Guidewire Research Articles

Comparison of Doppler Guided Seldinger Technique Versus Classic Palpatory Seldinger Technique for Radial Artery Cannulation-an Open Label Randomized Controlled Trial

Objective: Radial artery cannulation is commonly performed by the conventional palpatory technique. However, in circumstances where the cannulation is difficult, other methods such as Doppler or ultrasound are used to guide the cannulation. Incorporating the Seldinger technique can further improve the successful cannulation. The aim of the study was to compare the first attempt success rate of radial artery cannulation between conventional palpatory Seldinger technique and Doppler guided Seldinger technique. Methods: Ninety patients undergoing major open abdominal surgeries were divided into two groups -the Classic palpatory and the Doppler guided radial artery cannulation. The Seldinger Technique was used in both the groups. First attempt success rate of radial artery cannulation and time to cannulation were noted by both the techniques. Results: The number of attempts and the time to cannulation were significantly less in the palpatory Seldinger group as compared with the Doppler Seldinger group. Complication rates were similar in both the groups but there were 4 failure in palpatory Seldinger group. Conclusion: The classic palpatory technique along with the Seldinger technique for radial artery cannulation is better in terms of first attempt cannulation rate and duration of cannulation than the Doppler guided Seldinger technique in patients undergoing elective surgeries. However, Doppler method had no failures and can be a useful rescue method in failed cannulation.

Favour the best in case of emergency cricothyroidotomy-a randomized cross-over trial on manikin focused training and simulation of common devices.

Performing an emergency cricothyroidotomy (EC) is extremely challenging, the devices used should be easy to handle and the selected technique reliable. However, there is still an ongoing debate concerning the most superior technique. Three different techniques were compared using a standardized, simulated scenario regarding handling, performing, training and decision making: The scalpel-bougie technique (SBT), the surgical anatomical preparation technique (SAPT) and the Seldinger technique (ST). First, anaesthesia residents and trainees, paramedics and medical students (each group n = 50) performed a cricothyroidotomy randomly assigned with each of the three devices on a simulator manikin. The time needed for successful cricothyroidotomy was the primary endpoint. Secondary endpoints included first-attempt success rate, number of attempts and user-satisfaction. The second part of the study investigated the impact of prior hands-on training on both material selection for EC and on time to decision-making in a simulated "cannot intubate cannot ventilate" situation. The simulated scenario revealed that SBT and SAPT were significantly faster than percutaneous EC with ST (p < 0.0001). Success rate was 100% for the first attempt with SBT and SAPT. Significant differences were found with regard to user-satisfaction between individual techniques (p < 0.0001). In terms of user-friendliness, SBT was predominantly assessed as easy (87%). Prior training had a large impact regarding choice of devises (p < 0.05), and time to decision making (p = 0.05; 180 s vs. 233 s). This study supports the use of a surgical technique for EC and also a regular training to create familiarity with the materials and the process itself.The trial was registered before study start on 11.11.2018 at ClinicalTrials.gov (NCT: 2018-13819) with Nicole Didion as the principal investigator.

A cross-sectional study on non-infectious dysfunction of hemodialysis cuffed catheter.

Dialysis cuffed catheter dysfunction results in inadequate dialysis, increased sepsis risk,and a shortenedcatheter life. It may be possible to prolong catheter function by identifying the causes of cuffed catheter dysfunction. This study was a cross-sectional descriptive study conducted in 2021-2022 on hemodialysis patients with jugular cuff catheters. The catheterizations were performed using the Seldinger technique and were confirmed by fluoroscopy. A 12-month follow-up was conducted with respect to the performance of the cuffed catheter. A total of 123 patients underwent hemodialysis over 2 years via a cuffed catheter. Catheters were most commonly inserted into the right internal jugular vein, with lengths of 19 cm (tip to cuff). The rate of dysfunction of cuffed catheters was 27.6%. Catheter-related thrombosis was the most common cause in 10 cases (29.4%), followed by catheter tip fibrin sheath in 8 cases (23.5%) and catheter tip malposition in 8 cases (23.5%). Furthermore, 18 patients (52.94%) of cuffed catheter dysfunction occurred within 3 months of catheter placement, based on our study. The dysfunction of cuffed catheters on the left side 23 (67.64%) is more prevalent than the right side 11 (32.35%) (P=0.043); the malposition of catheter tips is more prevalent on the left side (P=0.023). Most commonly, cuffed catheter dysfunction is caused by thrombosis, fibrin sheath formation, and catheter tip malposition. Cuffed catheter failure can be reduced by carefully monitoring the catheter's path and tip position, searching for fibrin sheaths when investigating cuffed catheter failure, and preventing thrombotic events.

