Femoral Approach Research Articles

Removal of Spontaneously Fractured Leads with Their Proximal Ends in the Heart and Vasculature—Description of Different Approaches and Tools

Background: Removal of spontaneously fractured leads with their proximal ends migrated into the vascular space has not been analysed in detail thus far. The study aimed to compare the effectiveness of different approaches and auxiliary tools for removing fractured leads with migrated proximal ends. Methods: Retrospective analysis of 72 cases from a database containing 3847 TLEs (transvenous lead extraction). Results: Most of the leads were passive, especially unipolar. Procedure complexity in such cases was high but with satisfying effectiveness (procedural success rate 93.06%) and independent of the position of the proximal end. The rate of major complications was 2.78%, which may be attributed to long implant duration (152.2 months). Extraction of such leads did not influence long-term survival. The femoral approach was most often used (62.50%). In 79.16% of leads, mechanical dissection was required. In 66.7%, proximal ends were strongly attached to the wall, and a loop had to be applied. In 15.28% of procedures, the lead was wrapped around a pig-tail catheter (“spaghetti twisting technique”). Conclusions: (1) Spontaneous lead fracture with the proximal ends migrated into the vascular space is a rare finding (1.87% of the TLE). (2) Removal of such leads requires the use of different approaches as well as dedicated and non-dedicated tools. (3) Despite a high level of procedure complexity, its effectiveness is high, with an acceptable rate of major complications.

Adverse Events and Failure Modes Related to Impella RP/RP Flex: Insights From FDA MAUDE Database.

Impella RP and RP Flex can provide right ventricular (RV) support in numerous clinical situations. Notably, the redesigned RP Flex allows for an internal jugular approach compared to the femoral venous approach with RP. We investigated the type and frequency of device-related complications as reported in the US Food and Drug Administration (FDA) Manufacturer and User Facility Experience (MAUDE) for both Impella RP and RP Flex to see if there are any differences. The MAUDE database was accessed from January 1, 2019 to April 30, 2024, yielding 206 reports pertaining to Impella RP and 64 to RP Flex. Reports were reviewed for device indications, mode of device failure, and device-related complications. The most common indication for Impella RP placement was acute myocardial infarction with RV failure. The most commonly reported failure mode was pump failure. Death was reported in 8.5% and vascular complications in 3.7% of the reports. The most reported device-related complication was hemolysis (18.5%), followed by bleeding requiring transfusion (14.1%), with new dialysis occurring in 3.3% of patients. Our analysis of the MAUDE database showed that device delivery issues, bleeding, and vascular complications accounted for a smaller proportion of reports with Impella RP Flex than with its predecessor. However, device-related thrombosis and pump malfunction accounted for a higher proportion of reports with RP Flex. These data do not reflect the overall incidence of complications, but instead highlight the need for physicians and other healthcare providers to return devices to the manufacturer for inspection when a failure occurs.

Early identification of vascular access site complications and frequent heart rate and blood pressure monitoring after cardiac catheterization: A scoping review

BackgroundNurses perform frequent heart rate (HR) and blood pressure (BP) monitoring, a widespread and longstanding practice, after cardiac catheterization (CC) to identify vascular access site complications for femoral and radial arterial approach in adult patients. ObjectiveThe objective of this scoping review was to answer two questions: (1) how does the available evidence support frequent HR and BP monitoring after CC via femoral and radial approach in adult patients and (2) how does this practice prompt bedside nurses in identifying the procedure's major vascular access site complications, including bleeding, hematoma, and pseudoanurysm? MethodFollowing the scoping review approach, literature search was conducted (PubMed, CINAHL, Google Scholar) by two co-authors and medical librarian. We reviewed, evaluated, and analyzed the evidence from twenty articles. ResultsThe reviewed medical and nursing literature revealed findings challenging the present practice. Out of fifteen research studies, five found frequent HR and BP monitoring after CC to be uninformative while the remaining ten did not report frequent vital signs. Two research articles reported that vascular complications after CC were discovered by RNs directly assessing the access site or by the patients themselves, unrelated to HR and BP. Five non-research articles were included, which all recommended frequent HR and BP monitoring. ConclusionsFrequent HR and BP assessment during the recovery period is not supported by empirical research despite being consistently recommended by nursing guidelines and expert opinion articles. Current evidence supports frequent vascular access site assessments and patient education.

