Femoral Vein Access Research Articles

Impact of Access Site Choice on Outcomes of Inferior Vena Cava Filter Placement

Limited studies have evaluated optimal access site choice during placement of inferior vena cava (IVC) filters. In this study, we aim to compare the outcomes of IVC filter placement between femoral and internal jugular vein access sites.

Digital radiograph (DR) guided bedside IVC filter placements in patients with intracranial pressure monitors

PurposeThe purpose of this study is to report a single center experience with portable digital radiographically (DR) guided bedside IVC filters placed in intensive care unit (ICU) patients with high ICP and elevated head of bed (HOB). Materials and methodsA retrospective chart review was conducted on all bedside IVC filters placed from January 1, 2010 to September 16, 2020. Patients with high ICP and elevated head of bed requirements were included. Charts were reviewed for filter type, common femoral vein (CFV) access, filter location, pre procedure imaging, pre and post filter ICPs, glascow coma scale, number of radiographs taken, and filter removal. ICPs were obtained 1 ​h prior to procedure and 2 ​h post procedure and analyzed with a paired T test.Filters were placed by reviewing prior CT scan for IVC size, caval variants, renal and iliac veins and vertebral body landmarks. Then, CFV access was obtained and a Bentson wire was advanced 30–40 ​cm. A radiograph was used to confirm adequate position of the of the wire. The filter sheath was advanced and serial radiographs were used to position the filter sheath at the final predetermined position below the renal veins and above the iliac bifurcation. The filter was deployed, and a radiograph was obtained to confirm filter positioning. ResultsA total of 9 DR guided bedside IVC filters were placed (4 Denali, 3 Option Elite, 2 Celect). Indications included prophylactic placement (n ​= ​8) and acute DVT (n ​= ​1). The average patient age was 35.8 years (range: 18–56 years) CT abdomen and pelvis was used to assess for the level of renal veins in all patients (n ​= ​9). No caval variants were encountered on pre-procedural planning. The average pre, intraprocedural, and post procedure intracranial pressure was 16 ​mmHg, 13 ​mmHg, and 16 ​mmHg, respectively. Confirmation of placement after final placement was available in 7 patients (4 DR, 2 CT and one fluoroscopic examination). Two non-procedural related deaths occurred.Technical success, defined as successful placement of IVC filter at the predetermined level, was achieved in 100% of patients (n ​= ​9). The right CFV was used in most patients (n ​= ​7). The left CFV was used for access in two patients due to right CFV thrombus (n ​= ​1) and existing right femoral venous central line (n ​= ​1). The average number of radiographs taken was 5.8 (range 4–9). In all cases, filters were placed below the level of the lowest renal vein (n ​= ​9). A comparison of pre, during and post intervention ICP pressures is shown in table, 2. No differences between pre and post filter ICP was noted (p ​= ​0.77). Three filters were later removed. One minor complication was reported, which was filter tilt (23%) in an Option filter. ConclusionBedside IVC filters can be safely placed in patients with head trauma and high ICP who are unable to lay supine using portable DR guidance with a high rate of technical success and minimal complications.

Intravascular Ultrasound-Guided Transvenous Biopsy of Abdominal and Pelvic Targets Difficult to Access by Percutaneous Needle Biopsy: Technique and Initial Clinical Experience

