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Clinical Research in Vascular Access Devices

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Vascular Medicine".

Deadline for manuscript submissions: 20 November 2026 | Viewed by 1289

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Dr. Antonio Gidaro

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Department of Biomedical and Clinical Sciences, Università degli Studi di Milano and Internal Medicine, Luigi Sacco Hospital, ASST-FBF-Sacco, Milan, Italy
Interests: vascular access devices (VADs); peripherally inserted central catheter (PICC); catheter-related thrombosis (CRT); catheter-related bloodstream infection (CRBSI); central line-associated bloodstream infection (CLABSI); angioedema

Special Issue Information

Dear Colleagues,

Vascular access devices (VADs) are among the most frequently used medical instruments. A significant proportion of hospitalized patients are administered venous catheters, and their utilization has similarly expanded among outpatient populations for the administration of chemotherapy, antibiotics, nutritional support, and other intravenous medications. VADs encompass peripheral vascular access devices (PVADs) and central venous access devices (CVADs). Their length characterizes the former: short peripheral catheters (SPCs) measure less than 6 cm, long peripheral catheters (LPCs) range from 6 to 15 cm, and midline catheters (MCs) measure between 15 and 25 cm. CVADs are further categorized into peripherally inserted central catheters (PICCs), femorally inserted central catheters (FICCs), centrally inserted central catheters (CICCs), and totally implantable venous access devices (TIVADs).

Therefore, the use of VADs is not risk-free. Complications with VAD use can occur even when using the most appropriate device, insertion technique, and care. The most important are as follows:

Intraprocedural complication: arterial puncture, pneumothorax, and primary malposition of CVAD;
VAD infection: catheter-related bloodstream infection (CRBSI), catheter-associated bloodstream infection (CABSI), or central line-associated bloodstream infection (CLABSI);
Catheter-related thrombosis (CRT) and fibroblastic sleeve;
Tissue injuries (infiltration and extravasation);
Mechanical complications, including accidental removal, occlusion, rupture of the catheter, or secondary malposition;
Medical adhesive-related skin injury (MARSI);
Catheter-associated skin impairment (CASI).

This Special Issue focuses on collecting works that address the topic from aspects, including visualization techniques, insertion techniques, nursing care, and more, to improve patient care standards and reduce all VAD-related complications.

Dr. Antonio Gidaro
Guest Editor

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Keywords

short peripheral catheters
long peripheral catheters
midline
peripherally inserted central catheters (PICCs)
femoral-inserted central catheters (FICCs)
centrally inserted central catheters (CICCs)
totally implantable venous access devices (TIVAD)
catheter-related bloodstream infection (CRBSI)
catheter-associated bloodstream infection (CABSI)
central line-associated bloodstream infection (CLABSI)
catheter-related thrombosis (CRT)
fibroblastic sleeve
infiltration
extravasation

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Published Papers (2 papers)

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Research

16 pages, 641 KB

Open AccessArticle

Mechanical Compression Versus Vascular Closure Devices for Femoral Artery Haemostasis After Peripheral Endovascular Procedures: A Randomised Controlled Trial

by Irina Shevchenko, Bernardette Jingfei Lee, Davina Daudu, James Dodd, Jackie Wong, Olufemi Ayoadeleke Oshin, Fernando Picazo-Pineda, Mahmoud Al-Najjar, Tanya Michelle Rhine, Carolina Bravo Ceballos and Bibombe Patrice Mwipatayi

