical University of South Carolina, Charleston, SC - USA.
authors.forename: Marcelo S
authors.initials: MS
authors.lastname: Guimaraes
authors.affiliation: University of Tennessee Graduate School of Medical Education, Knoxville, TN - USA.|University of Tennessee Medical Center, Knoxville, TN - USA.
authors.forename: Alexander S
authors.initials: AS
authors.lastname: Pasciak
authors.affiliation: University of Tennessee Graduate School of Medical Education, Knoxville, TN - USA.|University of Tennessee Medical Center, Knoxville, TN - USA.
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Ferrell
authors.affiliation: University of Tennessee Graduate School of Medical Education, Knoxville, TN - USA.|University of Tennessee Medical Center, Knoxville, TN - USA.
authors.forename: Yong
authors.initials: Y
authors.lastname: Bradley
authors.affiliation: University of Tennessee Graduate School of Medical Education, Knoxville, TN - USA.|University of Tennessee Medical Center, Knoxville, TN - USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Kvamme
mesh_terms: D002533:Cerebral Angiography / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D002983:Clinical Competence; D004867:Equipment Design; D004868:Equipment Failure; D005263:Femoral Artery / Q000000981:diagnostic imaging; D006470:Hemorrhage / Q000209:etiology / Q000517:prevention & control; D006489:Hemostatic Techniques; D006801:Humans; D059032:Learning Curve; D011677:Punctures; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D062666:Vascular Access Devices