PurposeTo report initial clinical experience with intravascular ultrasound (US)-guided transvenous biopsy (TVB) for perivascular target lesions in the abdomen and pelvis using side-viewing phased-array intracardiac echocardiography catheters. Materials and MethodsIn this single-institution, retrospective study, 48 patients underwent 50 intravascular US-guided TVB procedures for targets close to the inferior vena cava or iliac veins deemed difficult to access by conventional percutaneous needle biopsy (PNB). In all procedures, side-viewing phased-array intracardiac echocardiography intravascular US catheters and transjugular liver biopsy sets were inserted through separate jugular or femoral vein access sheaths, and 18-gauge core needle biopsy specimens were obtained under real-time intravascular US guidance. Diagnostic yield, diagnostic accuracy, and complications were analyzed. ResultsIntravascular US-guided TVB was diagnostic of malignancy in 40 of 50 procedures for a diagnostic yield of 80%. There were 5 procedures in which biopsy was correctly negative for malignancy, with a per-procedure diagnostic accuracy of 90% (45/50). Among the 5 false negatives, 2 patients underwent repeat intravascular US-guided TVB, which was diagnostic of malignancy for a per-patient diagnostic accuracy of 94% (45/48). There were 1 (2%) mild, 2 (4%) moderate, and 1 (2%) severe adverse events, with 1 moderate severity adverse event (venous thrombosis) directly attributable to the intravascular US-guided TVB technique. ConclusionsIntravascular US-guided TVB performed on difficult-to-approach perivascular targets in the abdomen and pelvis resulted in a high diagnostic accuracy, similar to accepted thresholds for PNB. Complication rates may be slightly higher but should be weighed relative to the risks of difficult PNB, surgical biopsy, or clinical management without biopsy.

Retrograde Transcatheter Perforation in Adult with Pulmonary Atresia and Single Ventricle: A Unique Case of Ventricular Outflow Tract Opening

Radiofrequency-assisted perforation and subsequent balloon dilatation technique is accepted for treating pulmonary stenosis and pulmonary atresia in patients with intact interventricular septum, but its high cost limits the widespread use. Perforation of the atretic pulmonary valve using the stiff end of a coronary wire seems to be an effective alternative to the radiofrequency perforation. We report on a 47-year-old man with a complex cardiopathy including a pulmonary valve atresia, who underwent a partial surgical repair. Due to high surgical risk, a completion could not be foreseen and a percutaneous retrograde perforation of the pulmonary valve was proposed. The perforation was managed by means of BMW wires with stiff tip from the right internal jugular vein because the femoral vein access was not accesible. Following three Armada balloon inflations, an Express stent was properly introduced to keep the ventricular outflow tract (VOT) open. We describe a successful unusual technique of atretic pulmonary valve percutaneous retrograde perforation that can be an efficient alternative when surgery or anterograde percutaneous access are not possible.

Percutaneous Left Atrial Appendage Occlusion: An Emerging Option in Patients with Atrial Fibrillation at High Risk of Bleeding.

Atrial fibrillation (AF) is a common cardiac arrhythmia with an estimated prevalence of 1% in the general population. It is associated with an increased risk of ischemic stroke, silent cerebral ischemia, and cognitive impairment. Due to the blood flow stasis and morphology, thrombus formation occurs mainly in the left atrial appendage (LAA), particularly in the setting of nonvalvular AF (NVAF). Previous studies have shown that >90% of emboli related to NVAF originate from the LAA, thus prevention of systemic cardioembolism is indicated. According to the current guidelines, anticoagulant therapy with direct oral anticoagulants (DOACs) or vitamin K antagonists (VKAs), represents the standard of care in AF patients, in order to prevent ischemic stroke and peripheral embolization. Although these drugs are widely used and DOACs have shown, compared to VKAs, non-inferiority for stroke prevention with significantly fewer bleeding complications, some issues remain a matter of debate, including contraindications, side effects, and adherence. An increasing number of patients, indeed, because of high bleeding risk or after experiencing life-threatening bleedings, must take anticoagulants with extreme caution if not contraindicated. While surgical closure or exclusion of LAA has been historically used in patients with AF with contradictory results, in the recent years, a novel procedure has emerged to prevent the cardioembolic stroke in these patients: The percutaneous left atrial appendage occlusion (LAAO). Different devices have been developed in recent years, though not all of them are approved in Europe and some are still under clinical investigation. Currently available devices have shown a significant decrease in bleeding risk while maintaining efficacy in preventing thromboembolism. The procedure can be performed percutaneously through the femoral vein access, under general anesthesia. A transseptal puncture is required to access left atrium and is guided by transesophageal echocardiography (TEE). Evidence from the current literature indicates that percutaneous LAAO represents a safe alternative for those patients with contraindications for long-term oral anticoagulation. This review summarizes scientific evidences regarding LAAO for stroke prevention including clinical indications and an adequate patient selection.

