Access Approach Research Articles

Radial Access Approach to Peripheral Vascular Interventions: A Scientific Statement From the American Heart Association.

Transradial arterial access has transformed the field of coronary interventions, where it has several advantages over femoral access, such as reduced bleeding and access site complications, improved patient comfort, shorter time to ambulation after the procedure, reduced length of hospital stay, and potentially reduced mortality rates. Because of these benefits, as well as the concurrent expanding indications for various endovascular therapies, there is growing interest in adopting radial access for peripheral vascular interventions. However, radial access can present challenges, and specialized equipment for peripheral interventions through this route are under development. Nevertheless, a growing number of studies, largely comprising single-center and registry data, have broadly suggested that transradial arterial access is likely to be safe and associated with reduced bleeding and local access site complications for most peripheral interventions compared with transfemoral access. Large, prospective randomized trials are lacking, and the question of any effect on mortality rates has not been addressed. Whereas the field of transradial arterial access for peripheral vascular interventions is in development, it is clear that this approach, at least with available equipment, will not be suitable for all patients, and careful case selection is paramount. Furthermore, the remaining knowledge gaps must be addressed, and robust outcome data obtained, to allow full understanding of the factors that determine optimal patient, lesion, and equipment selection. Nevertheless, the use of transradial arterial access for peripheral vascular interventions holds great promise, particularly if the necessary technologic advances are rapid and favorable clinical trial data continue to emerge.

Abstract 4134878: Single Perclose Plus Angioseal Versus Double Perclose for Percutaneous Femoral Access: A Systematic Review and Meta-Analysis

Background: Vascular Closure utilizing Suture Based Devices (SBD) is an established approach for large-bore arterial access in percutaneous procedure patients. Standard of care uses two devices when accessing the artery with 8 Fr sheaths and above. The bailout use of Plug-based devices (PBD) is well established, but little is known about the intentional combination of SBD with PBD and how this technique compares to the standard approach. We aimed to compare these different approaches in this meta-analysis. Methods: PubMed, Scopus, and Cochrane databases were searched for observational studies comparing the hybrid approach to the standard one utilizing exclusively SBDs for arterial closure in large bore vascular access and reported the outcomes of (1) Access-related complications (ARC); (2) Major bleeding; (3) All bleeding events; (4) Need for surgical intervention; (5) Need for endovascular intervention ; (6) Device failure; (7) Pseudoaneurysm. Heterogeneity was examined with I2 statistics. A random-effects model was used for all outcomes. Results: We included five observational studies with 1,586 patients, of whom 1,489 (93.8%) underwent TAVI and 97 (6.1%) EVAR. Sheath size had an average of 20.56 Fr in the EVAR patients. ARC (RR 0.48; 95% CI 0.28-0.81; p<0.01), major bleeding (RR 0.29; 95% CI 0.19-0.44; p<0.01), all bleeding events (RR 0.36; 95% CI 0.23-0.56; p<0.01), surgical intervention (RR 0.28; 95% CI 0.10-0.78; p=0.01), or endovascular intervention (RR 0.53; 95 % CI 0.28-0.98; p=0.04), and device failure (RR 0.28; 95% CI 0.11-0.72; p<0.01) were significantly less common in patients treated with the hybrid technique compared to standard care. Pseudoaneurysm (RR 1.13; 95% CI 0.57-2.25; p=0.71) was not significantly different between groups. Conclusion: These findings suggest the hybrid technique, was associated with fewer access complications compared to the standard double SBD as a closure strategy in patients with large bore arterial access.

