Femoral Artery Approach Research Articles

Impact of aortoceliac angle in implantation of subcutaneous hepatic artery port-catheter system for hepatic arterial infusion chemotherapy via femoral approach.

In patients with an acute aortoceliac angle, the diagnostic catheter often fails to enter the common hepatic artery. To retrospectively evaluate the impact of aortoceliac angle on the implantation of a port-catheter system via a femoral approach for hepatic arterial infusion chemotherapy (HAIC) in patients with advanced hepatocellular carcinoma (HCC). A total of 399 patients with advanced HCC underwent percutaneous implantation of a port-catheter system for HAIC. Among these patients, 383 underwent successful implantation via a femoral artery approach (success group). In 16 patients, port-catheter systems were implanted via a subclavian artery approach (failure group) after failure of the initial attempt via the femoral artery due to failed catheter tip fixation to the gastroduodenal artery. We statistically analyzed aortoceliac angle, ostial celiac stenosis, sex, age, weight, height, and body mass index (BMI) between groups. The average aortoceliac angle, weight, and BMI were significantly different between the two groups (P < 0.001, P = 0.02, P < 0.001, respectively). Among them, only the aortoceliac angle was a significant risk factor in logistic regression analysis. The smaller the aortoceliac angle, the more often the femoral approach failed (P < 0.001, odds ratio = 0.817, 95% confidence interval = 0.752-0.887). There were no significant differences in ostial celiac stenosis, sex, or age between the two groups (P = 0.549, 0.056, 0.173, and 0.773, respectively). For patients with an acute aortoceliac angle, the femoral approach is likely to fail. A subclavian artery approach should be preferentially considered for percutaneous implantation of a port-catheter system in such patients.

CORONARY ARTERY DISEASE IN PATIENTS OF PERIPHERAL ARTERIAL DISEASE: AN OBSERVATIONAL STUDY

This study assessed the frequency of coronary artery disease in patients with peripheral arterial disease undergoing angiography. The study was carried out between January 2019 and June 2019, at the Department of Cardiology, MTI-KTH, Peshawar, on 149 patients who met the operational characteristics of PAD as stated were enrolled in the study through the outpatient and accident and emergency departments before being admitted to the cardiology ward for additional assessment. The patients were informed of the study's goals and advantages, and written informed consent was taken. Patients underwent coronary angiography in the same setting through the femoral or radial artery approach electively. The mean and SDs for age were 51 ±10.92, whereas the disease duration was 4±1.58. The mean and SDs for BMI were 29.4±1.07. 114 (76.51%) patients were found to be hypertensive, whereas 35 (23.48%) patients had normal blood pressure. 133 (89.26%) patients had diabetes, while 17 (10.73%) patients were non-diabetic. 91 (61.07%) patients were found to be smokers, whereas 58 (38.92%) patients were nonsmokers. 80 (53.69%) patients were recorded with coronary artery disease (CAD). It is concluded that scrutiny must be concentrated on the concomitant likelihood of coronary artery disease in patients with diagnosed severe peripheral arterial disease. Moreover, non-invasive coupled with invasive investigation must also be carried out to lessen the burden of this condition regarding morbidity and mortality.

The Height and Mobility of Protruding Plaque After Carotid Artery Stenting Are Associated with Postoperative Ischemic Lesions.

Tissue protrusion (TP) is a possible cause of cerebral infarction after carotid artery stenting (CAS). Using optical frequency domain imaging (OFDI) and angioscopy, we investigated the relationship between the morphological features of TP and postoperative new ischemic lesions on magnetic resonance imaging (MRI)-diffusion weighted imaging (DWI) after CAS. Fifty patients who underwent CAS and subsequent poststenting intravascular evaluation using both OFDI and angioscopy were included. CAS was performed for proximal protection via the femoral artery approach, and intravascular evaluation with OFDI and angioscopy were performed after stent placement. We compared the background and poststenting intravascular findings between patients with and without postoperative new ischemic lesions on MRI-DWI. TP was observed in 42 patients (84%), and postoperative new ischemic lesions on MRI-DWI were observed in 32 patients (64%). The frequency of TP did not differ between the 2 groups, but the height of TP was higher in the DWI-positive group (0.62mm vs. 0.29mm, P=0.0028), and mobile TP was observed only in the DWI-positive group. The height of TP (P= 0.023) was an independent predictor of new periprocedural ischemic brain lesions after CAS, and its cut-off value for mobility was 0.55mm on the receiver operating characteristic curve (area under the curve, 0.93). The height of TP on OFDI and mobile-TP on angioscopy after CAS were associated with postoperative new ischemic lesions on MRI-DWI. The intravascular evaluation using OFDI and angioscopy could be helpful for a detailed evaluation of TP.