Transradial and transfemoral access in hepatic artery chemoembolization in patients with hepatic malignancies

Objective. To evaluate the potential and prospects of the transradial approach as an alternative to the transfemoral approach during hepatic artery chemoembolization (HAE) in the treatment of patients with liver malignancies.Material and methods. Patients, who underwent CEPA, were divided into two groups depending on the arterial access: through the radial artery (first group) or through the femoral artery (second group). Next, a retrospective analysis of the clinical indicators and effectiveness of this treatment method, technical aspects and complication rates, was carried out when comparing the use of given groups in patients who underwent CEPA.Results. The study showed that the radial approach provided superior technical results and clinical effectiveness. Patients with radial access had a significantly lower incidence of hepatic artery spasms and spent less time in the hospital in the postoperative period. However, pain scores assessed using the visual analogue scale (VAS) remained statistically similar in both groups. The use of the radial approach for CEPA also resulted in a significant reduction in the overall complication rate (72.5 % versus 84.1 % with the transfemoral approach, P = 0.027).Conclusion. Our results confirm that the radial approach is an effective, safer, and promising alternative to the femoral approach for CEPA in patients with liver malignancies.

OGC SO30 - Radiological thoracic duct embolisation for post oesophagectomy chyle leak: A single centre retrospective review

Abstract Background Chyle leak is a recognised complication of oesophagectomy associated with increased length of hospital stay, morbidity and is potentially fatal. Chyle leak management is controversial, and lacks a standardised or validated approach. Interventional radiological approaches are well described and routinely able to identify and embolise these thoracic duct leaks reducing need for return to theatre. The aim is to retrospectively evaluate outcomes of lymphangio-embolisation and in patients post Ivor Lewis oesophagectomy for oesophageal carcinoma. Method Data was analysed retrospectively from 168 patients who underwent Ivor Lewis oesophagectomy for oesophageal carcinoma from June 2020 to June 2024, of which 15 patients had chyle leak post operatively. Chyle leak was suspected when chest drain output >500ml in 24 hours and confirmed by high biochemical levels of chylomicrons and triglycerides within the drain fluid. Conservative management involved keeping the patient nil by mouth, total parenteral nutrition and monitoring intercostal drain output. Thoracic duct lymphangiogram was carried out to confirm location of chyle leak-embolisation was carried out using the femoral approach with lipidiol and/or microcoils and/or glue. Results 15 out of 168 (9%) patients had post operative chyle leaks. Four resolved with conservative management within <14 days. 11 chyle leaks persisted after a median of 17 days (range 14-30 days) conservative management and went onto have thoracic duct embolisation. Of those embolised, six chyle leaks resolved within three days post procedure. Two resolved 5-7 days post embolization. One had repeat embolization seven days post primary embolisation. Two patients required thoracoscopic ligation of thoracic duct, due to obesity making embolisation technically impossible and lack of interventional radiology capacity respectively. No patients had adverse outcomes. Conclusion Thoracic duct embolisation is an effective and safe approach for routine management of post oesophagectomy chyle leaks and may reduce return to theatre.

Abstract 437: Total Endovascular Reconstruction of ICA CTO. Technique, Predictors of Success and Complications, An 18‐year Experience

