Conduit For Grafting Research Articles

The obstinate question of vein graft versus arterial conduits.

The obstinate question of vein graft versus arterial conduits.

To reverse or not to reverse the radial artery in coronary artery bypass graft surgery? Histopathologic concerns and media thickness

Background and aimsRadial artery (RA) is a popular coronary artery bypass grafting (CABG) conduit. The challenging issue is vasospasm. A few studies are available on histopathological differences between RA's proximal and distal ends. This study aims to compare histopathological features of the proximal and distal end of RA to find the best technique for anastomosis. MethodsIn this matched case-control study, 80 patients were included who underwent CABG and used RA as a graft. Ten subjects were excluded. RA was harvested by open technique, and a cocktail of Papaverine, Verapamil, and Nitroglycerine was frequently applied topically. One centimeter of proximal and distal ends of the RA was evaluated considering its Histopathology. Clinical signs of RA graft vasospasm were monitored from harvesting until the post-operative period. Intima, media, and intima-media thickness (IMT) index were compared between the two cohorts. ResultsVasospasm occurred in 1.41% of patients. The mean intimal thickness in the proximal and distal ends were, respectively, 0.20 (standard deviation [SD] 0.17 mm) vs. 0.31 (SD 0.18 mm) (p < 0.001). The mean media thickness in the distal end was higher than the proximal end (0.98 [SD 0.36] vs. 1.09 [SD 0.37], p = 0.004). IMT index of the proximal and distal ends showed a statistically significant difference (0.22 [SD 0.17] vs. 0.31 [SD 0.19]) (p < 0.001). ConclusionThe overall incidence rate of vasospasm in our study is comparable with other studies using the same cocktail. Proximal RA has a relatively lower medial thickness compared to the distal part, which may induce less vasospasm in CABG patients.

Expert systematic review on the choice of conduits for coronary artery bypass grafting: endorsed by the European Association for Cardio-Thoracic Surgery (EACTS) and The Society of Thoracic Surgeons (STS).

The finalized document was endorsed by the EACTS Council and STS Executive Committee before being simultaneously published in the European Journal of Cardio-thoracic Surgery (EJCTS) and The Annals of Thoracic Surgery (The Annals) and the Journal of Thoracic and Cardiovascular Surgery (JTCVS).

Radial artery harvesting with harmonic scalpel: fully no-touch technique

The radial artery has been used for decades as an alternative to other arterial bypass graft conduits. Positive long-term patency results and survival benefits have led to an increase in its popularity. The emerging evidence of the need for total arterial myocardial revascularization unleashes the potential of the radial artery as a versatile arterial conduit capable of reaching all coronary targets in a lot of different configurations. In addition, a radial artery graft has proven benefits in terms of graft patency compared with a saphenous venous graft. In this context, multiple randomized clinical trials have repeatedly proven the improved clinical outcomes of radial artery grafts based on 10 years of follow-up; the radial artery graft has also been shown to be a suitable arterial conduit in up to 90% of coronary artery bypass grafting cases. Despite the scientific evidence regarding the benefits of the radial artery graft, most surgeons are still reluctant to use the radial artery in coronary artery bypass graft procedures. Consequently, surgical residents risk not developing solid surgical skills for utilization of the radial artery graft. Safe, easy-to-learn techniques are needed to speed up the learning curve and at the same time lower the complications. In this context, a fully no-touch technique for harvesting the radial artery using a harmonic scalpel can be the right way to introduce young surgeons to this basic but paramount skill.

Percutaneous coronary intervention with ridaforolimus-eluting stents in long lesions: the BIONICS 38 mm prospective trial.

The ridaforolimus-eluting stent (RES) system is a novel cobalt alloy-based coronary stent with a durable elastomeric polymer eluting ridaforolimus. The aim of this trial was to assess the performance of a 38 mm RES in long coronary lesions. A prospective, multicenter, single-arm, open-label clinical trial. Clinical follow-up was performed at 30 days, 6 months, and 1 year after the procedure. Target lesions were located in native coronary arteries or bypass graft conduits, with visually estimated diameters of ≥2.75 mm to ≤4.25 mm. The primary endpoint was combined efficacy (final in-stent residual diameter stenosis <30%) without 30-day major adverse cardiovascular events (MACE) (composite of cardiac death, any myocardial infarction), or ischemia-driven target lesion revascularization. A total of 50 patients were enrolled in the study. Fourteen (28%) had acute coronary syndromes; 17 (34%) had diabetes. The mean lesion length was 32.4 mm ± 8.3, reference vessel diameter 2.88 mm ± 0.45, minimal lumen diameter 0.80 mm ± 0.41, and percent diameter stenosis 72.6% ± 13.2. The primary endpoint was achieved in 88% (44/50) of the patients (95% confidence interval: 75.7-95.5%). Thirty-day and 1-year MACE rates were 6% and 8%, respectively. Target lesion failure after 1 year occurred in three patients (6%). Forty-seven lesions (94%) were treated successfully, with final in-stent diameter stenosis of < 30% [95% confidence interval: (84-99%). Percutaneous coronary intervention (PCI) of long lesions with a 38 mm RES achieved satisfactory results, and support the safety and efficacy of PCI with RES in patients with long lesions. (ClinicalTrials.gov NCT03702608).