Percutaneous Patent Ductus Arteriosus (PDA) closure: When and how to close Coil VS Occluder “step by step” cases report

Background: The PDA defines the pathological persistence after the birth of a fetal physiological communication between the aorta and the pulmonary artery frequently encountered in preterm infants and whose clinical and hemodynamic consequences depend on the importance of the shunt directly bound to the diameter of the canal. Percutaneous closure is the most frequent management modality with excellent immediate and long-term results (two modes of closure: using coil or Occluder). The surgery remains reserved for complex anatomies or associated with other surgical congenital anomalies. Case presentation: We detail in this document the two methods of percutaneous closure step by step illustrated by pediatric cases. The first case concerns a 7 years old girl of 17 kg weight with a history of heart murmur that presented in the TTE a PDA estimated at 1mm with LV dilation. The second case concerns a 12 years old girl of 30 kg weight with also a history of heart murmur that presented on TTE a PDA of 4.5mm with LV dilation. Therapeutic intervention: In the first case, we perform a closure with coil 5/5 by a unique femoral arterial approach as a standardized attitude in our center avoiding additional venous access. For the second case, we opted for closure with prosthesis N° 6/8 by a double femoral approach (arterial and venous access). Outcomes: The follow-up was favorable for both patients, with total sealing of the defect immediately after the procedures that persist during the 6 months of control. Conclusion: The closure of PDA in children is a challenging procedure whose safety requires a good pre-and per-procedural evaluation allowing the right choice of the method and size of the closing device. The respect of the different closure stages and the critical per procedural ultrasound and angiographic control reduce the rate of complications making this technique accessible and safe. In our series of 108 PDA closures by Coil in children, the unique femoral arterial approach is the standardized attitude in the first line in all patients avoiding additional venous access, which allows the Coil release in the basic technique while the arterial access allows opacification and measurement of the channel. The unique arterial approach has reduced the risk of local complications at the puncture site and the duration of the procedure without difference in closure efficiency and embolization risk. In our series of 92 PDA closures by Occluder in children the double femoral approach is the standardized attitude for all patients, the venous access allows the device release while the arterial access allows opacification/ measurement of the channel and control device deployment.

Transarterial Embolization of Ruptured Pancreaticoduodenal Artery Pseudoaneurysm Related to Chronic Pancreatitis

We presented a 67-year-old woman with lightheadedness, diaphoresis, and acute epigastric and right hypochondrium pain, with a past medical history including stage 2 essential hypertension, chronic ischemic cardiomyopathy, and class 1 obesity. An abdominal contrast-enhanced CT scan showed an extensive hematoma (3 × 4 cm2 in size) located intra-abdominally, adjacent to the duodenojejunal area, with hyperdensity around the duodenum, positioned inferior to the pancreas (30-59 HU). Moreover, the CT scan also revealed an enhancing lesion as a pseudoaneurysm of the inferior pancreaticoduodenal artery, measuring 5 × 8 × 8 mm3 with active bleeding and associated hematoma. Following these investigations of the abdominal area, a decision was made to proceed with an endovascular intervention within the interventional radiology department. With the patient under conscious sedation, via a right common femoral artery approach, the superior mesenteric artery was catheterized. While injecting the contrast agent to obtain a better working projection, the pseudoaneurysm ruptured, and acute extravasation of the contrast agent was noted, followed by injection of a mixture of 1 mL Glubran 2 with 2 mL Lipiodol until complete obliteration of the pseudoaneurysm was obtained. The patient was hemodynamically stable at the end of the procedure and was discharged 6 days later in a good condition without active bleeding signs.