Introduction/Purpose Chronic total ICA occlusion (CTO) can be associated with a high risk of stroke. Surgical bypass is no better than medical therapy. Total endovascular reconstruction (TER) for treatment of carotid CTO is feasible and in this abstract the technique and predictors of outcomes of TER are presented. Methods All patients with carotid CTO treated with TER over an 18year period were entered in a prospectively collected database. Patients with angiographically proven symptomatic chronic (>7days) occlusion with impairment of cerebrovascular reserve or recurrent ischemia despite maximal medical therapy were treated under local anesthesia via a femoral approach. Occlusions were crossed with 014inch wires and angioplasty performed. Drug‐eluting coronary and/or self‐expanding stents were deployed in all angioplastied segments. All patients were treated with dual antiplatelet therapy for 6months. Angiographic features (e.g. landing zone in cervical, petrous or cavernous segment) and clinical outcomes and complications (stroke, death, MI, perforation, cranial neuropathy) were recorded. Technical success was defined as restoration of normal antegrade ICA flow. Carotid U/S was performed at discharge, 30days, and at subsequent follow‐up. Angiographic follow‐up was performed between 6‐12months in all willing patients. Results Twenty‐six patients with a mean age of 65±7.8years and mean CTO duration of 210.7±456.6days (median 66, range 7‐2190) underwent 29 procedures. Technical success was achieved in 22/26 (85%) on first attempt and in 3/4 on second attempt for total technical success rate of 25/26(96%). The only technical failure was in a patient with no ICA stump at the bulb and all 3 patients requiring a second attempt had a landing zone in the cavernous ICA with failure to cross into the true lumen beyond the lacerum segment. Mean procedural duration was 152±69.8hours (median 136.5hrs) which increased with more distal landing zone: mean 118.5±98, 140.3±46.6, and 169.5±71min for cervical, petrous and cavernous landing zone, respectively. Patients received a median of 2 stents (range 1‐7). Fifty‐five percent were treated via a 6 French transfemoral approach. CTO wires and/or catheters were used in 69% of cases with 34% requiring multiple CTO wires to cross the proximal fibrous cap, to overcome calcified segment or to cross the lacerum segment. Knuckling wire technique was used in 24.1%. Total 30‐day stroke/death/MI was 2/29 (6.9%). There were 2 (6.9%) cases of asymptomatic wire tip retention in the cervical ICA, 1 case of transient contrast extravasation in cervical segment associated with transient vocal cord weakness and 1 case of isolated vocal cord weakness in a patient with a 360‐degree loop in the cervical ICA and a history of ipsilateral neck radiation therapy. There were no cases of acute carotid re‐occlusion but there was 1 asymptomatic re‐occlusion at 7months. Conclusion TER has a high technical success rate. The presence of a carotid stump and a more proximal landing zone favored procedural success and shorter over all procedural duration. Although the 30‐day event rate is low there is a risk of transient vocal cord paralysis, wire tip retention and rarely, cervical segment perforation. Acute occlusion is very rare with appropriate technique and dual antiplatelet therapy.

Abstract 094: Embolization of middle meningeal artery for subacute and chronic subdural hematomas using liquid embolic materials and coils: a multistudy comparison

Introduction Chronic subdural hematomas (SDH) are common in older adults due to increased risks of falls, cerebral atrophy, and antithrombotic therapy, leading to higher bleeding risks. Current randomized clinical trials are evaluating the safety and efficacy of middle meningeal artery (MMA) embolization for chronic SDH. These trials, such as EMBOLISE, MAGIC‐MT, and STEM, have reported preliminary promising results using different embolic agents. This study examines the safety and efficacy of MMA embolization using liquid embolic materials and coils at a single institution, comparing outcomes with the aforementioned trials. Methods We conducted a retrospective review of 66 patients who underwent MMA embolization for subacute and chronic SDH at a single institution from February 2021 to March 2024. Data were collected from electronic medical records, including demographics, clinical data, imaging, procedural details, use of antiplatelet or anticoagulation medications, and outcomes at discharge and follow‐up. Patients aged 18 or older with subacute or chronic SDH who underwent MMA embolization were included. Follow‐up assessments were conducted at multiple intervals post‐procedure. Descriptive statistics were used for data analysis. Results The median age of the cohort was 71 years, with a predominance of males (64.71%) and African Americans (54.90%). Eighteen patients had prior SDH interventions, and 62.75% were on antithrombotic therapy before diagnosis. The median time from symptom onset to diagnosis was one day, with most SDHs being traumatic (60.78%). Elective MMA embolizations were performed in 64.71% of cases, primarily using a femoral approach. N‐butyl cyanoacrylate (n‐BCA) was used in 97.37% of procedures, and coils in 27.63%. Complications were rare, with two cases (3.92%) of MMA rupture and access site hematoma. The technical success rate was 97.37%. The median hospital stay was seven days, with most patients discharged home (70.59%). The in‐hospital mortality rate was 1.96%, with seven post‐discharge deaths unrelated to MMA embolization or SDH. The median follow‐up duration was 130 days, with two patients (3.92%) requiring repeat MMA embolization and three (5.88%) needing SDH evacuation. Compared to EMBOLISE, MAGIC‐MT, and STEM trials, our study showed a recurrence rate of 9.8% for all patients, with 6.45% in the MMA embolization alone group and 15% in the surgery with adjunctive MMA embolization group. EMBOLISE reported a 4.10% recurrence rate with surgical evacuation with adjunctive MMA embolization, MAGIC‐MT showed 1.90% recurrence with MMA embolization alone and 4.70% with surgery and adjunctive MMA embolization, and STEM found 19.10% recurrence with MMA embolization alone and 12.30% with surgery with MMA embolization. Discussion Our study suggests that selective distal embolization using n‐BCA is effective, with a low complication rate. Distal embolization may prevent cranial nerve injuries and strokes associated with proximal embolizations. The ongoing trials will provide further insights into optimal embolization sites and agents, and the timing for restarting anticoagulation. Conclusion MMA embolization using liquid embolic materials and coils is a promising treatment for subacute and chronic SDH, with low recurrence and complication rates. Comparison with current trials indicates favorable outcomes. Further research is needed to refine embolization techniques and optimize patient management strategies, potentially revolutionizing chronic SDH treatment.

