scholarly journals Simultaneous radio-ulnar cannulation: shifting gears from ‘feasibility’ to ‘applicability’

2021 ◽  
Vol 73 (1) ◽  
Author(s):  
Ankit Kumar Sahu ◽  
Sudesh Prajapati ◽  
Danish Hasan Kazmi
Keyword(s):  
Arterial Occlusion ◽  
Femoral Access ◽  
Artery Cannulation ◽  
Arterial Access ◽  
Pseudoaneurysm Formation ◽  
Femoral Arterial Access ◽  
Coronary Procedures ◽  
Prolonged Immobilization ◽  
Contemporary Practice ◽  
Vascular Spasm

AbstractConventionally, routes of vascular access commonly include femoral and radial arteries with brachial, ulnar and subclavian arteries being rarely used for coronary interventions. Non-femoral arterial access is being increasingly preferred to minimise groin puncture site complications, prolonged immobilization and duration of hospital stay. However, radial artery cannulation is also fraught with fears of tortuosity, loops, vascular spasm, perforation, pseudoaneurysm formation, arm hematoma and arterial occlusion. In contemporary practice when most of the coronary procedures are being done via transradial access, encountering one of the above-mentioned hurdles often forces the operator to switchover to femoral access. Here, we explore the rationale, feasibility, operational logistics, clinical implications and future directions for using simultaneous radio-ulnar arterial access in the same extremity.

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 Deep Vein Thrombosis after Femoral Arterial Access: Pathophysiologic and Therapeutic Challenges

2019 ◽  
Vol 2019 ◽  
pp. 1-4
Author(s):  
Evan Harmon ◽  
Yoo Jin Lee ◽  
Sula Mazimba ◽  
Kanwar Singh ◽  
Aditya Sharma ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Rare Complication ◽  
Clot Formation ◽  
Heart Catheterization ◽  
Femoral Access ◽  
Arterial Access ◽  
Vein Thrombosis ◽  
Left Heart Catheterization ◽  
Femoral Arterial Access ◽  
Deep Vein

Deep vein thrombosis (DVT) after femoral arterial access is a rare complication of left heart catheterization (LHC). The reasons for paradoxical venous clot formation after arterial access are identifiable in some cases but less clear in others. Here, we present one case of provoked DVT after femoral access followed by a second case in which clot formation appears to be spontaneous. Additionally, though each of the patients presented here demonstrated thrombus resolution, only one received anticoagulation. These cases highlight the complex pathophysiology of DVT following femoral arterial access and the challenges of management strategy selection.

Ipsilateral Iliac Branch Repair Using a Looped Wire, Precannulated Gate Technique

2021 ◽  
pp. 152660282198933
Author(s):  
Jordan R. Stern ◽  
Sean P. Lyden ◽  
Christopher J. Agrusa ◽  
Darren B. Schneider
Keyword(s):  
Internal Iliac Artery ◽  
Endovascular Aneurysm Repair ◽  
Successful Completion ◽  
Femoral Access ◽  
Arterial Access ◽  
Flow Divider ◽  
Internal Iliac ◽  
Femoral Arterial Access ◽  
Aneurysm Repair ◽  
Steerable Sheath

Purpose To describe a novel, entirely ipsilateral femoral technique for distal endograft extension using the Gore Iliac Branch Endoprosthesis. Technique Femoral arterial access is obtained on the side of the intended repair, and a 16F sheath is inserted over a stiff wire. A looped wire is used to pre-cannulate the internal gate of the IBE device prior to insertion, and the device is then positioned and deployed. This through-wire guides access over the IBE flow divider and into the internal gate with a steerable sheath. The internal iliac artery is then selected, and a Viabahn VBX balloon-expandable stent (W.L. Gore, Flagstaff, AZ) is advanced into position and deployed. We present the successful completion of this technique in 4 patients. Conclusion This novel technique allows distal endograft extension with an IBE device using only ipsilateral femoral access and is particularly useful for patients with aneurysmal iliac degeneration in the setting of prior open or endovascular aneurysm repair. This eliminates the need for upper extremity access or contralateral femoral access and navigation across the steep flow divider.

Evaluation of carotid artery access in comparison with femoral artery access in neonatal percutaneous stenting of ductus arteriosus

2021 ◽  
pp. 1-7
Author(s):  
Gehan A. Alsawah ◽  
Hala Elmarsafawy ◽  
Mona Hafez ◽  
Shaimaa Rakha
Keyword(s):  
Carotid Artery ◽  
Patent Ductus Arteriosus ◽  
Femoral Artery ◽  
Ductus Arteriosus ◽  
Late Complications ◽  
Femoral Access ◽  
Arterial Access ◽  
Local Complications ◽  
Femoral Arterial Access ◽  
Patent Ductus

Abstract Background: Patent ductus arteriosus stenting in duct-dependent pulmonary circulation is a challenging procedure. Percutaneous carotid artery access for ductal stenting has proven to be feasible; however, comparison with femoral artery access in terms of procedure details and complications either immediate or late is scarce. Therefore, we evaluated carotid artery access in comparison with femoral artery for stenting of patent ductus arteriosus. Methods: Forty neonates were reviewed, 20 were stented via carotid artery access, and 20 via the traditional femoral artery access. Comparison variables were neonatal demographics at the procedure, angiographic ductal anatomy, procedure details, and immediate complications. Follow-up Doppler ultrasound on access site was performed to document late complications. Results: Median age of included cases was 10.5 (3–28) days with complex ductal anatomy more frequently accessed via carotid artery than femoral. Immediate access-related complications were significantly higher with femoral than carotid artery access; 9 (45%) versus 3 (15%) respectively, p = 0.038. With carotid access, we had only one case with small pseudoaneurysm and acute hemiparesis 3 days after the procedure. Delayed local complications were more common with femoral access (15%) than carotid access (5%), mild stenosis in one case, and severe in another with femoral access; while with transcarotid arterial access, only one case had mild narrowing. Conclusion: Percutaneous carotid artery access in neonates is a more convenient approach for patent ductus arteriosus stenting especially with complex ductal anatomy. Moreover, local complications are limited and vascular patency is better preserved, in comparison with trans-femoral arterial access. However, the potential for neurological adverse events should not be overlooked.

