Venous Approach Research Articles

Retrospective clinical study on the efficacy and complications of interventional embolization in the treatment of scalp arteriovenous fistula

IntroductionScalp arteriovenous fistula (AVF) is a rare and intricate vascular anomaly characterized by a direct connection between an artery and a vein, without an intervening capillary system. This anomaly can induce significant local hemodynamic changes and is associated with various complications, such as pain, a pulsatile mass, increasing swelling, and venous hypertension skin ulcerations which may be non-healing. This study aimed to evaluate the efficacy and safety of interventional embolization treatments for scalp AVF at Shandong Provincial Hospital.MethodsThis retrospective clinical analysis assessed 21 patients who underwent interventional embolization between 2018 and 2024. Patients included were those treated in the vascular surgery department at Shandong Provincial Hospital, who had comprehensive medical records and follow-up data. Treatment methods, outcomes, and complications were thoroughly analyzed through patient medical records.ResultsAmong the patients studied, direct puncture was the most prevalent treatment method, employed in 42.86% (9/21) of cases, followed by various combinations of arterial, venous, and direct approaches. Ethanol, used in 85.71% (18/21) of the cases, demonstrated its broad efficacy and application in clinical settings. Immediate imaging post-treatment confirmed a cure rate of 85.71% (18/21). The main postoperative complications included swelling, with some patients also experiencing nodules, scabbing, or hair loss.ConclusionInterventional embolization has proven to be a safe and effective method for managing scalp AVF, significantly minimizing complications. Future research should focus on further optimizing these treatment methods to enhance efficacy and improve patient quality of life.

Comparative evaluation of approach sites in right ventricular biopsy: influence on complication rates, particularly conduction defects

Abstract Background Myocardial biopsy is an essential procedure for the diagnosis of myocarditis and cardiomyopathy. As specific treatment for secondary cardiomyopathies becomes available, EMB becoming increasingly important. Although the procedure can be performed safely at institutions familiar with the procedure, some institutions tend to hesitate to perform EMB because of procedural complications. In addition, complete right bundle branch block (CRBBB) is a complication of right ventricular biopsy (RV-EMB) that occurs at a certain rate. Therefore, Patient with complete left bundle branch block (CLBBB) often exibit reluctance to undergo RV-EMB due to the risk of complete atrioventricular block. Although there are two approaches to RV-EMB, transfemoral vein and trans-intracavitary vein, and each institution is familiar with its approach, no study has ever looked at the difference in complication rates, mainly complete right bundle branch block, due to the different approach sites for right ventricular biopsy. Aims This study aims to examine the differences in complication rates, mainly CRBBB, due to differences in the approach site of the RV-EMB procedure. Methods/Results The subjects were 338 consecutive patients who underwent RV-EMB at our hospital between January 2017 and December 2022. We performed a retrospective analysis of 274 cases, excluding 43 cases that were originally CRBBB and 21 cases with ventricular pacing, ventricular fibrillation (VF), complete atrioventricular block from beginning to end, and no pre- and post-ECGs. The transfemoral venous approach group (Group TF) included 96 cases and the transjugular venous approach (Group TJ) included 178 cases, with Group TF using more warfarin (13.5% vs. 3.4%, p=0.004) and obtaining fewer specimens compared to Group TJ (3.0±1.0 vs. 3.8±0.6 pieces, p<0.001). Transient CRBBB was present in 28 (29.2%) patients in Group TF and 12 (6.7%) patients in Group TJ (p<0.001); CRBBB persisted beyond 24 hours in 8 (8.3%) and 2 (1.1%) patients, respectively. There was one case of cardiac tamponade in Group TF and two cases of VF in Group TJ, but no cases of stroke, permanent pacemaker implantation, or death. Multivariate logistic regression analysis showed that the transfemoral approach and corticosteroid administration emerged as independent predictor in the occurrence of CRBBB (p<0.001, odds ratio 0.17 and p=0.021, odds ratio 3.76, respectively.), whereas in cases of sustained CRBBB, solely the transfemoral approach stood as an independent predictor (p=0.002, odds ratio 0.07). Conclusions In RV-EMB, the transjugular venous approach has the potential to decrease CRBBB as a complication. The transjugular vein approach may be preferable in cases where complete AV block is a concern, such as patients who originally have CLBBB.