Abstract No. 527 High incidence of large-bore temporary hemodialysis catheter thrombosis in patient with COVID-19–related kidney injury

Purpose: To evaluate the incidence of large-bore hemodialysis catheter thrombosis in the setting of COVID-19. Materials and Methods: A retrospective review was performed of all patients who underwent placement of a temporary hemodialysis catheter after developing kidney injury after COVID 19 infection at our institution. Data collected included demographic information, procedure related information, and incidence of replacement due to lumen thrombosis. Groups were compared using students t-test for continuous variables and Fisher’s exact test for nominal variables. Results: 64 patients (43M, mean age 63.2 ± 13.3) underwent placement of temporary hemodialysis catheter placement for kidney injury related to COVID 19 infection. 31 (48.4%) of catheters were placed via an internal jugular vein (IJV) access and 33 (52.6%) of catheters were placed via a common femoral vein (CFV) access. Overall, 15 (23.4%) catheters required replacement due to lumen thrombosis despite heplock. There were no difference in age or sex in patients who required replacement to those who did not (P.0.05) [sic]. Of the replacements, 5/31 (16%) were placed via an IJV access and 10/33 (30.3%) were placed via a CVF access, although this difference was not statistically significant (P = 0.18). The average time to malfunction/replacement was 7.8 ± 4.8 days for catheters placed via an IJ access versus 3.4 ± 3.3 days for catheters placed via a CFV access (P = 0.055), trending toward significance. Conclusions: A high incidence of temporary dialysis catheter lumen thrombosis was present in patients with COVID-19 infection. This may be due to COVID related thrombosis versus decreased level of catheter care. Catheters placed via a femoral vein access had more frequent malfunction and with shorter indwelling time, although not significant, which may be due to small sample size.

Abstract No. 76 ▪ FEATURED ABSTRACT Intravascular ultrasound-guided transvenous biopsy of retroperitoneal targets inaccessible by percutaneous iopsy: technique and initial clinical experience

Retroperitoneal lymph nodes and masses adjacent to the inferior vena cava (IVC) or iliac veins can be inaccessible by a conventional percutaneous needle biopsy (PNB) approach due to surrounding vascular and osseous structures. The purpose of this study was to report initial clinical experience with the use of intravascular ultrasound-guided transvenous biopsy (IVUS-TVB) of difficult to access extravascular lymph nodes and masses. From October 2018 to August 2020, 41 IVUS-TVB procedures were performed under fluoroscopy in 38 patients (n = 19 males, mean age = 63) using side viewing intracardiac echocardiography IVUS catheters (ViewFlex Xtra, St. Jude Medical) and 18-gauge transjugular liver biopsy kits (Argon) through separate 10 French sheaths. All cases were initially reviewed for feasibility by PNB but were deemed unacceptably high risk. Patient demographics, target locations and sizes, success rates, and 30-day complications were recorded. Forty biopsies were performed, and 1 lesion was determined to be a vascular malformation by IVUS. Lymph nodes were interaortocaval (n = 11), porta hepatis (n = 5), right paracaval (n = 3), retrocaval (n = 3), iliac chain (n = 3), and retrocrural (n = 2), and masses were in liver (caudate n = 2, dome n = 2, segment 6 n = 2), right adrenal (n = 3), pancreas (n = 2), aortic wall (n = 1) and IVC (n = 1). The average short axis size was 2.6 cm (range 1.0-6.8). IVUS access was jugular (n = 27) or femoral (n = 13), and biopsy access was jugular (n = 28), femoral (n = 11), or portal (n = 1) with passes made from the IVC (n = 37), iliac (n = 2), or portal vein (n = 1). In 32 procedures (80%) IVUS visualization was good. Final pathology was diagnostic of malignancy in 29 procedures (73%), correctly excluded malignancy in 4 (10%), and was non-diagnostic in 7 (18%) with subsequent diagnosis made via repeat IVUS-TVB (n = 3) or surgical biopsy (n = 2) or remaining unknown (n = 2). There were 3 minor complications requiring no treatment (hyperbilirubinemia attributed to hemobilia; contrast induced acute kidney injury; small non-occlusive IVC thrombus at the biopsy site). There was 1 major complication directly related to the biopsy (bleeding at the femoral vein access site requiring transfusion) and 1 other major complication (aortic pseudoaneurysm in a patient with preexisting salmonella aortitis). IVUS-TVB achieves high diagnostic yields similar to accepted thresholds for PNB. Complications rates may be higher but should be weighed relative to the risks of difficult PNB, surgical biopsy, or clinical management without biopsy.