Healthcare professionals’ cross-organizational access to electronic health records: A scoping review

BackgroundCross-organizational access to shared electronic health records can enhance integrated, people-centered health services. However, a gap remains between these potential benefits and the limited support currently offered by electronic health records. The Valkyrie research project aims to bridge this gap by developing a technical prototype of an architecture to promote healthcare service coordination. ObjectiveTo inform the Valkyrie project, we aimed to evaluate approaches for healthcare professionals’ access to electronic health records across healthcare providers and identify factors influencing the success and failure of these approaches. Materials and methodsUsing the Joanna Briggs Institute guidance for scoping reviews, searches were conducted in six research databases and grey literature, without limitations on year or language. Papers selected for full-text review were analyzed, and data was extracted using standardized forms that reflected the population, concept, and context framework and the categorization model used in the qualitative analysis of the barriers and facilitators reported in the included papers. ResultsAmong the 290 identified papers, five were deemed eligible for full-text review. The included papers were heterogeneous in country, year of publication, study setting, implementation level, and access approaches to electronic health records, highlighting various techniques, from federated to centralized, for accessing shared electronic health records. Discussion and conclusionThe review did not identify one single superior access approach. However, a hybrid approach incorporating components from the different approaches combined with emerging technologies may benefit the Valkyrie project. The key facilitators were identified as improved information quality and flexible and easy access. In contrast, lack of trust and poor information quality were significant barriers to successful cross-organizational access to electronic health records. Future research should explore alternative access approaches, considering information quality, user training, and collegial trust across healthcare providers.

Novel technique of laparoscopic mid-urethral autologous rectus fascial sling for stress urinary incontinence.

Serious concerns have been raised over the safety of vaginal mesh tapes for stress urinary incontinence (SUI). Autologous rectus fascial sling and the more recent 'sling on a string' through a laparotomy are gaining popularity as native tissue options for SUI. We describe a novel technique of laparoscopic mid-urethral autologous rectus fascial sling for SUI. Ten patients underwent this new technique safely. At 12 months, all patients reported cure of SUI with normal voiding. The advantages of this technique include the minimal access approach, introduction of the sutures under laparoscopic guidance, and avoidance of over-tightening of the sling.

Diastereoselective Construction of Spirocyclic Isobenzofurans via a Tandem Michael Addition/5-Exo-dig Cyclization Reaction.

A practical approach for rapid and efficient access to spirocyclic isobenzofurans is described. The reaction proceeds through the cycloaddition of 1,6-ynenone derivatives and 4-nitro-1,3-diarylbutan-1-ones, promoted by Cs2CO3 in the presence of l-proline as a catalyst. The advantages of this reaction include the formation of two C-C bonds and one C-O bond as well as mild reaction conditions. Extended spirocyclic isobenzofurans are obtained with good efficiency and diastereoselectivity under these mild conditions, and this new protocol avoids the use of any transition-metal reagents.

Improved migration algorithms for uplink transmission secrecy sum rate maximization in MIMO-NOMA

The most significant technology that could assist future high-speed wireless systems in meeting their growing capacity demands is Non-Orthogonal Multiple Access (NOMA). Nevertheless, NOMA should strive to achieve a harmonious equilibrium between equitable distribution among users and optimal network performance. A wireless communication network is a system that enables connections with limited power resources, such as Internet of Things (IoT) devices. Horizontal multiplexing is a feature of MIMO networks that allows for the concurrent transmission of multiple data streams. Nevertheless, there is a correlation between space multiplexing and the advantages of diversity. The issue of Secrecy Sum Rate (SSR) is complex and challenging. To address this, a first-order Taylor estimate is employed to transform the initial problem into a more manageable convex problem. Striking the right balance to optimize network performance and maximize overall rate can be quite challenging, particularly in time-sensitive scenarios. The total rate that can be achieved is reduced due to interference from different users and the use of multiple transmitting antennas. To optimize performance and achieve the highest possible data transmission rate, it is crucial to employ efficient techniques for managing interference. These may include coding methods, adjustments to positioning, or coordinating multiple users. Thus, this work proposes the utilization of optimization to enhance SSR in the MIMONOMA uplink transmission framework. The Singular Value Decomposition (SVD) method is commonly used for the decomposition of channels in the MIMONOMA system. The primary goal of the developed MIMONOMA uplink transmission framework is to enhance the capacity of the Base Station (BS) by optimizing the power allocation measures of the near user and far user using an Improved Migration Algorithm (IMA). In addition, the SSR is optimized and multiple experimental validations are generated to appraise the suggested model. Ultimately, the suggested outcomes are contracted with conventional Orthogonal Multiple Access (OMA) and other traditional approaches to assess the efficacy of the designed model, and developed model given the SSR to be 30bit/s/Hz.

