Standardized Forearm Angiography Increases Procedural Success Rates of Coronary Angiography and PCI: A Retrospective Analysis of an All-Comers Patient Cohort

Abstract Background: There is a consensus, that transradial-access (TRA) for coronary procedures should be preferred over transfemoral-access (TFA). Previously, forearm-artery-angiography was mainly performed when difficulties during the advancement of the guidewire were encountered. We explored the implication of a standardized forearm-angiography (SFA) on procedural success rates of TRA.Methods: 1191 consecutive cases were assessed retrospectively. Primary TFA rates, crossover to TFA, reasons for forearm-artery-access (FAA) failure, the prevalence of kinking at the level of the forearm and the occurrence of vascular complications were analyzed.Results: Primary FAA access was attempted in 97.9%. Crossover to TFA after a primary or secondary FAA attempt was necessary in 2.8%. Severe kinking was the most frequent cause of FAA failure and occurred in 3.0%. A second or third FAA attempt to avoid TFA was successful in 81%. Severe kinking at the level of the forearm was reported in 1.8%.Conclusion:This is the first study to provide detailed success rates of a primary FAA strategy combined with SFA. While severe kinking proved to be a rare but relevant challenge for FAA success, the prevalence of arterial spasm was marginal. Multiple attempts of FAA to avoid TFA might be safe possibly due to collateral blood supply.

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A Comparative Analysis between Ultrasound-Guided and Conventional Distal Transradial Access for Coronary Angiography and Intervention

Journal of Interventional Cardiology ◽

10.1155/2020/7342732 ◽

2020 ◽

Vol 2020 ◽

pp. 1-8

Author(s):

Shinsuke Mori ◽

Keisuke Hirano ◽

Masahiro Yamawaki ◽

Norihiro Kobayashi ◽

Yasunari Sakamoto ◽

...

Keyword(s):

Coronary Angiography ◽

Failure Rate ◽

Complication Rate ◽

Artery Occlusion ◽

Ultrasound Guided ◽

Access Site ◽

Transradial Access ◽

Hospital Stays ◽

Procedural Success ◽

A New Technique

Objectives. To compare feasibility and safety between ultrasound-guided and conventional distal transradial access (dTRA). Background. Distal transradial access, a new technique for coronary angiography (CAG) and percutaneous coronary interventions (PCI), is safe and feasible and will become popular worldwide. Ultrasound-guided dTRA has been advocated to reduce failure rate and access-site complications. However, to date, the comparison of feasibility and safety between ultrasound-guided and conventional dTRA has not been reported. Method. Overall, 137 patients (144 procedures) who underwent CAG or PCI using dTRA between September 2018 and February 2019 were investigated. These patients were classified into two groups: C (dTRA with conventional punctures; 76 patients, 79 procedures) and U (dTRA with ultrasound-guided punctures; 61 patients, 65 procedures) groups. Successful procedural rate, procedural outcomes, and complication rate during hospital stays were compared between the two groups. Results. The procedural success rate was significantly higher in the U group than in the C group (97% vs. 87%, P=0.0384). However, the rate of PCI, puncture time, total fluoroscopy time, the volume of contrast medium, the rate of access-site ecchymosis, and incidence of nerve disorder were similar between the two groups. Additionally, radial artery occlusion after the procedure did not occur in this study. Conclusion. The ultrasound-guided dTRA for CAG or PCI was associated with a lower failure rate than conventional dTRA. However, there were no significant differences in puncture time and complication rate between the two procedures.

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Repair of the Protruding Lobule

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489419875160 ◽

2019 ◽

Vol 129 (1) ◽

pp. 63-69

Author(s):

Hermann Raunig ◽

Grant S. Hamilton

Keyword(s):