Influence of the Seldinger technique on the dwell time and failure rates of ultrasound-guided peripheral cannulas: A prospective observational study

Ultrasound is commonly used to assist with peripheral vascular access and there is growing evidence that there is an advantage to using guidewires to aid insertion. This prospective observational study compares outcomes in ultrasound-guided peripheral cannulation using either standard catheter-over-needle devices or a single lumen arterial catheter inserted using the Seldinger technique. Analysis of results demonstrated a clear advantage in terms of device survival to completion of therapy in the guidewire group.

B超引导下Seldinger技术置入中线导管在减重手术患者中的应用

B超引导下Seldinger技术置入中线导管在减重手术患者中的应用

One-year outcomes of percutaneous continuous ambulatory peritoneal dialysis catheter insertion by nephrologists: First experience from Sri Lanka

Introduction: Continuous ambulatory peritonealdialysis (CAPD) via a catheter placed in the peritoneum is an established mode of renal replacement therapy. CAPD catheters are placed using either percutaneous or surgical techniques. Percutaneous method is less invasive and avoids the need for general anaesthesia, surgical space, and expertise. This study was conducted to measure one-year outcomes of percutaneous CAPD catheter insertions performed by a nephrology team; the first experience from Sri Lanka.Methods: We retrospectively studied 96 patients in two centers, who underwent percutaneous CAPD catheter insertion over two years with a follow-up period of minimum one year. The catheter was placed using modified Seldinger technique under local anesthesia with ultrasound guidance.Results: Majority were males (78.1%) with a median age of 56 years. Most were on haemodialysis (HD) (85.4%) prior to CAPD catheter insertion. The commonest reason for opting for CAPD was to avoid hospital visits for HD (54.2%). During the follow-up of one year, 85.4% were free of complications. Frequent non-infectious complications were catheter removal (12.5%), visceral injury (4.2%), primary insertion failure (4.2%), and catheter dysfunction (2.1%). Pre-training peritonitis was found in 2.1% with an overall peritonitis rate of 0.4 episodes per patient a year. There was no significant association between catheter-related complications and gender (p=0.68), previous abdominal surgery (p=0.54), diabetes mellitus (p=0.84), and hypertension (p=0.46). One-year catheter survival was 92%.Discussion: One-year outcomes of percutaneous CAPD catheter insertion by nephrologists were efficacious and safe with low complication rates. Hence, CAPD catheter insertion by well-trained nephrologists should be encouraged. Further studies comparing percutaneous versus surgical catheter placement are warranted.

Superhydrophilic and Antifriction Thin Hydrogel Formed under Mild Conditions for Medical Bare Metal Guide Wires.

Medical guide wires play a crucial role in the process of intravascular interventional therapy. However, it is essential for bare metal guide wires to possess both hydrophilic lubricity and coating durability, avoiding tissue damage caused by friction inside the blood vessel during the interventional procedure. Additionally, it is still a huge challenge for diverse metal materials to bind with polymer coatings easily. Herein, we present a hydrogel coating scheme and its preparation method for various wires under mild conditions for environmental protection purposes. The preparation process involves surface pretreatment, including low-temperature heating and silanization, followed by a two-step dip coating and ultraviolet polymerization. The whole process leads to the formation of an interpenetrating cross-linked hydrogel network from the substrate to the surface section. This study confirms the superhydrophilicity and lubricity of three metal wires with the designed coating, especially reducing the friction significantly by ≥ 95%. The thin coating (average thickness <6.2 μm) demonstrates strong adhesion with various substrates and exhibits resistance to 25 or even 125 cycles of friction, indicating excellent stability and preventing easy detachment. The finally prepared composite nickel-titanium (NiTi) guide wire with stainless steel (SS) and platinum-tungsten (Pt-W) coils (overall diameter of ∼0.36 mm) shows satisfactory performance with a friction of 0.183 N for 25 cycles, meeting the clinical requirements (average friction ≤0.2 N) for interventional operation. These findings highlight the potential of this study in advancing the development of medical devices, particularly in the field of intravascular interventional therapy.