Outcomes of different types of pulmonary atresia in neonates treated by ductus arteriosus stenting

Objective: To summarize the outcomes of different types of pulmonary atresia in neonates treated by ductus arteriosus stenting. Methods: This study was a retrospective cohort study. A total of 19 neonates who had pulmonary atresia treated by ductus arteriosus stenting in Xinhua Hospital, Shanghai Jiao Tong University School of Medicine from April 2014 to June 2021 were included. They were divided into the intact ventricular septum (PA-IVS) group and the ventricular septal defect (PA-VSD) group. Ductus arteriosus stents were implanted by different approaches. These children were followed up regularly at the 1, 3, 6, and 12 months after the surgery and annually since then to evaluate the outcome. Independent sample t-test was used for the statistical analysis. Results: There were 12 children in PA-IVS group and 7 in PA-VSD group. All of them were full term in fants. The gestational age of the PA-IVS group and the PA-VSD group was (38.8±1.1) and (37.7±1.8) weeks, the birth weights were (3.2±0.4) and (3.4±1.1) kg, and the age at operation was (10±9) and (12±7) days, respectively, without significant difference (all P>0.05). Among the 12 children with PA-IVS, 9 had stents successfully implanted through the femoral artery and 3 through the femoral vein. Of the 7 children with PA-VSD, 2 had the stents successfully implanted via the femoral artery and 2 failed, and the remaining 3 had stents successfully implanted via the left carotid artery. There was no postoperative thromboembolism, arteriovenous fistula, pseudoaneurysm or other vascular complications. Five children with PA-VSD who had successful operations were followed up at 6 months of age. They all had the operation for pulmonary atresia, repair of the ventricular septal defect, removal of arterial duct stents, and ligation of the arterial duct. All children survived without any stent displacement or stenosis and biventricular circulation was achieved during the follow-up. Conclusions: Ductus arteriosous stenting can be the first-stage treatment for children with PA-IVS and PA-VSD. In addition to the traditional femoral vein and femoral artery approach, the carotid artery can be used as a route for stent placement.

Stenting of Ductus Arteriosus for Duct-Dependent Pulmonary Circulation: An Emergency and Life Saving Procedure

BACKGROUND: Critical congenital heart defect with ductal-dependent pulmonary flow presents as a life-threatening condition. The patency of ductus arteriosus is required to supply blood flow into the lung. Stent implantation into ductus arteriosus has been proposed as non-surgical management for critical congenital heart disease with duct-dependent. CASE DESCRIPTION: We present full-term newborns who had critical congenital heart disease with ductal-dependent pulmonary blood blow and successfully managed with ductal stenting. Patient A, a 13-days-old male newborn had Tetralogy of Fallot-Pulmonary Atresia, restrictive Ventricular Septal Defect (VSD) and patent ductus arteriosus (PDA). Patient B, a 5-days-old female newborn had Tricuspid Atresia, restrictive VSD, PDA, and multiple congenital anomaly. Patient C, a 2-days-old female newborn had PA-IVS, PDA with stretched Patent Foramen Ovale (PFO). Prostaglandin-E1 infusion was started at first and stopped 6 hours prior to the procedure. All patients underwent ductus arteriosus stenting via femoral artery approach with drug-eluting stent. Pulmonary vascular markings were increased and oxygen saturations were improved in all of the patient. 5-month follow up, patients were in stable condition and prepared for surgical correction. DISCUSSION: Ductal stenting in patient with duct-dependent pulmonary circulation appears to be an alternative to surgery. It provides bridging palliation until the time of definitive surgery. The effectiveness of the procedure was highlighted by the fact that all the patients showed a significant improvement in arterial saturation and pulmonary vascular marking. CONCLUSION: Stenting of ductus arteriosus is feasible and safe with great result. Early detection and timely management are imperative to save the life. KEYWORDS: critical congenital heart defect, ductus arteriosus, ductal stenting, ductal-dependent pulmonary blood flow

Initial experience of using a large-bore (0.096″ inner diameter) access catheter in neurovascular interventions.