Single arterial access versus standard access in TAVI: results from a large multicenter registry

Abstract Background The transfemoral approach has become the gold standard primary access for transcatheter aortic valve implantation (TAVI) due to low complication rates. An additional secondary access (ScA) is used for angiographic guidance of the procedure. Recently, small, single-center studies demonstrated feasibility of single-access for transfemoral TAVI without a secondary access. However, comparative and large-scale data are missing. Purpose We assessed vascular and bleeding complications of ScA and Single access (SA) approaches in a large multicenter registry to evaluate both strategies. Methods The PULSE registry (Plug or sUture based vascuLar cloSurE after TAVI) retrospectively evaluated data of 10,120 patients who underwent transfemoral TAVI at 10 high-volume German heart centers from 2016 to 2021. In 9,457 patients who qualified for analysis ScA (80.7% femoral, 19.3% radial) were performed in 8709 (92%) and SA in 748 (8%). Outcomes were evaluated in accordance with the Valve Academic Research Consortium (VARC-3) definitions. Results Median age was 81.9[IQR 78.2, 85.1] years and 48.9% of patients were female (median logistic EuroSCORE II: 3.3% [IQR 2.1, 5.6]). Peripheral artery disease was comparable between groups (13.5 vs. 14.0%, p=0.73). While overall major access-related vascular complications did not differ significantly (6.1% vs. 4.8%, p=0.20), there was a higher incidence of minor complications for ScA compared to SA (9.0% vs. 2.8%, p<0.001). Secondary access complications amounted to 2.7% in the ScA group and were mainly characterized as bleeding (1.2%) and pseudoaneurysms (1.2%) mostly treated conservatively (1.2%), yet in some cases surgical repair was needed (0.8%). No significant difference was observed regarding type III/IV bleeding (4.1% vs. 4.3%, p=0.91), stroke rate (2.4% vs. 3.6%, p=0.05), stage III/IV acute kidney injury (2.4% vs. 2.4%, p=1.00) or all-cause 30-day mortality (5.8% and 5.7%, p=0.99) for ScA compared to SA groups. Conclusion In patients treated with transfemoral TAVI, a single access approach was associated with lower rates of minor access-related vascular complications without compromising overall outcomes, suggesting potential benefits of a minimally-invasive TAVI approach with the omission of additional vascular access.

TAVI-related vascular access complications: are Viabahn stents a good option?

Abstract Background Vascular access complications (VACs) remain one of the biggest challenges when performing transcatheter aortic valve implantation (TAVI). Historically, concerns regarding stent placement in flexing points have been a deterrent to the percutaneous treatment of VACs, due to the potential development of claudication over time. The Viabahn stent, being a covered stent that offers flexibility and conformability, may be well-suited for deployment in these anatomies. Purpose This study aimed to evaluate the safety and efficacy of the iliofemoral Viabahn stenting for treating TAVI-related VACs. Methods Retrospective analysis of patients submitted to Viabahn stenting in the iliofemoral sector for TAVI-related VACs in a single tertiary centre between January 2017 and October 2023. Baseline characteristics, procedure data and complications were noted according to the Valve Academic Research Consortium-2. Results A total of 722 patients were submitted to transfemoral TAVI during the study period. Of these, 25 (3.6%) underwent Viabahn stenting to treat TAVI-related VACs and were included in this study. Patient mean age was 82.1±6.13 years, 61.2% were male. At the baseline, patients had a mean Euroscore II of 2.73±1.91. A unilateral access approach was used in 40% of cases. The median size of the main access sheath was 14 Fr [IQ 14-16], and the closure devices deployed were Manta® in 72%, and Perclose® in 28%. The Viabahn stent treated different types of VACS, including vessel rupture in 56%, acute dissection in 28% (12% with no antegrade flow), and failed sealing in 16%. The complicated artery was the common femoral in 82%, and the external iliac in 18%. Percutaneous treatment with Viabahn stenting was successful in 92% of cases. In two cases (8%), one of acute occlusion and one of vessel rupture, vascular surgery was required. During the hospital stay, there were no further vascular or hemorrhagic complications. After a mean follow-up of 15 months, 20% of patients were evaluated by Doppler which showed no signs of restenosis or stent complications. Only one patient experienced lower limb claudication at 1 year due to stent restenosis detected in the CT scan, which was managed with medical therapy. There were no other adverse vascular events during follow-up. Conclusion Our study suggests that Viabahn stenting emerges as a valuable therapeutic option, ensuring long-term safety and efficacy, in the complex realm of TAVI-related vascular complications.

