Arterial Route Research Articles

Duplex-ultrasound as a single imaging test for Global Limb Anatomic Staging System (GLASS) assignment stage and comparison with intraoperative arteriography

Obtaining a prognostic and predictive classification based on the risk of amputation is crucial in ischemic pathology of the lower limbs. Accurate anatomical characterization of arterial lesions is essential for optimal clinical decision-making. The Global Limb Anatomic Staging System (GLASS) provides a comprehensive anatomy assessment of the femoropopliteal and infrapopliteal arterial system. GLASS introduces concepts such as the target arterial path (TAP) and estimated limb-based patency (LBP), crucial for determining the best arterial route to restore blood flow. A prospective study conducted from May to December 2022 involved 66 patients undergoing revascularization surgery for Critical Limb-Threatening Ischemia (CLTI). Preoperative arterial mapping (PAM) using duplex ultrasonography was the sole imaging modality. The TAP was defined in each patient, and GLASS staging was determined. Intraoperative arteriography (IA) was used on the day of surgery for comparison. Agreement between PAM and IA was assessed using Cohen's kappa coefficient, and diagnostic metrics were compared using ROC curves. Doppler ultrasound demonstrated a sensitivity of 98%, specificity and PPV of 100%, and NPV of 94.7% in the femoropopliteal sector, with a Kappa coefficient of 0.98. For the infrapopliteal sector, sensitivity was 95%, specificity 96.5%, PPV 97.3%, and NPV 93.3%, with a Kappa coefficient of 0.89. Combining both sectors, the overall GLASS stage showed a 93.9% concordance with a Kappa coefficient of 0.91. ROC curves revealed no significant differences between ultrasound and arteriography in terms of staging. This study demonstrates that Doppler Ultrasound can serve as the exclusive imaging modality for determining the preoperative GLASS stage.

An in-vitro method for comparative analysis of aspiration catheter tracking performance.

Mechanical thrombectomy (MT) for acute ischemic stroke (AIS) relies on efficient tracking of aspiration catheters through complex vascular anatomies. Differences in catheter design lead to variation in tracking performance which may only become apparent after use in patients. We developed an in-vitro methodology for evaluating aspiration catheter performance under a variety of pre-defined circumstances, that can be used during catheter development for design optimization. Validation of the in-vitro methodology involved testing four large bore aspiration catheters on recreated challenging vascular access routes derived from patient angiograms. Two experienced neurointerventionalists conducted the tests under controlled physiological and procedural conditions. Each catheter design was evaluated across 30 unique anatomy-procedural set-up combinations. A fifth, prototype large bore catheter was evaluated by trained engineers to assess the applicability of the in-vitro test. Results from statistical analysis using a general linear model demonstrated the methodology's effectiveness in detecting significant tracking differences among catheter designs (p < 0.01). Minimal inter-operator variability was observed (p = 0.304), while procedural techniques significantly influenced tracking performance (p < 0.01). The tortuosity of the arterial access route notably impacted catheter performance (p < 0.01), with anatomical features revealing varying degrees of influence on desirable and undesirable catheter design aspects. We successfully developed a test methodology for evaluating the trackability of large bore aspiration catheters intended for treating acute ischemic stroke with large vessel occlusions. This methodology offers a robust approach to pre-clinical design assessment, utilizing anatomical models that simulate real-world vascular challenges to enhance catheter optimization.

Transarterial embolization for anterior cranial fossa dural arteriovenous fistulas: a retrospective single-center study

BackgroundClip ligation of anterior cranial fossa (ACF) dural arteriovenous fistulas (DAVFs) is the traditionally accepted first-line treatment. Endovascular treatment for ACF DAVFs may achieve good outcomes as endovascular techniques advance....

Percutaneous femoral access: Stuck guide wire, decannulation difficulty due to unravelling and knotting.

