Umbilical vessel catheter retro-exchange technique (U-RET) for repeat use of the umbilical artery for neonatal vascular intervention: Technical note

2021 ◽  
pp. 159101992110414
Author(s):  
Shinsuke Sato ◽  
Yasunari Niimi ◽  
Tatuki Mochizuki ◽  
Shougo Shima ◽  
Tatuya Inoue ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Umbilical Artery ◽  
Contrast Material ◽  
Technical Note ◽  
Vascular Intervention ◽  
Umbilical Vessel ◽  
Vessel Injury ◽  
Arteriovenous Shunts ◽  
First Choice ◽  
Exchange Technique

A high flow arteriovenous shunts in newborns may require urgent endovascular treatment right immediately after delivery if high output cardiac failure is resistant to medical treatment. The umbilical approach is often the first choice of the access route for endovascular treatment in the newborn. It is, however, not infrequent that the patient has an extensive lesion, which necessitates a second session of treatment because of the limitation of the usable amount of the contrast material in one session. In such a case, re-puncturing the femoral artery is difficult and carries the risk of leg ischemia. On the other hand, leaving the umbilical sheath for the second procedure carries risks of infection, thrombosis, and vessel injury. Herein we introduce our umbilical vessel catheter (UVC) retro-exchange technique (U-RET) in which we replace the umbilical sheath to a 3.5Fr UVC at the end of the first endovascular procedure to preserve the umbilical artery access and prepare for the repeated use. We believe that this method minimizes the risks of infection and vessel injury.

UMBILICAL VESSEL ANGIOCARDIOGRAPHY IN THE NEWBORN INFANT

PEDIATRICS ◽  
1963 ◽  
Vol 31 (6) ◽  
pp. 946-951
Author(s):  
Samuel O. Sapin ◽  
Leonard M. Linde ◽  
George C. Emmanouilides
Keyword(s):  
Newborn Infant ◽  
Umbilical Artery ◽  
Umbilical Vein ◽  
Newborn Infants ◽  
Umbilical Vessel ◽  
Accurate Interpretation ◽  
Sick Newborn

Angiocardiography from an umbilical vessel approach was performed in 10 critically sick newborn infants. The umbilical vein route was successfully employed up to the eighth day of life, while the umbilical artery was safely used as late as age 5 days. This approach has advantages over other methods of catheterization and angiocardiography. Angiocardiographic quality was satisfactory for accurate interpretation.

An Unusual Complication of Umbilical Artery Catheterization

PEDIATRICS ◽  
1972 ◽  
Vol 49 (2) ◽  
pp. 281-283
Author(s):  
Donald A. Lackey ◽  
Paddy Taber
Keyword(s):  
Umbilical Artery ◽  
Clinical Course ◽  
Unusual Complication ◽  
Umbilical Vessel ◽  
Umbilical Artery Catheterization

Attention is called to the clinical course of a neonate who experienced the accidental retro-grade loss of part of a polyvinyl catheter into the aorta. This had occurred after treatment via an umbilical artery had been completed, and attempts to remove the catheter had resulted in its breaking. The management of this problem is presented, and the various complications of umbilical vessel cathethenization are reviewed.

In Vivo Retrieval of a Trapped Merci Embolectomy Device: Technical Case Report

2010 ◽  
Vol 67 (3) ◽  
pp. onsE304-onsE304 ◽  
Author(s):  
Ajeet Gordhan ◽  
John Soliman
Keyword(s):  
Vertebral Artery ◽  
Conformational Changes ◽  
Basilar Artery ◽  
Technical Note ◽  
Vessel Injury ◽  
Artery Segment ◽  
In Vitro Assessment ◽  
Artery Flow

Abstract BACKGROUND AND IMPORTANCE: This technical note describes a complication related to the use of the Merci embolectomy device not previously reported. The device can induce critical flow limitation within an accessed vessel because of a combination of vasospasm and anatomic conformational changes. Furthermore, this can limit the safe removal of the device from intracranial vasculature. We present a novel rescue technique that can be used to safely retrieve the entrapped Merci device without inciting localized vessel injury. CLINICAL PRESENTATION: A 51-year-old male with embolic occlusion of the distal basilar artery and dissection-related occlusion of the left cervical vertebral underwent mechanical thrombolysis. Flow-limiting vasospasm and/or anatomic conformational changes/ telescoping of the intracranial right vertebral artery segment was induced during deployment with subsequent entrapment of the device. Reclamation of the entrapped device was performed by initially removing the Merci microcatheter. The entrapped and fixated device was then resheathed into a 4F slip catheter within the intracranial vertebral artery. The Merci device and the slip catheter were then removed. Right vertebral and proximal basilar artery flow was reestablished after removal of the Merci device. Successful clot extraction was thereafter performed using a microsnare. CONCLUSION: In vitro assessment of the device has demonstrated its propensity to induce vasospasm. In vivo entrapment of the device has not been previously reported. Successful retrieval can be achieved if the Merci device becomes entrapped and fixated. This may be an important consideration as increased utilization of the device occurs.