SCUBA implements a storage format-agnostic API for single-cell data access in R

While robust tools exist for the analysis of single-cell datasets in both Python and R, interoperability is limited, and analysis tools generally only accept one object class. Considerable programming expertise is required to integrate tools across package ecosystems into a comprehensive analysis, due to their differing languages and internal data structures. This complicates validation of results and leads to inconsistent visualizations between analysis suites. Conversion between object formats is the most common solution, but this is difficult and error-prone due to the rapid pace of development of the analysis suites and their underlying data structures. To address this, we created SCUBA (Single-Cell Unified Backend API), an R package that implements a unified data access API for all common R and Python single-cell object formats. SCUBA extends the data access approach from the widely used Seurat package to SingleCellExperiment and anndata objects. SCUBA also implements new data-specific access functions for all supported object types. Performance scales well across all SCUBA-supported formats. In addition to performance, SCUBA offers several advantages over object conversion for the visualization and further analysis of pre-processed single-cell data. First, SCUBA extracts only data required for the operation at hand, leaving the original object unmodified. This process is simpler, less error prone, and less memory intensive than object conversion, which operates on the entire dataset. Second, code written with SCUBA can use any supported object class as input, with simple and consistent syntax across object formats. This allows a single analysis script or package (like our interactive single-cell browser, scExploreR) to work seamlessly with multiple object types, reducing the complexity of the code and improving both readability and reproducibility. Adoption of SCUBA will ultimately improve collaboration and reproducible research in single-cell analysis by lowering the barriers between package ecosystems.

Upper- vs Lower-Extremity Secondary Access During Transcatheter Aortic Valve Implantation

An upper-extremity approach for secondary access during transfemoral transcatheter aortic valve implantation (TAVI) may reduce clinically relevant secondary access site-related bleeding. To investigate the safety and efficacy of an upper-extremity approach compared with a lower-extremity approach in patients undergoing TAVI. The TAVI XS trial was a randomized clinical trial performed between November 28, 2022, and November 15, 2023, with a 30-day follow-up, in 4 TAVI centers in the Netherlands. Eligibility was determined first, and only those patients with severe aortic stenosis and no contraindication for upper- or lower-extremity secondary access were informed about the study and asked to participate. Participants were randomized 1:1 between the upper-extremity approach (radial artery diagnostic access and upper-arm vein for temporary pacing lead placement) and lower-extremity approach (femoral artery diagnostic access and femoral vein for temporary pacing lead placement) for secondary access during TAVI. Primary end point was clinically relevant bleeding (Bleeding Academic Research Consortium type 2, 3, or 5) of the randomized secondary access. Secondary end points included any clinically relevant bleeding, time to mobilization, duration of hospitalization, secondary access failure, and procedural time. Of a total of 324 eligible patients, 238 patients undergoing transfemoral TAVI (mean [SD] age, 79.4 [6.5] years; 150 male [63.0%]; median European System for Cardiac Operative Risk Evaluation II score, 2.2% [IQR, 1.5%-3.5%]) were included. The primary end point occurred in 5 of 119 patients (4.2%) in the upper-extremity group and 16 of 119 (13.4%) in the lower-extremity group (odds ratio [OR], 0.28 [95% CI, 0.10-0.80]; P = .01). Incidence of any clinically relevant bleeding was decreased in the upper-extremity group (25 of 119 [21.0%] vs 41 of 119 [34.5%] patients; OR, 0.51 [95% CI, 0.28-0.91]; P = .02). There was no difference in time to mobilization or duration of hospitalization. Secondary access failure (14 of 119 [11.8%] vs 1 of 119 [0.8%] patients; OR, 15.73 [95% CI, 2.03-121.69]; P = .001) and procedural time (60.0 [IQR, 39.0-88.0; 95% CI, 53.0-70.0] vs 48.0 [IQR, 34.0-64.0; 95% CI, 40.0-55.0] minutes; P = .002) were higher in the upper-extremity cohort. In this randomized clinical trial of patients undergoing transfemoral TAVI, the upper-extremity approach for secondary access was associated with less clinically relevant access site-related bleeding compared with the conventional lower-extremity approach and should be considered to reduce periprocedural bleeding complications. ClinicalTrials.gov Identifier: NCT05672823.