Upper extremity transvenous access for neuroendovascular procedures: an international multicenter case series

BackgroundRadial artery access for transarterial procedures has gained recent traction in neurointerventional due to decreased patient morbidity, technical feasibility, and improved patient satisfaction. Upper extremity transvenous access (UETV) has recently...

Infections from temporary catheters in hemodialysis patients in Kosovo.

The objective of this study is to evaluate the frequency of infections from central venous temporary catheters and the type of a microorganism caused, from January 2017 up to December 2019. This study was performed on patients who were on hemodialysis (HD) through the central temporary venous catheter, right and left femoral vein, right jugular vein, and right subclavian vein.The patients in the HD center in Pristina, Kosovo, were used as a clinical sample. In this study, 1902 patients with temporarily central venous catheters (CVCs) were involved, while the control group consisted of 642 patients. Both groups were matched for age and gender. In all patients and the subjects of the control group, following data were obtained: Anamnesis, medical examination, as well as biochemical and hematological laboratory tests, CVC swab and antibiogram and hemoculture. Data analysis was performed using the descriptive statistical methods and the Chi-square test comparing the laboratory results of a HD patients treated through the central temporary venous catheter. Based on the results of this research, higher incidence of infections occurred with femoral vein access, compared to other CVCs accesses. The most common microorganisms responsible were Staphylococus epidermidis, while the 2019 had the highest incidence of infection.

Pediatric Extracorporeal Cardiopulmonary Resuscitation ELSO Guidelines.

Pediatric Extracorporeal Cardiopulmonary Resuscitation ELSO Guidelines.

Increased Intracranial Hemorrhage Amid Elevated Inflammatory Markers in Those With COVID-19 Supported With Extracorporeal Membrane Oxygenation.

COVID-19-related coagulopathy is a known complication of SARS-CoV-2 infection and can lead to intracranial hemorrhage (ICH), one of the most feared complications of extracorporeal membrane oxygenation (ECMO). We sought to evaluate the incidence and etiology of ICH in patients with COVID-19 requiring ECMO. Patients at two academic medical centers with COVID-19 who required venovenous-ECMO support for acute respiratory distress syndrome (ARDS) were evaluated retrospectively. During the study period, 33 patients required ECMO support; 16 (48.5%) were discharged alive, 13 died (39.4%), and 4 (12.1%) had ongoing care. Eleven patients had ICH (33.3%). All ICH events occurred in patients who received intravenous anticoagulation. The ICH group had higher C-reactive protein (P = 0.04), procalcitonin levels (P = 0.02), and IL-6 levels (P = 0.05), lower blood pH before and after ECMO (P < 0.01), and higher activated partial thromboplastin times throughout the hospital stay (P < 0.0001). ICH-free survival was lower in COVID-19 patients than in patients on ECMO for ARDS caused by other viruses (49% vs. 79%, P = 0.02). In conclusion, patients with COVID-19 can be successfully bridged to recovery using ECMO but may suffer higher rates of ICH compared to those with other viral respiratory infections.

