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Meucci F, Stolcova M, Caniato F, Sarraf M, Mattesini A, Di Mario C. The Essentials of Femoral Vascular Access and Closure. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Manning JE, Moore EE, Morrison JJ, Lyon RF, DuBose JJ, Ross JD. Femoral vascular access for endovascular resuscitation. J Trauma Acute Care Surg 2021; 91:e104-e113. [PMID: 34238862 DOI: 10.1097/ta.0000000000003339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Endovascular resuscitation is an emerging area in the resuscitation of both severe traumatic hemorrhage and nontraumatic cardiac arrest. Vascular access is the critical first procedural step that must be accomplished to initiate endovascular resuscitation. The endovascular interventions presently available and emerging are routinely or potentially performed via the femoral vessels. This may require either femoral arterial access alone or access to both the femoral artery and vein. The time-critical nature of resuscitation necessitates that medical specialists performing endovascular resuscitation be well-trained in vascular access techniques. Keen knowledge of femoral vascular anatomy and skill with vascular access techniques are required to meet the needs of critically ill patients for whom endovascular resuscitation can prove lifesaving. This review article addresses the critical importance of femoral vascular access in endovascular resuscitation, focusing on the pertinent femoral vascular anatomy and technical aspects of ultrasound-guided percutaneous vascular access and femoral vessel cutdown that may prove helpful for successful endovascular resuscitation.
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Affiliation(s)
- James E Manning
- From the Department of Emergency Medicine (J.E.M.), University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Division of Trauma Surgery (J.E.M.), Oregon Health & Sciences University, Portland, Oregon; Ernest E Moore Shock Trauma Center at Denver Health (E.E.M.), Denver; Department of Surgery (E.E.M.), University of Colorado, Denver, Colorado; R. Adams Cowley Shock Trauma Center (J.J.M., J.J.D.); Department of Surgery (J.J.M., J.J.D.), University of Maryland School of Medicine, Baltimore, Maryland; Naval Postgraduate School Department of Defense Analysis (R.F.L.) Monterey, California; Charles T. Dotter Department of Interventional Radiology (J.D.R.), Oregon Health & Sciences University, Portland, Oregon; and Military & Health Research Foundation (J.D.R.), Laurel, Maryland
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Covered Stent Grafts for Acquired Arterial Venous Fistulas: A Case Series. Ann Vasc Surg 2018; 46:369.e1-369.e5. [DOI: 10.1016/j.avsg.2017.08.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Revised: 07/24/2017] [Accepted: 08/04/2017] [Indexed: 11/18/2022]
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Yao BJ, He XQ, Lin YH, Dai WJ. Cardioprotective effects of anisodamine against myocardial ischemia/reperfusion injury through the inhibition of oxidative stress, inflammation and apoptosis. Mol Med Rep 2017; 17:1253-1260. [PMID: 29115503 DOI: 10.3892/mmr.2017.8009] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Accepted: 07/12/2017] [Indexed: 11/05/2022] Open
Abstract
The aim of the present study was to investigate the cardioprotective effects of anisodamine against myocardial ischemia/reperfusion (I/R) injury and the molecular mechanisms involved. The present results demonstrated that anisodamine attenuated myocardial infarct sizes, decreased the levels of creatine kinase and lactate dehydrogenase, whereas it increased the left ventricular (LV) systolic pressure, the LV end‑diastolic pressure, and the LV pressure maximum rising and falling rates in a myocardial I/R rat model. In addition, anisodamine was revealed to suppress oxidative stress, inflammatory factor production and myocardial cell apoptosis, as demonstrated by the downregulation of caspase‑3 and apoptosis regulator BAX protein expression. The production of reactive oxygen species was decreased and the protein expression of inducible nitric oxide synthase (iNOS) was downregulated, whereas the expression of endothelial NOS was enhanced. In addition, the activity of nicotinamide‑adenine dinucleotide phosphate oxidase (Nox) was suppressed and the expression of Nox4 was downregulated in rats with myocardial I/R injury. In conclusion, the results of the present study suggested that anisodamine exerted a cardioprotective effect against myocardial I/R injury in rats, through the inhibition of oxidative stress, the suppression of inflammatory processes and the inhibition of myocardial cell apoptosis.