scholarly journals A Technical Note

2013 ◽  
Vol 19 (1) ◽  
pp. 27-34 ◽  
Author(s):  
V.M. Pereira ◽  
A. Marcos-Gonzalez ◽  
I. Radovanovic ◽  
P. Bijlenga ◽  
A.P. Narata ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Young Patient ◽  
Arteriovenous Malformations ◽  
Technical Note ◽  
Cerebral Arteriovenous Malformations ◽  
Arterial Access ◽  
Therapeutic Method ◽  
Endovascular Approach ◽  
Ruptured Avm ◽  
Transvenous Approach

Ruptured cerebral arteriovenous malformations (AVMs) usually require treatment to avoid re-bleeding. Depending on the angioarchitecture and center strategy, the treatment can be surgical, endovascular, radiosurgical or combined methods. The classic endovascular approach is transarterial, but sometimes it is not always applicable. The transvenous approach has been described as an alternative for the endovascular treatment of small AVMs when arterial access or another therapeutic method is not possible. This approach can be considered when the nidus is small and if there is a single draining vein. We present a technical note on a transvenous approach for the treatment of a ruptured AVM in a young patient.

scholarly journals Aneurysm of the Fenestrated Basilar Artery: Case Report and Literature Review

2017 ◽  
Vol 36 (04) ◽  
pp. 225-229
Author(s):  
Linoel Valsechi ◽  
Lucas Meguins ◽  
Isabela Maia ◽  
Adil Fares ◽  
Diogo Taffarel ◽  
...  
Keyword(s):  
Case Report ◽  
Endovascular Treatment ◽  
Basilar Artery ◽  
Cranial Nerve ◽  
Three Dimensional ◽  
Vascular Diseases ◽  
Sixth Cranial Nerve ◽  
3D Angiography ◽  
Complex Anatomy ◽  
First Choice

Introduction Aneurysms of the vertebrobasilar junction are rare, but when present, they are often associated with fenestration of the basilar artery. Frequently, the endovascular treatment is the first choice due to the complex anatomy of the posterior fossa, which represents a challenge for the open surgical treatment alternative. Case Report A 47-year-old man was admitted to the emergency unit with headache, diplopia, neck pain and mental confusion. The neurological exam showed: score of 15 in the Glasgow coma scale (GCS), no motor or sensitivity deficit, palsy of the left sixth cranial nerve and Hunt-Hess grade III. The computed tomography (CT) scan showed subarachnoid hemorrhage (Fisher III) and hydrocephalus. The patient was submitted to ventricular-peritoneal shunt. A diagnostic angiography was performed with 3D reconstruction, which showed evidence of fenestration of the basilar artery associated with aneurysm in the right vertebrobasilar portion. An aneurysm coil embolization was performed without complications. The patient was discharged 19 days later maintaining diplopia, with paralysis of the left sixth cranial nerve, but without any other complaints or neurological symptoms. Discussion Fenestration of the basilar artery occurs due to failure of fusion of the longitudinal neural arteries in the embryonic period, and it is associated with the formation of aneurysms. The endovascular treatment is the first choice and several techniques are described, including simple coiling, balloon remodeling, stent-assisted coiling, liquid embolic agents and flow diversion devices. The three-dimensional rotational angiography (3DRA) is an extremely helpful tool when planning the best treatment course. Conclusion Fenestrated basilar artery aneurysms are rare and complex vascular diseases and their treatment improved with the advent of the 3D angiography and the development of the endovascular techniques.

scholarly journals Vascular dimorphism ensured by regulated proteoglycan dynamics favors rapid umbilical artery closure at birth

2020 ◽  
Author(s):  
Sumeda Nandadasa ◽  
Jason M. Szafron ◽  
Vai Pathak ◽  
Sae-Il Murtada ◽  
Caroline M. Kraft ◽  
...  
Keyword(s):  
Smooth Muscle ◽  
Blood Loss ◽  
Computational Analysis ◽  
Umbilical Artery ◽  
Umbilical Vein ◽  
Mammalian Evolution ◽  
Vascular Responses ◽  
Umbilical Vessel ◽  
Arterial Lumen ◽  
Selection Step

