Abstract P541: Avoiding the Radial Paradox: Radial Adoption is Not Associated With Worse Femoral Outcomes in Neuroendovascular Cases

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
D. Andrew Wilkinson ◽  
Neil Majmundar ◽  
Joshua Catapano ◽  
Tyler Cole ◽  
Jacob Baranoski ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Vascular Access ◽  
Older Patients ◽  
Population Level ◽  
Single Center ◽  
Access Site ◽  
Patient Level ◽  
Transradial Access ◽  
Increased Risk ◽  
Historical Controls

Background and Purpose: Transradial access (TRA) for neuroendovascular procedures is increasing in prevalence, although numerous procedures are still performed using transfemoral access (TFA). Some cardiology studies have suggested the safety benefits of TRA at a patient level may be offset at a population level by a paradoxical increase in TFA vascular access site complications (VASCs) associated with radial adoption, the so-called “radial paradox.” We studied the effect of TRA adoption on TFA performance and VASC rates in neuroendovascular procedures. Methods: Data were collected for all neuroendovascular procedures performed over a 10-month period by trainees after implementation of a radial-first paradigm at a single center. Results: Over the study period, 1,084 procedures were performed, including 689 (63.6%) via TRA and 395 (36.4%) via TFA. In comparison to TRA, TFA cases were performed in older patients (TFA 63 ±15 vs. TRA 56 ±16), were predominantly male (TFA 52.9% vs. TRA 38.6%), used larger sheath sizes (≥7 French, TFA 56.6% vs. TRA 2.3%), were more often emergent (TFA 37.7% vs. TRA 1.1%), and used tPA administration (TFA 15.3% vs. TRA 0%) (p<.001 for all comparisons). Overall, 29 VASCs occurred (2.7%), including 27 minor (TFA 4.6% [18/395] vs. TRA 1.3% [9/689], p=.002) and 2 major (TFA 0.3% [1/395] vs. TRA 0.1% [1/689], p>.99) complications. After multivariate analysis, independent predictors of any VASC included TFA (OR 2.8, 95% CI 1.1-7.4) and use of dual antiplatelets (OR 4.2, 95% CI 1.6—11.1). Conclusions: TFA remains an essential route for neuroendovascular procedures, accounting for 36.4% of cases under a radial-first paradigm. TFA is disproportionately performed in patients undergoing procedures with an increased-risk for VASCs, though the minor and major VASC rates are comparable to historical controls. TFA proficiency may still be achieved in radial-first training without an increase in femoral complications.

scholarly journals Iatrogenic Radial Arteriovenous Fistula Secondary to Transradial Coronary Angiography: A Case Report

2020 ◽  
Vol 5 (01) ◽  
pp. 53-56
Author(s):  
Satish Kumar Rao V. ◽  
Srinivas Bhyravavajhala ◽  
Ramakrishna Narayanan ◽  
Sreekanth Yerram
Keyword(s):  
Risk Factors ◽  
Case Report ◽  
Coronary Angiography ◽  
Arteriovenous Fistula ◽  
Vascular Access ◽  
Rare Case ◽  
Access Site ◽  
Transradial Access ◽  
Percutaneous Coronary ◽  
Cardiovascular Interventions

AbstractTransradial access is the commonly followed route for performing percutaneous coronary diagnostic and angioplasty interventions. Transradial access has drastically decreased the vascular access site complications when compared with the transfemoral access. Arteriovenous fistula developing at the transradial access site is one of the rare complications. The risk factors and the mechanism of development are not entirely known. We present a rare case of a 63-year-old female developing radiocephalic fistula a few days after transradial coronary angiography and discuss management.The transradial route is preferred for cardiovascular interventions. Complications arising out of this are rare even though this route is widely used. Arteriovenous fistula is one of the rare complications, and the mechanisms causing it are not always clearly evident. This report will elaborate on the possible causes and steps to prevent this complication and help in managing once it occurs.

scholarly journals Dialysis access as a source of infective endocarditis in dialysis patients

2020 ◽  
Vol 90 (4) ◽  
Author(s):  
Hee D. Jeon ◽  
Kevin B. Lo ◽  
Eduardo E. Quintero ◽  
Byeori Lee ◽  
Asma Gulab ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Vascular Access ◽  
Medical Center ◽  
Bacterial Invasion ◽  
Dialysis Access ◽  
Dialysis Patients ◽  
Access Site ◽  
Source Of Infection ◽  
Duke Criteria ◽  
Increased Risk

