Illustrated Guide to the Transradial Approach for Neuroendovascular Surgery: A Step-by-Step Description Gleaned From Over 500 Cases at an Early Adopter Single Center

2020 ◽  
Vol 19 (2) ◽  
pp. 181-189 ◽  
Author(s):  
Mithun G Sattur ◽  
Eyad Almallouhi ◽  
Jonathan R Lena ◽  
Alejandro M Spiotta
Keyword(s):  
Stage Iv ◽  
Stage I ◽  
Early Adopter ◽  
Single Center ◽  
Femoral Access ◽  
Transradial Approach ◽  
Entire Cohort ◽  
Arterial Access ◽  
Femoral Route ◽  
Procedural Success

Abstract BACKGROUND Traditionally, neuroangiography for diagnosis and therapy has been achieved via the transfemoral route. Femoral access, however, has been associated with catastrophic complications. Although transradial access (TRA) has been adopted late by the field of neuroendovascular surgery, several groups have recently demonstrated a dramatically safe and rapid learning curve with a radial-first approach. However, there is a need for a detailed illustrative approach on the transradial technique. OBJECTIVE To provide a detailed description of the operative technique with step-by-step illustrations derived from our single center series of 506 cases, as an early adopter. METHODS A step-by-step illustrated approach to our technique of transradial angiography is provided, based on our clinical experience of an early radial-first approach. Prospective review of patients undergoing transradial angiography and interventions from April 1 to November 30, 2019, at our institution was performed. We included all cases that received radial-first arterial access for diagnostic and interventional neuroangiography. Efficacy, complications, catheter use, and radiation metrics of TRA for the entire cohort were noted. The radial approach was described in 4 stages beginning from the wrist (Stage I) and ending with distal access to target vessel of interest (Stage IV). RESULTS A total of 506 patients underwent TRA over the 7-mo period. Procedural success was achieved in 92.3% of patients (93.7% for diagnostic and 88.5% for interventional). Crossover to the femoral route occurred in 33 (6.5%) cases (25 diagnostic and 8 interventional). The majority occurred in Stage I. No major complications were noted. CONCLUSION Our preferred technique for the transradial approach provides excellent safety and efficacy in performing diagnostic and interventional neuroangiography. The illustrated technical steps are expected to provide guidance for early adopters of TRA.

Treatment Outcomes in Completely Resected Stage I to Stage IV Uterine Carcinosarcoma With Rhabdomyosarcoma Differentiation

2013 ◽  
Vol 23 (9) ◽  
pp. 1635-1641 ◽  
Author(s):  
Vicky Makker ◽  
Sara J. Kravetz ◽  
Jacqueline Gallagher ◽  
Oana-Paula Orodel ◽  
Qin Zhou ◽  
...  
Keyword(s):  
Adjuvant Chemotherapy ◽  
Early Stage ◽  
Group Versus ◽  
Stage Iv ◽  
Stage I ◽  
Cancer Center ◽  
Uterine Carcinosarcoma ◽  
Entire Cohort ◽  
Gynecology And Obstetrics ◽  
Resected Stage

ObjectiveTo evaluate overall survival (OS) and progression-free survival (PFS) after adjuvant therapy in stage I to stage IV uterine carcinosarcoma with rhabdomyosarcoma differentiation.MethodsMemorial Sloan-Kettering Cancer Center medical records from 1990 to 2012 were reviewed. Patients who received chemotherapy with or without radiation therapy (RT), or RT alone, for completely resected stage I to stage IV uterine carcinosarcoma with rhabdomyosarcoma differentiation were included.ResultsOf 53 patients, International Federation of Gynecology and Obstetrics stage distribution was as follows: I, 13 (24.5%); II, 8 (15.1%); III, 13 (24.5%); and IV, 19 (35.9%). Forty-one (77.4%) of 53 patients received adjuvant chemotherapy, and 34% of the patients who received chemotherapy also received pelvic RT or intravaginal brachytherapy (IVRT). Twelve (22.6%) of the 53 patients received only pelvic RT with/without IVRT. Paclitaxel-carboplatin was the most commonly used adjuvant chemotherapy treatment. The median PFS for the entire cohort was 13.4 months (95% confidence interval [CI], 10.5–17.0). The median OS for the entire cohort was 23.0 months (95% CI, 16.9–34.3). The median PFS periods by stage were 15.9 months for stages I/II versus 11.2 months for stages III/IV (P= 0.012). Median OS was not reached in the early-stage cohort. The median OS for the late-stage cohort was 20.9 months (P= 0.004). The median PFS periods by treatment were 10.4 months for pelvic RT with/without IVRT group versus 13.1 months for chemotherapy with/without pelvic RT with/without IVRT group (P= 0.498). The median OS periods by treatment were 23.6 months for chemotherapy with/without pelvic RT with/without IVRT group versus 16.9 months for pelvic RT with/without IVRT group (P= 0.501).ConclusionThe results suggest that chemotherapy alone or in combination with RT is associated with longer PFS and OS compared to RT alone. Only the stage of disease significantly affected PFS and OS.