Intraorbital AVF Treated by Direct Puncture of the Superior Ophthalmic Vein: A Case Report and Review of the Literature

Intraorbital AV fistulas are quite uncommon, so they are a challenge for most neurointerventional teams. Since a venous approach has shown better results, it is the preferred approach for physicians, but it is not always feasible. A direct puncture of the superior ophthalmic vein (SOV) as shown in this case is a safe and quick alternative in such cases, providing a definitive solution for the patient.

Kissing-catheter technique in percutaneous transcatheter closure of patent ductus arteriosus: a snare-free approach.

For percutaneous closure of the patent ductus arteriosus (PDA) with a mushroom-shaped occluder, the establishment of a guidewire rail with the antegrade venous approach may be difficult in some cases. The retrograde technique can be used instead; however, the use of a snare system may bring extra costs and risks. The aim of the study was to report on a new method that fulfills the retrograde technique without the use of a snare system in transcatheter closure of PDA. From May 2019 to January 2023, we attempted transcatheter closure using the kissing-catheter technique after failure of the conventional antegrade venous approach on 22 consecutive patients with PDA. This technique involves docking the distal ends of the antegrade catheter and retrograde catheter in the main pulmonary artery, and sending an exchange guidewire from one catheter, through the docking junction, and externalized from the proximal end of the other. Then an artery-PDA-vein guidewire loop was established for the delivery of the occluder. The results and operation time of this method were analyzed. Successful establishment of the guidewire rail was achieved in all patients. The average time from attempting to dock the 2 catheters to successfully passing the guidewire was 26 ± 15 seconds. There were no complications during or after the procedures. The snare-free kissing-catheter technique is an efficient and reliable method for transcatheter closure of PDA in cases where the antegrade approach is difficult.

Aveir VR, retrievable leadless pacing in the young.

Successful implantations of the Aveir VR, have been effectively demonstrated in adults; however, there remain limited reports supporting safe and feasible implantation of the Aveir VR in the young population. Retrospective, observational study of Aveir VR implantation of young patients (≦21 years old) at UC Davis Medical Center from November 2022 to January 2024 via the internal jugular or femoral vein implantation approaches. Indications for pacing, patient demographics, pacing thresholds and longevity were reported at the time of implantation and last follow-up. A total of 10 patients received the Aveir VR with a median age of years (IQR 12.5-17) and median weight of 50.8kg (IQR 44.6-60.9) kg. The majority were male (80%). Aveir VR leadless pacemaker occurred via internal jugular venous (90%) or femoral venous (10%) approaches. Indications for placement were intermittent complete heart block (60%) and sinus pauses (40%). Adequate impedance, sensing and thresholds were maintained from implantation to a median follow-up of 9 months. Predicted pacemaker longevity at follow-up median was 23.8 years. There were no complications in any of the 10 patients. Aveir VR implantation via the internal jugular and femoral veins is feasible in the young patient population with stable pacing parameters at follow-up.

Venous retrograde approach for endovascular angioplasty in chronic total pulmonary vein occlusion -a case report

IntroductionFibrosing mediastinitis (FM) is a rare disease characterized by excessive proliferation of fibrous tissue in the mediastinum and can cause bronchial stenosis, superior vena cava obstruction, pulmonary artery and vein stenosis, etc.Case presentationAn aging patient with intermittent chest tightness and shortness of breath was diagnosed with FM associated pulmonary hypertension (FM-PH) by echocardiography and enhanced CT of the chest, and CT pulmonary artery (PA)/ pulmonary vein (PV) imaging revealed PA and PV stenosis. Selective angiography revealed complete occlusion of the right upper PV, and we performed endovascular intervention of the total occluded PV. After failure of the antegrade approach, the angiogram revealed well-developed collaterals of the occluded RSPV-V2b, so we chose to proceed via the retrograde approach. We successfully opened the occluded right upper PV and implanted a stent.ConclusionsThis report may provide new management ideas for the interventional treatment of PV occlusion.

Femoral to abdomen tunneling at the bedside for medium/long term venous access.