The purpose of this study was to report our initial experience of using a large-bore (0.096″ inner diameter) access catheter in neurovascular interventions. Data were retrospectively collected from 5 sites in the US for neurovascular procedures performed using a large-bore access catheter. The effectiveness outcome was technical success, defined as the access catheter's successfully reaching its target vessel without conversion to direct carotid puncture or to a smaller-bore access catheter and successfully completing the intended neurointervention. One hundred and thirteen procedures performed in 112 patients were included in this study. The mean age of the patients was 67.5 years (SD 16.2), and about half (49.1%) were female. The most common primary access sites were the femoral (64.6%) or radial (32.7%) artery. Challenging anatomic variations included severe vessel tortuosity (26/81, 32.1%), type II aortic arch (17/88, 19.3%), type III aortic arch (14/88, 15.9%), bovine arch (16/104, 15.4%), severe angle (<30°) between the subclavian and target vessel (11/74, 14.9%), and subclavian loop (7/79, 8.9%). The median access time to branch view was 18 min (IQR 11-28, N = 75). The technical success rate was 94.7%. Two dissections (1.8%) were related to the large-bore access catheter. Access site complications occurred in 2 patients (1.8%). Four additional symptomatic periprocedural complications not related to the large-bore access catheter occurred (7.1%). For neurovascular interventions, a 0.096″ inner diameter access catheter could be used with both femoral and radial arterial approaches, had a high technical success rate, and had a low rate of periprocedural complications.

Endovascular Treatment of a Giant Iliac Vein Aneurysm After a Traumatic Arteriovenous Fistula

A 60 year old man with a history of a military mine injury 30 years previously presented with chronic leg swelling and a non-healing ulcer. Computed tomography angiography (CTA) revealed a giant iliac venous aneurysm (Figure A; red arrow) due to a chronic arteriovenous fistula (green arrows) in the proximal superficial femoral artery (SFA; mine fragments indicated by the blue arrows). An iliac limb stent graft (16 – 23 mm × 100 mm; W.L. Gore & Associates, Flagstaff, AZ, USA) was placed via an open antegrade common femoral artery approach into the SFA.

P.118 Radial to femoral “through and through” access for high grade ostial subclavian and innominate artery stenoses: a novel technique

Background: Endovascular approaches are typically preferred to open surgical techniques for symptomatic subclavian/innominate artery stenosis. Due to individual patient anatomy, endovascular treatment from a conventional femoral arterial approach can be technically challenging. Our alternative technique using a combined radial to femoral artery approach can facilitate an otherwise challenging revascularization procedure. Methods: Retrospective analysis between November 2017 to March 2021 yielded five procedures (in four patients) using a combined radial to femoral “through and through” access and stenting technique. Results: All patients presented with hypoperfusion symptoms, either to their extremities, brain, or both. Technical success was achieved in 100% of the five vessels treated in four patients with symptomatic subclavian/innominate artery stenosis using this approach. One of the patients developed a recurrent stenosis after 40 months, requiring a repeat procedure. Three patients received treatment to the left subclavian artery and one to the innominate artery. All of the patients experienced marked symptomatic improvement without significant complications. Conclusions: A combined radial to femoral “through and through” access technique is a simple and safe method to achieve successful recanalization of high grade symptomatic ostial stenoses of the subclavian and innominate arteries.