The Horrible Scenario in Cath Lab: Percutaneous Management of Guide Wire Entrapment During Coronary Intervention

The Horrible Scenario in Cath Lab: Percutaneous Management of Guide Wire Entrapment During Coronary Intervention

Onkolojik Hastalarda İnternal Jügüler Ven Yoluyla Venöz Port Implantasyonu- Tek Bir Genel Cerrahın Deneyimi

Central venous access is pivotal for patients undergoing repetitive chemotherapy, hemodialysis, blood transfusions, total parenteral nutrition, and blood tests. This study aims to present the single-center experience of a general surgeon in Totally Implantable Access Port (TIAP) implantation under general anesthesia using ultrasonography and fluoroscopy guidance and assess early and late complications. A retrospective study was conducted on patients who underwent TIAP implantation between January 2020 and December 2022. Patients eligible for intravenous chemotherapy with solid tumors were included. A single general surgeon performed the procedures. General anesthesia was administered in all patients, and a percutaneous Seldinger technique was utilized. Early and late complications were monitored, and relevant data were collected. The study comprised 186 patients with a median age of 46, predominantly female (65.1%). The overall success rate was 99.5%. Early and late complications occurred in 1.6% and 5.9% of cases. The most common late complications were pocket infection (1.6%) and symptomatic thrombosis (1.6%). Port migration occurred in one patient but was promptly corrected. No pneumothorax cases were observed. Port removal was performed in 92 patients upon chemotherapy completion. Implantation of TIAPs under general anesthesia, guided by ultrasound and fluoroscopy, resulted in a high success rate and low complication rate when performed by a skilled general surgeon. These findings underscore the safety and efficacy of TIAP implantation under general anesthesia in a private hospital setting. The study contributes to the growing body of evidence supporting general surgeons in providing effective and safe TIAP implantation for oncology patients, potentially expanding its availability in diverse clinical settings.

Developing “do it yourself” Phantom for Teaching Seldinger Technique in Vascular Access Placement to General Practitioners

Developing “do it yourself” Phantom for Teaching Seldinger Technique in Vascular Access Placement to General Practitioners

Risk of Diabetes Mellitus in Carotid Artery Involvement Among Coronary Artery Disease Patients Including History of Infection and Antibiotics Uses

Background: Diabetes mellitus causes involvement of coronary artery diseases. Objective: The purpose of the present study was to determine the risk of diabetes mellitus in the involvement of carotid artery among coronary artery disease patients. Methodology: This case-control study was conducted in the Department of Cardiology at Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from July 2013 to June 2015 for a period of two years. Patients who had coronary artery diseases or ischemic heart diseases and diabetes mellitus undergoing coronary angiography were selected as case of this study. In control group, age, sex match patients of IHD undergoing CAG not having DM were included. Every patient was clinically examined by detailed history and physical examination during entry into study. ECG, chest X-ray, echocardiogram, blood sugar (fasting), blood 2 hrs. after 75 gm of glucose and or breakfast were analyzed. Coronary angiography was done in all patients through femoral approach by modified Seldinger technique. Carotid arteriography was performed selective and non­selective method by Hunter head or right Judkin's catheter in standard AP, lateral and oblique views. Results: A total number of 100 patients were included in this study. Of them 50 patients were coronary artery disease with diabetes mellitus and another 50 patients were coronary artery disease without diabetes mellitus. The mean height of the DM was 163.4±8.5 cm and in NDM was 160.6±7.1 cm, mean weight of DM 63.5±7.2 kg, in NDM was 62.0±15.4 kg and mean BMI in DM was 26.24±2.36 kg/m2 and in NDM was 26.38±2.05 kg/m2. The mean total cholesterol in DM was 236.9±34.1 mg/dL and in NDM was 208.0±36.4 mg/dL, mean serum TG in DM 240.5±76.3 mg/dl and in NDM was 207.6±57.8 mg/dl and mean serum IDL in DM was 166.1±130.6 mg/dL and in NDM was 142.8±30.4 mg/dL, no significant mean difference was observed between DM and NDM in height, weight and BMI (P&gt;0.05). Concussion: In conclusion, significant mean difference is observed between DM and NDM in total cholesterol, serum triglycerides. Bangladesh Journal of Medical Microbiology, July 2023;17 (2):82-87

Total Aortic Arch Replacement. Does a management protocol impact the results?