Femoral to abdomen tunneling of small-bore central venous catheters is a bedside technique for patients with contraindications to a thoracic approach, or as an alternative to a lower extremity catheter exit site. A femoral to abdomen tunneling technique was implemented for patients receiving medium and long-term intravenous treatments with contraindications to the thoracic venous approach or as an alternative to a lower extremity catheter exit site. All venous access devices were inserted with ultrasound guidance under local anesthesia, and catheter tip placement assessed by post procedural radiography. In this case series, from January 2020 to January 2023, a total of eight FTA-tunneled venous access devices were inserted. There were seven ambulatory patients and one bedbound patient. The median length of the subcutaneous tunnel was 20 cm, ranging from 15 to 27 cm. The median length of the intravenous catheter to the terminal tip was 31 cm, ranging from 23 to 40 cm. Tip location was confirmed by post-procedural abdominal radiograph. The catheter tip locations were interpreted to be at the level of T8-T9 (2), T12 (1), L4 (2), L2 (2), L1(1).No insertion or post insertion related complication was reported. Six patients completed the scheduled intravenous treatment. One patient was unable to be tracked due to transfer to an outside facility. One catheter initially demonstrated to be coiled over the left common iliac vessel was repositioned using a high flow flush technique. There was one reported catheter dislodgment by the nurse providing care and maintenance. The overall implant days were 961, with a median dwell time of 125 days ranging from 20 to 399 days. Femoral to abdomen tunneling provides an alternative exit site useful in select patients with complex intravenous access. The data of this small retrospective review suggests this a safe and minimally invasive bedside procedure.

Angioarchitecture and Associated Dural Arteriovenous Fistulas of the Superior Petrosal Sinus and Petrosal Vein

The superior petrosal sinus and petrosal vein are important drainage routes for the posterior cranial fossa, with some variations and collateral vessels. An anterolateral-type tentorial dural arteriovenous fistula, which occurs around the petrosal vein, often develops aggressive symptoms due to venous reflux to the brainstem and cerebellum. Neuroendovascular treatment of this fistula is usually challenging because transarterial embolization has a high risk and indications for transvenous embolization are limited. In the cavernous sinus and transverse sinus/sigmoid sinus dural arteriovenous fistulas, venous reflux to the petrosal vein is dangerous, and a treatment strategy with the occlusion of the petrosal vein is indispensable. Furthermore, attention should be paid to venous approaches through the superior petrosal sinus.

Leads with the Cut Proximal Ends Migrated into the Heart and Vasculature: A Rare Phenomenon among 3847 Lead Extraction Procedures.

Background: The study aimed to describe the phenomenon of leads migrated (MPLE) into the cardiovascular system (CVS). Methods: Retrospective analysis of 3847 transvenous lead extractions (TLE). Results: Over a 17-year period, 72 (1.87%) MPLEs (median dwell time 137.5 months) were extracted, which included mainly ventricular leads (56.94%). Overall, 68.06% of MPLEs had their cut proximal ends in the venous system. Most of them were pacing (95.83%) and passive fixation (98.61%) leads. Independent risk factors for MPLE included abandoned leads (OR = 8.473; p < 0.001) and leads located on both sides of the chest (2.981; p = 0.045). The higher NYHA class lowered the probability of MPLE (OR = 0.380; p < 0.001). Procedure complexity was higher in the MPLE group (procedure duration, unexpected procedure difficulties, use of additional (advanced) tools and alternative venous approach). There were no more major complications in the MPLE group, but the rate of procedural success was lower due to more frequent retention of non-removable lead fragments. Extraction of MPLEs did not influence long-term survival. Conclusions: 1. Extraction of leads with MPLE is rare among other TLE procedures (1.9%), 2. risk factors include abandoned leads and presence of leads on both sides of the chest but a higher NYHA class lowers the probability of MPLE, 3. complexity of MPLE extraction is higher regarding procedure duration, unexpected procedure difficulties, use of advanced tools and techniques but rates of major complications are comparable, and 4. extraction of MPLEs did not influence long-term survival.

Pseudoaneurysm formation following transarterial embolization of traumatic carotid-cavernous fistula with detachable balloon: An institutional cohort long-term study.