The Effect of C-Arm Position on Femoral Tunnel Placement in Medial Patellofemoral Ligament Reconstruction.

Medial patellofemoral ligament (MPFL) reconstruction is a common treatment for patellar instability. Yet nearly 40% of revisions result from femoral tunnel misplacement. One reason may be the positioning of the C-arm relative to the knee. To assess how the C-arm's position affects femoral MPFL placement when the image receptor is positioned either contralateral or ipsilateral to the operated knee. Controlled laboratory study. Ten human cadaveric knee specimens were dissected, and the femoral MPFL insertion site was identified and marked using a 10-mm eyelet. According to the possible clinical scenarios, true lateral radiographs in 2 different C-arm positions were taken. In the first scenario, the image receptor was on the ipsilateral side, being 5 cm away from the knee with the x-ray beam directed from medial to lateral (ML5). In the second scenario, the image receptor was on the contralateral side, being 25 cm away from the knee with the x-ray beam directed from lateral to medial (LM25). In each radiograph, the eyelet position was recorded and the distance (proximal-distal and anterior-posterior) from the optimal radiographic insertion point according to the literature was determined. Differences between the groups were calculated using the Wilcoxon signed-rank test, and a P value of <.05 was considered significant. The anatomic femoral MPFL insertion in the ML5-position was located a mean of 2.7 ± 2.4 mm proximal and 4.5 ± 5.5 mm anterior to the Schöttle point. This resulted in an absolute distance of 7.2 ± 3.0 mm. In the LM25-position, it was located a mean of -0.7 ± 1.8 mm distal and 3.0 ± 5.3 mm anterior, which resulted in an absolute distance of 5.4 ± 3.2 mm. The ML5 was located more anterior (1.5 ± 2.1 mm) and proximal (3.4 ± 2.4 mm) compared with the LM25 position. Measurements following methods described in the literature significantly differed in both axes in the LM25 view when compared with the ML5 view measurements (P = .005). Compared with the ipsilateral C-arm position (ML5), the contralateral C-arm position (LM25) showed a smaller range with a lower standard deviation in identifying the femoral MPFL approach across all measurement methods. When applying the method according to Schöttle et al to locate the femoral MPFL insertion point, it should be noted that in the proximal-distal orientation, the femoral MPFL insertion point is situated proximal to the Blumensaat line in the contralateral view (LM25). In contrast, when using the ipsilateral view (ML5), the femoral MPFL footprint is positioned just distal to the proximal edge of the medial condyle.

Abstract 140: Safety and Efficacy of Trans carotid Intervention in Multiple Scenarios: Medellin Experience using Direct Carotid access

Purpose Direct Carotid Puncture (DCP) has been validated such as an alternative route to reach the intracranial vasculature. However, this approach has not been considered routinely in INR.This study was conducted to investigate the feasibility and safety of trans carotid Neuro intervention for a variety of pathologies. Materials and methods Since 2018 we implemented a DCP under special considerations to perform a therapeutic approach. A total of 28 patients from our centers were analyzed. Patients were divided into a variety of neurovascular conditions: Carotid Stenting CAS (n = 4), Mechanical Thrombectomy MT (n=10), AVM´s treatment (n=4), intracranial Aneurysms treatment (n=10). Patient demographics, technical data, intervention time, type of intervention, closure device used, local or systemic complications and a patient perception assessment were registered. Results Mean age was 64.3 ± 10.3 years. in all cases but two were treated under GA. Major indication to this approach were: anatomical and access limitations in 24 cases and, two patients with Leriche Syndrome. All cases performed with ultrasound US assistance. A 4 Fr. Micro‐ puncture set were used in all procedures and posteriorly a 6Fr. Introducer was inserted. Technical success in all cases (100%) selected. Two patients presented mild vasospasm and resolved using IA vasodilators. All CAS were performed without any complications and none embolic protection device used. For MT(n=10): a SOFIA 6Fr for ADAPT was used in 6 cases with TICI 2b‐3 in all cases. Combined approach was used in four cases, one TICI 2a and one TICI 3. A total of 10 aneurysms were treated with this approach (4 ICA – ophthalmic; 4 MCA and two AcomA) Mean average time of the procedure was 34.5 min. (ranged 9‐59 min) Only one hemorrhagic complication observed at the closure device use. In all cases but one we use Angio‐Seal 6Fr as closure device, in a single case where we used a ProGlide suture device we had a serious complication at the puncture site. Conclusion Trans Carotid Intervention TCI. was feasible and safe in selected patients in this small series. A multiple variety of neurovascular conditions would be treated successfully by this way improving the learning curve. Complication rates and clinical outcomes were comparable with those in trans femoral or radial approach.