To describe the surgical protocol and the short and long-term results of aortic arch replacement surgery in a center in the metropolitan region of Santiago, Chile. Retrospective descriptive study from April 2015 to August 2022. Elective, urgent, and emergency patients were included, with diagnoses of arch aneurysm and acute or chronic type I and II DeBakey aortic dissection. Arterial cannulation at the brachiocephalic trunk, right axillary artery, or directly into the true lumen of the aortic dissection with Seldinger technique, guided by epiaortic and transesophagic ultrasound. Deep hypothermia at 24°C. Uni or bilateral antegrade cerebral perfusion according to runoff. Four devices were used: a straight tube, a tube with 3 or 4 branches, and a frozen elephant trunk. 37 patients were operated on; 24 of them were men. The average age was 57 years old. In seven patients, a straight tube with anastomosis was used with anastomosis on the island; in six patients, a tube with 3 branches; in ten patients, a tube with four branches; and in fourteen patients, a frozen elephant trunk. There were twenty-one patients (57%) with associated morbidity: prolonged mechanical ventilation 14 the most frequent, paralysis chordae in 7 patients; there were six neurological morbidities, one of them permanent, renal dysfunction in 5 patients, pneumonia associated with mechanical ventilation in 4 patients, reoperation due to bleeding in 4. There was no associated cardiac morbidity. Operative and global mortality at 30 days was 13.5%. Follow-up was closed in October 2022 and is complete in the 30 survivors; the average was 20 months. Two patients died in the follow-up at five years; the survival in the follow-up was 90%. The management protocol has good results regarding morbidity and mortality, similar to the international series.

Characteristics of Carotid Artery among Ischemic Heart Disease Patients with or without Diabetes Mellitus

Background: Involvement of coronary artery can vary among the ischemic heart disease patients with or without diabetes mellitus. Objective: The purpose of the present study was to assess the characteristics of carotid artery among ischemic heart disease patients with or without diabetes mellitus. Methodology: This case-control study was conducted in the Department of Cardiology at Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh. The study was carried out from July 2003 to June 2005 for a period of two years. Patients who had coronary artery diseases or ischemic heart diseases and diabetes mellitus undergoing coronary angiography were selected as case of this study. In control group, age, sex match patients of IHD undergoing CAG not having DM were included. Every patient was clinically examined by detailed history and physical examination during entry into study. ECG, chest X-ray, echocardiogram, blood sugar (fasting), blood 2 hrs. after 75gm of glucose and or breakfast were analyzed. Coronary angiography was done in all patients through femoral approach by modified Seldinger technique. Carotid arteriography was performed selective and non­selective method by Hunter head or right Judkin's catheter in standard AP, lateral and oblique views. Results: A total number of 100 patients were included in this study. Of them 50 patients were coronary artery disease with diabetes mellitus and another 50 patients were coronary artery disease without diabetes mellitus. Morphological character of the lesion was also assessed. The mean age was found 57.48 years with 6.04 standard deviation (SD) in DM and 55.64 years with 6.34 standard deviation in NDM group and also 56.56 years with 6.49 standard deviation in the whole study population. The value of unpaired t-test was 0.158 and it was insignificant (p&gt;0.05). The common site of lesion was bifurcation, internal carotid, common carotid and external carotid artery which were 13 cases, 9 cases, 4 cases and 1 case respectively. The individual vessel involvement was 9(18.0%) cases in right, 6(12.0%) cases in left, and 3(6.0%) cases in both in DM group whereas 5 (10.0%) cases in right, 3(6.0%) cases in left, and 1(2.0%) case in both in NDM group. It observed that out of 100 study subjects 10 had complex carotid lesion in DM and 4 in NDM. Concussion: In conclusion the common site of lesion was bifurcation and internal carotid artery mostly in right side. Journal of Current and Advance Medical Research, January 2023;10(1):7-12

Should a forgotten guidewire be removed after years? An undesirable complication of hemodialysis catheter wire left in the body