Катетеризация бедренной вены у детей. Безопасный сосудистый доступ

Objective. To identify risk factors of injuries to femoral vasculature of femoral vessel injuries, optimize the process of cannulation, reduce the risk of injury to femoral artery and its branches. Patients and methods. A screening sonography of the femoral puncture area was carried out in 466 patients. Of those, 240 patients had the bilateral sonography of the recommended optimal point for femoral vein access. The sonography of major vessels in the femoral vein access areas was performed using the ultrasound scanners Phillips HD 11 ХЕ, SonoSite М-turbo. Mindrey M7, M9, Samsung HM 70, and others; linear multi-frequency transducers with the working frequency range of 7 to 18 mHz, of 40mm and 20mm aperture. Sonography was perfromed from the level of inguinal ligament downwards, in the plane orthogonal to the major vessels in B mode and later with color Doppler mapping (CDM) of venous and arterial vessels. Results. Ultrasound findings of 240 patients were analyzed and anatomic variants of the femoral vascular bundle were identified: 29% patients had high origin of the deep femoral artery on one of the sides; 17.9% had high origin of the deep femoral artery combined with high origin of the medial circumflex femoral artery immediately behind the femoral vein; 5% had high origin of the medial circumflex femoral artery immediately from the femoral artery behind the femoral vein; in 2%, the femoral vein was located between the deep femoral artery and femoral artery 2 cm inferiorly to the inguinal fold. Sonography demonstrated that the femoral vein is easily compressible during venipuncture, and the distance between the anterior and posterior walls of the compressed femoral vein gets less than the access needle diameter. Special techniques were suggested to avoid perforation of the posterior femoral vein wall during access. It was clearly demonstrated that utilization of these techniques combined with ultrasound-assisted placement of a peripheral venous catheter on a trocar needle during femoral vein access has decreased injuries of the femoral artery and its branches from 10% to 1.3% of cases. A proprietary technology of safe stepwise cannulation of femoral veins is described. Conclusion. Ultrasound examination facilitates detection of vascular anatomy nuances and choice of the safer approach to femoral vein access. Measures preventing inadvertent puncture of the posterior wall, such as increased blood filling of the femoral vein, utilization of peripheral venous catheters for initial access, and a stepwise vein catheterization, have made it possible to achieve high percentage of successful cannulations and reduce complications. Key words: intensive care in children, ultrasound examination, venous access, femoral vein cannulation

Endovascular Treatment of Malignant Superior Vena Cava Syndrome through Upper-Limb Access: A Comparison between Venous-Dedicated and Conventional Stents

PurposeTo retrospectively evaluate the technical and clinical outcomes of superior vena cava (SVC) stent placement through upper-limb venous access in malignant SVC syndrome (SVCS) and compare the efficacy of different nitinol stent types. Materials and MethodsBetween 2006 and 2018, 156 patients (132 male; mean age, 62 y; age range, 33–81 y) underwent SVC stent placement for malignant obstructions through upper-limb venous access with 1 of 3 types of nitinol stent: 1 venous-dedicated (Sinus-XL stent) and 2 non–venous-dedicated (E-Luminexx Vascular Stent and Protégé GPS). Cases of common femoral vein access or non-nitinol stents were excluded from further analysis. The mean duration of follow-up was 8 mo. ResultsTechnical success was achieved in 99.3% of cases. One patient died during the procedure as a result of cardiac tamponade. Balloon predilation was performed in 10 patients and postdilation in 126. Mean procedural time was 34.4 min (range, 18–80 min). Overall survival rates were 92.3%, 57.3%, and 26.8%, and overall primary patency rates were 94.5%, 84.8% and 79.6%, at 1, 6, and 12 mo, respectively. There were no statistically significant differences in primary patency rates between venous- and non–venous-dedicated stents or among different Stanford SVCS grading groups (P > .05). ConclusionsSVC stent placement through an upper-limb approach is a safe, fast, and effective technique. There is no evident benefit of venous-dedicated vs non–venous-dedicated stents in the treatment of malignant SVCS.