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Affiliation(s)
- Bao-Ju Yao
- Department of Cardiology, The First People's Hospital of Huainan, Huainan, Anhui 232007, P.R. China
| | - Xiao-Qing He
- Department of Cardiology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510150, P.R. China
| | - Yu-Hui Lin
- Department of Cardiology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510150, P.R. China
| | - Wen-Jun Dai
- Department of Cardiology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510150, P.R. China
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Nawaz Y, Barvalia M, Rana G, Khakwani MZ, Azim K, Patel R, Idrees S, Baker G, Cohen M, Wasty N. Poorly recognized age-related downward deviation of the inguinal ligament. SAGE Open Med 2016; 4:2050312116675565. [PMID: 27826446 PMCID: PMC5084609 DOI: 10.1177/2050312116675565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 09/26/2016] [Indexed: 11/17/2022] Open
Abstract
Objective: To determine factors affecting actual inguinal ligament course in live human subjects. Introduction and hypothesis: Although the expected inguinal ligament course is supposedly a straight line extending from anterior superior iliac spine to pubic tubercle, the actual inguinal ligament course is frequently depicted a priori by a downward bowing dotted line. There are no studies in a live subject supporting this assumption. We hypothesized this assumption is indeed valid and is related to among other factors a lifelong effect of gravity and lax abdominal musculature on the inguinal ligament course. Methods: We retrospectively reviewed 54 consecutive computed tomography scans of the abdomen and pelvis randomly distributed across all age groups. Actual inguinal ligament course was visualized by reconstructing images using Terracon software. Vertical distance from the lowest point of actual inguinal ligament course to the expected inguinal ligament course was measured. We used multiple linear regression analysis to study the correlation between degree of inguinal ligament deviation and several variables. Results: Actual inguinal ligament course was below the expected inguinal ligament course in 52 of 54 patients. The mean deviation was 8.2 ± 5.9 mm. Advanced age was significantly associated with greater downward bowing of the inguinal ligament (p = 0.001). Conclusion: Actual inguinal ligament course is often well below the expected inguinal ligament course; this downward bowing of the inguinal ligament is especially pronounced with advancing age. Operators need to be mindful as this downward bowing can lead to supra-inguinal sticks causing vascular complications.
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Affiliation(s)
- Yassir Nawaz
- Cardiac Catheterization Lab, Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ, USA
| | - Mihir Barvalia
- Cardiac Catheterization Lab, Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ, USA
| | - Gurinder Rana
- Cardiac Catheterization Lab, Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ, USA
| | - M Zain Khakwani
- Cardiac Catheterization Lab, Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ, USA
| | - Khizr Azim
- Cardiac Catheterization Lab, Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ, USA
| | - Rahul Patel
- Cardiac Catheterization Lab, Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ, USA
| | - Sohira Idrees
- Cardiac Catheterization Lab, Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ, USA
| | - Gail Baker
- Cardiac Catheterization Lab, Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ, USA
| | - Marc Cohen
- Cardiac Catheterization Lab, Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ, USA
| | - Najam Wasty
- Cardiac Catheterization Lab, Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ, USA
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Seto AH, Tyler J, Suh WM, Harrison AT, Vera JA, Zacharias SJ, Daly TS, Sparling JM, Patel PM, Kern MJ, Abu-Fadel M. Defining the common femoral artery: Insights from the femoral arterial access with ultrasound trial. Catheter Cardiovasc Interv 2016; 89:1185-1192. [PMID: 27566991 DOI: 10.1002/ccd.26727] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 05/16/2016] [Accepted: 08/01/2016] [Indexed: 11/06/2022]
Abstract
OBJECTIVE We sought to establish the typical location of the common femoral artery (CFA) bifurcation, the origin and most inferior reflection of the inferior epigastric artery (IEA) relative to the femoral head (FH) and whether patient demographics predicted anatomical variations. BACKGROUND In the absence of ultrasound guidance or prior imaging, the precise location of the CFA bifurcation and IEA can only be determined following access site angiography. Fluoroscopic landmarks are commonly used to estimate the location of the CFA bifurcation, but the position of the IEA is less well characterized. METHODS Prospectively collected data on 989 patients with femoral angiography in the FAUST trial were analyzed. The level of CFA bifurcation and the origin and most inferior reflection of the IEA were classified by angiography. Logistic regression was used to explore whether baseline demographics were associated with anatomic variations. RESULTS The CFA bifurcation occurs below the middle 1/3rd of the femoral head in 95% of patients, and no patient factors are predictive of a high bifurcation. The IEA origin has a more variable anatomically pattern, with high BSA, male gender, and white race associated with a low IEA origin. CONCLUSION Operators should attempt to access the CFA at the level of the middle 1/3rd of the FH to maximize the chance of CFA cannulation. However, this location carries an 11% risk of being at or above the IEA origin. Baseline demographics were of limited utility for predicting anatomic variants of the CFA bifurcation and the course of the IEA. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Arnold H Seto
- Department of Medicine, Veterans Affairs Long Beach Health Care System, Long Beach, California.,Department of Medicine, University of Califonia, Irvine Medical Center, Orange, California
| | - Jeffrey Tyler
- Department of Medicine, University of California, San Francisco Medical Center, San Francisco, California
| | - William M Suh
- Department of Medicine, University of California, Los Angeles Medical Center, Los Angeles, California
| | | | - Jesus A Vera
- Cardiothoracic Department, St Jude Medical Center, Fullerton, California
| | | | - Timothy S Daly
- Department of Cardiology, INTEGRIS Heart Hospital, Oklahoma City, Oklahoma
| | - Jeffrey M Sparling
- Department of Cardiology, INTEGRIS Heart Hospital, Oklahoma City, Oklahoma
| | - Pranav M Patel
- Department of Medicine, University of Califonia, Irvine Medical Center, Orange, California
| | - Morton J Kern
- Department of Medicine, Veterans Affairs Long Beach Health Care System, Long Beach, California.,Department of Medicine, University of Califonia, Irvine Medical Center, Orange, California
| | - Mazen Abu-Fadel
- Department of Medicine, Cardiovascular section, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
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