B-10 | Successful Treatment of Shock in Septic Patient with Left Ventricular Suicide-like Presentation Refractory to Medical Therapy with Impella Hemodynamic Support

B-10 | Successful Treatment of Shock in Septic Patient with Left Ventricular Suicide-like Presentation Refractory to Medical Therapy with Impella Hemodynamic Support

THE CLINICAL PROFILE AND CORONARY ARETERY FINDINGS IN PATIENTS WITH ATRIAL FIBRILLATION

Background: Atrial fibrillation (AF) is a common arrhythmia in daily practice and one of the heart disorders with the highest morbidity and death rates, as it is responsible for a huge number of negative consequences. In our country, there is limited information on the prevalence or natural history of the less well-defined clinical types. Objective: to evaluate the clinical profile and coronary artery findings in atrial fibrillation patients. Patients and Methods: This cross-sectional study was conducted during the period from the first of October 2019 to end of July 2021 at the Iraqi Center for the heart disease at Baghdad Medical City. Included 32 Iraqi patients with atrial fibrillation of both genders. Angiography performed through the femoral Artery approach, Data collected by history, through clinical examination and investigations, using data collection sheet Results: The main type of AF was chronic, (62.5%), Echocardiography findings revealed Systolic dysfunction in 31.1% of patients, Diastolic dysfunction in 37.5%, and both dysfunctions in 6.2%, Left atrium was dilated in 13 (40.6%). Angiographic findings revealed RCA lesion in 13 (40.6%) patients, LCA in 9 (28.1%) while both RCA and LCA lesions present in 3 (9.4%) patients. LAD lesions reported in 10 (31.2%) patients, LCX in 27.8% and LMS in 16.8%. Conclusion: Chronic AF was the more frequent type, Systolic and diastolic dysfunction are frequent among AF patients. RCA was more frequently affected than LCA, LAD was the more affected branch.

Consideration of the Femoral Artery Approachin Percutaneous Coronary Intervention of Acute St-Segment Elevation Myocardial Infarction in Kommerell’s Diverticulum With A Right-Sided Aortic Arch: A Case Report

Owing to vascular malformations, it is difficult to perform catheter operation following the radial artery approach in percutaneous coronary intervention for acute ST-segment elevation myocardial infarction (STEMI) with Kommerell’s diverticulum on the right-sided aortic arch. However, only few studies have reported the use of the femoral artery approach to achieve early reperfusion; however, there is no established approach for patients with a right-sided aortic arch. In this study, we retrospectively analyzed the usefulness of the femoral artery approach in patients with STEMI and a right-sided aorta from January 2010 to March 2021.The total number of computed tomography (CT) cases was 180,514, of which 2 involved STEMI. In one of the two cases, the right radial artery approach was used. Therefore, only one patient with STEMI with a right-sided aortic arch underwent and operation using the femoral artery approach. In this patient, early revascularization was achieved with a door-to-balloon time of 70 min, suggesting the usefulness of the femoral artery approach.

Thoracic endovascular aortic repair with a right thoracotomy approach

BackgroundThe common femoral artery is usually the preferred access route for thoracic endovascular aortic repair (TEVAR). However, if access from the common femoral artery is challenging, other routes must be considered. We report a case of TEVAR performed by approaching the descending thoracic aorta with a right thoracotomy and using the descending thoracic aorta as an access route.Case presentationA 70-year-old female was diagnosed with a descending thoracic aortic aneurysm (65 mm in diameter), a thoracoabdominal aneurysm (54 mm in diameter), and an abdominal aortic aneurysm (49 mm in diameter). Since the patient had severe chronic obstructive pulmonary disease, one-stage replacement of the thoracoabdominal aortic aneurysm was contraindicated and TEVAR on the descending aorta was selected. A strong tortuous section of the aorta—from the descending aorta to the abdominal aorta—hampered endovascular access to the site from the common femoral artery. A TEVAR approach from the abdominal aorta was also considered; however, an abdominal aortic aneurysm and a transverse colon loop stoma from an earlier surgery presented challenges to this technique. We chose to access the descending thoracic aorta with a thoracotomy from the right 6th intercostal space for TEVAR, because the access route that is not affected by the meandering of the aorta is considered to be the descending aorta with a right thoracotomy. The patient’s postoperative course was uneventful after the stent graft was placed. No complications were detected with postoperative contrast-enhanced computed tomography (CT).ConclusionsOur findings suggest that TEVAR can be performed by approaching the descending aorta from a right thoracotomy, if variations of vascular anatomy interfere with the more commonly used femoral artery approach.