Percutaneous techniques for femoral arterial access are increasingly being performed due to advances in endovascular cerebral procedures, as they provide a less morbid and minimally invasive approach than open procedures. Common complications associated with this peripheral puncture include hematoma, bleeding, pseudoaneurysm, arteriovenous fistula, retroperitoneal bleeding, inadvertent venous puncture, dissection, etc. The retrograde femoral access is currently the most frequently used arterial access as it is technically straightforward, allows for the use of larger size sheaths and catheters, allows repeated attempts, etc. Although being technically less challenging, grave complications can occur due to hardware failure. Here, we present a case of unruptured posterior inferior cerebellar artery (PICA) aneurysm, who underwent uneventful diagnostic cerebral digital substraction angiography (DSA) via right femoral artery route on first attempt, but on second attempt for therapeutic intervention, landed up with stuck guide wire and faced decannulation difficulty due to unravelling of guide wire and multiple knot formation, which was finally removed after multiple attempts at pulling and improvised manoeuvres. Such cannulation and decannulation difficulties have been reported multiple times for central venous access, but extremely rarely for femoral routes, making this case a rarity and worth reporting.

Endovascular treatment strategy and clinical outcome of tentorial dural arteriovenous fistula.

To evaluate treatment strategies and clinical outcomes following endovascular embolization of tentorial dural arteriovenous fistulas. We retrospectively analyzed 19 patients with tentorial dural arteriovenous fistulas admitted to the Department of Neurosurgery at Jiangsu Provincial People's Hospital between October 2015 and May 2022, all treated with endovascular therapy. To collect and analyze patients' clinical presentation, imaging data, postoperative complications, and prognosis and to analyze the safety and clinical outcomes of endovascular treatment of tentorial dural arteriovenous fistulas. Imaging cure was achieved in 18 patients, with the arterial route chosen for embolization in 17 patients and the venous route in one patient; one patient received partial embolization. Staged embolization was performed in four patients. At postoperative follow-up of 9-83 months (37.8 ± 21.2), all 19 patients had recovered well (mRS score ≤ 2). Three patients experienced perioperative complications: intraoperative Onyx reflux into the middle cerebral artery in one patient; postoperative permanent limited left visual field loss and deafness in the left ear in one patient; and transient diplopia, vertigo, and decreased pain and temperature sensation of the left limb in one patient, with no abnormalities on post-procedure magnetic resonance examinations. A total of 17 patients completed a postoperative digital subtraction angiography review during follow-up, and one patient had a recurrence of an arteriovenous fistula. Endovascular treatment of tentorial dural arteriovenous fistulas is safe and effective. Reduction of the Borden or Cognard classification via eliminating cortical venous reflux through multi-staged embolization or combined open surgery is a reasonable goal of treatment where complete obliteration of the fistula is not achievable.

Transvenous embolization of patent ductus arteriosus in 16 dogs using the Amplatzer Vascular Plug II device: description of a modified technique and complications.

Patent ductus arteriosus (PDA) is a deadly congenital disease in dogs if left untreated. Occlusion of the defect is the treatment of choice and can be achieved by surgical ligation or interventional closure. In this retrospective study of 16 dogs, an alternative to the classically used canine device which is placed by an arterial route is described. The Amplatzer Vascular Plug II® (AVPII) can be deployed by a transvenous approach, using a modified and simplified technique using a single catheter to perform angiography and device delivery. This allows the percutaneous treatment of smaller dogs <3kg and the concomitant treatment of pulmonic stenosis if present. Successful and complete closure was achieved in all dogs with a mean device/ampulla diameter ratio of 1.28 and a mean device/ostium ratio of 3.6. Embolization into the pulmonary artery was observed in one dog where the device/ampulla diameter ratio was <1.1 and device/ostium ratio was <2.1. In conclusion, our study confirms that PDA transvenous closure using the AVPII appears to be a viable alternative to transarterial closure, allowing the treatment of smaller dogs and a fully percutaneous approach. Care should be taken in patients with very large ducti where undersizing might result in device embolization.