AbstractThe umbilical artery lumen occludes rapidly at birth, preventing blood loss, whereas the umbilical vein remains patent, providing the newborn with a placental infusion. Here, we identify differential arterial-venous proteoglycan dynamics as a determinant of these contrasting vascular responses. We show that the umbilical artery, unlike the vein, has an inner layer enriched in the hydrated proteoglycan aggrecan, external to which lie contraction-primed smooth muscle cells (SMC). At birth, SMC contraction drives inner layer buckling and centripetal displacement to occlude the arterial lumen, a mechanism elicited by biomechanical and computational analysis. Vascular dimorphism arises from spatially regulated proteoglycan expression and breakdown in umbilical vessels. Mice lacking aggrecan or the metalloprotease ADAMTS1, which degrades proteoglycans, demonstrated their opposing roles in umbilical cord arterial-venous dimorphism and contrasting effects on SMC differentiation. Umbilical vessel dimorphism is conserved in mammals, suggesting that their differential proteoglycan dynamics were a positive selection step in mammalian evolution.

scholarly journals Single-Center Retrospective Series of Intracranial Aneurysms Treated with the Barricade Coil System: Immediate and Six-Month Results

2020 ◽  
Vol 74 (3) ◽  
pp. 181-187
Author(s):  
Kārlis Kupčs ◽  
Aigars Lācis ◽  
Zane Saleniece ◽  
Helmuts Kidikas
Keyword(s):  
Clinical Outcome ◽  
Endovascular Treatment ◽  
Stent Implantation ◽  
Intracranial Aneurysms ◽  
Neurological Symptoms ◽  
University Hospital ◽  
Complete Occlusion ◽  
Coil System ◽  
Unruptured Intracranial Aneurysms ◽  
First Choice

AbstractIntracranial aneurysms (IAs) are most commonly found at the branch points of large arteries that form the circle of Willis. The prevalence of IAs in the adult population is 1–5%. IAs rupture is associated with subarachnoid haemorrhage (SAH) in 6–8 cases per 100 000 population, causing mortality in 40–50%. Aneurysm treatment is used to prevent rupture or rebleeding (for ruptured IAs). Randomised trials demonstrated the superiority of endovascular treatment (EVT) of ruptured aneurysms with coil systems over surgery. The objective of the study was to evaluate the effectiveness of the Barricade coil system in the treatment of intracranial aneurysms. Detachable platinum coils, since their introduction 25 years ago, have become the first choice EVT method for ruptured and unruptured IAs and have shown acceptable mortality (~2%). The retrospective study of intracranial aneurysms treated with the Barricade coil system at Pauls Stradiņš Clinical University Hospital (Rīga, Latvia) conducted in a 20-month period included 95 patients and 97 IAs. Thirty-one (32.6%) males and 64 (67.4%) females with median age 56 ± 15 years underwent endovascular treatment. The minority, 22 (23.16%) patients, were asymptomatic, while 73 (76.84%) patients had neurological symptoms directly associated with aneurysm progression and SAH development. Preoperatively, 52 (53.6%) aneurysms were ruptured, causing SAH, and 24 (25.26%) patients with unruptured IAs had neurological symptoms. Sixty-four (66.0%) IAs were treated using coils without neurovascular stent implantation or balloon assistance, 22 (22.7%) — with coils and stent implantation, and 11(11.3%) aneurysms were embolised with balloon-assisted coiling. The immediate anatomical result of endovascular treatment of IAs and technical success of aneurysm coiling was evaluated using the simplified Raymond scale. In the majority of cases, complete occlusion of the aneurysm was achieved while residual neck of the aneurysm or aneurysm remnant was uncommon. Immediate clinical results were evaluated using the modified Rankin scale (mRs). The majority of patients had favourable immediate clinical outcome (mRs 0–2), but four (4.21%) patients died in 1–6 days after the procedure as a consequence of SAH. In 72 (75.79%), patients no new neurological pathological symptoms developed 2–3 days after endovascular procedure and they were discharged from the hospital. Intraprocedural complications occurred in 4 (4.21%) cases. Technical issues occurred in two (2.1%) patients. In 19 (20%) patients, neurological symptoms remained even after the procedure, six (6.32%) patients had clinical worsening, and we had one case of procedural related mortality. Six-month follow-up evaluation was performed for 58 (61.0%) patients (59 IAs). In the majority of cases, complete occlusion of the aneurysm and favourable clinical outcome (mRs 0–2) was observed. Our experience showed that the treatment of ruptured and unruptured intracranial aneurysms with the Barricade coil system is feasible, effective, clinically safe and has a low risk of intraprocedural complications.

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