J. Clin. Med. 2026, 15(11), 4197; https://doi.org/10.3390/jcm15114197 - 29 May 2026

Viewed by 317

Abstract

Background: Femoral arteriotomy closure after peripheral angiography and intervention is commonly achieved using vascular closure devices (VCDs) or compression-based strategies; however, comparative randomised data in contemporary peripheral endovascular practice remain limited. Methods: In this prospective randomised trial, adults undergoing femoral-access diagnostic angiography or peripheral endovascular intervention were assigned in a 1:1 ratio to haemostasis with the FemoStop™ II Gold pneumatic compression system or a contemporary VCD strategy. The primary endpoint was a composite of major or minor groin-site complications immediately after sheath removal. Secondary endpoints included composite complications at recovery, discharge, and 30 days, with separate analyses of major and minor complications. Patient-reported pain was assessed using the Verbal Numerical Rating Scale (VNRS). Efficacy and safety analyses were performed according to the intention-to-treat and as-treated principles, respectively. Risk ratios were estimated using modified Poisson regression with robust variance, with prespecified adjustment for sex, systolic blood pressure before sheath removal, and sheath size. Results: A total of 130 participants underwent randomisation, including 66 assigned to FemoStop™ II Gold and 64 assigned to VCDs. The primary composite endpoint occurred in 23/66 participants (34.9%) in the FemoStop™ II Gold group and 16/64 (25.0%) in the VCD group (absolute difference, 9.9 percentage points; 95% confidence interval [CI], −6.1 to 25.7; p = 0.25), with the numerical difference driven predominantly by minor-only events (28.8% versus 15.6%; p = 0.09). At 30 days, the composite endpoint occurred in 17/66 participants (25.8%) and 12/64 participants (18.8%), respectively (absolute difference, 7.0 percentage points; 95% CI, −13.3 to 26.4; p = 0.40). Serious access-site events remained infrequent both immediately post-procedure (6.1% versus 9.4%; p = 0.53) and at 30 days (6.1% versus 4.7%; p = 0.72). The adjusted risk ratios were 1.28 (95% CI, 0.74 to 2.21) for the primary composite endpoint and 1.23 (95% CI, 0.63 to 2.40) for the 30-day composite endpoint. Ordinal VNRS pain distributions did not differ significantly at any timepoint, although “any pain” immediately post-procedure was less frequent with FemoStop™ II Gold (22.7% versus 40.6%; unadjusted risk ratio, 0.56; 95% CI, 0.33 to 0.93); this association was attenuated after adjustment (adjusted risk ratio, 0.63; 95% CI, 0.38 to 1.03). Prespecified interaction testing suggested that the effect of treatment on composite complications varied according to sheath size both immediately post-procedure and at 30 days (p < 0.001 for both interactions). Conclusions: In patients undergoing femoral-access diagnostic angiography or peripheral endovascular intervention, haemostasis with FemoStop™ II Gold resulted in 30-day groin-site complication rates that did not differ significantly from those observed with contemporary VCD strategies. Serious access-site events remained infrequent in both groups, and the apparent early reduction in patient-reported pain with FemoStop™ II Gold was not definitive after adjustment. Larger, adequately powered multicentre studies are warranted to clarify sheath size-dependent effects and uncommon clinically consequential vascular events. Full article

(This article belongs to the Special Issue Clinical Research in Vascular Access Devices)

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14 pages, 1003 KB

Open AccessArticle

Risk Factors for Catheter-Related Thrombosis

by Leyla La Cava, Davide Giustivi, Arianna Bartoli, Alessia Meschia, Federica Cirigliano, Teresa Lanzi, Beatrice Tramalloni, Maria Calloni, Paolo Zappa, Alba Taino, Giacomo Ronzoni, Antonella Foschi, Igor Giarretta, Marco Gemma, Adam Fabiani, Chiara Cogliati and Antonio Gidaro

J. Clin. Med. 2026, 15(10), 3932; https://doi.org/10.3390/jcm15103932 - 20 May 2026

Viewed by 466

Abstract

Background: Although guidelines emphasize proper insertion techniques and tip positioning, catheter-related thrombosis (CRT) remains a common and clinically significant complication of peripherally inserted central catheters (PICCs) and midline catheters (MCs). In this context, the use of pharmacological prophylaxis is still debated. This study aims to assess the incidence of CRT in patients receiving anticoagulant therapy (therapeutic or prophylactic) and antiplatelet therapy. Methods: This retrospective study was conducted at a tertiary care hospital and included adult patients from March 2021 to May 2023. Six potential confounders were analyzed: anticoagulation status (none, prophylaxis, therapeutic), antiplatelet therapy, tip position (PICCs vs. MCs), number of lumens, CRT risk factors, and drug infusion requiring central access. CRT was diagnosed in symptomatic patients using compression ultrasonography. Propensity score weighting and logistic regression were employed to estimate odds ratios (OR) and average treatment effects. Results: A total of 1431 patients were enrolled. PICCs and therapeutic anticoagulant therapy were highly protective against CRT (OR 0.068 [95% CI 0.013–0.2] and OR 0.007 [95% CI 0.001–0.046], respectively). Prophylactic anticoagulant therapy (OR 0.328 [95% CI 0.200–0.519]) and antiplatelet therapy (OR 0.342 [95% CI 0.182–0.595]) also showed protective effects. At the same time, neither the number of lumens, the presence of risk factors, nor the infusion of irritating drugs was independently associated with CRT. Conclusions: The use of anticoagulant drugs (both prophylactic and therapeutic), antiplatelet therapy, and PICC use significantly lowered the risk of CRT. The findings support personalized prevention strategies and underscore the need for a well-designed randomized controlled trial to validate these findings. Full article

(This article belongs to the Special Issue Clinical Research in Vascular Access Devices)

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