Today, one of the most common methods used in the emergency room or intensive care unit (ICU) in patients is the Seldinger technique to access the central venous system, shunting for hemodialysis, intra-aortic balloon pump, or arterial insertion. Accidental leaving of the guide wire is an uncommon but important complication that can occur as a result of an incorrect technique, and it is sometimes found accidentally or due to complications years after the procedure. The case is a 53-year-old patient who underwent aortic valve replacement with a mechanical valve and mitral valve repair with a ring 12 years ago and was treated with warfarin. Two years after the heart surgery, due to chronic renal failure, the patient underwent dialysis, and after the preparation of an arteriovenous fistula, he underwent stenting. After approximately ten years, the patient developed fever, chills, and shortness of breath. During the examination, endocarditis was diagnosed, and a part of the aortic valve was released. There was a severe paravalvular leak in the aortic valve, and an abscess was formed in the aorta root. We also noticed a forgotten guide wire in the superior vena cava, right atrium, inferior vena cava, and hepatic vein, and echogenic masses were located on the guidewire. The diagnosis was confirmed by echocardiography, chest x-ray, and phenocopy. After antibiotic therapy, the patients underwent heart surgery, aortic valve replacement, and aortic root repair, and the guidewire was removed (70 cm long). Unfortunately, despite all measures, the patient died a few days after the surgery. Due to complications, a forgotten guidewire should be removed immediately after diagnosis. The preferred intervention is the removal of the guidewire by endovascular interventions, but surgical treatment should also be considered in some cases.

Abstract 11994: Lithotripsy-Assisted Transcatheter Aortic Valve Implantation: An Emerging Approach to Vascular Access Issues in Severe Peripheral Arterial Disease

Introduction: Advances in minimally invasive valvular interventions like transcatheter aortic valve implantation (TAVI) allow for treatment of an increasingly older population. Severe calcific iliofemoral peripheral arterial disease (PAD) can preclude large sheath introduction necessary in TAVI. Conventional peripheral angioplasty has limited efficacy in these situations given its high-pressure dilation, which increases the risk of vascular complications. Intravascular shockwave lithotripsy (IVL) for PAD is an emerging and safe alternative for vascular access. Case Description: A 90-year-old man with severe symptomatic aortic stenosis (AS), coronary artery disease (CAD) status-post CABG and extensive PAD was referred for TAVI following balloon aortic valvuloplasty. Transthoracic echocardiogram showed severe, low-flow, low-gradient AS despite recent balloon aortic valvuloplasty. Abdominal imaging showed severe atherosclerosis and calcification of the bilateral common and external iliac arteries. Prior to TAVI, peripheral angiogram was performed, followed by IVL for a total of nine runs, each for fifteen seconds with a 7x60mm balloon to the right iliac and femoral arteries. Then, the right femoral groin sheath was upsized from six to eighteen French, followed by deployment of a 29mm Medtronic Evolute Pro+ self-expanding bioprosthetic aortic valve. Following successful TAVI, the patient was discharged home on aspirin and clopidogrel. Conclusion: IVL utilizes pulsatile mechanical shockwaves to modify plaque burden without altering arterial elasticity or structural integrity, which greatly reduces the risk for vascular complications in severely calcified arteries. The DISRUPT-PAD-III trial showed IVL was superior to percutaneous transluminal angioplasty with fewer complications in patients with calcified PAD. Therefore, IVL can be a safe alternative approach for PAD limiting vascular access in percutaneous valvular interventions.

Abstract 032: Ovine Models for Cerebral Venous Catheter Access: A Single Center Experience