Trans-Arterial Embolization of Anterior Cranial Fossa Dural Arteriovenous Fistulas via the Sphenopalatine Artery: A Technique Report

BackgroundTrans-arterial embolization (TAE) via the ophthalmic artery and middle meningeal arterial are the common arterial routes for anterior cranial fossa (ACF) dural arteriovenous fistulas (DAVFs). However, TAE via the sphenopalatine artery (SPA) to treat ACF DAVFs is rarely reported. Here, we describe 14 cases of ACF DAVFs that were either treated solely or in conjunction with other arterial routes via the SPA. A total of 15 embolization attempts were performed via the SPA. Method14 patients were treated with TAE via the SPA over a 20-year period. There were 13 males and 1 female in total, with a mean age of 57.4 (57.4±6.0) years. The clinical presentation, angiographic features, treatment strategy, and clinical outcomes were all documented. Results14 patients with ACF DAVFs underwent TAE via the SPA. Complete immediate angiographic occlusion was achieved in 78.6% of the fistulas (11/14). Complete embolization via the SPA alone was achieved in 63.6% (7/11) of the fistulas. A total of 15 embolization attempts were performed via the SPA, with a 46.7% (7/15) success rate. After TAE via the SPA, no complications were found. 42.9% (6/14) of the patients had DSA or MRA follow-up. There was no recurrence of the fistulas. ConclusionsThe SPA may be as an alternative arterial route if other appropriate arterial routes are unavailable. However, its safety and efficiency need to be confirmed further.

The influence of the digital pulse wave reference point on the pulse transit time measurement and variability

By measuring pulse wave velocity (PWV) via an arterial route, one can determine the stiffness of the artery. The duration between the ECG R-wave climax and a reference point on the digital pulse wave (DPW) in the same cardiac cycle must be determined in order to determine the pulse transit time (PTT). The time it takes for a pulse wave to travel from the heart to a peripheral artery location is known as the PTT. To find out the best reference point on the DPW that is associated with the least beat-beat coefficient of variation (CV) of PWV. The study was carried out on 10 healthy young males aged 19 years. A two-minute recording of the left middle fingertip DPW signals (through piezoelectric Finger Pulse Transducer) and lead II ECG (through three surface electrodes) were carried out. PTT was calculated as follows: from the climax of the electrocardiogram R wave to the onset (foot) of the DPW (PTT1); from the apex to the onset points of the DPW at 10% of its amplitude (PTT2); and from the apex to the onset points of the DPW at 50% of its amplitude (PTT3). PTT1, PTT, and PTT3 were measured on each volunteer and on the same cardiac cycles.

Clinical study of HAIC via left distal branchial radial artery route in the treatment of liver tumors.

Clinical study of HAIC via left distal branchial radial artery route in the treatment of liver tumors.

Community policing and security management in Nigeria: A study of Abuja arterial routes and satellite settlements-Lugbe and Chika

The pattern of policing in Nigeria is still at the abysmal stage as many still see the police as enemies while the police are still overtly caught on tape, daily abusing and infringing the rights of citizens and extorting them whether on traffic, in motor parks or at police stations. This study leveraged on structural functionalism theory to interrogate the nexus between community policing and security management in Nigeria. The study focused on the Abuja arterial routes and satellite settlements of Lugbe and Chika. Study employed survey research design through a structured five point Likert scale questionnaire to elicit responses from 400 respondents as guided by Taro Yamane sampling technique. The study analysis tool was the ordinary least squares simple linear regression technique. Finding from the study revealed that community policing has significant impact on security management in Nigeria. The Study concluded that Intelligence gathering and surveillance must be constantly undertaken, which is important in order to ensure that law enforcement agents are proactive and can reasonably predict potential insecurity threats with near perfect accuracy rather than being reactive. The study recommends that government must devote attention to security intelligence, capacity-building to meet the global best practice and acquisition of modern technology. This will be attainable when the culture of good governance that makes responsiveness and accountability to the community a norm, particularly by law enforcement agencies.

Alternative Arterial Access Routes for Endovascular Thrombectomy in Patients with Acute Ischemic Stroke: A Study from the MR CLEAN Registry.