The incidence of Infective Endocarditis (IE) is higher in dialysis patients compared to the general population. A major risk factor for IE in this group stems from bacterial invasion during repeated vascular access. Previous studies have shown increased risk of bacteremia in patients with indwelling dialysis catheters compared to permanent vascular access. However, association between the development of IE and the type of dialysis access is unclear. We aimed to examine the associated types of intravascular access and route of infection in dialysis patients who were admitted with infective endocarditis at our center. All patients admitted to Albert Einstein Medical Center in Philadelphia with a diagnosis of infective endocarditis who were on chronic hemodialysis were identified from the hospital database for the period of 1/1/07 to 12/31/18. Modified Duke criteria was used to confirm the diagnosis of infective endocarditis. A total of 96 cases were identified. Of those, 57 patients had an indwelling dialysis catheter while the other 39 had permanent dialysis access. In 82% of patients with dialysis catheters, their dialysis access site was identified as the primary source of infection compared to 30% in those with permanent dialysis access (p<0.001). The number of dialysis catheters placed in the preceding 6 months was strongly associated with endocarditis resulting from the dialysis access site (OR = 3.202, p=0.025). Dialysis catheters are more likely to serve as the source of infection in dialysis patients developing IE compared to permanent dialysis access. Increased awareness of risk of IE associated with dialysis catheters is warranted.

scholarly journals Pituitrin use is associated with an increased risk of inguinal hematomas and pseudoaneurysms in patients undergoing femoral artery puncture

2019 ◽  
Vol 47 (7) ◽  
pp. 2976-2986
Author(s):  
Fang Wang ◽  
Hua Su ◽  
Xiaoxia Wang ◽  
Qionghui Wu ◽  
Yong Zhou ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Femoral Artery ◽  
Complication Rate ◽  
Bronchial Artery ◽  
Bronchial Artery Embolization ◽  
Single Center ◽  
Artery Embolization ◽  
Postoperative Hematoma ◽  
Vascular Closure Devices ◽  
Increased Risk

Objective Femoral artery puncture (FAP) is an effective method for interventional percutaneous vascular procedures. However, FAP leads to complications including hematomas and pseudoaneurysms. This study was performed to determine whether pituitrin infusion or vascular closure devices (VCDs) increase the risk of complications after FAP. Methods This single-center retrospective study included 3641 patients who underwent FAP. The patients were divided into two groups: a groin complication group (including hematomas and pseudoaneurysms) and a no-groin complication group. Results In the multivariate analysis, perioperative pituitrin infusion and the use of VCDs were strongly associated with inguinal hematomas and pseudoaneurysms. The complication rate was obviously higher in patients who underwent bronchial artery embolization (BAE). Because high dosages of pituitrin and VCDs were used in patients undergoing BAE, postoperative hematoma development occurred significantly earlier in these patients. Hematomas occurred within 14 days of the operation in all patients who underwent BAE. Conclusion Perioperative pituitrin infusion and the use of VCDs are associated with an increased risk of complications after FAP, including hematomas and pseudoaneurysms. Notably, patients who underwent BAE, who are subject to higher pituitrin and VCD use, showed a higher complication rate. The incidence of complications was highest within 2 weeks postoperatively.

scholarly journals Clinical usefulness of a new method to improve transradial crossing by coronary catheters

2020 ◽  
Vol 30 (3) ◽  
pp. 409-412
Author(s):  
Claudiu Ungureanu ◽  
Marc Blaimont ◽  
Jacques Auslender ◽  
Antoine de Meester ◽  
Adel Aminian
Keyword(s):  
Radial Artery ◽  
Vascular Complications ◽  
Vascular Complication ◽  
New Technique ◽  
Single Center ◽  
Access Site ◽  
Pump System ◽  
Transradial Access ◽  
Single Center Study ◽  
A New Technique

Aims – The objective of this study was to evaluate the feasibility of a new technique for crossing the radial artery in case of severe refractory arterial spasm. Methods and Results – We conducted a prospective, non-randomized, single center study to evaluate a new technique „Pressure Facilitated Crossing” (PFC) that can facilitate radial artery crossing with coronary catheters by injecting saline solution directly by an automated pump system trough the introducer sheath. The primary endpoint was technical success which was defined as successful catheter passage after PFC. The secondary endpoint was the rate of access-site vascular complications. From January 2018 to December 2019, 22 patients with severe and refractory radial artery spasm, with an inability to advance coronary catheters, were prospectively included in a single center. The PFC technique was used as a bailout option and was successful in 21 patients (95%). No vascular complication was noted. Overall, this strategy was well tolerated despite a short-duration of pain during saline injection. Conclusion – In case of severe radial artery spasm during transradial access, the use of the PFC technique was effective and safe for crossing the radial artery with coronary catheters after failure of conventional approaches. This bailout method has the potential to decrease the need for vascular access conversion during transradial access.