Introduction Large animal models are utilized for preclinical neuroendovascular research, and aid in the characterization and de‐risking of novel therapeutic approaches. To date, only a single prior study has been published providing a detailed account of an ovine model (Corriedale sheep) for cerebral venous access. The generalizability of these experiments has not yet been validated externally. In an effort to replicate these findings and de‐risk a novel, non‐surgical trans‐dural venous sinus approach to the cerebrum, cerebral venous access was attempted in 3 sheep specimens using transcranial and endovascular approaches. We report our experience validating this large animal model for translational and preclinical research. Methods 3 animal experiments were performed at the UCLA TRIC laboratory between 02/2022 and 10/2022. The sheep were anesthesitized and handled under approval of the Animal Research Committee at UCLA (protocol ARC 2020‐19). The neck and groin areas were shaved and aseptically prepped. MRI Brain and MR Brain venogram imaging was performed on a 3T Siemens Magnetom MRI. Femoral artery and external jugular vein access were obtained using the Seldinger technique under ultrasound guidance and did not require a surgical cut down. Two Suffolk and one Rambouillet sheep were used (average weight 60 kg and 40 kg, respectively). The animals were transferred to the catheter laboratory and image guidance was performed with a monoplane Siemens Artis Zeego. A transcranial approach to the dorsal sagittal sinus was attempted in one Suffolk sheep specimen utilizing a Hubly Drill and a micro‐puncture kit. An endovascular approach to the dorsal sagittal sinus was attempted in second Suffolk sheep specimen using a 25 cm, 8 Fr Pinnacle Sheath via the external jugular vein followed by a 132 cm Catalyst 5 catheter, 0.027" Medtronic Marksman, Stryker SL‐10 and Offset microcatheters assembled over 0.014" Synchro Standard and exchange‐length Choice PT microguidewires. In a third experiment, an endovascular approach to the dorsal sagittal sinus was attempted in a Rambouillet sheep specimen using a 95 cm TracStar, 115 cm Catalyst 5 catheter, and 0.027" Medtronic Marksman microcatheter assembled over 0.014" Synchro Standard and exchange‐length Boston Scientific (BS) Choice PT microguidewires. The 0.027" Marksman microcatheter was subsequently exchanged for a 2.7 French BS Stingray LP coronary CTO re‐entry microcatheter in the Rambouillet sheep, which was tracked to the anterior third of the dorsal sagittal sinus over the exchange length wire. Results A transcranial approach to the dorsal sagittal sinus was complicated by misaligned needle trajectories resulting in brain parenchymal damage. The external jugular vein was the conduit for accessing the first and second emissary veins of the retroauricular foramen (figure 2). Access to the temporal and then transverse sinuses was possible from either of the aforementioned emissary veins. Interestingly, the morphology of the dorsal sagittal sinus was bifid and each vessel channel measured between 1.65 – 1.7 mm in diameter (figure 1). Access to the temporal sinus from an endovascular approach was possible with all microcatheters. However, access with a 0.027" microcatheter beyond the torcular herophili and into the dorsal sagittal sinus was only possible in the Rambouillet sheep despite its smaller body size. Intermediate catheters (&gt;4 Fr) could not be advanced beyond the skull base in none of the sheep breeds. Lastly, microcatheter advancement into the cerebral hemispheric space across a transdural venous sinus puncture access point deliberately created by wire perforation was feasible from the Stingray re‐entry system after exchanging for a 0.017" microcatheter. A coil (Stryker Target) was deployed extravascularly from the 0.017" microcatheter for post‐mortem characterization (figure 3). Conclusion One of three experiments met criteria for success. Due to reliance on a monoplane projection, a transcranial approach failed as an access route to the dorsal sagittal sinus resulting in iatrogenic parenchymal damage. Despite the larger body size, the second Suffolk sheep dural venous sinus system could not be catheterized beyond the skull base, likely due to the small caliber or focal stenosis of the temporal or transverse sinuses. The Rambouillet sheep breed proved to be a more adequate specimen for cerebral venous—specifically dorsal sagittal sinus—access with larger bore microcatheters. Based on this experience, careful selection of an appropriate sheep breed is necessary for modeling endovascular cerebral venous access and assessing novel procedures.

Clinical feasibility of endovascular recanalization with intravascular ultrasound-guided wiring for chronic total occlusion of below-the-knee arteries

BackgroundRevascularization with endovascular therapy (EVT) for complex below-the-knee (BTK) chronic total occlusion (CTO) remains a challenging problem. The Japanese-BTK (J-BTK) CTO score is reported as an indicator of the difficulty of BTK CTO, with the guidewire (GW) passage success rate decreasing as the grade increases. We previously reported an effective GW crossing method for the intravascular ultrasound (IVUS)-guided parallel wiring of complex BTK CTO. In this study, we investigated the feasibility of EVT using IVUS-guided wiring for BTK CTO.Materials and methodsThis single center, retrospective study analyzed 65 consecutive BTK CTO vessels in which IVUS-guided wiring was attempted after the failure of a conventional antegrade wiring approach from November 2020 to November 2022. The primary endpoint was the clinical success of the target CTO vessel. The secondary endpoints were the GW success rate per grade based on the J-BTK CTO score, number of GW used for CTO crossing, fluoroscopy time, and complications.ResultsTarget vessels were the anterior tibial artery (66.2% of cases), peroneal artery (9.2%), and posterior tibial artery (24.6%). Blunt type CTO entry was performed in 55.4% of cases, calcification of entry was observed in 24.6% of cases, the mean occlusion length was 228.2 ± 93.7 mm, mean reference vessel diameter was 2.1 ± 0.71 mm, and outflow was absent in 38.5% of cases. J-BTK CTO scores of 0/1 (grade A), 2/3 (grade B), 4/5 (grade C), and 6 (grade D) were seen in 18.5%, 43.1%, 36.3%, and 1.5% of cases, respectively. The clinical success rate was 95.4%. The GW success rate by J-BTK CTO grade was as follows: grade A (100%), B (100%), C (91.7%), and D (0%). The mean number of GW used was 3.4 ± 1.4, the mean fluoroscopy time was 72.3 ± 32.5 min, and complications occurred in 7.7% of cases.ConclusionThis study showed a very high clinical success rate despite the difficulty of BTK CTO. IVUS-guided EVT might be a feasible strategy for complex BTK CTO.