Soft Tissue ◽

Retrospective Analysis ◽

Blood Supply ◽

Surgical Procedures ◽

Successful Intervention ◽

Small Areas ◽

Patient Cohort ◽

Protruding Ear

Background: In this paper, the author describes a novel step-by-step setback procedure for correcting protruding lobules; the success of correcting protruding lobules depends on the nature and severity of the auricular lobule deformity. Although the auricular lobules occupy small areas on either side of the head, protruding or misshapen lobules exert a significant and sometimes exaggerated disfiguring influence on the otherwise aesthetically pleasing appearance of the ears. Because the lobule is a soft structure without a cartilage skeleton, the correction of a protruding ear and lobule is always a challenge. Methods: Protruding lobule abnormalities stem from deformities of the cauda helicis (cartilaginous helical tail) of the auricular lobule, soft tissue, and/or a shortage of anterior skin; however, the abnormalities are usually a combination of all of the above. Therefore, surgical procedures should address all of the causes of lobule deformity and preserve as much tissue and blood supply as possible. Achieving a successful intervention depends on reducing the tension that affects the entire lobule. Results: This is a retrospective analysis of 660 patients who had otoplasty performed by the first author between January 2010 and December 2017. Correction of the ear lobule was needed in 398 (60.3%) patients. Of these, 44.6% patients were male, 55.4% female and the average age was 9 years (range 4-18 years). In this patient cohort, 356 (89.4%) required bilateral and 42 (10.5%) unilateral ear lobule correction. Standardized pre- and postoperative images were recorded for each patient. Conclusion: The goal of a setback procedure is a natural and harmonious auricular lobule appearance that is achieved through simple, optimal surgery that addresses all of the features of the auricular anatomy.

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Percutaneous endoscopic versus radiologic gastrostomy for enteral feeding: a retrospective analysis on outcomes and complications

Endoscopy International Open ◽

10.1055/a-0953-1524 ◽

2019 ◽

Vol 07 (11) ◽

pp. E1487-E1495 ◽

Cited By ~ 4

Author(s):

Denise Strijbos ◽

Daniel Keszthelyi ◽

Lennard P. L. Gilissen ◽

Martin Lacko ◽

Janneke G. J. Hoeijmakers ◽

...

Keyword(s):

Retrospective Analysis ◽

Enteral Feeding ◽

Success Rates ◽

Multivariate Logistic Regression ◽

Endoscopic Gastrostomy ◽

Procedural Success ◽

Percutaneous Radiologic Gastrostomy ◽

Lateral Sclerosis ◽

Related Mortality

Abstract Background and study aims Percutaneous endoscopic gastrostomy (PEG) and percutaneous radiologic gastrostomy (PRG) are techniques used for long-term enteral feeding. Our primary aim was to analyze procedure-related and 30-day mortality and complications between PEG and PRG in relation to indications. Patients and methods A single-center retrospective analysis was performed thath included all adult patients receiving initial PEG (January 2008 until April 2016) and PRG (January 2010 until April 2016). Outcomes were mortality (procedure-related, 30-day), complications (early (≤ 30 days) and late) and success rates. Results A total of 760 procedures (469 PRG and 291 PEG) were analyzed. Most common indications were head and neck cancer (HNC), cerebrovascular accident (CVA) and amyotrophic lateral sclerosis (ALS). Success rates for placement were 91.2 % for PEG and 97.1 % for PRG (P = 0.001). Procedure-related mortality was 1.7 % in PEG and 0.4 % in PRG (P = 0.113). The 30-day mortality was 10.7 % in PEG and 5.1 % in PRG (P = 0.481 after multivariate logistic regression) CVA was associated with higher 30-day mortality, whereas ALS, higher body weight, and prophylactic placements in HNC were associated with lower rates.Tube-related complications were less frequent in PEG, both early (2.7 % vs. 26.4 %, P ≤ 0.001) and late (8.6 % vs. 31.5 %, P ≤ 0.001). The percentage of major complications and infections did not differ. Conclusions With respect to procedure-related and 30-day mortality, PEG and PRG compare equally. PRG had a higher procedural success rate. Tube-related complications and pain are less frequent after PEG compared to PRG. The choice for either PEG or PRG therefore should primarily be based on local facilities and expertise.

