Multiple Vessels Research Articles

Metachronous carcinogenesis of superficial esophagus squamous cell carcinoma after endoscopic submucosal dissection: incidence and risk stratification during long-term observation.

This study aimed to reveal long-term outcomes, such as incidence of metachronous esophageal and head and neck squamous cell carcinomas and overall survival rate, through long-term observation of patients with esophageal carcinoma post-endoscopic submucosal dissection. Risk of metachronous carcinogenesis was evaluated in 88 patients with intramucosal esophageal carcinoma (without history of metachronous esophageal or head and neck squamous cell carcinomas) who underwent endoscopic submucosal dissection from 2007 to 2008 and were endoscopically observed for > 3years. Histologically, the papillary vessel is defined as the clock gear-like structure composed of capillaries directly penetrating the epithelium (starting from the lamina propria) and covering at least two-thirds of it, around which the tumor cells are arranged in a spiral pattern. Median endoscopic follow-up period was 11.0years. Cumulative 2-, 5-, and 10-year metachronous esophageal carcinoma rates were 11.4%, 20.6%, and 39.3%, respectively. Stepwise multivariate Cox proportional hazard regression analysis identified multiple Lugol-voiding lesions (LVLs) as the single significant independent predictor. Cumulative 2-, 5-, and 10-year metachronous head and neck squamous cell carcinoma rates were 6.9%, 10.4%, and 19.6%, respectively. Stepwise multivariate Cox proportional hazard regression analysis identified multiple LVLs, Brinkman index, papillary vessel, and younger age as significant predictive factors. Overall post-endoscopic submucosal dissection survival rates were 98.8% and 87.5% at 5 and 10years, respectively. Patients with a history of esophageal carcinoma remain at risk for metachronous carcinogenesis even > 5years after endoscopic submucosal dissection. Thus, long-term follow-up is important.

Bearing-Only Motional Target-Surrounding Control for Multiple Unmanned Surface Vessels

This article proposes a distributed bearing-only controller for multiple unmanned surface vessels (USVs) to encircle and rotate evenly around a motional target with inter-USV topologies. The distributed control law consists of three terms, i.e., a bearing-only estimation term to approximate the target state, an upper-level surrounding term to fulfill the target-surrounding mission, and a single-vessel regulation term to track the upper-level signal. Significantly, technical conditions are derived to guarantee the asymptotical stability of the closed-loop system. Finally, experimental results on a real platform composed of three HUSTER-0.3 USVs and a target vessel are conducted to substantiate the effectiveness of the proposed controller.

Small Bowel Hemolymphangioma Treated by Polypectomy in a Pediatric Patient with Cystic Fibrosis

Small Bowel Hemolymphangioma Treated by Polypectomy in a Pediatric Patient with Cystic Fibrosis

Techniques of Onyx Embolization of Arteriovenous Malformation: 2-Dimensional Operative Video.

Advances in endovascular techniques and tools have allowed for treatment of complex arteriovenous malformations (AVMs), which historically may have posed unacceptable risk for open surgical resection. Endovascular treatment may be employed as an adjunct to surgical resection or as definitive therapy. Improvements in embolization materials have made endovascular AVM treatment safer for patients and useful across a variety of lesions. While many techniques are employed for transarterial AVM embolization, the essential tenets apply to all procedures: (1) great care should be taken to cannulate only vessels directly supplying the lesion, and not en passage vessels, prior to injecting embolisate; (2) embolisate should travel into the nidus, but not into the draining veins; (3) embolistate reflux proximal to the microcatheter should be avoided. There are several techniques that accomplish these goals, including the plug and push method, or using a balloon to prevent embolisate reflux. We use controlled injection of liquid Onyx (Medtronic), with increasing pressure over multiple injections pushing the embolisate forward into the AVM. This is repeated in multiple feeding vessels to decrease or eliminate supply to the AVM. Here, we present a 36-yr-old female with a right parietal AVM discovered on workup of headaches. After informed consent was obtained, she underwent preoperative embolization using this technique prior to uncomplicated surgical resection. The video shows the endovascular Onyx embolization of multiple feeding vessels over staged treatment.