scholarly journals Vascular Access and Chronic Total Occlusion Angioplasty

2015 ◽  
Vol 10 (2) ◽  
pp. 90
Author(s):  
Smith David ◽  
Hailan Ahmed ◽  
Chase Alexander ◽  
◽  
◽  
...  
Keyword(s):  
Vascular Access ◽  
Chronic Total Occlusion ◽  
Best Practice ◽  
New Technologies ◽  
Coronary Intervention ◽  
Success Rates ◽  
Total Occlusion ◽  
Femoral Access ◽  
Arterial Access ◽  
Procedural Success

The hybrid algorithim approach, together with innovative new technologies, has lead to increased interest in chronic total occlusion (CTO) percutaneous coronary intervention (PCI) and increasing procedural success rates. Unlike non-CTO PCI, there is an increased rate of femoral access. When considering arterial access in CTO PCI, a balance is needed between anticipated procedural difficulty, planned CTO strategy and the desire to minimise the risk of vascular access-related complications. We review the evidence for best practice with respect to femoral puncture technique and also assess the technologies and techniques available to place larger inner diameter catheters into the radial artery.

Intra-arterial, abdominal chemoperfusion with chemofiltration in the treatment of progressive stage IV gastric cancer.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 141-141
Author(s):  
Andreas Sendler ◽  
Karl R. Aigner
Keyword(s):  
Gastric Cancer ◽  
Abdominal Cavity ◽  
Stage Iv ◽  
Celiac Trunk ◽  
Malignant Ascites ◽  
Femoral Access ◽  
Stage Iv Gastric Cancer ◽  
Arterial Access ◽  
Lymphatic Fistula ◽  
The Right

141 Background: Treatment of patients (pts.) with progeressive stage IV gastric cancer remains a therapeutical problem. Survival of the pretreated pts. is low and the therapeutic options are sparse. In this situation, locoregional therapeutic strategies could be an option. Methods: 28 pretreated pts. (17 male, 11 female, mean age 59 y.) after resection and at least second line systemic chemotherapy were included in a phase II study of isolated abdominal perfusion and subsequent chemofiltration. All pts. had liver metastases (mets.), 50% (n = 14) had peritoneal carcinomatosis with malignant ascites. No pat. had cerebral, pulmonal or bone mets.. After insertion of a venous and arterial 21 ch. stop flow catheter via a femoral access, the v. cava was blocked beneath the right atrium, the arterial catheter was blocked above the celiac trunk. The thighs were blocked by pneumatic cuffs. Chemotherapy consisted of 35 mg/m2 cisplatinum, 20 mg/m2 adriamycin and 12 mg/m2 mitomycin q 3 weeks till progress or dead. The agents were administered via the arterial access, followed by 15 min of hypoxic abdominal perfusion via an external pump, followed by chemofiltration for 45 min. The procedure was done under general anaesthesia. Primary endpoint of the study were overall survival, secondary endpoint was control of the ascites. Results: A total of 92 cycles (mean 3.25) were administered. Toxicity was low with leucopenia CTC grad I in 9 pts., gastrointestinal disorders grad II in 8 pts. and surgical complications grad II in 40 % of the pat. (lymphatic fistula). In 9/14 (65%) of pts. with ascites, the ascites was at least controlled or vanished. One year survival was 28.6% (Kaplan-Meier), 2 year survival was 11.4%. Median survival was 6 months. Conclusions: Intra-arterial, isolated abdominal chemoperfusion with consecutive chemofiltration in heavily pretreated patients with gastric cancer metastasized to the abdominal cavity is a valuable option for palliative treatment with low side effects. In 65% of the affected pts., malignant ascites was controlled sufficiently, ameliorating the quality of life.