Y Stent Rendezvous to Treat Symptomatic Innominate Artery Stenosis.

A male in his 60s presented with transient ischemic attacks 5 years after aortic arch branch graft repair for type A aortic dissection. Computed tomographic angiography demonstrated 80% stenosis of the brachiocephalic artery close to the origins of the right common carotid and subclavian arteries. The case was reviewed at our multidisciplinary aortic meeting and a plan for endovascular management was made. Percutaneous endovascular Y stenting from the innominate artery into the left common carotid and subclavian arteries was achieved using self-expanding nitinol stents with a rendezvous technique that included retrograde right radial artery, retrograde right external carotid artery, and retrograde right femoral arterial approaches. At 6 months review, the stents remained widely patent and the patient was symptom-free.

Anatomical Factors That Impede Using the Radial Artery Approach for Carotid Artery Revascularization

We investigated the anatomical characteristics that complicate utilizing the radial artery approach (RAA) for craniocervical intravascular intervention. The data of 73 lesions in 65 consecutive patients who underwent transradial cervical carotid artery intervention was evaluated. We assessed the success rate of RAA in right-sided and left-sided lesions. The diameters and angles of the left and right common carotid arteries and the aortic, brachiocephalic, and right subclavian arteries, which constitute the paths of the guiding sheath, were assessed for each of the left- and right-sided lesions. It was difficult to apply RAA in 10 cases (13.7%), of which 2 (5.0%) involved right-sided and 8 (24.2%) left-sided lesions. The approach was significantly more difficult to perform in left-sided than in right-sided lesions (P= 0.02). Although the treatments were successfully completed, crossover to the femoral artery approach was required in 4 cases (5.5%, 2 cases for left-sided lesions). Placement of the guiding sheath in the common carotid artery was successful for all right-sided lesions; however, the guiding sheath slipped off to the aorta during stent advancement in 2 cases. When the angle between the brachiocephalic artery and aortic arch was small, the introduction of the guiding sheath to left-sided lesions was difficult in eight cases (P= 0.0001). RAA was difficult to perform in cases involving left-sided lesions and a small angle between the brachiocephalic artery and aortic arch. This study could help delineate the factors associated with difficulty of catheter introduction and instability of RAA.

Transcatheter Closure of Patent Ductus Arteriosus via Different Approaches.

Background: There have been marked advances in devices such as Amplatzer Duct Occluder II (ADO-II) or vascular plug through 5Fr delivery sheath for closure of patent ductus arteriosus (PDA) in the past five decades, making it possible for cardiologists to deliver occluders via different approaches. However, comparisons of these different approaches have not been reported. Therefore, the aim of this study was to summarize and compare the advantages of different approaches for PDA closure, and to guide clinical strategies.Methods: This retrospective study included all patients undergoing transcatheter closure of PDA from 2019 to 2020. Patients were matched by 1:1 propensity score matching (PSM). The retrograde femoral artery approach (FAA) and simple vein approach (SVA) groups were compared with the conventional arteriovenous approach (CAA).Results: The average age of the 476 patients was 21.05 ± 21.15 years. Their average weight was 38.23 ± 24.1 kg and average height was 130.14 ± 34.45 cm. The mean diameter of the PDA was 4.29 ± 2.25 mm. There were 127 men and 349 women, comprising 205 adults and 271 children. Among them, 197 patients underwent CAA, 223 underwent SVA, and 56 underwent retrograde FAA. The diameter in the FAA group was smaller than that in the other two groups, but was similar in adults and children. In the PSM comparison of CAA and SVA, 136 patients with CAA and 136 patients with SVA were recruited. Simple vein approach was associated with markedly reduced length of hospital stay, length of operation, and contrast medium usage as compared with CAA (all P < 0.05). In the PSM comparison of FAA and CAA, 30 patients with CAA and 30 patients with FAA were recruited. The operation duration was longer in the CAA than in the FAA group. There were no significant differences in postoperative complications among groups.Conclusion: Patent ductus arteriosus closure by using the SVA and FAA is safe and effective, and has certain advantages in some respects as compared with CAA.