Update to U.S. National Response Team's Abandoned Vessels Authorities and Best Practices Guidance

Abstract The U.S. National Response Team promulgated an interagency guidance document entitled “Abandoned Vessel Authorities and Best Practices Guidance” (AVG) in 2014 to address a myriad of questions that the Federal On-Scene Coordinators and broader response community tend to face when mitigating threats caused by abandoned or derelict vessels. This document compiles information surrounding existing laws, policies, and best practices to inform and advise responders without bogging them down in “legalese” or forcing them to search from document to document to find all the relevant information. In the aftermath of the 2017 Atlantic Hurricane Season and associated responses, the National Response Team tasked its Preparedness Committee to reopen the 2014 AVG to ensure the document addressed the challenges that were brought to light amid the responses. The Committee chartered a working group to systematically review and update this document and incorporate the latest pertinent policy changes, including those from Federal Emergency Management Agency to ensure that it most thoroughly addressed the gamut of issues a responder may come up against in the arena of abandoned (or derelict, or displaced) vessel management. The updated AVG was completed and approved by the NRT in 2020 and is posted to the NRT website. Major updates include: Considerations for long-term storage and disposal;Clarification on foreign-flagged vessel nuances;Information for responders to consider regarding contaminants other than those covered under NCP/ESF constructs (e.g. if typical response authorities do not cover a scenario, what options might the responder still leverage);An additional section addressing nuances of managing multiple vessel casualties at once, either due to a natural disaster or an act or omission from a third party; andImportant differences between National Contingency Plan and Stafford Act funded/organized responses. This paper dives into the rationale for making changes, the benefits of additions made, the processes and methodologies for undertaking updates, and major elements of the AVG to provide a snapshot of the guidance it affords the reader.

A prediction model of vessel trajectory based on generative adversarial network

AbstractTrajectory prediction is an important support for analysing the vessel motion behaviour, judging the vessel traffic risk and collision avoidance route planning of intelligent ships. To improve the accuracy of trajectory prediction in complex situations, a Generative Adversarial Network with Attention Module and Interaction Module (GAN-AI) is proposed to predict the trajectories of multiple vessels. Firstly, GAN-AI can infer all vessels’ future trajectories simultaneously when in the same local area. Secondly, GAN-AI is based on adversarial architecture and trained by competition for better convergence. Thirdly, an interactive module is designed to extract the group motion features of the multiple vessels, to achieve better performance at the ship encounter situations. GAN-AI has been tested on the historical trajectory data of Zhoushan port in China; the experimental results show that the GAN-AI model improves the prediction accuracy by 20%, 24% and 72% compared with sequence to sequence (seq2seq), plain GAN, and the Kalman model. It is of great significance to improve the safety management level of the vessel traffic service system and judge the degree of ship traffic risk.

Output Feedback Cooperative Dynamic Positioning Control for an Unactuated Floating Object Using Multiple Vessels

This paper proposes an output feedback cooperative dynamic positioning control scheme for an unactuated floating object using multiple vessels under model uncertainties and environmental disturbances. The floating object is connected to multiple vessels through towlines. At first, nonlinear extended state observers are developed for the floating object and vessels to reconstruct the unmeasured velocity and to estimate the model uncertainties and disturbances. Second, observer-based controllers are designed for the floating object and vessels to drive the floating object to track the reference signal and to achieve the cooperative control of multiple vessels, respectively. The salient features of the proposed control scheme are presented as follows. Firstly, by design the object controller, the tracking performance of the object is improved. Secondly, according to the required force of the floating object, the time-varying formation of vessels is obtained by using the towline attachment geometry of the floating object, control allocation and a towline model. It is shown that all signals in closed-loop system are bounded via Lyapunov analysis. Simulation study is carried out to verify the effectiveness of proposed control method.

