{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T14:17:32Z","timestamp":1787926652240,"version":"build-2784847793"},"reference-count":10,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T00:00:00Z","timestamp":1787529600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Endovasc Ther"],"abstract":"<jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>To describe the ECO-PLUG technique, a standardised ultrasound-guided workflow for percutaneous femoral access and plug-based closure, and to report its feasibility and clinical performance in patients undergoing peripheral artery revascularization procedures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Technique:<\/jats:title>\n                    <jats:p>The ECO-PLUG protocol incorporates continuous ultrasound guidance throughout all procedural phases: femoral access, closure device deployment, and post-procedural haemostasis verification. Five predefined checkpoints (C1-C5) structure the workflow from pre-access mapping to early and delayed ultrasound follow-up. Key elements include in-plane puncture, ultrasound-guided plug deployment with a modified retract manoeuvre, and systematic colour-Doppler assessment at 0 and 3 to 5 minutes after closure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>A total of 200 elective endovascular procedures using 6F\/8F femoral access were analysed. Anatomical complexity was common, including moderate-to-severe anterior wall calcification (55%), arterial depth &gt;35 mm (24%), and bifurcation variants (22%). Immediate haemostasis was achieved in 98% of cases, while 2% required prolonged compression or manual conversion. Access-related complications occurred in 4% of patients, including pseudoaneurysms (1.5%) and haematomas. No arterial occlusions or surgical conversions were observed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>The ECO-PLUG protocol demonstrates acceptable haemostasis efficacy and a favourable access-site safety profile across anatomically complex settings, supporting its potential as a structured image-guided closure strategy. Prospective comparative studies are needed to validate these preliminary findings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Impact<\/jats:title>\n                    <jats:p>The ECO-PLUG protocol introduces the first formally structured, checkpoint-based ultrasound workflow integrating continuous imaging guidance across all phases of percutaneous femoral closure, from pre-access mapping through plug deployment and hemostasis verification. Unlike conventional approaches, where ultrasound use is typically limited to arterial puncture alone, ECO-PLUG extends real-time sonographic control to anchor positioning and collagen release, reducing operator dependency in anatomically complex cases. With 98% immediate hemostasis and no arterial occlusions or surgical conversions across 200 consecutive procedures, including patients with heavy calcification, deep vessels, and bifurcation variants, this protocol offers clinicians a reproducible, teachable standard applicable across varying experience levels.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/15266028261479300","type":"journal-article","created":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T13:07:19Z","timestamp":1787576839000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["The ECO-PLUG Technique: Ultrasound-Guided Optimization of Haemostasis After Percutaneous Femoral Access \u2013 a Pictorial Technical Note"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6619-0159","authenticated-orcid":false,"given":"Edoardo","family":"Pasqui","sequence":"first","affiliation":[{"name":"Vascular Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2559-3968","authenticated-orcid":false,"given":"Leonardo","family":"Pasquetti","sequence":"additional","affiliation":[{"name":"Vascular Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manfredi Giuseppe","family":"Anzaldi","sequence":"additional","affiliation":[{"name":"Vascular Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4073-9577","authenticated-orcid":false,"given":"Giuseppe","family":"Galzerano","sequence":"additional","affiliation":[{"name":"Vascular Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2451-8501","authenticated-orcid":false,"given":"Gianmarco","family":"de Donato","sequence":"additional","affiliation":[{"name":"Vascular Surgery Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,8,24]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCINTERVENTIONS.114.001306"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1177\/1538574412457475"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvs.2005.11.009"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2010.04.015"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCINTERVENTIONS.109.877407"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.25259\/JCIS_68_2023"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jvir.2017.06.019"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2014.05.036"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.avsg.2025.05.040"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.avsg.2022.04.017"}],"container-title":["Journal of Endovascular Therapy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/15266028261479300","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/15266028261479300","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/15266028261479300","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T13:18:11Z","timestamp":1787923091000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/15266028261479300"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,24]]},"references-count":10,"alternative-id":["10.1177\/15266028261479300"],"URL":"https:\/\/doi.org\/10.1177\/15266028261479300","relation":{},"ISSN":["1526-6028","1545-1550"],"issn-type":[{"value":"1526-6028","type":"print"},{"value":"1545-1550","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,24]]},"article-number":"15266028261479300"}}