Michael E. DeBakey VA Medical Center - Houston, Texas

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VA Physicians Help Draft American Heart Association Guidelines on Vascular Closure Devices

December 29, 2010

Jneid & Rojas

“Our goal was to provide an overview of the benefits and risks of vascular closure devices and help guide the physicians as they decide which instrument is best for each procedure and patient,” said Hani Jneid, M.D. Interventional Cardiology assistant director (left) pictured with Francia Rojas-Delgado, M.D., Baylor College of Medicine fellow in the Cardiac Catheterization Lab at the Michael E. DeBakey VA Medical Center.
PHOTO:  Bobbi Gruner, Public Affairs


HOUSTON – Recommendations on the safety and effectiveness of vascular closure devices have been released by an American Heart Association expert panel made up of physicians and researchers, including two cardiologists from the Michael E. DeBakey VA Medical Center (MEDVAMC) and Baylor College of Medicine (BCM).

“Each year more than 6 million invasive cardiovascular procedures are performed worldwide, and the majority of these procedures use some type of vascular closure device,” said Hani Jneid, M.D., MEDVAMC Interventional Cardiology assistant director. “Many times these devices are overused for certain procedures or used with the purpose of preventing complications. There is no definitive evidence, statement, guidelines to help direct the practicing invasive cardiologists on the use of these devices.”

In response to this concern, members of the Council on Clinical Cardiology of the American Heart Association, along with the Council on Cardiovascular Radiology and Intervention, and the Council on Peripheral Vascular Disease, worked jointly to objectively and systematically review the existing evidence and provide non-binding guidelines on the use of vascular closure devices.

A set of recommendations was created by this group and outlined in a recent edition of the medical journal Circulation.

“Vascular closure devices are used by invasive cardiologists and vascular surgeons to close the femoral artery after diagnostic and interventional cardiovascular procedures and include a wide range of instruments,” said Jneid, who was on the panel and co-authored the statement of recommendations. “As we drafted these recommendations, our goal was to provide an overview of the benefits and risks of these devices and help guide the physicians as they decide which instrument is best for each procedure and patient.”

The AHA Statement focuses on when to use the devices to achieve faster clotting and shorter bed rest, and compares their effectiveness with alternative approaches, such as manual compression. It also gives recommendations for the use of these instruments during clinical trials and includes information on how the use of these devices and their complications should be recorded for future reviews.

“Our hope is that these recommendations are considered by doctors to help them enhance patient care,” said Jneid, also an assistant professor of medicine and interventional cardiologist at BCM.

The panel also included Glenn N. Levine, M.D., F.A.H.A., MEDVAMC staff cardiologist and BCM professor of medicine in cardiology. Drs. Manesh R. Patel, Colin P. Derdeyn, Lloyd W. Klein, Robert Lookstein, Christopher J. White, Yerem Yeghiazarians, and Kenneth Rosenfield participated on behalf of the American Heart Association Diagnostic and Interventional Cardiac Catheterization Committee of the Council on Clinical Cardiology, Council of Cardiovascular Radiology and Intervention, and the Council on Peripheral Vascular Disease. 

For the complete list of recommendations and disclosures related to the panel, log onto http://circ.ahajournals.org/cgi/content/full/122/18/1882?hits=10&FIRSTINDEX=0&FULLTEXT=jneid&SEARCHID=1&gca=circulationaha%3B122%2F18%2F1882&

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Awarded re-designation for Magnet Recognition for Excellence in Nursing Services in 2008, the Michael E. DeBakey VA Medical Center serves as the primary health care provider for more than 120,000 veterans in southeast Texas. Veterans from around the country are referred to the MEDVAMC for specialized diagnostic care, radiation therapy, surgery, and medical treatment including cardiovascular surgery, gastrointestinal endoscopy, nuclear medicine, ophthalmology, and treatment of spinal cord injury and diseases. The MEDVAMC is home to a Post Traumatic Stress Disorder Clinic; Network Polytrauma Center; an award-winning Cardiac and General Surgery Program; Liver Transplant Center; VA Epilepsy and Cancer Centers of Excellence; VA Substance Abuse Disorder Quality Enhancement Research Initiative; Health Services Research & Development Center of Excellence; VA Rehabilitation Research of Excellence focusing on mild to moderate traumatic brain injury; Mental Illness Research, Education and Clinical Center; and one of the VA’s six Parkinson’s Disease Research, Education, and Clinical Centers. Including the outpatient clinics in Beaumont, Conroe, Galveston, Houston, Lufkin, and Richmond, MEDVAMC outpatient clinics logged more than one million outpatient visits in fiscal year 2010. For the latest news releases and information about the MEDVAMC, visit www.houston.va.gov.