Feasibility of Percutaneous Ultrasound Guided Intervention with Direct Access in Failing Infrainguinal Vein Bypass Grafts

Patients with infrainguinal venous bypass grafts are at risk of graft stenosis leading to thrombosis and failure of the graft conduit. When primary assisted reintervention is needed, a common first choice of treatment is percutaneous angioplasty using fluoroscopy and digital subtraction angiography (DSA). We investigated whether percutaneous ultrasound-guided intervention (PUSGI) is feasible for such endovascular reinterventions. In this retrospective observational study (feasibility study), we included patients with ultrasound evidence of significant stenosis in below-the-knee vein grafts in the lower extremities. Inclusion period was 18 months. Reinterventions were disrupted by performing PUSGI in between traditional DSA. Perioperative success was defined as no sign of residual stenosis, stenosis at the access point in the vein, or need for further fluoroscopy guided intervention. Patient follow-up was conducted 6weeks after the intervention. Patency of the procedure was defined as no disease recurrence or signs of ultrasonographic restenosis at follow-up. PUSGI was performed in 17 patients referred for reintervention with imminent failing grafts (12 men, 5 women, age range 52-82years). PUSGI alone was performed successfully in 10 out of 17 patients (59%). The remaining 7 patients underwent successful revascularization with PUSGI in combination with DSA-guided angioplasty. Periprocedural complications occurred in 4 patients. Two of 17 patients had occluded grafts at 6weeks of follow-up. No PUSGI access site stenoses in grafts were observed. Percutaneous ultrasound-guided reintervention in peripheral vein bypass disease is feasible for selected patients. The study provides insight to qualitative criteria of eligibility for PUSGI in such reinterventions with direct conduit access.

P195 INFECTIVE ENDOCARDITIS OF COMPOSITE AORTIC VALVE GRAFTS

Abstract Background The Infection of aortic valve graft conduit is a relatively rare complication still burdened by notable morbidity and mortality. Medical and surgical strategies play a crucial role in patient outcome and vary depending on infection extends into adjacent cardiac structures, systemic spread and identify microbes. Methods In this retrospective and observational study, we report two centre experience in the management of thirty patients consecutively admitted to our centre with composite aortic valve graft infection during the period 2008–2020. Our end–points were: infection control, early mortality and long–term survivor. Results Twenty patients underwent redo surgery with an early mortality of 10% and a survival of 83% at 7–year follow–up. Ten patients were treated medically and experienced an early mortality of 30% and a mid–term survival of 33%. Patients with stable haemodynamic in the absence of local and systemic complications had an acceptable survival after lone antibiotic therapy.

O007 Glycaemic variability is a predictor of graft failure following infra-inguinal bypass for peripheral arterial disease (PAD). A retrospective cohort study