When 7 times angioplasty on Saphenous Vein graft would not compete the Native vessel Percutaneous Coronary intervention

Coronary artery bypass graft (CABG) has been the first option for revascularization in multiple vessel coronary artery disease. One of the most major obstacles after CABGs is atherosclerotic changes of SVGand more than 50 percent ofSVGare occluded at 10 years and 25 percent show severe stenosis at angiographic follow-up. Whether native vessel percutaneous coronary intervention (PCI) on native vessel or saphenous vein graft intervention is of benefit in these patients is still a debate. In this case report we want to clarify a common clinical scenario in a patient with prior CABG seven years ago which a proper decision in the right time could save many futile efforts. The patient underwent 7 PCI on the diseased SVG on OM with frequent occlusion due to stent thrombosis and in-stent restenosis which finally native vessel antegrade CTO PCI alleviated the problem and patient followed up 2 months after the procedure without any chest pain in his ordinary activities.

Model-Free Containment Control of Underactuated Surface Vessels Under Switching Topologies Based on Guiding Vector Fields and Data-Driven Neural Predictors.

This article investigates the model-free containment control of multiple underactuated unmanned surface vessels (USVs) subject to unknown kinetic models. A novel cooperative control architecture is presented for achieving a containment formation under switching topologies. Specifically, a path-guided distributed containment motion generator (CMG) is first proposed for generating reference points according to the underlying switching topologies. Next, guiding-vector-field-based guidance laws are designed such that each USV can track its reference point, enabling smooth transitions during topology switching. Finally, data-driven neural predictors by utilizing real-time and historical data are developed for estimating total uncertainties and unknown input gains, simultaneously. Based on the learned knowledge from neural predictors, adaptive kinetic control laws are designed and no prior information on kinetic model parameters is required. By using the proposed method, the fleet is able to converge to the convex hull spanned by multiple virtual leaders under switching topologies regardless of fully unknown kinetic models. Through stability analyses, it is proven that the closed-loop control system is input-to-state stable and the tracking errors are uniformly ultimately bounded. Simulation results verify the effectiveness of the proposed cooperative control architecture for multiple underactuated USVs with fully unknown kinetic models.

ESSENTIAL HYPERTENSION OR A MISSING CAUSE FOR SECONDAY HYPERTENSION?

Objective: The case highlights the importance of diagnosing secondary hypertension and adequate treatment in the setting of a patient with classical cardiovascular risk factors which would otherwise make primary hypertension the most likely diagnosis. Design and method: Clinical Case Results: A 57 year-old male with cardiovascular risk factors (smoking, dislypidemia), grade 2 essential hypertension (ESC/ESH) and G3a stage chronic kidney disease (CKD) presents to our clinic with fatigue and persistent high blood pressure values despite treatment with ACEi. Clinical exam was unremarkable except for a 10mmHg difference between the arm and foot systolic blood pressure. The 24-hour ambulatory blood pressure monitoring revealed a non-dipping profile, with a mean blood pressure value of 150/100mmHg. TTE was performed and the following were observed: bicuspid aortic valve with tight aortic stenosis (mean AV PG > 40mmHg, AVA = 1.12cm2) and LV systolic dysfunction (LVEF = 35%). TEE was also performed and confirmed the bicuspid aortic valve. Given the context of the patient, computed tomography angiography (CTA) was the investigation of choice in order to visualize the aorta. Postductal coarctation was detected with a hypoplastic thoracic aorta and multiple collateral vessels. The coronary angiogram was normal. The ACEi was stopped and the patient received a dihydropyridine calcium channel blocker in combination with an adolsterone receptor antagonist with a favourable course. Aortic valve replacement surgery with mechanical valve implantation was recommended. Considering the multiple collateral vessels and complex vascular morphology, surgical correction of the coarctation was considered no longer feasible Conclusions: CoA was the actual cause for the persistent high blood pressure values in an adult male with cardiovascular risk factors who was believed to have essential hypertension. In the setting of aortic stenosis with impaired LV systolic function, high blood pressure values are not typical. Taking into account the BAV, the clinical suspicion of CoA was high and prompted further investigations. The CKD is the result of the the underperfusion of the kidneys secondary to the CoA and the use of ACEi.