Trans-jugular approach for safe and successful cryoablation of para-Hisian/anterior-septal, anterior, and anterior-lateral accessory pathways in children.

Cryoablation of APs localized near the atrioventricular (AV) junction is a well-established ablation strategy in children, and it has proved to be very safe. However, recurrence rates remain considerable for specific accessory pathway (AP) localizations. The aim of this retrospective study was to evaluate the efficacy and safety of a trans-jugular approach for cryoablation of right anterior, anterior-lateral, and anterior-septal APs in children, as compared to the conventional femoral approach. From June 2019 to November 2023, 24 consecutive patients (mean age 13.2 ± 4.6, 12 males (50% of total cohort)) with right anterior-lateral, anterior, and anterior-septal/para-Hisian APs underwent 3D non-fluoroscopic transcatheter cryoablation through the right jugular vein at our Institution. Ablation results were compared with 24 patients for whom a conventional trans-femoral approach was used. Acute procedural success rate was 100% (n = 24/24), with a non-statistically significant difference as compared to the control group (100% vs. 83%, p = 0.1). During follow-up (1.1 years, interquartile range 0.6-1.3), one patient (4%) had a recurrence in the trans-jugular group, as opposed to eight (38%) in the control group (p = 0.006). No permanent complications occurred. 3D cryoablation of right anterior-lateral, anterior, and anterior-septal/para-Hisian APs in children using a trans-jugular approach is extremely effective and safe, resulting in higher chronic success rate compared to the conventional femoral approach.

Abstract 098: Endovascular Treatment of Symptomatic Bilateral Carotid Artery Occlusions

Introduction The annual incidence of acute ischemic strokes or transient ischemic attacks due to chronic carotid occlusion (CCO) is estimated at 5‐10%. While initial trials did not show a clear benefit for surgical treatment of symptomatic CCO, emerging data suggests that endovascular treatment (EVT) may offer significant advantages over best medical management (BMM) in selected cases. However, the use of EVT for bilateral symptomatic CCO has not been previously investigated. Method We present the case of a 67‐year‐old male with a history of oropharyngeal carcinoma, treated with extensive neck radiation, leading to bilateral common carotid artery occlusions. The patient, initially presenting for elective gastric endoscopy, experienced hypotension during anesthesia induction and subsequently became comatose. Imaging revealed complete occlusion of the bilateral common carotid arteries and the right vertebral artery, with CT perfusion showing extensive global hypoperfusion correlating with severe EEG attenuation. Due to the failure of medical management, EVT was deemed necessary. Results A femoral approach was utilized for endovascular access to each common carotid artery. The procedure involved the use of a guide catheter, microwires for crossing occlusions, and multiple angioplasties with various balloon sizes to create a passage through the occlusions. An embolic protection device was employed to prevent iatrogenic distal embolization. Rheolytic thrombectomy aided in recanalization, followed by the placement of several stents in a telescopic fashion to achieve vessel patency. Intravascular ultrasound (IVUS) was performed pre‐ and post‐recanalization to evaluate vessel integrity. The procedure resulted in the complete recanalization of both carotid arteries, with subsequent resolution of perfusion abnormalities and normalization of electroencephalographic patterns. The patient returned to his neurological baseline within days post‐procedure. Conclusion This case demonstrates the safe and effective use of EVT for the treatment of bilateral chronic carotid artery occlusions. It highlights the potential of EVT as a promising therapeutic option in managing CCO, particularly in cases where medical management fails.