Abstract Introduction Many factors influence graft patency following infra-inguinal bypass (IIB). Glycaemic variability (GV) is associated with increased risk of multiple adverse outcomes. However, the impact of GV on outcomes following IIB is unknown. Methods A 3-year single centre retrospective case notes analysis of all people undergoing IIB between 2017–2019. Rutherford stage, graft conduit, bypass level, procedure details, baseline demographics, co-morbidities, mean HbA1c and GV (HbA1c SD) were assessed. Time to re-intervention, ipsilateral amputation or death were recorded to determine primary (PP). Results Were reported as hazard ratios (HR) following multivariate adjustment.193 IIB outcomes were analysed: mean (±SD) age 68.9(9.2) years; 135(69.9%) male. 156 (80.8%) had pre-operative HbA1c for analysis and 88(45.6%) had DM; 87(45.1%) were current smokers; 107(55.4%) underwent emergency procedures. Those without diabetes were more likely to smoke (P=0.011), but those with DM were more likely to have IHD (0.007), had higher Rutherford stage (p=0.0006), underwent more distal bypasses (p=0.004) and more emergency procedures (p=0.04). GV&amp;gt;9.1% was associated with significantly lower PP than GV&amp;lt;9.1%, 198 [105–377] vs. 713 [313-1287] days (p=0.02). Univariate predictors of PP included Rutherford stage 4 vs 3 (p=0.01), level of bypass, (p=0.0003), DM (p=0.04) and GV&amp;gt;9.1% (p=0.02). On multivariate adjustment, GV &amp;gt;9.1% and level of bypass remained independent predictors of primary patency, HR 1.96 (95% CI:1.12-3.42, p=0.018) and HR 2.54 (95%CI:1.24-5.22, p=0.038) respectively. Conclusion We have demonstrated GV and level of bypass as independent predictors of graft failure on multivariate analysis. Therefore, optimising GV should be a therapeutic target to improve outcomes.

O062 Female gender is associated with increased length of hospital stay following infra-inguinal bypass for peripheral arterial disease (PAD). A retrospective cohort study

Abstract Introduction Women have previously been found to have longer post-operative stays following coronary artery bypass. However, impact of gender on length of stay following infra-inguinal bypass (IIB) surgery for PAD is unknown. Methods A 3-year single centre retrospective case notes analysis of all people undergoing IIB between 2017-2019. Rutherford stage, graft conduit, urgency of bypass, level of bypass, procedure details, baseline demographics, length of stay (LoS), co-morbidities were collected and univariate associations with LoS were reported. Factors associated with increased LoS on univariate analysis were entered into a multivariate model and reported as hazard ratios (HR). Results :193 IIB outcomes on 176 patients were analysed on: mean(±SD) age 68.9(9.2) years; 135(69.9%) male; 88(45.6%) had DM; 87(45.1%) were current smokers and 107(55.4%) underwent emergency procedures. On univariate analysis, LoS for female patients was significantly longer than for male patients (9.5 [6-21] vs. 7[5-15] days, p=0.016). Other factors associated with increased LoS were emergency vs. elective (13[7-22] vs. 5 [4-9] days, p&amp;lt;0.0001, Rutherford stage (p&amp;lt;0.0001), bypass level (p=0.001) and diabetes (9 [5-21] vs. 7[4-15] days, p=0.017) After multivariate adjustment, female gender (RR 1.56 95% CI: 1.12-2.18) was associated with increased LoS. As was elective bypass (RR 0.50 95% CI:0.36-0.71) and lower Rutherford stage (3 vs. 5: RR 0.32 95% CI: 0.2-0.52) (4 vs 5:0.46 95% CI: 0.31-0.68). Conclusion We have demonstrated that female gender is independently associated with significantly longer hospital stays. With further investigation into causation, this could potentially inform pre- and post-operative management to reduce risks to women undergoing IIB.

Survival and Independent Predictors of Mortality Following Coronary Artery Bypass Graft Surgery in a Single-Unit Practice in the United Kingdom Over 20 Years

The types of graft conduits and surgical techniques may impact the long-term outcomes of patients after coronary artery bypass graft (CABG) revascularization. This study observed a long-term survival rate following CABG surgery over 20 years in the United Kingdom. A total of 2979 isolated CABG patients were studied from 1999 to 2020, and postoperative data were obtained from the hospital-recorded mortality by the data quality team of the information department. Postdischarge survival was estimated using the Kaplan-Meier method, and statistical significance was obtained with log-rank tests and the Gehan-Breslow test, and the Holm-Sidak method was used for multiple pairwise comparisons. The study observed male predominance (80%), and the median age was statistically significant (P <0.001) among the groups, 66 years (interquartile range 58-73) and 72 years (interquartile range 66-78) in survivor and non-survivor groups, respectively. In the Holm-Sidak method analysis, the best survival rate (mean 18.7 years) was observed in the total arterial group with significantly decreased survival for the mixed arterial and venous group (mean 16.12 years) and only the vein group (10.44 years). The Cox regression model observed that the New York Heart Association (NYHA) class III-IV (HR 1.57), chest re-exploration (HR 2.14), preoperative dialysis (HR 3.13), and redo surgery (HR 3.04) were potential predictors of the postoperative mortality (P ≤0.05). In our series over 20 years, albeit off-pump and on-pump CABG observed similar survival rates, the total arterial myocardial revascularization population has significantly better long-term survival benefits.