Hydroacoustic survey standardization: Inter-vessel differences in fish densities and potential effects of vessel avoidance

Hydroacoustics is used broadly to assess fish populations in marine and freshwater systems. Large-scale surveys often employ multiple vessels to complete a survey. Vessels can be a source of variation in multi-vessel surveys, and accounting for this variation is critical to precise and accurate assessments, whether as indices or measures of absolute abundance. We examined areal and volumetric density estimates, area backscattering coefficient (ABC), and mean target strength (TS) produced by three vessels in Lake Erie along three cross-lake transects in July 2014. Our study showed positive correlation in areal ABC, mean TS, and density among vessels; however, there was an almost 30 % higher density obtained with the largest vessel, on average. As a result, vessel choice could contribute to variation and/or bias in forage fish surveys deploying multi-vessels conducted on Lake Erie. Additionally, in some situations, differential depth patterns of fish contributed to vessel related differences in survey results suggesting a difference in vessel avoidance behaviors among targeted forage species, primarily emerald shiner Notropis atherinoides and rainbow smelt Osmerus mordax. This work demonstrates the potential magnitude of differences among vessels and highlights the need to identify and account for or otherwise control for these effects when monitoring or managing fisheries through standardized hydroacoustic assessments surveys.

The impact of multiple donor renal arteries on perioperative complications and allograft survival in paediatric renal transplantation

The impact of using allografts with multiple renal arteries in paediatric kidney transplantation has not been clearly established. The aim of this study was to determine whether kidney grafts with multiple arteries pose any adverse effects upon perioperative surgical outcomes, and graft survival up to 12 months post-transplant. The objective of this study was to perform a comparative analysis of a minimum of 12-month graft survival and transplant renal function in paediatric renal transplant recipients receiving single versus multiple donor arteries, and to assess perioperative and early post-operative surgical outcomes. A retrospective divisional chart review of 379 transplants performed (2000-2018), of which 90 (23.7%) contained multiple donor arteries. The number of arteries of the graft, donor type, vascular reconstruction technique, occurrence of urological and vascular complications, estimated GFR and graft survival up to 12 months post-transplantation, graft loss and mortality were analysed. Comparisons in baseline characteristics and outcome measures were made between both groups. No significant differences were found in age (p=0.42), BMI (p=0.39), estimated intraoperative blood loss (p=0.14), overall (p=0.63) or warm ischaemic time (p=0.37). 51.3% patients with multiple donor arteries underwent an exvivo reconstruction. There were no differences in the site of arterial anastomosis (aorta, external iliac, internal iliac), or anastomotic type (end-side; end-end). Whilst there was a significantly higher post-operative lymphocoele rate in the multiple vessel cohort (p=0.024), there was no increase in post-transplant urine leaks, rejection episodes, graft loss (1.1% multiple vs 2.1% single), perioperative complications (p=0.68), or estimated GFR at 1 month (p=0.9) or at 1 year (p=0.67). We demonstrated in this study that there was no significant difference in postoperative complications up to 3 months, eGFR and renal function up to 1 year, and graft survival up to 4 years post transplantation irrespective of allograft type or reconstruction technique. There was however, a higher rate of lymphocoeles in the multiple artery cohort. The results seen here broadly mirror trends seen in adult studies, however, there is little data available from paediatric series. Our study demonstrates that multiple renal artery allografts - previously been considered to carry a high complication risk - can be safely used for paediatric renal transplantation with equivalent perioperative complications and graft outcomes to single artery allografts.