SUCCESSFUL PERFORMANCE OF CARDIAC ELECTROPHYSIOLOGICAL PROCEDURES VIA A CONGENITAL INFERIOR VENA CAVA ANOMALY- REPORT OF 2 CASES

Background: Femoral vein access is the preferred approach for advancing multiple catheters via the inferior vena cava (IVC) to the heart during routine cardiac electrophysiology study and catheter ablation. Compared to acquired venous abnormalities, congenital inferior vena cava anomalies are encountered rather infrequently in adult electrophysiology procedures and their presence may pose technical procedural challenges. Presentation: We describe 2 cases in which we were able to successfully perform cardiac electrophysiological procedures in the presence of a complex congenital venous anomaly, the left sided IVC. First case was 30 year old gentleman presented with history of recurrent episodes of supraventricular tachycardia terminated with AV nodal blocking agents. Second case was 21 year old boy with WPW syndrome and recurrent supra-ventricular tachycardia. Diagnosis and Management: We managed to pass the EP catheters in both cases with a bit difficulty and angulation, while given I/V heparin to reduce the risk of thrombosis and confirmed the position of catheters via subclavian venous placement of a guidewire. In first case, typical AV node reentry tachycardia was induced which was mapped and ablated in the slow pathway region. In second case, right posterior accessory pathway was ablated at 6 0’clock. CT angiography of the abdominal veins was performed which confirmed the finding of left sided IVC. Follow-up and Outcomes: Abnormalities of the IVC are relatively uncommon. But it is an important condition that may be encountered by electrophysiologist. Catheter ablation of the slow AV nodal pathway and right posterior accessory pathway was safely and successfully performed with this unusual venous anomaly. Keywords: SVT, LEFT IVC, RFA

European Society of Anaesthesiology guidelines on peri-operative use of ultrasound-guided for vascular access (PERSEUS vascular access).

: Ultrasound for diagnostic and procedural purposes is becoming a standard in daily clinical practice including anaesthesiology and peri-operative medicine. The project of European Society of Anaesthesiology (ESA) Task Force for the development of clinical guidelines on the PERioperative uSE of Ultra-Sound (PERSEUS) project has focused on the use of ultrasound in two areas that account for the majority of procedures performed routinely in the operating room: vascular access and regional anaesthesia. Given the extensive literature available in these two areas, this paper will focus on the use of ultrasound-guidance for vascular access. A second part will be dedicated to peripheral nerve/neuraxial blocks. The Taskforce identified three main domains of application in ultrasound-guided vascular cannulation: adults, children and training. The literature search were performed by a professional librarian from the Cochrane Anaesthesia and Critical and Emergency Care Group in collaboration with the ESA Taskforce. The Grading of Recommendation Assessment (GRADE) system for assessing levels of evidence and grade of recommendations were used. For the use of ultrasound-guided cannulation of the internal jugular vein, femoral vein and arterial access, the level evidence was classified 1B. For other accesses, the evidence remains limited. For training in ultrasound guidance, there were no studies. The importance of proper training for achieving competency and full proficiency before performing any ultrasound-guided vascular procedure must be emphasised.

TCT-784 Comparison of Simultaneous Radial Artery With Upper Extremity Venous Access and Femoral Artery With Femoral Vein Access in Patients Undergoing Bilateral Heart Catheterization: A Systemic Review and Meta-Analysis

The transradial approach is becoming the access method of choice in many countries because of its lower risk for vascular complications, earlier post-procedural ambulation, and better patient satisfaction. Many patients planned for left heart catheterization require simultaneous right heart

The inside-out technique for tunneled dialysis catheter placement with central venous occlusion