Prevention of radial artery occlusion with rivaroxaban after trans-radial access coronary procedures: The RIVARAD multicentric randomized trial.

Radial artery occlusion (RAO) remains the most frequent complication of trans-radial access. Once the radial artery is occluded, its future use as an access site for coronary procedures, or as a conduit for coronary bypass grafting or fistula for hemodialysis, will be precluded. Therefore, we aimed to assess the value of the short-term use of Rivaroxaban to prevent RAO after a trans-radial coronary procedure. This was a prospective, open-label, randomized study. The patients were randomly assigned (1:1) to one of two groups: those who received Rivaroxaban 10 mg for 7 days following the trans-radial coronary procedure (the Rivaroxaban Group) and those who received the standard treatment (the Control Group). The primary outcome was an occurrence of RAO evaluated by Doppler ultrasound at 30 days, and the secondary outcomes were hemorrhagic complications according to BARC classification. We included 521 patients randomized into two Groups: the Control Group (N = 262) and the Rivaroxaban Group (N = 259). The 1-month RAO was significantly reduced in the Rivaroxaban Group as compared to the Control Group [6.9% vs. 13%; p = 0.011, OR = 0.5, (95% CI, 0.27-0.91)]. We noted no cases of severe bleeding events (BARC3-5). The overall incidence of minor bleeding (BARC1) was 2.3%, with no significant difference between the two groups [Rivaroxaban Group = 2.7%, Control Group = 1.9%, p = 0.54, OR= 1.4, (95%CI 0.44-4.5)]. Short-term postoperative anticoagulation with Rivaroxaban 10 mg for seven days reduces the rate of 1-month RAO.

Conduit selection and early graft failure in coronary artery bypass surgery: A post hoc analysis of the Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) coronary artery bypass grafting study.

Relative rates of early graft failure and conduit selection in coronary artery bypass grafting (CABG) surgery remain controversial. Therefore, we sought to determine the incidence and determinants of graft failure of the left internal mammary artery (LIMA), radial artery, saphenous vein, and right internal mammary artery (RIMA) 1year after CABG surgery. A post hoc analysis of the Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) CABG study, involving patients from 83 centers in 22 countries. We completed an analysis of 3480 grafts from 1068 patients who underwent CABG surgery with complete computed tomography angiography data. The primary outcome was graft failure as diagnosed by computed tomography angiography 1year after surgery. Graft failure occurred in 6.4% (68/1068) for LIMA, 9.9% (9/91) for radial artery, 10.4% (232/2239) for saphenous vein, and 26.8% (22/82) for RIMA grafts. The RIMA had a greater rate of graft failure (26.8%) than radial artery (9.9%) and veins (10.4%) (adjusted odds ratio, 2.69; 95% confidence interval, 1.30-5.57; P=.008 and adjusted odds ratio, 2.07; 95% confidence interval, 1.33-3.21; P=.001, respectively). In this international trial dataset, LIMA and radial artery performed as expected, whereas vein grafts performed better. However, high rates of RIMA failure are worrisome and highlight the need for a thorough evaluation of the patency and safety of the RIMA in CABG surgery.

RETRACTED ARTICLE: Predictors of sternal wound infection post cardiac surgery in a Saudi Centre: a case control study

BackgroundSternal wound infection (SWI) post cardiac surgery remains an important cause of extra morbidity, mortality and cost. The objective was to identify risk factors for SWI in a cardiac centre in Eastern Saudi Arabia as part of the investigation into Surveillance variance in the local rates of SWI.MethodsWe included cases and controls from a cross section of patients who underwent major cardiac surgery between 2017 and 2020 matched for age, sex and time of surgery. An explanatory logistic regression model was fitted to estimate the risk factors.ResultsN = 204 (51 cases and 153 controls matching ratio 1:3, from a source population of 985 patients). factors significantly associated with SWI in the final multivariate model: hospital stay OR (1.05, Cl 1.01–1.10), Graft Conduit BIMA versus No Graft OR (10.94, Cl 1.60–74.63), transfusion of both packed cells plus other blood products versus no transfusion OR (3.53, Cl 93–13.44), HbA1c OR (1.09 Cl 0.84–1.41), BMI OR (1.25, Cl 1.04–1.50), perioperative blood glucose OR (1.02, Cl 1.004–1.03), surgery time OR (1.19, Cl 1.00–1.58).ConclusionsThe diverse aetiology, cross-disciplinary nature of SWI prevention, and despite improved prevention and control practices, including related care bundles with their proven value, SWI remain a serious challenge in cardiac surgery. Multidisciplinary consensus guidelines are well overdue.