An Abnormal Heart Lung Connection: A Case of Coronary Artery Fistula Formation Post Orthotropic Heart Transplantation

<h3>Introduction</h3> Coronary artery fistulas (CAF) are rare anomalies often congenital in origin, however, they have been seen after orthotropic heart transplantation (OHT). The mechanism of CAF formation is unclear, but it has been proposed that angiogenesis may occur in response to inflammation, surgical trauma, and hypoxia. Most are incidentally discovered on coronary angiography, and a majority of patients are asymptomatic. However, a potentially serious complication of CAF is ischemia due to coronary steal phenomenon. <h3>Case Report</h3> A 23-year-old male with a past medical history significant for nonischemic cardiomyopathy thought secondary to viral etiology who had OHT one year prior presented for post-transplant biopsy and angiography to evaluate for rejection. His post-transplant course was uncomplicated. Coronary angiography was notable for collaterals between diagonal branches of left anterior descending artery to pulmonary vasculature (Figure 1). To further evaluate, he had a gated cardiac computerized tomography scan which showed multiple small vessels from the left upper lobe that appeared to directly communicate with the pericardial surface at the left ventricular apex (Figure 2). After multidisciplinary discussion, decision was made to monitor patient with annual echocardiogram with strain imaging and coronary angiography. <h3>Summary</h3> Management of patients post OHT is a complex process. Surveillance and management of patients found to have CAF is not well established due to its rarity and unclear clinical significance. Additional research is necessary to better understand this phenomenon.

Prominent hypointense vessel on susceptibility-weighted images accompanying hyperacute and acute large infarction.

Multiple prominent hypointense vessels on susceptibility-weighted image (SWI) have been found in the ischemic territory of patients with acute ischemic stroke. SWI is suitable for venous imaging. To evaluate the conditions of prominent hypointense vessel (PHV) in hyperacute and acute cerebral infarctions using susceptibility-weighted image (SWI). Magnetic resonance images, including SWI, of 284 patients with acute infarction were evaluated. Based on lesion size, the infarction was classified as a small (< 3cm) or a large (> 3cm) infarction. Stage of infarction was classified as hyperacute (< 6h) or acute (> 6h, < 1week) on the basis of the onset of stroke. The site of infarction was categorised as a deep grey matter or a mixed (cortical and/or deep grey matter) infarction. The venous structures were analysed qualitatively for the calibre difference between ipsilateral and contralateral hemispheres. We quantitatively analysed the relationship between the size of areas with PHV on SWI and the abnormalities on MR angiography, apparent diffusion coefficient value, and signal intensity on T2WI in the 271 patients. PHV over the infarction site was observed in 54.1% (137/253) of the large infarctions, and 19.3% (6/31) of the small infarctions on SWI. PHV was demonstrated in 63.1% (118/187) of mixed infarctions and 25.8% (25/97) of deep grey matter infarctions, and 59.2% (58/98) in hyperacute and 45.7% (85/186) of acute infarctions. The presence of PHV was statistically significant in the size and region of cerebral infarction (p < 0.05), and was not significant in the stage of infarction (p = 0.137). Quantitative analysis revealed significant differences in the MRA abnormalities and ADC values in the PHV ( +) group (p < 0.05) and no significant difference in the T2WI SI ratio in the PHV ( +) group (p = 0.086), compared with PHV (-) group. PHV on SWI was more prominent at the portions with the large and mixed infarctions. PHV was observed both in hyperacute and acute infarction.