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Downsizing – the Future of Interventional Cardiology

Interventional Cardiology Review ◽

10.15420/icr.2012.7.1.28 ◽

2012 ◽

Vol 7 (1) ◽

pp. 28

Author(s):

Giovanni Amoroso ◽

Keyword(s):

Contrast Agent ◽

Vascular Complications ◽

Cost Savings ◽

Length Of Hospital Stay ◽

Interventional Cardiology ◽

Coronary Intervention ◽

Transradial Approach ◽

Technical Developments ◽

Coronary Procedures ◽

Angiographic Image

The concept of downsized catheters (i.e., using catheters smaller than 6 French) for invasive coronary procedures, such as diagnostic cardiac catheterisation and percutaneous coronary intervention, has been developing over the years, particularly as a result of the rise of the transradial approach. Recent advances have allowed the use of smaller and sheathless catheters, which confer a number of advantages – such as fewer vascular complications, reduced use of contrast agent and reduced haemostasis – thus increasing patient safety and comfort and allowing more rapid patient mobilisation. Reductions in patient complications, number and length of hospital stay, and amount of contrast agent used can also lead to cost savings. While the use of smaller catheters has been hindered in the past because of poor angiographic image quality, new automated contrast injectors have helped overcome this limitation. There is a need to make interventional cardiologists worldwide more aware of the benefits of downsizing, in the light of the latest technical developments and the increased use of transradial approach.

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267 Histopathologic ultrastaging of sentinel lymph nodes in endometrial carcinoma: A retrospective analysis of the tuebingen women’s hospital 2006-2016 patient cohort

10.1136/ijgc-2020-igcs.229 ◽

2020 ◽

Author(s):

L Baudoux ◽

A Staebler ◽

K Greif ◽

B Krämer ◽

S Hoffmann ◽

...

Keyword(s):

Lymph Nodes ◽

Endometrial Carcinoma ◽

Retrospective Analysis ◽

Sentinel Lymph Nodes ◽

Patient Cohort

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Clinical and echocardiographic trends in percutaneous balloon mitral valvuloplasty

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01442-w ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Ofir Koren ◽

Asaf Israeli ◽

Ehud Rozner ◽

Nassem Darawshy ◽

Yoav Turgeman

Keyword(s):

Heart Failure ◽

Medical Center ◽

Success Rates ◽

Mitral Valvuloplasty ◽

Percutaneous Balloon Mitral Valvuloplasty ◽

Developing Heart ◽

Percutaneous Balloon ◽

Study Population ◽

Procedural Success ◽

Over Time

Abstract Background The prevalence of Rheumatic Mitral Stenosis (MS) has significantly changed over the last decades. We intend to examine patient demographics, Echocardiographic characteristics, procedural success rates, and complications throughout 30-years. Methods We conducted a single-center descriptive observational study. The study population consists of patients undergone percutaneous balloon mitral valvuloplasty (PBMV) at Emek Medical Center in Israel from January 1990 to May 2019. Results Four hundred seventeen patients underwent PBMV during the study period and were eligible for the study. Age did not change significantly over time (p = 0.09). The prevalence of Male and patients who were smoking and had multiple comorbidities such as hypertension, dyslipidemia, ischemic heart disease, and chronic kidney disease became increases over time (p = 0.02, p = 0.02, p = 0.001, p = 0.01, p = 0.02, and p = 0.001, respectively). Wilkins score and all its components increased over time, and the total score was higher in females (p = 0.01). Seventy-nine (18.9%) patients had complications. The rate of complications did not change over decades. Patients with Wilkins score > 8, post-procedural MR of ≥2, and post-procedural MVA < 1.5 had the highest risk for the need of Mitral valve replacement (MVR) surgery in 2 years following PBMV (3.64, 4.03, 2.44, respectively, CI 95%, p < .0001 for all). The median time in these patients was 630 days compared to 4–5 years in the entire population. Patients with Post-procedural MR of ≥2 and post-procedural MVA < 1.5 had ten times risk for developing heart failure (HR 9.07 and 10.06, respectively, CI 95%, P < .0001). Conclusion Our research reveals trends over time in patients’ characteristics and echocardiographic features. Our study population consists of more male patients with multiple comorbidities and more complex and calcified valvular structures in the last decade. Wilkins score > 8, post-procedural MR of ≥2, and post-procedural MVA < 1.5 cm2 were in-depended predictors for the time for surgery and heart failure hospitalization.

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