The concept of an anatomy related individual arterial access: lowering technical and clinical complications with transradial access in bovine- and type-III aortic arch carotid artery stenting

VASA ◽  
2011 ◽  
Vol 40 (6) ◽  
pp. 468-473 ◽  
Author(s):  
Dahm ◽  
van Buuren ◽  
Hansen ◽  
Becker ◽  
Wolpers
Keyword(s):  
Carotid Artery ◽  
Aortic Arch ◽  
Carotid Artery Stenting ◽  
Access Site ◽  
Transradial Approach ◽  
Arterial Access ◽  
Type Iii ◽  
Procedural Success ◽  
The Right ◽  
Diagnostic Catheter

Background: Carotid artery stenting (CAS) from the femoral approach can be anatomically very difficult and the incidence of complications is higher in patients with anatomical variations of the aortic arch, difficulties related to peripheral vascular disease and/or with access site complications. Because the typical morphology in patients with a bovine- or type-III aortic arch applies for an arterial access from the right upper extremity (e.g. radial, brachial) we evaluated success rates and safety of the right transradial access in a prospective study. Patients and methods: Between June 2009 and October 2010, seventeen patients (mean age 74,4 ± 9 years, 10 male) with a bovine- (n = 4) or type-III aortic arch (n = 12) underwent CAS with a planned transradial- (n = 3) or after problematic transfemoral access (n = 14). In patients with a type-III aortic arch (n = 13), the right target common carotid artery (CCA) was cannulated from the right radial artery with a 5F IMA diagnostic catheter-, in patients with a bovine aortic arch (n = 4), the left CCA was accessed from the right radial artery with a 5F Amplatz- or Judkins left catheter. In all patients a 6F- (n = 14) or 5F- (n = 3) shuttle sheath was inserted via the diagnostic catheter and a 0.035” extra-stiff guidewire. All interventions were carried out with the use of a peripheral embolization protection device (EPD). Primary study endpoints were procedural success and major adverse cardiac and cerebrovascular events (MACCE), secondary endpoints were access site complications and the mean intervention time. Results: Procedural success could be achieved in all patients (100 %), MACCE and access site complications did not occur in any patient. Mean interventional time was 48 ± 18 min. Conclusions: CAS using the right transradial approach for left CAS in bovine-type aortic arch or the right transradial approach in type-III aortic arch for right CAS appears to be safe and technically feasible.

scholarly journals Association of Chromosome 1q Gain With Inferior Survival in Favorable-Histology Wilms Tumor: A Report From the Children’s Oncology Group

2016 ◽  
Vol 34 (26) ◽  
pp. 3189-3194 ◽  
Author(s):  
Eric J. Gratias ◽  
Jeffrey S. Dome ◽  
Lawrence J. Jennings ◽  
Yueh-Yun Chi ◽  
Jing Tian ◽  
...  
Keyword(s):  
Copy Number ◽  
Wilms Tumor ◽  
Multivariable Analysis ◽  
Stage Iv ◽  
Stage I ◽  
Disease Stage ◽  
Copy Number Loss ◽  
Entire Cohort ◽  
Favorable Histology ◽  
1Q Gain