FETAL HEPATIC HEMANGIOMA: A CASE REPORT

Fetal liver tumors represent approximately 5% of all congenital tumors and hemangiomas account for approximately 15% of all fetal liver tumors. Hem­angioma and hemangioendothelioma are benign vascular tumors but they are associated with a significant morbidity and mortality due to high output congestive heart failure and arteriovenous shunting. Ultrasound features of hepatic hemangioma can overlap with arteriovenous malformation. This is a case report of fetal hepatic hemangioma with aretriovenous shunting de­tected on routine anomaly scan at 20 weeks of gestation in 22 years old Nep­alese women who was asymptomatic. Prenatally, a 3.2cm x 2.8cm multicystic mass was seen in the left hypochondrium of the fetal abdomen displacing the stomach. On color Doppler examination, the mass showed internal color flow and multiple tortuous dilated vessels noted around the lesion. After counsel­ing regarding the lesion to the mother and her family; decision to abort the fetus was made. Autopsy was done for the final diagnosis of the lesion, which showed vascular mass in the left lobe of liver insinuating between stomach and spleen.

Distributed Surrounding Control of Multiple Unmanned Surface Vessels With Varying Interconnection Topologies

In this brief, a distributed surrounding control problem is investigated for multiple unmanned surface vessels (USVs) with varying interconnection topologies. A distributed estimation-and-control hierarchical framework is developed, where an individual estimator is designed for a USV to predict the state of the target in an interconnection network with jointly dwellingly connected topologies. Thereby, the vessels could be governed to encircle the target in a convex hull, which evenly rotate around the target at the center. Moreover, asymptotical stability conditions are derived to guarantee the feasibility of the proposed surrounding controller. Finally, experiments are conducted for a real multi-USV system consisting of three 1.6 meters-long vessels and a differential GPS station, to verify the effectiveness of the proposed controller.

Infarction-Related Cardiogenic Shock- Diagnosis, Monitoring and Therapy–A German-Austrian S3 Guideline.

The second edition of the German-Austrian S3 guideline contains updated evidence-based recommendations for the treatment of patients with infarction-related cardiogenic shock (ICS), whose mortality is several times higher than that of patients with a hemodynamically stable myocardial infarction (1). In five consensus conferences, the experts developed 95 recommendations-including two statements-and seven algorithms with concrete instructions. Recanalization of the coronary vessel whose occlusion led to the infarction is crucial for the survival of patients with ICS. The recommended method of choice is primary percutaneous coronary intervention (pPCI) with the implantation of a drug-eluting stent (DES). If multiple coronary vessels are diseased, only the infarct artery (the "culprit lesion") should be stented at first. For cardiovascular pharmacotherapy-primarily with dobutamine and norepinephrine-the recommended hemodynamic target range for mean arterial blood pressure is 65-75 mmHg, with a cardiac index (CI) above 2.2 L/min/m2. For optimal treatment in intensive care, recommendations are given regarding the type of ventilation (invasive rather than non-invasive, lungprotective), nutrition (no nutritional intake in uncontrolled shock, no glutamine supplementation), thromboembolism prophylaxis (intravenous heparin rather than subcutaneous prophylaxis), und further topics. In case of pump failure, an intra-aortic balloon pump is not recommended; temporary mechanical support systems (Impella pumps, veno-arterial extracorporeal membrane oxygenation [VA-ECMO], and others) are hemodynamically more effective, but have not yet been convincingly shown to improve survival. Combined cardiological and intensive-care treatment is crucial for the survival of patients with ICS. Coronary treatment for ICS seems to have little potential for further improvement, while intensive-care methods can still be optimized.

Connectivity-maintaining and collision-avoiding performance function approach for robust leader–follower formation control of multiple uncertain underactuated surface vessels

A robust leader–follower formation tracking design using connectivity-maintaining and collision-avoiding performance functions is developed for multiple uncertain underactuated surface vessels (USVs). It is assumed that the USVs communicate within limited ranges and all nonlinearities of the USV dynamics are completely unknown. Compared with the related literature, two primary contributions of this paper are to derive connectivity-maintaining and collision-avoiding performance functions for designing a robust formation tracking scheme using only relative state information and to establish an obstacle avoidance strategy guaranteeing the connectivity between the leader and the followers while avoiding an obstacle. Based on the Lyapunov stability theorem, the predesignated formation tracking performance and stability of the proposed control system have been analyzed without using potential-like functions and function approximation techniques. Simulation results are provided to show the effectiveness of the proposed theoretical result.