Heparin coated decellularized xenogeneic small diameter vascular conduit for vascular repair with early luminal reendothelialization.

Small diameter vascular graft is a clinical need in cardiovascular disease (CAD) and peripheral atherosclerotic diseases (PAD). Autologous graft has limitations in availability and harvesting surgery.To make luminal surface modification with heparin coating in xenogeneic small diameter vascular graft. We constructed a conduit from decellularized human saphenous vein (HSV) matrices in small diameter vascular graft (< 0.8mm diameter). Luminal surface modification was done with heparin coating for transplantation in the rat femoral artery. Biocompatibility of conduit was checked inChorioallantoicMembrane (CAM) assay and in vivo. The blood flow rate in conduit grafts was measured, and immuno-histological analysis was performed.CAM assay and in vivo biocompatibility test showed cellular recruitment in the HSV scaffold. Heparin binding was achieved on the luminal surface. After three months of transplantation surgery neo-intimal layer was formed in the graft. The graft was patent for two weeks after surgery. There were no statistically differences between blood flow rate in graft (at proximal end 0.5 ± 0.01m/s and at distal end 0.4 ± 0.01m/s (n = 6)) and native artery (0.6 ± 0.1m/second, (n = 3)). Biomarkers of endothelial cells, medial smooth musclecells, and angiogenesis were observed in the transplanted graft.Our study demonstrates that xenogeneic decellularized vascular grafts with surface modification with heparin coating could be useful for the replacement of small diameter vessels.

Management and Clinical Outcome of Aortic Graft Infections: A Single-Center Retrospective Study.

This study aimed to evaluate the outcome of various treatment options for aortic graft infection (AGI) patients and identify factors affecting their prognosis. The data of AGI patients from January 2008 to December 2019 were retrospectively collected and analyzed. The primary endpoints were 30-day mortality and perioperative complication-related morbidity; the secondary endpoints were re-infection (RI) rates, primary and secondary graft patency, overall mortality, duration of antibiotic therapy, and the number of antibiotic types used in treatment. There was no significant difference in the 30-day mortality and perioperative-related complications between the conservative treatment, in-situ reconstruction (ISR), and extra-anatomic reconstruction (EAR) groups. The ISR group had lower re-infection rates and better overall survival rates than the EAR and conservative treatment groups. Different bypass graft conduits had no significant influence on the RI rate or primary and secondary graft patency. AGI patients infected with high-virulence pathogens had higher RI and overall mortality rates than those infected with low virulence pathogens, but this was not statistically significant. Initial procedures prior to the AGI also had no influence on the prognosis of AGI patients. Patients undergoing ISR or EAR surgery received antibiotic therapy for a longer duration than patients undergoing conservative treatment. Patients without RI received more types of antibiotics than patients with RI. ISR had lower RI rates and better overall survival rates than EAR and conservative treatment and may be a better choice for patients with AGI. Several factors were found to have no influence on patients' prognosis however, further studies are required.

Current intraoperative storage and handling practices of autologous bypass conduit: A survey of the royal australasian college of surgeons

During bypass surgery for peripheral arterial occlusive disease and ischaemic heart disease, autologous graft conduit including great saphenous veins and radial arteries are frequently stored in solution. Endothelial damage adversely affects the performance and patency of autologous bypass grafts, and intraoperative graft storage solutions have been shown to influence this process. The distribution of storage solutions currently used amongst Cardiothoracic and Vascular Surgeons from Australia and New Zealand is not well defined in the literature. The aim of this study was to determine current practices regarding autologous graft storage and handling amongst this cohort of surgeons, and discuss their potential relevance in the context of early graft failure. From this survey, the most frequently used storage solutions were heparinized saline for great saphenous veins, and pH-buffered solutions for radial arteries. Duration of storage was 30–45 min for almost half of respondents, although responses to this question were limited. Further research is required to investigate whether ischaemic endothelial injury generates a prothrombotic state, whether different storage media can alter this state, and whether this is directly associated with clinical outcomes of interest such as early graft failure.