The goal of therapy for traumatic carotid-cavernous fistula (TCCF) is the elimination of fistula while maintaining patency of the parent artery. The treatment for TCCF has evolved from surgery to endovascular management using detachable balloons, coils, liquid embolic agents, covered stents, or flow-diverter stent through arterial or venous approaches. Despite the withdrawal of detachable balloons from the market in the United States since 2004, transarterial embolization with detachable balloons has currently remained the best initial treatment for TCCF in several countries. However, the pseudoaneurysm formation following transarterial detachable balloon embolization has rarely been observed in long-term follow-up. To determine the occurrence and long-term follow-up of pseudoaneurysm after transarterial detachable balloon for TCCF. Between January 2009 and December 2019, 79 patients diagnosed with TCCF were treated using detachable latex balloons (GOLDBAL) of four sizes. Pseudoaneurysm sizes were stratified into five grades for analysis. Initial and follow-up assessments involved computed tomography angiography at 1 month, 6 month, 1 year, and longer intervals for significant cases. Clinical follow-ups occurred semi-annually for 2 years, then annually. Factors analyzed included sex, age, fistula size and location, and balloon size. In our cohort of 79 patients treated for TCCF, pseudoaneurysms formed in 67.1%, with classifications ranging from grade 0 to grade 3; no grade 4 or giant pseudoaneurysms were observed. The majority of pseudoaneurysms did not progress in size, and some regressed spontaneously. Calcifications developed in most large pseudoaneurysms over 5-10 years. Parent artery occlusion occurred in 7.6% and recurrent fistulas in 16.5%. The primary risk factors for pseudoaneurysm formation were identified as the use of specific balloon sizes, with balloon SP and No. 6 significantly associated with its occurrence (P = 0.005 and P = 0.002, respectively), whereas sex, age, fistula size, location, and the number of balloons used were not significant predictors. Pseudoaneurysm formation following detachable balloon embolization for TCCF is common, primarily influenced by the size of the balloon used. Despite this, all patients with pseudoaneurysms remained asymptomatic during long-term follow-up.

Impact on nurse workload and patient satisfaction of atrioventricular junction ablation performed simultaneously with conduction system pacing using a superior approach from the pocket compared with the conventional femoral approach.

Conduction system pacing (CSP) and atrioventricular junction ablation (AVJA) improve outcomes in patients with symptomatic, refractory atrial fibrillation (AF). Superior approach (SA) from the pocket, via the axillary or subclavian vein, has been recently proposed as an alternative to the conventional femoral access (FA) to perform AVJA. In this study, we compare the impact of these alternative approaches on nurse workload (NWL) and patient satisfaction. This was a prospective, observational study enrolling consecutive patients undergoing simultaneous CSP and AVJA. Electrophysiology laboratory (EP Lab) NWL was calculated by using a self-developed model. Ward NWL was calculated using the MIDENF® validated scale. Patient satisfaction was collected using the Hospital Consumer Assessment of Healthcare Provider Systems questionnaire. A total of 119 patients were enrolled: in 50, AVJA was primarily attempted with SA, and in 69 with FA. Compared with FA, SA was associated with a lower EP Lab NWL (169.8 ± 26.7 vs. 202.7 ± 38.9 min; P < 0.001) and a lower Ward NWL (474.5 ± 184.8 vs. 808.6 ± 289.9 min; P < 0.001). Multivariate analysis identified SA as an independent predictor of lower EP Lab NWL [hazard ratio (HR) 4.60; P = 0.001] and of lower Ward NWL (HR 45.13; P < 0.001). Compared with FA, SA was associated with a higher patient-reported rating regarding their experience during hospital stay (P = 0.035) and the overall hospital evaluation (P = 0.026). In patients undergoing simultaneous CSP and AVJA, the use of an SA for ablation is a valid alternative to conventional FA. Compared with FA, this approach significantly reduces NWL and is associated with greater patient satisfaction. ClinicalTrials.gov: NCT03612635.