Background: Endovascular thrombectomy (EVT) through femoral access is difficult to perform in some patients with acute ischemic stroke due to challenging vasculature. We compared outcomes of EVT through femoral versus alternative arterial access. Methods: In this observational study, we included patients from the MR CLEAN Registry who underwent EVT for acute ischemic stroke in the anterior circulation between 2014 and 2019 in the Netherlands. Patients who underwent EVT through alternative and femoral access were matched on propensity scores in a 1:3 ratio. The primary endpoint was favorable functional outcome (modified Rankin Scale score ≤ 2) at 90 days. Secondary endpoints were early neurologic recovery, mortality, successful intracranial reperfusion and puncture related complications. Results: Of the 5197 included patients, 17 patients underwent EVT through alternative access and were matched to 48 patients who underwent EVT through femoral access. Alternative access was obtained through the common carotid artery (n = 15/17) and brachial artery (n = 2/17). Favorable functional outcome was less often observed after EVT through alternative than femoral access (18% versus 27%; aOR, 0.36; 95% CI, 0.05-2.74). The rate of successful intracranial reperfusion was higher for alternative than femoral access (88% versus 58%), although mortality (59% versus 31%) and puncture related complications (29% versus 0%) were more common after alternative access. Conclusions: EVT through alternative arterial access is rarely performed in the Netherlands and seems to be associated with worse outcomes than standard femoral access. A next step would be to compare the additional value of EVT through alternative arterial access after failure of femoral access.

Abundance and composition of anthropogenic macrolitter and natural debris in road runoff in Ohio, USA

Urban stormwater conveys dissolved pollutants, micropollutants, particulate matter, natural debris, and anthropogenic macrodebris to receiving waters. Though it is widely recognized that anthropogenic macrodebris mobilized by stormwater contributes to global pollution management issues (e.g., ocean garbage patches), these materials often are not the focus of stormwater sampling campaigns. Furthermore, macrodebris can cause clogging of sewer systems, exacerbating flooding and public health hazards. Due to their engineered structures draining directly connected impervious areas (e.g., catch basins, inlets, and pipes), roads present a unique opportunity to mitigate the conveyance of macrodebris in stormwater. To optimize control measures, data are needed to understand expected volume and mass of macrodebris in road runoff. To address this gap in knowledge, a field monitoring study was conducted in Ohio (USA) to quantify the mass, volume, and moisture content of macrodebris transported by road runoff. Designed to filter macrodebris (i.e., material with diameter greater than 5 mm) while maintaining drainage, purpose-built inserts were deployed in catch basins at eleven geographically diverse locations across the state. Macrodebris samples were collected from the inserts every 11.6 days (mean) over a two-year monitoring period. Volume and mass of total and categorical (i.e., vegetation, cigarettes, plastic, glass, metal, wood, fabric, gravel, and paper) debris were characterized. Mean total macrodebris volume and mass were 4.62 L and 0.49 kg per sampling window, corresponding to mean volumetric and mass loading rates of 8.56 L/ha/day and 0.79 kg/ha/day, respectively. Natural debris (e.g., vegetation) was the primary contributor to macrodebris (mean 80.3% (i.e., 3.94 L of the mean 4.66 L total sample volume) and 79.7% (i.e., 0.42 kg of the mean 0.53 kg total sample mass) of total volume and mass, respectively), and exhibited seasonal peaks in autumn due to leaf drop. Road functional class (i.e., interstate, principal arterial, and minor arterial routes), land use, and development density significantly impacted macrodebris generation, with increased total and categorical macrodebris along urbanized interstate highways near commercial and residential areas. Macrodebris moisture content was highly variable (ranging from 1.5 to 440%; mean 78.5%), indicating additional management (e.g., drying, solidification) may be required prior to landfilling. Results of this study inform macrodebris mitigation strategies and required maintenance frequencies for pre-treatment devices for other stormwater control measures treating road runoff, including catch basin inserts and hydrodynamic separators, among others.

Pre-Operative Embolisation In Surgical Carotid Body Tumour Resection: Is It Really Useful?