Purpose The goal of this study was to analyze the association of copy number gain of 1q in favorable-histology Wilms tumors (FHWTs) with event-free survival (EFS) and overall survival (OS) within each tumor stage and with 1p and 16q copy number loss and/or loss of heterozygosity. Methods Unilateral FHWTs from 1,114 patients enrolled in National Wilms Tumor Study-5 that were informative for 1p and 16q microsatellite markers (previously determined) and informative for 1q gain, 1p loss, and 16q loss using multiplex ligation-dependent probe amplification were analyzed. Results Eight-year EFS was 86% (95% CI, 84% to 88%) for the entire cohort. Of 1,114 patients, 317 tumors (28%) displayed 1q gain. Eight-year EFS was 77% for those with 1q gain and 90% for those lacking 1q gain (P < .001). Eight-year OS was 88% for those with 1q gain and 96% for those lacking 1q gain (P < .001). Within each disease stage, 1q gain was associated with inferior EFS (stage I, 85% v 95%; P = .0052; stage II, 81% v 87%; P = .0775; stage III, 79% v 89%; P = .01; stage IV, 64% v 91%; P = .001). OS was significantly inferior in patients with stage I (P < .0015) and stage IV disease (P = .011). With multivariable analysis, 1q gain was associated with an increased relative risk of relapse of 2.4 (P < .001), whereas 1p loss was not, despite significance on univariable analysis. Conclusion Gain of 1q is associated with inferior survival in unilateral FHWTs and may be used to guide risk stratification in future studies.

scholarly journals Survival rates and prognostic factors in right- and left-sided colon cancer stage I–IV: an unselected retrospective single-center trial

2021 ◽  
Author(s):  
Claudius E. Degro ◽  
Richard Strozynski ◽  
Florian N. Loch ◽  
Christian Schineis ◽  
Fiona Speichinger ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Overall Survival ◽  
Blood Level ◽  
Proportional Hazards ◽  
Survival Rates ◽  
Cox Proportional Hazards ◽  
Stage I ◽  
Cancer Stage ◽  
Single Center ◽  
Significant Difference

Abstract Purpose Colorectal cancer revealed over the last decades a remarkable shift with an increasing proportion of a right- compared to a left-sided tumor location. In the current study, we aimed to disclose clinicopathological differences between right- and left-sided colon cancer (rCC and lCC) with respect to mortality and outcome predictors. Methods In total, 417 patients with colon cancer stage I–IV were analyzed in the present retrospective single-center study. Survival rates were assessed using the Kaplan–Meier method and uni/multivariate analyses were performed with a Cox proportional hazards regression model. Results Our study showed no significant difference of the overall survival between rCC and lCC stage I–IV (p = 0.354). Multivariate analysis revealed in the rCC cohort the worst outcome for ASA (American Society of Anesthesiologists) score IV patients (hazard ratio [HR]: 16.0; CI 95%: 2.1–123.5), CEA (carcinoembryonic antigen) blood level > 100 µg/l (HR: 3.3; CI 95%: 1.2–9.0), increased lymph node ratio of 0.6–1.0 (HR: 5.3; CI 95%: 1.7–16.1), and grade 4 tumors (G4) (HR: 120.6; CI 95%: 6.7–2179.6) whereas in the lCC population, ASA score IV (HR: 8.9; CI 95%: 0.9–91.9), CEA blood level 20.1–100 µg/l (HR: 5.4; CI 95%: 2.4–12.4), conversion to laparotomy (HR: 14.1; CI 95%: 4.0–49.0), and severe surgical complications (Clavien-Dindo III–IV) (HR: 2.9; CI 95%: 1.5–5.5) were identified as predictors of a diminished overall survival. Conclusion Laterality disclosed no significant effect on the overall prognosis of colon cancer patients. However, group differences and distinct survival predictors could be identified in rCC and lCC patients.

scholarly journals Managing vascular access and closure for percutaneous mechanical circulatory support

2021 ◽  
Vol 23 (Supplement_A) ◽  
pp. A10-A14
Author(s):  
Konstantinos Karatolios ◽  
Patrick Hunziker ◽  
David Schibilsky
Keyword(s):  
Mechanical Circulatory Support ◽  
Axillary Artery ◽  
Vascular Complications ◽  
Vascular Trauma ◽  
Circulatory Support ◽  
Femoral Access ◽  
Arterial Access ◽  
Femoral Arterial Access ◽  
Artery Disease ◽  
Critical Aspects

Abstract Even with current generation mechanical circulatory support (MCS) devices, vascular complications are still considerable risks in MCS that influence patients’ recovery and survival. Hence, efforts are made to reduce vascular trauma and obtaining safe and adequate arterial access using state-of-the-art techniques is one of the most critical aspects for optimizing the outcomes and efficiency of percutaneous MCS. Femoral arterial access remains necessary for numerous large-bore access procedures and is most commonly used for MCS, whereas percutaneous axillary artery access is typically considered an alternative for the delivery of MCS, especially in patients with severe peripheral artery disease. This article will address the access, maintenance, closure and complication management of large-bore femoral access and concisely describe alternative access routes.