HVPG minimally invasive era: exploration based on forearm venous approach

Objective: The transjugular or transfemoral approach is used as a common method for hepatic venous pressure gradient (HVPG) measurement in current practice. This study aims to confirm the safety and effectiveness of measuring HVPG via the forearm venous approach. Methods: Prospective recruitment was conducted for patients with cirrhosis who underwent HVPG measurement via the forearm venous approach at six hospitals in China and Japan from September 2020 to December 2020. Patients' clinical baseline information and HVPG measurement data were collected. The right median cubital vein or basilic vein approach for all enrolled patients was selected. The HVPG standard process was used to measure pressure. Research data were analyzed using SPSS 22.0 statistical software. Quantitative data were used to represent medians (interquartile ranges), while qualitative data were used to represent frequency and rates. The correlation between two sets of data was analyzed using Pearson correlation analysis. Results: A total of 43 cases were enrolled in this study. Of these, 41 (95.3%) successfully underwent HVPG measurement via the forearm venous approach. None of the patients had any serious complications. The median operation time for HVPG detection via forearm vein was 18.0 minutes (12.3~38.8 minutes). This study confirmed that HVPG was positively closely related to Child-Pugh score (r = 0.47, P = 0.002), albumin-bilirubin score (r = 0.37, P = 0.001), Lok index (r = 0.36, P = 0.02), liver stiffness (r = 0.58, P = 0.01), and spleen stiffness (r = 0.77, P = 0.01), while negatively correlated with albumin (r = -0.42, P = 0.006). Conclusion: The results of this multi-centre retrospective study suggest that HVPG measurement via the forearm venous approach is safe and feasible.

Dural Arteriovenous Fistula Treated with Transvenous Embolization via the Upper Limb Cutaneous Vein.

In recent years, the transradial artery approach has gained prominence and is increasingly employed in neurovascular angiography and therapy due to its safety, reduced complications, and minimal invasiveness. While various venous approaches, including the conventional transfemoral vein approach, exist for procedures such as transvenous embolization, recent reports have highlighted methods involving upper extremity cutaneous veins. However, the practicality and efficacy of these approaches remain unclear. This study presents our experience with three cases of dural arteriovenous fistulas, where transvenous embolization was performed via upper limb cutaneous veins. In all instances, the arteriovenous approach was successfully executed using a single upper extremity, leading to the successful completion of treatment. This technique demonstrates significant advantages, not only in terms of its minimal invasiveness but also due to its simplicity and safety. Anticipating broader acceptance in the future, this approach offers a promising avenue for further exploration in neurovascular interventions.

Use of the transfemoral access approach for cardiac stimulation device implantation when the superior venous approach is not feasible: A single-centre twenty-year series

Background: When permanent cardiac stimulation device implantation via superior venous access (i.e., cephalic, axillary or subclavian veins) is not possible or advisable, safe and feasible surgical alternatives must be used. The transfemoral approach is relatively unknown; therefore, it is seldom used and studied. This single-centre study analysed the 20-year outcomes of patients who underwent implantation using a transfemoral implantation approach. Methods: Data on the implantation procedure (indication, approach, lead and pacemaker models, complications), patient characteristics (age, sex, medications, comorbidities), and follow-up were analysed for all patients who underwent permanent cardiac stimulation device implantation using the transfemoral approach between June 2001 and December 2021. Results: A permanent cardiac stimulation device was implanted using the transfemoral approach in 66 patients (mean age, 76 years [range: 45-96], 40 [60%] men). The most frequent indication was atrioventricular block, associated with sinus rhythm in 36 patients and atrial fibrillation in 11 patients. The mean implantation time was 61 min (range: 20-210), and the mean fluoroscopy time was 7.9 min (range: 0.2-87). The minimum follow-up period was one year (December 2022), with a mean of 60 months [range: 2-180]). Overall, 26 patients (42%) were treated with oral anticoagulants postimplantation. No deaths, septic episodes, or severe complications were associated with the procedure in the short or long term. Follow-up data were available for 64 patients, of whom 52 (81%) died during follow-up (mean age, 84 years [range: 55-101]). No deaths were associated with the use of the transfemoral technique. Conclusions: Permanent cardiac stimulation device implantation using the transfemoral access approach is feasible and straightforward for an experienced implant surgeon. The outcomes of systems implanted by the transfemoral access approach were comparable to those of systems implanted by the superior venous approach, and no severe complications were observed at the 20-year follow-up.