Objective: Carotid body tumour (CBT) is the most common tumour in the family of head and neck paragangliomas, making up approximately 60 – 70% of them. They are typically diagnosed in the fourth to fifth decades with a female predilection. CBT present as soft tissue density on non-contrast CT and complete transfemoral angiography is considered the “gold standard” when establishing diagnosis of CBT with a 100% accuracy. Primary treatment consists of surgical resection to reduce tumour mass size and to decrease surgical risks associated with resection of these highly vascularised tumours, pre-operative embolisation of CBT has been proposed in the literature with varying results. There are no universal guidelines regarding pre-operative CBT embolisation and performance is mostly guided by preference of the surgeon and tumour size. The decision to perform pre-operative embolisation, usually 24 – 48 hours before surgery (though timing of surgical CBT resection following prior embolisation varies between 1 and 14 days post embolisation), is largely dependent on tumour size. Embolisation can be done via a transfemoral arterial route, or percutaneous (direct intralesional) route. The aim of this study was to investigate the efficacy of pre-operative embolisation prior to surgical CBT resection regarding intra-operative blood loss, operative time, length of hospital stay, and peri-operative complications (e.g., transient or ischaemic cerebrovascular event, vascular injury, or cranial nerve injury).

Combined Transarterial and Inferior Ophthalmic Vein Approach to a Direct Carotid-Cavernous Fistula: Technical Note

We describe our rescue technique for direct puncture of the inferior ophthalmic vein (IOV) for transvenous access of a direct, high-flow carotid-cavernous fistula (CCF). The CCF was caused by rupture of a large internal carotid artery aneurysm. Aneurysm and fistula embolization solely via the transarterial approach did not appear promising due to partial aneurysm thrombosis. Also, transvenous access via the facial vein failed due to extensive vessel tortuosity. Instead, the engorged and arterialized IOV was accessed by direct puncture with an 18-gauge venous cannula. After a small skin incision of the medial aspect of the lower eyelid and further transseptal puncture, the cannula was advanced stepwise between the maxillary bone and the bulbus oculi and below the medial rectus muscle to the IOV under repeated biplane roadmap guidance in 2 planes. Thereafter, the fistula and the aneurysm dome could be embolized with coils via a low-profile microcatheter. Hereby, a protective flow diverter was implanted via the arterial route into the internal carotid artery to seal the parent artery, prevent coil protrusion, and ensure permanent aneurysm occlusion. At 1-month follow-up, the aneurysm and CCF were completely occluded. Direct puncture of the IOV represents a feasible and minimally invasive approach for venous CCF access. The proposed method needs to be validated by further reports.

Understanding the capacities of urban street spaces by mapping Melbourne’s parklets

ABSTRACT During the COVID-19 pandemic, many parklets have been deployed onto kerbside carparking spaces throughout Melbourne, Australia, by street-fronting hospitality businesses, to provide socially-distanced outdoor dining spaces. These temporary parklets provide useful indicators of the varying capacities of urban streets to support street life and commercial activity. By examining the distribution of Melbourne’s parklets, this paper identifies numerous urban design factors that provide capacity for parklets, or inhibit them. The analysis shows parklets thrive on traditional, pedestrian-friendly shopping streets with narrow frontages and good access but low through-traffic. Car-dependent outer-suburban shopping streets and strip shopping centres also support numerous parklets. Key hindrances include commercial streets serving as arterial commuter routes and streets that already have extensive traffic-calming features. Minor side streets can provide parklet capacity, but many design conditions inhibit this. The paper challenges policy-makers, planners and designers to address a variety of impediments to creating more pedestrian-friendly street environments.

Transradial versus transfemoral approach for TACE: a retrospective study

ObjectiveTranscatheter arterial chemoembolization (TACE) has been widely applied in the treatment of hepatocellular carcinoma (HCC). Our study aimed to investigate the feasibility and efficacy of transradial access as an alternative to transfemoral access for TACE.MethodsPatients undergoing TACE were divided into the radial artery (RA) route group or the femoral artery (FA) route group according to the operation approach, namely, transradial or transfemoral access. We retrospectively analysed the clinical characteristics, technical outcomes, clinical efficacy and incidence of adverse events to compare the two technologies for intervention for HCC.ResultsTransradial access was found to achieve superior technical outcomes and clinical efficacy, as the patients in the RA group had a lower rate of hepatic arterial spasm, a higher partial response rate and a lower progression rate than the patients in the FA group according to the mRECIST evaluations. In contrast, the liver function indices and VAS (visual analogue scale) pain scores were consistent across the two groups. Moreover, patients in the RA group had a shorter length of stay than those in the FA group, despite similar hospitalization expenses. The total adverse events were significantly reduced by transradial access for TACE (72.5% vs. 84.1%, P = 0.027).ConclusionOur study suggested that transradial access is an effective and feasible alternative to transfemoral access for TACE. Large-scale prospective randomized controlled studies are expected.