Abstract P1017: Tissue Engineered Human Acellular Blood Vessels For Coronary Artery Bypass Grafting

Objective: Conduit for coronary artery bypass grafting (CABG) can be limited due to poor quality or prior removal of saphenous veins. A human acellular vessel (HAV) bioengineered from vascular cells and then decellularized for implantation may provide a readily available, off-the-shelf conduit for CABG. Here we evaluate the use of small diameter HAV for CABG in a non-human primate model. Methods: Adult male baboons (n=7; 26.8 - 37.0 kg) were imaged by left heart catheterization and computed tomography angiography. CABG was performed using a 3.5 mm diameter HAV to the left anterior descending (LAD) or right coronary artery (RCA) via sternotomy with cardiopulmonary bypass. The proximal coronary artery was ligated to prevent competitive flow and graft transit time flowmetry (TTFM) was assessed after implant. Angiography at 2 weeks, 1, 3, and 6 months evaluated graft patency and heart function. HAVs explanted at 6 months were assessed by immunohistochemistry for host cellular response and remodeling. Results and Conclusion: Baboons underwent CABG using a 3.5 mm HAV from the ascending aorta to the LAD (n=2) or RCA (n=5). The diminutive LAD led to early graft loss due to size mismatch and poor runoff. HAV bypass to the dominant RCA (TTFM: 22 ± 7.7 mL/min) resulted in sustained graft patency for up to 6 months post-implantation. HAV explant histology revealed infiltration of multiple host cell populations with formation of a neoadventitial layer and evidence of luminal endothelization. HAV conduits retained structural integrity with no evidence of mechanical failure throughout the study. These results demonstrate that tissue-engineered HAVs may provide an off-the-shelf conduit for CABG.

The influence of grafted coronary arteries on vascular conduits

Both arterial and venous conduits can be used for coronary bypass surgery. Arterial conduits have more advantages over venous conduits. The concept of “graft-artery junction” was created to help specialists understand the complex interaction between the chosen conduit and target coronary vessel, and assist clinicians in choosing the appropriate vascular conduit for coronary artery bypass grafting. Supposedly, the system is comprised of two parts. The first part is represented by the chosen conduit and its influence on coronary arteries. The existence of such influence has been proven by previous studies, some of which indicated that internal mammary artery has cardioprotective effects. Artery walls secrete such vasoactive substances as nitric oxide, prostacyclin, endothelial hyperpolarized factor, etc. The second part is represented by coronary arteries, their influence and specific mechanisms of atherosclerosis spreading (involving grafts). The number of studies devoted to this topic remains low, therefore, we have attempted to highlight this issue within this review.

Efficacy of prophylactic platelet rich plasma (PRP) following open saphenous vein harvesting in cardiac surgery.

Wound infection represents a frequent trouble following open saphenous vein harvesting in cardiac surgery. Platelets' growth factors are crucial for the healing process. Prophylactic platelet rich plasma (PRP) application on leg wound might reduce the incidence of saphenous vein harvest site infections in patients undergoing coronary artery bypass graft surgery (CABG). Between January 2009 and December 2020, 987 consecutive patients underwent CABG using saphenous vein as conduit graft and were retrospectively divided into two groups. All patients had standard surgical leg wound closure and wound care, but treatment group received adjunctive topical application of PRP (no-PRP and PRP group, respectively). The primary outcome was wound infection. Saphenous vein harvest site infection rate was similar between PRP (3.5%) and No-PRP (5.2%) group, p = 0.215. The ASEPSIS score was lower for the PRP group (PRP: 3.6 ± 9.1 vs. No-PRP: 5.3 ± 11.2; p = 0.014). Performing a subgroup analysis, the diabetic patients (PRP-DM) group had a lower rate of infection than control group (No-PRP DM) (2.6% vs. 7.7%, p = 0.026). PRP-DM patients had an inferior ASEPSIS score (PRP-DM: 2.7 ± 8.3 vs. No PRP-DM: 7.5 ± 13.2, p < 0.001). Topical application of autologous PRP on saphenoug vein harvest site might reduce the rate of surgical site infection, with particular benefit among diabetic patients.

SCAI Position Statement on Best Practices for Percutaneous Axillary Arterial Access and Training.

Axillary artery access has become increasingly widespread as an alternative to the femoral route for large-bore transcatheter aortic valve replacement (TAVR), endovascular aortic repair (EVAR), and mechanical circulatory support (MCS) procedures. Advantages of percutaneous access include avoidance of a surgical incision, general anesthesia, and conduit graft infection. This statement aims to review the anatomic considerations and risks for percutaneous axillary artery access, suggest best practices for access techniques, hemostasis/closure strategies, and complication management, and recommend options for training and privileging.