Upper-Extremity Approach for Secondary Access in TAVI—Ready for Standard Clinical Practice?

Upper-Extremity Approach for Secondary Access in TAVI—Ready for Standard Clinical Practice?

Is endoscopic decompression for Morton's neuroma a safe technique?

IntroductionMorton's neuroma is predominantly attributed to chronic nerve entrapment within third space adjacent metatarsals, the deep transverse metatarsal ligament (DTML), and the plantar skin. While conservative treatments are of election, failures require alternative interventions such as ultrasound-guided injections and various surgical procedures, including minimally invasive neurectomy and DTML release. This study aimed to anatomically assess the risks associated with the endoscopic dorsal surgical decompression of Morton's neuroma. Materials and methodsTwenty feet from ten fresh-frozen cadaveric specimens underwent a dorsal percutaneous approach for endoscopic access. Surgical procedures were monitored by three foot and ankle surgeons. Post-surgical anatomical dissections were conducted to evaluate potential risks to surrounding structures. ResultsThe endoscopic technique successfully sectioned the DMTL in all specimens (100%) without iatrogenic injury of tendons, nerves, or arteries, while lumbricals may be at risk. ConclusionEndoscopic dorsal decompression of Morton's neuroma presents as an accessible minimally invasive surgical option with low risk of collateral associated injuries.

Ontology-based GraphQL server generation for data access and data integration

In a GraphQL Web API, a so-called GraphQL schema defines the types of data objects that can be queried, and so-called resolver functions are responsible for fetching the relevant data from underlying data sources. Thus, we can expect to use GraphQL not only for data access but also for data integration, if the GraphQL schema reflects the semantics of data from multiple data sources, and the resolver functions can obtain data from these data sources and structure the data according to the schema. However, there does not exist a semantics-aware approach to employ GraphQL for data integration. Furthermore, there are no formal methods for defining a GraphQL API based on an ontology. In this work, we introduce a framework for using GraphQL in which a global domain ontology informs the generation of a GraphQL server that answers requests by querying heterogeneous data sources. The core of this framework consists of an algorithm to generate a GraphQL schema based on an ontology and a generic resolver function based on semantic mappings. We provide a prototype, OBG-gen, of this framework, and we evaluate our approach over a real-world data integration scenario in the materials design domain and two synthetic benchmark scenarios (Linköping GraphQL Benchmark and GTFS-Madrid-Bench). The experimental results of our evaluation indicate that: (i) our approach is feasible to generate GraphQL servers for data access and integration over heterogeneous data sources, thus avoiding a manual construction of GraphQL servers, and (ii) our data access and integration approach is general and applicable to different domains where data is shared or queried via different ways.

Multiplexed Random Access Approach to DNA Microspheres for High‐Capacity Data Storage

AbstractWith the rapid growth of modern information data, DNA has emerged as a novel medium for data storage due to its durability, replicability, sustainability, and high density. This study focuses on the compatibility, high capacity, and random access of DNA data storage systems. A calcium phosphate (CaP) mineralized fluorescent SiO2 DNA (FSD@CaP) microspheres is developed by encapsulating fluorescence‐labeled encoding DNA files onto the surface of the SiO2 microspheres that are intrinsically sized and fluorescent as addressed two‐dimensional (2D) barcodes. The various sizes of SiO2 and various fluorescence‐labeled encoding DNA files forming 2D barcodes of FSD@CaP. The 2D barcodes enhance the system's compatibility while allowing multiplexed random access to DNA files. The high‐capacity DNA storage permits effective single access to the DNA file using a minimal number of FSD@CaP microspheres, without impacting the matrix of the system. Ultimately, random access to arbitrary DNA files within a complex pool of distinct 2D barcode‐tagged FSD@CaP microspheres is demonstrated by utilizing a flow cytometer for multiplexed sorting. Consequently, the strategy of this storage system provides a scalable concept for compatibility and multiplexed random access to DNA data sets.