Revascularization of multiple tibial arteries is not associated with improved limb salvage

ObjectiveWe sought to determine the benefit of performing multiple tibial artery revascularization compared with single vessel revascularization for patients with chronic limb-threatening ischemia (CLTI). MethodsWe performed a single-center, retrospective cohort study of all patients with CLTI treated with below-the-knee endovascular intervention from 2012 to 2019. Group 1 included patients who had undergone single tibial artery revascularization. Group 2 included patients who had undergone multiple (two or more) tibial artery revascularization. More proximal disease, if present, was treated, in addition to the tibial disease. The primary endpoint was freedom from amputation. The secondary endpoints included the reintervention rates and all-cause mortality. ResultsA total of 527 limbs in 470 patients with CLTI (nonhealing ulcers, 62%; gangrene, 33%; and ischemic rest pain, 5%) were included in the present study. Of the 527 limbs, 245 (46%) had undergone single vessel revascularization and 282 (54%) had undergone multiple vessel revascularization. The mean follow-up was 19 ± 18 months. No difference was found in freedom from amputation between the two groups (68% vs 63%; P = .109). On multivariable analysis, the factors associated with amputation included dialysis (odds ratio [OR], 1.68; 95% confidence interval [CI], 1.16-2.45), dyslipidemia (OR, 1.37; 95% CI, 0.96-1.94), and gangrene (OR, 2.08; 95% CI, 1.50-2.98). No differences were found in the reintervention rates between the two groups (21.2% vs 16.7%; P = .13). The overall survival rate was 73% in both study groups. ConclusionsThe results from the present large, single-center study have demonstrated that multiple below-the-knee vessel revascularization is not associated with improved limb salvage compared with single vessel revascularization.

Vascular Access Complications and Clinical Outcomes of Vascular Surgical Repairs Following Transcatheter Aortic Valve Implantation (TAVI)

Transcatheter aortic valve implantation (TAVI) procedures have revolutionized the treatment of aortic stenosis. However, due to large sheaths, improperly deployed closure devices, and the comorbidities and challenges innate to this population, vascular access complications can be devastating. The objective of this study is to evaluate vascular access complications in one of the largest TAVI sites in North America. This was a retrospective single center review between January 2014 and December 2018 of vascular access complications necessitating operative intervention by vascular surgery. Patient demographics and preoperative comorbidities were collected. Type of vascular access complication, types of repair, closure device used, and postoperative outcomes were analyzed. A total of 37 cases out of a total of 985 TAVI procedures were identified. TAVI was carried out in the operating suite (70%) or the catheterization lab (30%). Consults to vascular surgery were requested intraoperatively (60%), immediately postoperative (14%), later in the day of the TAVI (20%), and on postoperative day 1 (6%). The location of injury included common femoral artery (49%), superficial femoral artery (11%) and external iliac artery (41%), with some cases injuring multiple vessels. Closure devices were found in the subcutaneous tissue (26%), anterior wall (37%), posterior wall (11%), intra-arterial (11%), closing the anterior to the posterior wall (16%), and in the inguinal ligament (5%). Injuries included tears (11%), dissections (38%), and vessel rupture (19%). The majority of repairs were done primarily (64%), with patch (28%) and bypass (8%) less frequently. Four patients died perioperatively (11%), 2 from hemorrhage, 1 from cardiac arrest, and 1 from progressive respiratory disease. Access complications during TAVI procedures predispose complex patients to increased risk of morbidity and mortality. Careful patient selection, proper access techniques, and performing high risk patients in the operating suite with vascular surgery are fundamental in minimizing complications.