Literature review of techniques for primary laparoscopic balloon gastrostomy and report of our experience of consecutive 80 children using the Seldinger technique

Literature review of techniques for primary laparoscopic balloon gastrostomy and report of our experience of consecutive 80 children using the Seldinger technique

ARTERIAL CATHETERIZATION IN GREAT APES.

Anesthesia is frequently required to provide appropriate medical care to captive great apes. Anesthetic safety can be optimized through placement of an arterial catheter, which allows direct measurement of arterial blood pressure and easy sampling of arterial blood for blood-gas analysis. Arterial catheterization in great apes can be achieved through palpation-guided or ultrasound-guided placement with or without a modified Seldinger technique. Potential sites for arterial catheterization include the anterior tibial artery, caudal tibial and posterior saphenous arteries, dorsal pedal artery, femoral artery, radial artery, and brachial artery. Arterial catheterization is recommended for lengthy great ape anesthetic procedures or those involving invasive procedures.

Outcomes of Percutaneous Access to the First Versus Third Segment of Axillary Artery During Aortic Procedures.

This article aims at investigating the outcomes of percutaneous access via the first versus third axillary artery (AXA) segments with closure devices during aortic procedures. All patients receiving percutaneous AXA access closed with Perclose ProGlide device (Abbott, Santa Clara, California) from 2008 to 2021 were included in a retrospective multicenter registry (NCT: 04589962). Efficacy endpoint was the technically successful percutaneous procedure (no open conversion). Safety endpoints were stroke and access complications according to the Valve Academic Research Consortium-3 reporting standards. The first (AXA1) or third (AXA3) axillary puncture sites were compared. A total of 412 percutaneous AXA accesses were included: 172 (42%) in AXA1 and 240 (58%) in AXA3. Left AXA was catheterized in 363 cases (76% of AXA1 vs 97% of AXA3, p<0.001) and 91% of fenestrated/branched endovascular repair (F/BEVAR) procedures were conducted from the left. A ≥12F internal diameter (ID) sheath was used in 49% of procedures. Open conversion rate was 1%, no major vascular complications occurred, and only one major non-vascular complication was recorded. Primary closure failure occurred in 18 AXA1 (11%) and 32 AXA3 accesses (13%), treated by covered (8.3%) or bare-metal (2.7%) stenting. Bailout stent patency was 100% at median follow-up of 12 months, with 6 of 6 stents still patent after >36 months of follow-up. Stroke rate was 4.4%. An introducer sheath >12F was independently associated with both access complications (p<0.001) and stroke (p=0.005), while a right-side access was associated with stroke only (p=0.034). Even after adjustment for covariates, AXA1 versus AXA3 showed an equal success rate (odds ratio [OR]=0.537, 95% confidence interval [CI]=0.011-1.22 for AXA3, p=0.104). The combination of AXA3 and a >10F introducer sheath provided worse outcomes compared with >10F sheaths through AXA1 (OR for success=0.367, 95% CI=0.176-0.767, p=0.008). This was not confirmed for >12F sheaths, associated with similar outcomes (p=0.31 AXA 1 vs AXA 3). Major local complications with the percutaneous axillary approach and ≤12F sheaths are infrequent and solvable by complementary endovascular interventions. Stroke risk remains an issue. First and third AXA segments are both amenable for access with good results, but larger sheaths (12F) perform better in AXA1. Percutaneous access with vascular closure devices at the first or third axillary artery (AXA) segments during aortic procedures is burdened by a negligible risk of open conversion. Local complications with the percutaneous axillary approach are infrequent and solvable by complementary endovascular interventions. First and third AXA segments are both amenable to access with excellent results, but larger sheaths (12F) perform better in the wider first AXA segment. In this setting, bailout stenting does not appear to be associated with mid-term stent occlusion.