Lateglacial and Early Holocene palaeoenvironmental change and human activity at Killerby Quarry, North Yorkshire, UK

ABSTRACTThe hunter‐gatherers that entered the British peninsula after ice‐retreat were exploiting a dynamic, rapidly changing environment. Records of vegetation change and human occupation during the Lateglacial to Early Holocene in northern Britain are more commonly found at upland and cave sites. However, recent research highlights many areas of the Swale–Ure Washlands that preserve extensive environmental sequences in low‐lying ice‐wastage basins, channels and depressions. The Lateglacial–Early Holocene environment of Killerby Quarry, North Yorkshire, is investigated here using a multi‐proxy approach of sedimentary ancient DNA (sedaDNA), pollen, sedimentological (geochemistry and portable optically stimulated luminescence), and rare and well‐preserved archaeology (Lavvu structures and lithics). Results show that the wetland basins and kettleholes were small lakes or ponds in the Lateglacial surrounded by sedge‐fen and birch woodland. A gradual (centennial scale) succession to reed‐swamp and then marsh is seen by the Early Holocene. This environment formed the resource‐scape for hunter‐gatherer transitory settlement in both the Lateglacial (Late Upper Palaeolithic) and Holocene (Early Mesolithic), attracted by the rich communities of pond‐related flora and fauna as well as easy strategic landscape access by way of the River Swale, an arterial route through the landscape connecting the North Sea Basin with the Pennine uplands via the palaeolakes around Killerby.

Occurrence of Bleeding Complications of Radial and Femoral Artery Routes in Patients Undergoing Percutanous Coronary Intervention

Background: Percutaneous coronary angiography and percutaneous trans-luminal coronary angioplasty are the standard diagnostic and therapeutic strategies for coronary artery disease [1]. Angiography/ percutaneous coronary intervention (PCI) is usually performed by the femoral and radial artery routes. However, the ulnar artery can also be used [2]. Conventionally, the femoral route has been favored for coronary angiography and percutaneous coronary intervention, but there is growing interest for radial access due to reduced hemorrhagic complications during and after the procedure. This is due to the fact that severe bleeding is considered a determinant of poor prognosis in patients with acute coronary syndrome [3]. In the current practice of interventional cardiology, it has been recognized that bleeding has become the most common early complication associated with PCI [4]. Objective: To determine the frequency of bleeding complications of radial and femoral artery routes (major bleeding and localized hematoma formation) in patients undergoing Percutanous Coronary Intervention. Setting: This cross sectional study Department of Cardiology, Cardiology, AFIC &amp; National Institute of Heart Diseases Rawalpindi. Methodology: Patients fulfilling the inclusion criteria was recruited for the study after informed consent and explanation about risks and benefits of the procedure. Bleeding complications was determined in transradial or transfemoral access groups undergoing Percutanous Coronary Intervention. The data was gathered through a pre-tested questionnaire after informed consent. Every patient was given an ID, Privacy of the patient was ensured. Post procedure patient was examined immediately for localized swelling, hematoma formation and hemoglobin were assessed. Results: Total 205 patients were included according to the inclusion criteria of the study. Mean age (years) in the study was 53.51 ± 13.97 whereas there were 146 (71.2) male and 59 (28.8) female patients who were included in the study according to the inclusion criteria. Frequency and percentage of localized haematoma among radial and femoral artery was 02 (2.1) and 06 (5.6) respectively and retroperitonial haematoma among radial and femoral artery was 8 (8.2) and 17 (15.7) respectively. Conclusion: The study concluded that common bleeding complications were observed more in femoral artery route then radial artery route. Future studies must be conduct at multiple setups to know the proportion of bleeding complication either in radial or femoral artery route, so that to suggest a uniform protocol for the management of patients undergoing percutaneous coronary intervention (PCI).