The “inside-out” technique eliminates the need for subclavian or femoral catheter placement by placing a supraclavicular catheter via a percutaneous femoral vein access. Few reports of its use in vascular surgery exist. The purpose of this article is to describe our version of the technique and report results. Between 2016 and 2017, the inside-out technique was performed on eight patients. All patients had more than four prior access sites and bilateral internal jugular vein occlusion. The technical success rates were 100% with no periprocedural complications and success in achieving dialysis access. One patient required catheter replacement within 48 hours, one catheter was used as a bridge to Hemodialysis Reliable Outflow (Hemosphere, a Cryolife Inc Company, Eden Prairie, Minn) graft placement, and one patient died of sepsis unrelated to their catheter. Our data show the inside-out technique to be safe and effective, removes the need for subclavian or femoral catheter placement, and should be a component of treatment algorithms for complex dialysis patients, which is consistent with National Kidney Foundation's Kidney Disease Outcomes Quality Initiative recommendations.

Percutaneous retrieval of an embolized gunshot bullet from right ventricle: a case report and review of literature.

BackgroundGunshots embolizing to the heart is a rare occurrence. We report a case of percutaneous retrieval of a gunshot bullet from the right ventricle (RV) cavity of a 40-year-old lady. To the best of our knowledge, this is the first case to be reported with a right supraclavicular inlet of the bullet and successful percutaneous retrieval using a snare from the RV cavity.Case summaryA 40-year-old female patient was referred to our cardiac centre from a general hospital with a gunshot injury 8 days prior. On arrival, she was haemodynamically stable, there was an inlet wound at the right supraclavicular area. Transthoracic echocardiography revealed the bullet in the RV cavity. Under conscious sedation, right femoral vein access succeeded to retrieve the shot from the RV to the groin. The bullet slipped out and resnared from the right internal iliac vein and came out safely from the right femoral vein through the 24-Fr sheath. The vein was closed using a figure of 8 suture. The patient discharged home after 2 days.DiscussionBullet emboli to the heart are rare, endovascular retrieval of a bullet from the right ventricular cavity is feasible and relatively safe; however, more research is required. Echocardiography during the procedure is strongly recommended to early detect any complications. Accurate use of available tools such as X-ray, echocardiography, computed tomography, and fluoroscopy is a must for precise diagnosis.

Antecubital vein access for balloon pulmonary angioplasty in patients with chronic thromboembolic pulmonary hypertension: safe new approach

Background ― Balloon pulmonary angioplasty (BPA) is an effective and safe method of treating patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH). Currently, femoral and jugular vein accesses are the most frequently used for BPA. Authors all over the world report different numbers of access side complications, mostly exceeding 0.4%. We suggest new alternative access for BPA procedures – antecubital vein access (AVA) that is safe and easy. Methods ― In 2015-2017 period we performed 64 BPA in 19 patients with inoperable CTEPH. We performed BPA via AVA using standard radial access kit and in case of unsuccessful AVA we switched to femoral vein access (FVA). All procedures were successful with no serious complications and patients demonstrated clinical and hemodynamic improvement. Results ― Fifty-six from 64 procedures (87.5%) were performed via AVA, 8 – via femoral access (12.5%). There were no severe complications via AVA, local extravasates were managed with bandage compression. Conclusion ― Performing BPA via AVA in patients with CTEPH is a new alternative approach that is safe and easy.

Acute Lower Extremity Ischemia Following an Intervention Requiring a Femoral Vein Access

Acute limb ischemia is defined as a sudden and rapidly progressing decrease in limb perfusion, usually producing new or worsening symptoms or signs, and often threatening limb viability. Acute limb ischemia is most commonly caused by an acute thrombotic occlusion of a preexisting stenotic arterial segment (60% of cases) or by embolus (30%). Prompt diagnosis and urgent medical and percutaneous/surgical interventions are warranted. If not identified and addressed immediately, decreased perfusion and thrombosis can result in a high degree of limb loss–related morbidity. This report focuses on a rare case of an acute lower extremity ischemia following a lower extremity femoral vein access site–related intervention.