Large bore access for transcatheter aortic valve replacement, endovascular aortic repair, and thoracic endovascular aortic repair. A review of anatomic challenges and operative considerations.

Transcatheter aortic valve replacement (TAVR), endovascular aortic repair (EVAR), and thoracic endovascular aortic repair (TEVAR) are standard and prolific procedures in the modern cardiovascular world, and appropriate delivery of these endoprostheses requires adequate understanding of the requisite large bore access. Percutaneous large bore access is the preferred route but may be accompanied by complications like thrombosis, hemorrhage, or inability to deliver the device. Anatomic limitations such as vessel tortuosity, small size, and heavy calcification may require alternative approaches for successful large bore access. This study aimed to better define large bore access, as well as to elucidate optimal adjuncts and alternatives to enable successful delivery of large bore endoprostheses. A systematic review for "large bore access" in the cardiovascular literature was conducted on PubMed and the Cochrane Library Central according to PRISMA guidelines. Identified articles were filtered and sub-selected for TAVR, EVAR, and TEVAR; studies related to other large bore interventions were excluded. A representative selection of 39 full-text studies included both cardiac and vascular studies and was critically interpreted to identify a consensus definition for large bore access, challenging anatomy, and adjuncts or alternative approaches to the standard transfemoral approach. Transfemoral access remains the first-line approach but in the setting of unfavorable anatomy, adjunct maneuvers (e.g. intravascular lithotripsy, endoconduits) or alternative approaches (supra-aortic, transcaval) help decrease morbidity, mortality, length of procedure, and overall health care cost in large bore access.

Energy optimization and age of information enhancement in multi‐UAV networks using deep reinforcement learning

AbstractThis letter introduces an innovative approach for minimizing energy consumption in multi‐unmanned aerial vehicles (multi‐UAV) networks using deep reinforcement learning, with a focus on optimizing the age of information (AoI) in disaster environments. A hierarchical UAV deployment strategy that facilitates cooperative trajectory planning, ensuring timely data collection and transmission while minimizing energy consumption is proposed. By formulating the inter‐UAV network path planning problem as a Markov decision process, a deep Q‐network (DQN) strategy is applied to enable real‐time decision making that accounts for dynamic environmental changes, obstacles, and UAV battery constraints. The extensive simulation results, conducted in both rural and urban scenarios, demonstrate the effectiveness of employing a memory access approach within the DQN framework, significantly reducing energy consumption up to 33.25% in rural settings and 74.20% in urban environments compared to non‐memory approaches. By integrating AoI considerations with energy‐efficient UAV control, this work offers a robust solution for maintaining fresh data in critical applications, such as disaster response, where ground‐based communication infrastructures are compromised. The use of replay memory approach, particularly the online history approach, proves crucial in adapting to changing conditions and optimizing UAV operations for both data freshness and energy consumption.

Needle-free atrial transseptal access: A safe and reproducible alternative for left atrial catheterization

Left atrial catheterization is a common procedure in electrophysiology labs to treat arrhythmogenic substrates on the left side of the heart. Needle transseptal puncture is the standard approach, but it can lead to complications related to device design or operator technique. To reduce these complications, needle-free alternatives have been explored. This study aims to report the first multicenter application of the needle-free transseptal access (NeFTA) approach, assessing its safety and efficacy in patients undergoing electrophysiological procedures. This retrospective, observational multicenter study evaluated the safety and efficacy of the NeFTA approach in patients undergoing ablation of left arrhythmogenic substrates across 3 electrophysiology centers in Mexico. NeFTA uses only a guidewire, without a needle or sharp guidewire. The sheath, with a dilator, is guided into the fossa ovalis under fluoroscopic guidance, using anterior force and clockwise torque to allow the guidewire to puncture the septum with minimal risk. The NeFTA technique was used in 366 patients. Most sheaths were deflectable, with nondeflectable sheaths in 43.4% of cases. Left atrial access via NeFTA was successful in 96.18% of cases, with pericardial effusion as the only complication (0.55% rate). This technique was reproducible and safe, achieving successful access on the first or second attempt in 96.18% of cases, regardless of the operator.

