Hemorrhagic complications after endovascular interventions and the effectiveness of vascular closure devices

Aim. To identify the factors associated with hemorrhagic complications after endovascular interventions, as well as to assess the effectiveness of vascular closure devices.Material and methods. The study included 423 patients after endo - vascular intervention with femoral arterial access: 118 — manual compression, 305 — hemostasis using vascular closure devices (VCDs). The development of following complications was recorded: retroperitoneal hematoma, false aneurysm, arteriovenous fistula, bleeding, thigh soft-tissue hematoma. Time to hemostasis, immobilization period, and length of stay were assessed.Results. The complication rate was lower in VCD group compared to manual hemostasis (2,95 vs 11%, p=0,021). In VCD group, hemostasis characteristics significantly differed from the manual compression group: time to hemostasis — 3,1 vs 22,3 min (p=0,001), immobilization duration — 4,1 vs 20 hours (p=0,001), length of stay — 4 vs 8 days (p=0,001), respectively. The risk of complications increased with following factors: anticoagulant therapy, female sex, age >65 years, diabetes, body mass index >30 kg/m2 , vascular access calcification, introducer diameter >6 Fr, prior puncture. There were following independent predictors of complications: glycoprotein IIb/IIIa inhibitor therapy, superficial or deep femoral artery puncture.Conclusion. VCDs significantly reduces the hemorrhagic complication rate and improves hemostasis parameters as compared to manual compression.

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

Conventionally, 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.

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

Prostate Artery Embolisation as a Palliative Care in a Patient with Prostate Cancer: A Case Report

Introduction: Prostate artery embolization is an emerging technique, that appears to be a promising option in the management of benign prostatic hyperplasia for patients unsuitable for surgery. Prostate artery embolization, similar to all other interventions, is not a suitable treatment for all patients with this disease. It is indicated as a minimally invasive option in patients unfit to undergo trans urethral resection of prostate. Case Report: A 78-year-old male suffering from castrate resistant prostate cancer and on treatment with Abiraterone plus prednisolone presented to the Uro-oncological services of the hospital with difficulty to void, incomplete voiding, and sense of incomplete voiding. He had other medical co-morbidities which included Diabetes mellitus, hypertension, and ischaemic heart disease. His cardiac ejection fraction was 25% and was advised not to undergo any surgical procedure. Serum creatinine on admission was 2.2 mg% and serum PSA were 26.5 ng/ml. Under local anaesthesia, using retrograde Seldinger’s technique right common femoral arterial access was obtained and 6F vascular introducer sheath was placed. Bilateral pelvic angiogram was performed, each of the prostatic arteries was superselectively catheterized and the prostatic gland was embolized using PVA (polyvinyl alcohol) particles 200m. Post catheter removal the patient voided well with a maximum flow of 14.5 ml/sec. Conclusion: Prostate artery embolization can successfully treat complications associated with prostate cancer such as LUTS, urinary retention and haematuria with a low risk of serious adverse events.

Managing vascular access and closure for percutaneous mechanical circulatory support

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.

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

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.