Clinical application of Shenton's line to determine the femoral artery bifurcation using the antegrade common femoral artery approach.

Clinical application of Shenton's line to determine the femoral artery bifurcation using the antegrade common femoral artery approach.

Ultrasound-guided percutaneous cannulation for extracorporeal membrane oxygenation in children

Objective: To evaluate the effectiveness and safety of ultrasound-guided percutaneous cannulation for extracorporeal membrane oxygenation (ECMO) in children. Methods: In this retrospective observational study, 66 cases who underwent non-cardiac surgery ECMO in pediatric intensive care unit (PICU) of Shanghai Children's Hospital from May 2016 to April 2021 were collected. The demographics, model of ECMO support, type and size of arteriovenous cannulas, way of catheterization and complications were recorded and summarized. Patients were divided into percutaneous cannulation group and surgical cannulation group according to catheterization strategies. The demographics, duration of cannulation and ECMO support, ECMO weaning rate and hospital survival rate were compared among two groups. χ2 and nonparametric rank sum test were used for comparison. Results: Among the 66 patients who received ECMO, 38 were male and 28 were female, with age 44.5 (12.0, 83.5) months and weight 15.0 (10.0, 25.0) kg; 21 patients underwent percutaneous cannulation, with a success rate of 95% (20 cases). Point-of-care ultrasound was performed for all percutaneous cannulation cases. The duration of percutaneous cannulation was significantly shorter than that of surgical cannulation (26.0 (23.3, 30.3) vs. 57.0 (53.8, 64.0) min, Z=6.31, P<0.001). Successful percutaneous cannulation cases were aged 70.5 (23.8, 109.5) months, and their weight was 23.2 (13.6, 37.0) kg. Ten cases were initially given veno-venous (VV) ECMO support, and 10 cases were given veno-arterial (VA) ECMO support. ECMO arterial cannulas were sized from 8 F to 17 F, and venous cannulas sized from 10 F to 19 F. For VV-ECMO, the right internal jugular and femoral veins were used as vascular access, while VA-ECMO used right internal jugular vein-femoral artery or right femoral vein-left femoral artery approach. Only one patient suffered severe complication (superior vena cava perforation). There was no catheter-related bloodstream infection. Conclusion: Ultrasound-guided percutaneous cannulation for ECMO can be performed with a high rate of success and safety in children.

C39. Ductus Arteriosus Stenting: A Promising and Life Saving Procedure for Ductal-Dependent Pulmonary Blood Flow

Abstract Background Duct-dependant congenital heart disease in newborn presents as a life-threatening emergency and the survival depends on patency of the ductus arteriosus. Stent implantation into ductus arteriosus has been proposed as non-surgical management for critical congenital heart disease with duct-dependent. Case Summary We present full-term newborn babies who had critical congenital heart disease with ductal-dependent pulmonary blood blow and successfully managed with ductal stenting. Patient A, a 13-days-old male had Tetralogy of Fallot-Pulmonary Atresia and restrictive Ventricular Septal Defect (VSD). Patient B, a 3-days-old male had Pulmonary Atresia-Intact Ventricular Septum (PA-IVS) with Patent Foramen Ovale (PFO). Patient C, a 5-days-old female had Tricuspid Atresia with restrictive VSD and multiple congenital anomaly. Patient D, a 2-days-old female had PA-IVS with PFO stretch. Prostaglandin-E1 infusion was started at first and stop 6 hours prior to the procedure. Ductus arteriosus stenting using drug-eluting stent and femoral artery approach was successful in all 4 patients. All patient had improvement of oxygen saturation and good post-procedure outcome. Discussion Ductal stenting in patient with duct-dependent pulmonary circulation appears to be an alternative to surgery. It provides a bridging palliation in cyanotic congenital heart disease until the time of definitive surgery. Stenting of ductus arteriosus is feasible and safe with good result, thus early recognition and timely management are important to save the life.