scholarly journals Gastric Cancer Treatments and Survival Trends in the United States

2020 ◽  
Vol 28 (1) ◽  
pp. 138-151
Author(s):  
Kelly A. Stahl ◽  
Elizabeth J. Olecki ◽  
Matthew E. Dixon ◽  
June S. Peng ◽  
Madeline B. Torres ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Overall Survival ◽  
Stage Iv ◽  
The United States ◽  
Current Treatment ◽  
Stage I ◽  
Stage Ii ◽  
Chi Square ◽  
Specific Guideline ◽  
Kaplan Meier

Gastric cancer is the third most common cause of cancer deaths worldwide. Despite evidence-based recommendation for treatment, the current treatment patterns for all stages of gastric cancer remain largely unexplored. This study investigates trends in the treatments and survival of gastric cancer. The National Cancer Database was used to identify gastric adenocarcinoma patients from 2004–2016. Chi-square tests were used to examine subgroup differences between disease stages: Stage I, II/III and IV. Multivariate analyses identified factors associated with the receipt of guideline concordant care. The Kaplan–Meier method was used to assess three-year overall survival. The final cohort included 108,150 patients: 23,584 Stage I, 40,216 Stage II/III, and 44,350 Stage IV. Stage specific guideline concordant care was received in only 73% of patients with Stage I disease and 51% of patients with Stage II/III disease. Patients who received guideline consistent care had significantly improved survival compared to those who did not. Overall, we found only moderate improvement in guideline adherence and three-year overall survival during the 13-year study time period. This study showed underutilization of stage specific guideline concordant care for stage I and II/III disease.

scholarly journals Serum Biomarker Signature-Based Liquid Biopsy for Diagnosis of Early-Stage Pancreatic Cancer

2018 ◽  
Vol 36 (28) ◽  
pp. 2887-2894 ◽  
Author(s):  
Linda D. Mellby ◽  
Andreas P. Nyberg ◽  
Julia S. Johansen ◽  
Christer Wingren ◽  
Børge G. Nordestgaard ◽  
...  
Keyword(s):  
Case Control Study ◽  
Early Stage ◽  
Stage Iv ◽  
The United States ◽  
Case Control ◽  
Stage I ◽  
Serum Biomarker ◽  
Patient Cohort ◽  
Biomarker Signature ◽  
Control Study

Purpose Pancreatic ductal adenocarcinoma (PDAC) has a poor prognosis, with a 5-year survival of < 10% because of diffuse symptoms leading to late-stage diagnosis. That survival could increase significantly if localized tumors could be detected early. Therefore, we used multiparametric analysis of blood samples to obtain a novel biomarker signature of early-stage PDAC. The signature was derived from a large patient cohort, including patients with well-defined early-stage (I and II) PDAC. This biomarker signature was validated subsequently in an independent patient cohort. Patients and Methods The biomarker signature was derived from a case-control study, using a Scandinavian cohort, consisting of 16 patients with stage I, 132 patients with stage II, 65 patients with stage III, and 230 patients with stage IV PDAC, and 888 controls. This signature was validated subsequently in an independent case-control cohort in the United States with 15 patients with stage I, 75 patients with stage II, 15 patients with stage III, and 38 patients with stage IV PDAC, and 219 controls. An antibody microarray platform was used to identify the serum biomarker signature associated with early-stage PDAC. Results Using the Scandinavian case-control study, a biomarker signature was created, discriminating samples derived from patients with stage I and II from those from controls with a receiver operating characteristic area under the curve value of 0.96. This signature, consisting of 29 biomarkers, was then validated in an independent case-control study in the United States. The biomarker signature could discriminate patients with stage I and II PDAC from controls in this independent patient cohort with a receiver operating characteristic area under the curve value of 0.96. Conclusion This serum biomarker signature might represent a tenable approach to detecting early-stage, localized PDAC if these findings are supported by a prospective validation study.

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