Comparison of Access Site Complications in Primary Percutaneous Coronary Intervention (PCI) Using the Radial Versus the Femoral Approach for Complex Lesions: A Prospective Study.

Percutaneous coronary intervention (PCI) is a widely used therapeutic approach for complex coronary artery disease, especially in patients with ST-elevation myocardial infarction (STEMI). The choice of vascular access site, typically radial or femoral, can significantly impact patient outcomes due to varying complication rates associated with each approach. This study aimed to compare access site complications between radial and femoral approaches in primary PCI for complex coronary lesions, providing insights into the safety and efficacy of these approaches. A prospective cohort study was conducted from January 1, 2023, to December 31, 2023, at a tertiary care cardiovascular center. A total of 350 adult patients presenting with STEMI and requiring emergency PCI for complex coronary lesions were included and randomized equally to either radial (n = 175) or femoral (n = 175) access groups. Primary outcomes included access site complications, such as hematomas, pseudoaneurysms, arteriovenous fistulas, and major bleeding events. Secondary outcomes included procedural success, access site crossover, and hospital stay duration. Data were analyzed using chi-square tests, Student's t-tests, and multivariate logistic regression. The incidence of access site complications was significantly lower in the radial group (11.4%) compared to the femoral group (22.9%) (p = 0.007). Major bleeding events were also notably reduced in the radial group (2.3% vs. 8.6%, p = 0.01). There was a significantly shorter median hospital stay for the radial group (three days vs. five days, p < 0.001), while procedural success rates were comparable between groups (97.1% vs. 94.3%, p = 0.31). The radial approach for primary PCI in complex lesions is associated with fewer access site complications and shorter hospital stays compared to the femoral approach, supporting its use as the preferred access site.

Patent ductus arteriosus stenting via femoral approach with wire twist technique: a case report

IntroductionPatent ductus arteriosus (PDA) stenting has emerged as a viable alternative to surgical interventions for ductus arteriosus-dependent pulmonary circulation. Several approaches and techniques have been reported but have had limited success.We present three cases of PDA stenting involving several types of PDA morphologies using the femoral vessel approach and introduce a highly successful technique.Case presentationCase 1: A 3-day-old female with pulmonary atresia and an intact ventricular septum had two stents implanted via the femoral artery (FA) in a PDA originating from the descending aorta. A 0.014-inch coronary guidewire was secured in the peripheral pulmonary artery (PA) to aid stent tracking, achieving postoperative oxygen saturation (SpO2) of 88%.Case 2: An 11-day-old male with pulmonary atresia and ventricular septal defect (PA/VSD) had a stent implanted in a PDA arising from the inferior aspect of the aortic arch via the femoral vein (FV). Postoperative SpO2 reached 92%.Case 3: A 2-month-old female with PA/VSD received two stents via the FA in a PDA originating from the innominate artery, achieving a postoperative SpO2 of 88%.ConclusionsThe wire twist technique is useful for implanting PDA stents through the transfemoral approach.

Incidence and predictors of radial artery occlusion following transradial coronary procedures

Abstract Background Transradial access for percutaneous coronary procedures has grown in popularity because of its advantages over the femoral approach. However, the benefit is overshadowed by an increased rate of radial artery occlusion (RAO). We aim to assess incidence and predictors of RAO after transradial catheterization. The anatomic variations of the radial artery (RA) were also studied. Methods This prospective study enrolled 427 patients who underwent coronary angiography or angioplasty via transradial access. An ultrasound evaluation of forearm arteries was performed. In case of RAO, another ultrasound check-up was performed after 1 month and 3 months of the procedure. Results Our study population includes 288 patients (32.6% female). The mean age was 61.9 ± 11.1 years. RAO occured in 48 patients (11.24%), among whom spontaneous recanalization was observed within 3 months in 15 patients (32.6%). On multivariate analysis, a younger age (OR 0.642 [CI 95%: 0.480 – 0.858], P = 0.031), low periprocedural systolic blood pressure, (OR 0.598 [CI 95%: 0.415 – 0.862], P = 0.007), a small radial diameter (OR 0.371 [CI 95%: 0.323 – 0.618], P = 0.031), insufficient anticoagulation (OR 0.287 [CI 95%: 0.163 – 0.505], P &amp;lt; 0.001), occlusive hemostasis (OR 0.128 [CI 95%: 0.047 – 0.353], P &amp;lt; 0.001), and a long duration of hemostasis emerged as independent predictors of radial occlusion. The overall incidence of radial artery anatomic variations was 14,8% (n=63). Among these patients, 40 (63.5%) had a high radial origin, 18 (28.6%) had extreme radial artery tortuosity, and 5 (7.9%) had a full radioulnar loop. Conclusion The incidence and prevalence of radial artery occlusion is expected to increase. Insufficient heparinization and occlusive hemostasis are the main modifiable predictors. The preventive strategy should focus primarily on these 2 predictive factors.