scholarly journals Frequency and risk factors of acute and permanent femoral arterial occlusion in neonates with congenital heart disease who undergo ultrasound˗guided femoral arterial access

2021 ◽  
Author(s):  
Mahmut GOKDEMIR ◽  
Nimet CINDIK
Keyword(s):  
Risk Factors ◽  
Congenital Heart Disease ◽  
Risk Factor ◽  
Heart Disease ◽  
Congenital Heart ◽  
Independent Risk Factor ◽  
Arterial Occlusion ◽  
Coarctation Of The Aorta ◽  
Arterial Access ◽  
Femoral Arterial Access

Background: In neonates, securing femoral arterial access is challenging and time consuming even in experienced hands. Data on frequency and risk factors of ALAP and PFAO are scarce in neonates with CHD. We investigated frequency and risk factors of acute loss of the arterial pulse (ALAP) and permanent femoral arterial occlusion (PFAO) in neonates with congenital heart disease (CHD) underwent ultrasound˗guided femoral arterial access (US˗GFAA). Methods: We divided the patients into groups according to the presence of ALAP and PFAO. We obtained data related to patient characteristics and access variables of US˗GFAA from our database of pediatric cardiac catheterization between August 2017 and May 2021. We used an echocardiography˗S6, 12˗MHz linear probe, 21˗gauge needle, and a 0.018”guidewire for arterial access. A 4˗French sheath (7cm) was placed in all patients. Results: US˗GFAA was obtained in 323(98.8%) of the 327 neonates. We identified ALAP in 130(40.2%) patients and PFAO in 19(5.9%) patients. Median weight was 3.05(IQR: 2.80˗3.40) kg, first attempt success rate was 88.2% and median access time was 46 sec (IQR: 23˗94). Logistic regression analysis identified coarctation of the aorta (Odds ratio: 2.46; 95% CI: 1.30˗4.66; P=0.006) as independent risk factor for ALAP, but did not identify any independent risk factors for PFAO. Conclusion: This study showed that coarctation of the aorta is an independent risk factor for ALAP in neonates with CHD underwent US˗GFAA and placed a 4˗French sheath. Although most cases of ALAP resolve in the early period, the frequency of PFOA remains high despite effective treatment.

Derivation of a procedural performance checklist for ultrasound-guided femoral arterial line placement using the modified Delphi method

2020 ◽  
Vol 21 (5) ◽  
pp. 715-722
Author(s):  
Jessica Baez ◽  
Elizabeth Powell ◽  
Megan Leo ◽  
Uwe Stolz ◽  
Lori Stolz
Keyword(s):  
Delphi Method ◽  
Competency Assessment ◽  
Arterial Line ◽  
Ultrasound Guided ◽  
Arterial Access ◽  
Modified Delphi Method ◽  
Modified Delphi ◽  
Item Checklist ◽  
Standard Quality ◽  
Femoral Arterial Access

Background: Many specialties utilize procedural performance checklists as an aid to teach residents and other learners. Procedural checklists ensure that the critical steps of the desired procedure are performed in a specified manner every time. Valid measures of competency are needed to evaluate learners and ensure a standard quality of care. The objective of this study was to employ the modified Delphi method to derive a procedural checklist for use during placement of ultrasound-guided femoral arterial access. Methods: A 27-item procedural checklist was provided to 14 experts from three acute care specialties. Using the modified Delphi method, the checklist was serially modified based on expert feedback. Results: Three rounds of the study were performed resulting in a final 23-item checklist. Each item on the checklist received at least 70% expert agreement on its inclusion in the final checklist. Conclusion: A procedural performance checklist was created for ultrasound-guided femoral arterial access using the modified Delphi method. This is an objective tool to assist procedural training and competency assessment in a variety of clinical and educational settings.

Radial versus femoral arterial access for trauma endovascular interventions: A noninferiority study

2020 ◽  
Vol 89 (3) ◽  
pp. 458-463 ◽  
Author(s):  
Sakib M. Adnan ◽  
Anna N. Romagnonli ◽  
Noha N. Elansary ◽  
James R. Martinson ◽  
Marta J. Madurska ◽  
...  
Keyword(s):  
Arterial Access ◽  
Endovascular Interventions ◽  
Femoral Arterial Access

scholarly journals Stent-assisted coiling of large common femoral artery pseudoaneurysm following coronary artery catheterization: an uncommon and novel approach

2017 ◽  
Vol 55 (1) ◽  
pp. 57-59
Author(s):  
Mohammad Parsa Mahjoob ◽  
Isa Khaheshi ◽  
Mohammadreza Naderian
Keyword(s):  
Coronary Artery ◽  
Femoral Artery ◽  
Common Femoral Artery ◽  
Access Site ◽  
Artery Pseudoaneurysm ◽  
Arterial Access ◽  
Novel Approach ◽  
Femoral Arterial Access ◽  
Cardiovascular Interventions

Abstract The femoral artery pseudoaneurysm is a disturbing groin complication associated with the femoral arterial access site used for invasive cardiovascular interventions. We present a 39 year old man who developed a huge right common femoral artery pseudoaneurysm, following diagnostic coronary artery catheterization, which was successfully managed with stent-assisted coiling, an emerging and narrative option in invasive percutaneous approaches to femoral artery pseudoaneurysm.

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