Precise Terminology and Specified Catheter Insertion Length in Ultrasound-Guided Infraclavicular Central Vein Catheterization.

Background and Objectives: As the latest research encourages the ultrasound-guided infraclavicular central venous approach, due to the lateral puncture site displacement, in comparison to the anatomical landmark technique based on subclavian vein catheterization, the need to re-calculate the optimal catheter insertion length and possibly to rename the punctuated vessel emerges. Although naming a particular anatomical structure is a nomenclature issue, a suboptimal catheter position can be associated with multiple life-threatening complications and must be avoided. The main study objective is to determine the optimal catheter insertion length by the most proximal ultrasound-guided, in-plane infraclavicular central vein approach, to compare results with the anatomical landmark technique based on subclavian vein catheterization and to clarify the punctuated anatomical structure. Materials and Methods: 109 patients were enrolled in this study. All procedures were performed according to the same catheterization protocol. In order to determine optimal insertion length, chest X-ray scans with an existing catheter were performed. The definition of punctuated vessel was based on computer tomography and evaluated by radiologists. Independent predictors for optimal insertion length were identified, prediction equations were generated. Results: The optimal catheter insertion length is approximately 1.5 cm longer than estimated by Pere's formula and can be accurately calculated based on anthropometric data. Computed tomography revealed: five cases with subclavian vein puncture and three cases with axillary vein puncture. Conclusions: Even the most proximal ultrasound-guided infraclavicular central vein access does not guarantee subclavian vein catheterization. A more accurate term could be infraclavicular central venous access, with the implication that the entry point could be through either subclavian or axillary veins. The optimal insertion length is approximately 1.5 cm deeper than the length determined for the anatomical landmark technique based on subclavian vein catheterization.

Detection of pathogens from venous or arterial blood of patients with left-sided infective endocarditis by metagenomic next-generation sequencing: A prospective study

BackgroundInfective endocarditis is a life-threatening uncommon infectious disease, and we aimed to explore the clinical utility of venous or arterial blood-based metagenomic next-generation sequencing (mNGS) approaches to diagnose left-sided infective endocarditis (LSIE). MethodsWe prospectively studied 79 LSIE patients who received valvular surgery in our hospital. Results of blood culture, valve culture, venous blood-based mNGS, arterial blood-based mNGS, venous blood-based mNGS plus blood culture, and arterial blood-based mNGS plus blood culture were evaluated and compared. ResultsBoth venous blood- and arterial blood-based mNGS methods displayed significantly higher positive detection rates than blood culture and valve culture (43.0 %, 49.4 % vs. 32.9 %, 19.0 %; P < 0.001). Strikingly, when combining blood-based mNGS and blood culture, the positive rate could be further improved to more than 60 %. Moreover, we found mNGS LSIE detection was closely associated with preoperative leukocyte (P = 0.027), neutrophil value (P = 0.018), vegetation ≥ 14 mm (P = 0.043), and vegetations in aortic valve (P = 0.048). In addition, we discovered that blood-based mNGS had a superir capacity over blood culture to detect gram-negative bacteria, fungi, Bartonella Quintana, and mixed infections than blood culture. ConclusionThis study indicates that venous blood- and arterial blood-based mNGS displayed high positive rate in the rapid detection of pathogens in high-risk LSIE patients.

Abstract 18352: Impact of Approach Site on Conduction Defect in Right Ventricular Biopsy