Comparison of complications and degree of correction between the extensile lateral and sinus tarsi approaches in the treatment of calcaneus fractures: a cross-sectional observational retrospective study

Introduction: Calcaneus fractures are a challenge for traumatologists. Their complex anatomy, relative scarcity of surrounding soft tissue, and long learning curve for surgical treatment partly explain the difficulties encountered by surgeons, in addition to contributing to the high rate of complications. Objective: This study aimed to identify the differences in complication rates and degree of correction between extensile lateral access (ELA) and sinus tarsi (STA) approaches by reviewing medical records between 2018 and 2023 of patients who underwent open reduction and internal fixation of calcaneus fractures at a hospital in the interior of São Paulo. Methods: The present study followed a retrospective observational and cross-sectional model (STROBE). The Kolmogorov Smirnov test, Student-t test, Wilcoxon Rank test, Mann-Whitney test, Pearson Chi-Square test, and binary and predictive logistic regression analysis were used, adopting a confidence risk of 0.05. Results and Conclusion: A total of 77 patients were included (52 ELA and 25 STA). It was concluded that no statistical differences were observed after intergroup comparisons (ELA vs. STA). There was also no statistically significant influence of the predictor “age” on the predictors of the responses “Böhler and Gissane angles in degrees” in the final post-procedure phase. In general, STA presented a lower probability of complications with the use of the sinus tarsi route, reaching the same level of joint reduction and control of progression to osteoarthritis. All these results of the present study almost completely confirm the literary findings that appear under discussion.

Optimizing Femoral Access in Emergency EVAR with a Decision-Making Algorithm.

Endovascular aneurysm repair (EVAR) has become the preferred approach over open repair for abdominal aortic aneurysms (AAAs) due to its minimally invasive nature. The common femoral artery (CFA) is the main access vessel for EVAR, with both surgical exposure and percutaneous access being utilized. However, in emergent cases, percutaneous access can be challenging and may result in complications such as bleeding or dissection thrombosis, leading to the need for surgical conversion. This study aimed to share experiences in implementing a decision-making algorithm to reduce surgical conversions due to percutaneous access failures. A total of 74 aortic patients treated with EVAR in emergency settings were included in this retrospective study. This study focused on various outcomes such as perioperative mortality, morbidity, procedure time, surgical exposure time, and surgical conversion rate. After the implementation of the decision-making algorithm, decreases in surgical conversions and operating time were observed. Percutaneous access was found to be more challenging in cases with specific anatomical characteristics of the CFA, such as severe atherosclerosis or smaller vessel diameter. This study highlighted the importance of carefully assessing patient anatomical features and utilizing a decision-making algorithm to optimize outcomes in EVAR procedures. Further research is needed to continue improving practices for managing aortic aneurysms and reducing complications in femoral artery access approaches.

Endoscopic Management of Benign Gallbladder Diseases.

Acute cholecystitis, cholelithiasis, and gallbladder polyps represent the most gallbladder benign diseases. Endoscopic approaches for the management of these diseases were an alternative to standard laparoscopic cholecystectomy. These endoscopic approaches include transpapillary approaches via endoscopic retrograde cholangiopancreatography, transmural access approaches via endoscopic ultrasound, and endoscopic surgical approaches using natural orifice transluminal endoscopic surgery approaches. However, it's still uncertain which approach is associated with the superior clinical outcomes due to the lack of high-level evidence. Our review provides new insight into the endoscopic approaches for the management of gallbladder benign diseases, with the latest evidence included.