A Better Way for Ductal Stenting in Patients with Duct-Dependent Pulmonary Flow and Vertical and Tortuous Patent Ductus Arteriosus.

In this study, we aimed to compare the femoral route and the carotid artery route in terms of procedural success of ductal stent implantation in patients with ductdependent pulmonary blood flow. The study included 51 patients with duct-dependent pulmonary circulation who underwent ductal stent implantation upon their admission to our clinic between July 2017 and March 2021. In total, 23 patients (group I) underwent ductal stent implantation via the femoral route, while the remaining 28 (group II) underwent the procedure via the carotid artery. The groups were compared in terms of procedural success, time, post-procedural blood pH, lactate levels, and complications. Duct morphology was observed in group 1 as follows: type 1 in 12 patients, type 3 in 8, type 2 in 2, and type 6 in 1 patient. In group 2, 26 patients had type 3, 1 had type 2, and 1 had type 6. The tortuosity index of the patients in group 1 was 1 in 8 patients, 2 in 8 patients, and 3 in 7 patients, while in group 2, it was 1 in 5 patients, 2 in 15 patients, and 3 in 8 patients. The success rate was 69.6% (16/26) in group I and 93.5% (29/31) in group II (P=.030). The cumulative success rate was 88.2% (45/51). The procedural durations were 78.2 ± 34.1 and 52.1 ± 22.0 minutes in group I and group II, respectively (P=.002). The mean blood pH values upon the completion of the procedure were 7.26 ± 0.1 and 7.33 ± 0.0 in group I and group II, respectively (P=.038). The mean post-procedural lactate levels were 2.8 mmol/L and 2.3 mmol/L in group I and group II, respectively (P=.038). The 2 groups did not show any differences in terms of procedural complications. The carotid artery route can be preferred, especially in vertical and tortuous ductus arteriosus, as it is associated with a high success rate and a short procedural time, as well as a better metabolic condition after the procedure.

Radiation Dose Exposure to Patients During Transcatheter Patent Ductus Arteriosus Closure via the Arterial Route

Objective This study aims to evaluate the radiation dose for transcatheter patent ductus arteriosus (PDA) viathe arterial route and compare it with previously published benchmarks. Background Exposure to radiation in the catheterization lab can cause skin injury and cancer in the long run, especially in pediatric patients with complex heart conditions, which necessitate serial catheterizations. Therefore, measuring the patient radiation dose and establishing a benchmark for each cardiac interventional procedure is essential. Material and methods In this prospective study, 34 patients with transcatheter patent ductus arteriosus closure via an arterial route were included. Patients who had silent PDAs, no left heart dilatation and PDA size of less than 2mm had PDA closed via an arterial route. All the study group patients received an Amplatzer duct occluder II-additional size device (St. Jude Medical Corp, St. Paul, MN) using biplane flat-panel fluoroscopy equipment adjusted in accordance with the pediatric parameters. Patients' dose area product, air kerma and fluoroscopytime were recorded in the catheterization lab and finally compared with internationally published reference data. Results Of 73 patients who had transcatheter patent ductus arteriosus closure between April 2021 to December 2021, 34patients who had a PDA closure via an arterial route were enrolled. The median age and weight were 11.5 (4-168) months and 10.5 (6-31) kg. Twenty-one (61.8%) were males, and 13 (38.2%) were males. The median radiation dose parameters were as follows: air kerma 11 (3-42) milliGray, dose area product 131 (33-443) microGray per m2, median dose area product indexed to weight 12 (1-48) microGray m2 per kg, fluoroscopy time 2 (2-4) min and frame rate 15 (7.5-15) frames per second. Due to many factors, our radiation dose parameters were less than internationally published reference values for transcatheter PDA closure. Conclusion Patient selection, detailed pre-catheterization echocardiography and procedure planning are essential for accomplishing device closure of PDA with a significant reduction in radiation dose. Hemodynamic assessment in the catheterization lab is unnecessary for most PDA patients. Additionally, a next-generation imaging platform equipped with flat-panel detectors and adjusted for pediatric settings and a fluoro recording option can be used to reduce radiation exposure.