Introduction: Myocardial biopsy is a fundamental procedure for diagnosing myocarditis and cardiomyopathy. Complete right bundle branch block (CRBBB) is a potential complication of right ventricular biopsy (RV-EMB) that occurs at a certain rate. Consequently, patients with complete left bundle branch block (CLBBB) often exhibit reluctance to undergo RV-EMB due to the risk of complete atrioventricular block. However, it is precisely in such cases that the diagnosis of CLBBB through myocardial biopsy becomes crucial and concerns clinicians.Although there are two approaches to RV-EMB, namely the transfemoral vein and transjuglar vein approaches, and each institution has its preferred method, no study has investigated the variation in complication rates, particularly the occurrence of CRBBB, based on the different approach sites for RV-EMB. AIMS:This study aims to analyze the disparity in complication rates, primarily CRBBB, attributable to differences in the approach site during the RV-EMB procedure. METHODS/RESULTS: Over all 266 cases who underwent RV-EMB at Kanazawa University between January 2017 and December 2022 including 87 cases with transfemoral venous approach (Group TF) and 179 cases with transjugular venous approach (Group TJ) were enrolled in this retrospective single-center study. Group TF exhibited a higher usage of warfarin (15.1% vs. 3.4%, p=0.001) and obtained fewer specimens compared to Group TJ (2.97±0.98 vs. 3.90±0.65 pieces, p&lt;0.001).Transient CRBBB was observed in 26 (29.9%) patients in Group TF and 13 (7.3%) patients in Group TJ (p&lt;0.001); CRBBB persisted beyond 24 hours in 8 (9.1%) and 2 (1.1%) patients(p=0.004), respectively. One case of cardiac tamponade occurred in Group TF, and two cases of VF were reported in Group TJ, with no instances of stroke, permanent pacemaker implantation, or mortality.Multivariate logistic regression analysis identified approach cite (Group TF/TJ) as an independent predictor of CRBBB (p&lt;0.001, odds ratio 0.43). CONCLUSIONS: The transjugular venous approach in RV-EMB demonstrates potential in reducing the occurrence of CRBBB as a complication. In cases where complete atrioventricular block is a concern, such as those with CLBBB, the transjugular vein approach may be preferable.

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.

Arm-only combined transarterial and transvenous access for neurointerventional procedures: a double-center retrospective study.

This study aims to share our experience with the arm-only combined transarterial and transvenous access approach for neurointerventional procedures and evaluate its efficacy and safety. The arm-only combined transarterial and transvenous access approach was performed using the right/bilateral proximal radial arteries and the right forearm superficial vein system, guided by ultrasonic guidance. Arterial access closure was achieved using a transradial band radial compression device, while manual compression was utilized for venous approach closure. Thirteen procedures were successfully performed using the arm-only combined transarterial and transvenous access approach, yielding favorable outcomes. The procedures included dural arteriovenous fistula embolization (seven cases), cerebral arteriovenous malformation embolization (four cases), venous sinus thrombosis catheter-directed thrombolysis and intravenous thrombectomy (one case), and cerebral venous sinus stenosis manometry (one case). All procedures were uneventful, allowing patients to ambulate on the same day. At discharge, all patients exhibited modified Rankin scores of 0-2, without any access site or perioperative complications. This double-center study preliminarily demonstrates the feasibility and safety of arm-only combined transarterial and transvenous access applied in neurointerventional procedures for complicated cerebrovascular diseases. The proximal radial artery and forearm superficial vein are recommended as the primary access sites. Unobstructed compression is strongly recommended for radial approach closure. This study aimed to add evidence and experience on the arm-only combined transarterial and transvenous access, as a new approach, for neurointerventional treatment that required arteriovenous approaches.

Extracorporeal Circulation and Venous Hemodynamics: A Literature Review on Physiological Foundations to Clinical Applications

The venous system constitutes a vital component of the human circulatory system, facilitating the return of deoxygenated blood from tissues and organs back to the heart. During cardiac surgeries while using cardiopulmonary bypass (CPB), a critical step involves diverting venous blood from a cannula through the heart-lung machine, where it undergoes oxygenation before re-entering the arterial circulation. This process demands careful control and management to ensure safe and effective perfusion throughout the body. This research paper offers an exploration of venous drainage strategies in the context of cardiac surgery and other applications of extracorporeal life support. The PRISMA method was employed as the guiding framework for conducting this review. The investigation utilized a qualitative research design to assess the artificial circulation and venous dynamics. Out of 85 selected journal publications, 63 peer-reviewed and evidence-based research works were shortlisted. Through an examination of existing evidence, the author underscores the significance of precise venous cannulation techniques and drainage approaches, underscoring the influence on hemodynamics, clinical outcomes, and potential complications. The study delves into advanced monitoring methods and future prospects within the realm of venous drainage. The insights presented in this review serve as a valuable resource for evidence-based decision-making, ultimately contributing to improved patient outcomes and elevated surgical practices.