A retrospective study on real world, 2-stent left main bifurcation PCI using DK crush technique with IVUS guidance - a single center experience

Abstract Objectives The aim of this study is to investigate clinical outcome of the IVUS guided 2-stent bifurcation strategy using DK crush technique performed in a complex Left Main (LM) bifurcation lesions defined according to DEFINITION study in our local setting. We seek to assess the composite endpoint of target vessel failure (TVF) at 9-12 months. Methods All patients underwent IVUS guided 2-stent Bifurcation PCI with DK crush technique for complex LM bifurcation lesions defined by the DEFINITION criteria performed in a heart institute from 1.1.2019 to 31.7.2023 were included..Patient baseline characteristics, post-procedural and 12-months follow-up outcomes including cardiac death,myocardial infarction (MI),rate of target vessel failure (TVF),rate of stent thrombosis (ST) and major adverse coronary event (MACE) were analysed.Exclusion criteria are patients age &amp;lt;18 years and previous stenting in the target vessel Results A total of 50 patients were included in this analysis. Mean age was 64.3±9.1 years with predominant males (n= 38, 76%).Majority were hypertensive (n=37, 74%) and diabetes mellitus accounted for 32 (64%) cases.Patients with pre-existing coronary artery disease were 39 (78%) cases. 40% presented with history of recent myocardial infarction (MI), 12% had new onset angina and 6% had heart failure. Pre-existing chronic renal failure (18%) and history of CVA (2%). Among chronic renal failure cases, 50% had eGFR &amp;lt;50 during index procedure.Additionally, previous PCI was performed in 22 cases (44%) and 2 previous CABG cases included (4%).Majority of the cases were performed as staged elective procedure ( n=45, 90%) and others were indicated for ACS ( n=5, 10%). Radial approach was predominantly preferred with 25 cases (50%), where additional 5 cases (10%) were converted to femoral approach due to severe radial spasm. Among these 50 cases, 1 case required additional PCI to CTO LAD and mid LCX, while 7 cases (14%) had calcified lesions requiring scoring / cutting balloons and atherectomy device utilization for adequate lesion preparation prior to bifurcation stenting.All 50 patients received combination of both aspirin and a P2Y12 inhibitors for 12 months. Follow up done at at 30-day, 60-days and 1 year after the index procedure.Clinical follow-up were available in 46 (92%) patients only.4 cases were lost to follow up due to logistic reasons. At 1 year follow-up, cardiac death occurred in 5 (10.9%) patients, out of which 3 (6.5%) cases were cardiac related and 2 (4.4%) are non-cardiac. Major adverse cardiac events (MACE) and target vessel failure (TVF) occurred in total 4 (8.7%) cases, where 3 (6.5%) cases resulted in cardiac death and 1 (2.2%) case had MI and clinically driven target lesion revascularization. Conclusion Our experience demonstrates that IVUS guided, upfront 2-stent Bifurcation PCI using DK crush technique for complex bifurcation lesions is effective and safe with a low MACE and TLR rate at 1 year follow-up.

TCT-896 Comparative Effectiveness of Balloon Aortic Valvuloplasty From Radial and Femoral Approach as Temporalizing Procedure

TCT-896 Comparative Effectiveness of Balloon Aortic Valvuloplasty From Radial and Femoral Approach as Temporalizing Procedure

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.

Feasibility and safety of transarterial chemoembolization in patients with liver cancer via the distal radial approach: a single-center retrospective cohort study.