Zinc Depletion Increases Readmission in Older Patients: An Example of Interactions Between Nutrition and Disease

2017 ◽  
Vol 87 (1-2) ◽  
pp. 10-16 ◽  
Author(s):  
Salah Gariballa ◽  
Awad Alessa
Keyword(s):  
Nutritional Status ◽  
Inductively Coupled Plasma ◽  
Older Patients ◽  
Controlled Trial ◽  
Prognostic Indicators ◽  
Hospitalised Patients ◽  
Increased Risk ◽  
Co Morbidity ◽  
The Impact ◽  
Poor Nutrition

Abstract. Background: ill health may lead to poor nutrition and poor nutrition to ill health, so identifying priorities for management still remains a challenge. The aim of this report is to present data on the impact of plasma zinc (Zn) depletion on important health outcomes after adjusting for other poor prognostic indicators in hospitalised patients. Methods: Hospitalised acutely ill older patients who were part of a large randomised controlled trial had their nutritional status assessed using anthropometric, hematological and biochemical data. Plasma Zn concentrations were measured at baseline, 6 weeks and at 6 months using inductively- coupled plasma spectroscopy method. Other clinical outcome measures of health were also measured. Results: A total of 345 patients assessed at baseline, 133 at 6 weeks and 163 at 6 months. At baseline 254 (74%) patients had a plasma Zn concentration below 10.71 μmol/L indicating biochemical depletion. The figures at 6 weeks and 6 months were 86 (65%) and 114 (70%) patients respectively. After adjusting for age, co-morbidity, nutritional status and tissue inflammation measured using CRP, only muscle mass and serum albumin showed significant and independent effects on plasma Zn concentrations. The risk of non-elective readmission in the 6-months follow up period was significantly lower in patients with normal Zn concentrations compared with those diagnosed with Zn depletion (adjusted hazard ratio 0.62 (95% CI: 0.38 to 0.99), p = 0.047. Conclusions: Zn depletion is common and associated with increased risk of readmission in acutely-ill older patients, however, the influence of underlying comorbidity on these results can not excluded.

An open-label, single-center pilot study to test the effects of an amino acid mixture in older patients admitted to internal medicine wards

Nutrition ◽  
2020 ◽  
Vol 69 ◽  
pp. 110588 ◽  
Author(s):  
Francesco Bellanti ◽  
Aurelio Lo Buglio ◽  
Elena Di Stasio ◽  
Giorgia di Bello ◽  
Rosanna Tamborra ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Amino Acid ◽  
Pilot Study ◽  
Older Patients ◽  
Amino Acid Mixture ◽  
Acid Mixture ◽  
Single Center ◽  
Open Label ◽  
Internal Medicine Wards

scholarly journals 22. Description of Hospitalized Patients with Influenza Vaccine Failure

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S35-S35
Author(s):  
Joanna Kimball ◽  
Yuwei Zhu ◽  
Dayna Wyatt ◽  
Helen Talbot
Keyword(s):  
Logistic Regression ◽  
Influenza Vaccine ◽  
Influenza Vaccination ◽  
Older Patients ◽  
Influenza A ◽  
Influenza Season ◽  
Hospitalized Patients ◽  
Vaccine Failure ◽  
Increased Risk ◽  
Immunosuppressed Patients

Abstract Background Despite influenza vaccination, some patients develop illness and require hospitalization. Many factors contribute to vaccine failure, including mismatch of the vaccine and circulating strains, waning immunity, timing of influenza season, age and patient comorbidities such as immune function. This study compared vaccinated, hospitalized patients with and without influenza. Methods This study used 2015–2019 Tennessee data from the US Hospitalized Adult Influenza Vaccine Effectiveness Network database. Enrolled patients were ≥ 18 years vaccinated for the current influenza season and admitted with an acute respiratory illness. Patient or surrogate interviews and medical chart abstractions were performed, and influenza vaccinations were confirmed by vaccine providers. Influenza PCR testing was performed in a research lab. Statistical analyses were performed with STATA and R using Pearson’s chi-squared, Kruskal-Wallis and Wilcoxon rank-sum tests and multivariate logistic regression. Results 1236 patients met study criteria, and 235 (19%) tested positive for influenza. Demographics, vaccines and comorbidities were similar between the two groups (Table 1) except for morbid obesity, which was more common in influenza negative patients (13% vs 8%, p = 0.04), and immunosuppression, which was more common in the influenza positive (63% vs 54%, p = 0.01). Logistic regression analysis demonstrated older patients (OR 1.47, 95% CI 1.03–2.10) and immunosuppressed patients (OR 1.56, 1.15–2.12) were at increased risk for influenza (Table 2 and Figure 1). Immunosuppression also increased the risk for influenza A/H3N2 (OR 1.86, 95% CI 1.25–2.75). A sensitivity analysis was performed on patients who self-reported influenza vaccination for the current season without vaccine verification and demonstrated increased risk of influenza in older adults (OR 1.66, 95% CI 1.16–2.39). Table 1: Demographics of influenza positive versus influenza negative patients in influenza vaccinated, hospitalized patients. Table 2: Logistic regression analyses of vaccinated, hospitalized influenza positive patients; vaccinated, hospitalized patients with influenza A subtypes and self-reported vaccinated, hospitalized influenza positive patients. Figure 1: Predicted Probability of Hospitalization with Influenza, Influenza A/H1N1 and Influenza A/H3N2 in Vaccinated Patients by Age. Conclusion Our study demonstrated an increased risk of influenza vaccine failure in older patients and immunosuppressed patients. These groups are also at increased risk for influenza complications. To improve protection of these patients against future influenza illnesses, more effective vaccines are needed, and more research on ring vaccination should be pursued. Disclosures All Authors: No reported disclosures

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