The femoral artery is the standard route for transarterial chemoembolization (TACE); however, it is negatively associated with the quality of life of patients, and carries an increased risk of deep vein thrombosis in the lower limbs. We employed the distal radial approach to TACE to assess its feasibility and safety. We conducted a retrospective study at the First Hospital of Jilin University from August 1, 2020 to October 31, 2023. To be eligible for inclusion in the study, the patients had to meet the following main inclusion criteria: (I) have undergone a preoperative imaging (abdominal computed tomography enhancement or magnetic resonance dynamic enhancement) examination, or have a pathologically confirmed diagnosis of primary liver cancer, and a Child-Pugh score of A or B; and (II) have undergone distal radial artery puncture. The primary endpoint of this study was the success rate of distal radial artery puncture. The secondary endpoints were complications and the duration of the puncture. Among the 343 patients with primary liver cancer (of whom 236 were male and 107 were female), a total of 1,315 distal radial artery punctures were attempted. The success rate was remarkably high at 95.13% (1,251/1,315), with only 64 cases requiring an alternative approach due to failed puncture. The average puncture duration was 20±7.43 minutes. No bleeding and hematoma, no arterial dissection and pseudoaneurysm formation were observed on ultrasound, and the radial pulse was palpable in all patients, highlighting the safety of the procedure. Further, no adverse events of vascular occlusion were observed among the 12 patients who received 6 or more punctures, indicating the sustainability of the distal radial artery access under the premise of adequate vascular protection. The development of this technique requires a learning curve of at least 50 cases to break through the learning baseline and be proficient in distal radial artery blind puncture. This may be the reason why many interventional physicians are reluctant to perform this procedure, adapting to the femoral approach with a shorter learning curve. The distal radial artery approach is feasible and safe in hepatic arterial chemoembolization, and should be widely promoted in TACE.

Prevalence of internal iliac artery anatomical variants in a Mexican population

The internal iliac artery arises as a terminal extension of the common iliac artery and supplies blood to the pelvic region. This study aims to identify the anatomic variations of the internal iliac artery (IIA) in a Mexican population sample. This is a retrospective cross-sectional observational study. A total of 81 angiographies via the femoral artery approach performed on patients undergoing various medical procedures were included. Variations in the IIA branching patterns were identified by evaluating the angiographic images and grouped according to Adachi’s classification into five types (I–V). A total of 139 hemipelvises were analyzed (78 right and 61 left). The frequencies of each type of variation were as follows: Type I (71.2%), Type II (10.79%), Type III (0 cases), Type IV (0.7%), Type V (12.94%), and unclassified (4.31%). The most frequent anatomical variants of the IIA in the western Mexican population sample were Type I, followed by Types V and II. Even though Type V is rare in most populations, it was the second most frequent variant in this study. Understanding the variants of the IIA branching pattern is necessary for performing invasive procedures in the pelvic region with precision and minimizing complications.

Transthoracic Cross Clamp versus Endoaortic Balloon Occlusion in Minimally Invasive Mitral Valve Surgery: A Pooled Study with Subgroup Analyses.

Objective: We assessed the available literature regarding patients undergoing minimally invasive mitral valve surgery (MIMVS) with either transthoracic clamping (TTC) or endoaortic balloon occlusion (EABO). Methods: Original research studies that evaluated the perioperative outcomes of TTC versus EABO group were identified from 2000 to 2024. The incidence of all-cause mortality, cerebrovascular accidents (CVA), and aortic dissections were the primary endpoints. The cardiopulmonary bypass (CPB), cross-clamp, and ventilation time, along with the incidence of conversion to sternotomy, re-exploration, new-onset atrial fibrillation (AF), postoperative acute kidney injury (AKI), ICU stay, and LOS were the secondary endpoints. Subgroup analyses were performed regarding the EABO cannulation approach (femoral and aortic) and MIMVS approach (video-assisted and robotic-assisted). Sensitivity analyses were performed with the leave-one-out method and by including risk-adjusted populations. Results: Sixteen studies were included in both the qualitative and quantitative syntheses. After pooling data from 6335 patients, both groups demonstrated similar outcomes on all primary and secondary endpoints in the non-adjusted and adjusted total cohort analyses. These outcomes were further validated by the leave-one-out sensitivity analysis. In addition, the aortic cannulation EABO was associated with a lower cross-clamp time, followed by TTC and the femoral cannulation EABO approach. Furthermore, in the video-assisted subgroup analysis, the EABO approach was associated with a higher incidence of CVA, conversion to sternotomy, and longer ICU stay compared to the TTC group. Conclusions: The present meta-analysis indicates that both aortic occlusion techniques are safe and feasible in the context of MIMVS. A future well-designed randomized-control trial should further validate the current outcomes.