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Kanhouche G, Cividanes FR, Sampaio RO, da Silva JCA, Machado RD, Werneck M, Accorsi TAD, Morales KRDP, Abizaid AC, Brito FSD, Tarasoutchi F, Palma JH, Ribeiro HB. Delayed left main coronary obstruction following transfemoral inovare transcatheter aortic valve replacement: A challenging case. J Cardiol Cases 2022; 25:61-64. [PMID: 35079298 DOI: 10.1016/j.jccase.2021.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 06/11/2021] [Accepted: 06/23/2021] [Indexed: 10/20/2022] Open
Abstract
Coronary obstruction is an uncommon and severe complication after a transcatheter aortic valve replacement (TAVR), that occurs during the procedure in the vast majority of patients. In the present case even in the absence of classic risk factors, an acute coronary syndrome occurred one day after TAVR. Selective angiography revealed a severe left main ostium obstruction by the bulky native leaflet calcification. This is the first case of delayed presentation of coronary obstruction with a transfemoral balloon-expandable valve using the Inovare bioprosthesis (Braile Biomedica, Brazil). In addition, after drug-eluting stent placement in the left main coronary, intravascular ultrasound revealed severe stent underexpansion, so that a second layer of a bare-metal stent and high-pressure balloon post-dilatation was necessary to improve the final result. The patient was discharged after 7 days, and at the 6-month follow-up remained asymptomatic. <Learning objective: This case illustrates an unusual cause of an acute coronary syndrome 24 h after a transcatheter aortic valve replacement. This is the first report of this severe complication with delayed presentation following the balloon-expandable Inovare bioprosthesis. Even in the absence of classic risk factors this complication may occur, and percutaneous coronary intervention is feasible in the vast majority of cases, often requiring various percutaneous techniques and intravascular image to improve outcomes.>.
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Affiliation(s)
- Gabriel Kanhouche
- Heart Institute of São Paulo (InCor), University of São Paulo, São Paulo City, São Paulo, Brazil
| | - Felipe Reale Cividanes
- Heart Institute of São Paulo (InCor), University of São Paulo, São Paulo City, São Paulo, Brazil
| | - Roney Orismar Sampaio
- Heart Institute of São Paulo (InCor), University of São Paulo, São Paulo City, São Paulo, Brazil
| | | | - Rodrigo Daghlawi Machado
- Heart Institute of São Paulo (InCor), University of São Paulo, São Paulo City, São Paulo, Brazil
| | - Marcelo Werneck
- Heart Institute of São Paulo (InCor), University of São Paulo, São Paulo City, São Paulo, Brazil
| | | | | | - Alexandre C Abizaid
- Heart Institute of São Paulo (InCor), University of São Paulo, São Paulo City, São Paulo, Brazil
| | - Fabio Sandoli de Brito
- Heart Institute of São Paulo (InCor), University of São Paulo, São Paulo City, São Paulo, Brazil
| | - Flavio Tarasoutchi
- Heart Institute of São Paulo (InCor), University of São Paulo, São Paulo City, São Paulo, Brazil
| | - José Honório Palma
- Heart Institute of São Paulo (InCor), University of São Paulo, São Paulo City, São Paulo, Brazil
| | - Henrique Barbosa Ribeiro
- Heart Institute of São Paulo (InCor), University of São Paulo, São Paulo City, São Paulo, Brazil
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Ueno H, Hida Y, Ueno Y, Tanaka S, Ushijima R, Sobajima M, Fukuda N, Imamura T, Kameyama A, Komiya R, Ito H, Yokoyama S, Doi T, Fukahara K, Kinugawa K. Percutaneous transseptal transcatheter mitral valve-in-valve replacement for degenerated mitral bioprosthesis: The first experience in Japan. J Cardiol Cases 2020; 23:49-52. [PMID: 33437342 PMCID: PMC7783651 DOI: 10.1016/j.jccase.2020.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 07/23/2020] [Accepted: 09/07/2020] [Indexed: 11/23/2022] Open
Abstract
A 76-year-old woman had received surgical mitral valve replacement with Magna Mitral Ease (Edwards Lifesciences, Irvine, CA, USA) 25 mm for functional severe mitral regurgitation 6 years previously. She presented recurrence of heart failure due to severe stenotic and moderate regurgitant degeneration of the implanted mitral bioprosthesis. Considering her comorbidities and left ventricular systolic dysfunction, our heart valve team eventually decided to perform percutaneous transseptal transcatheter mitral valve-in-valve replacement instead of surgical redo mitral valve replacement, using a 26 mm SAPIEN 3 valve (Edwards Lifesciences) via trans-femoral approach. Post-procedural course was uneventful and she was discharged on post-procedural day 2. This is, to the best of our knowledge, the first case of successful percutaneous transseptal transcatheter mitral valve-in-valve replacement in Japan. Further large-scale prospective studies are warranted to validate its long-term safety and efficacy, particularly by comparing with the redo surgery. <Learning objective: We experienced an off-label transseptal mitral valve-in-valve replacement using SAPIEN 3 to treat degenerative mitral bioprosthesis for the first time in Japan. Although further large-scale prospective studies are warranted, this procedure should be a promising therapeutic alternative to conventional redo-surgery, particularly for elderly patients with multiple comorbidities.>
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Affiliation(s)
- Hiroshi Ueno
- Cardiovascular Center, Toyama University Hospital, Toyama, Japan
| | - Yuki Hida
- Cardiovascular Center, Toyama University Hospital, Toyama, Japan
| | - Yohei Ueno
- Cardiovascular Center, Toyama University Hospital, Toyama, Japan
| | - Shuhei Tanaka
- Cardiovascular Center, Toyama University Hospital, Toyama, Japan
| | - Ryuichi Ushijima
- Cardiovascular Center, Toyama University Hospital, Toyama, Japan
| | - Mitsuo Sobajima
- Cardiovascular Center, Toyama University Hospital, Toyama, Japan
| | - Nobuyuki Fukuda
- Cardiovascular Center, Toyama University Hospital, Toyama, Japan
| | - Teruhiko Imamura
- Cardiovascular Center, Toyama University Hospital, Toyama, Japan
| | - Akiyo Kameyama
- Cardiovascular Center, Toyama University Hospital, Toyama, Japan
| | - Ryosuke Komiya
- Cardiovascular Center, Toyama University Hospital, Toyama, Japan
| | - Hisakatsu Ito
- Cardiovascular Center, Toyama University Hospital, Toyama, Japan
| | - Shigeki Yokoyama
- Cardiovascular Center, Toyama University Hospital, Toyama, Japan
| | - Toshio Doi
- Cardiovascular Center, Toyama University Hospital, Toyama, Japan
| | - Kazuaki Fukahara
- Cardiovascular Center, Toyama University Hospital, Toyama, Japan
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Bobovec D, Bohaček I, Juras J, Delimar D. Risk factors for subsidence of modular fluted tapered stem implanted by using transfemoral Wagner approach during revision hip arthroplasty. Int Orthop 2020; 44:1685-91. [PMID: 32405886 DOI: 10.1007/s00264-020-04582-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 04/18/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To determine clinical and radiographic risk factors for the vertical subsidence of modular fluted tapered stems implanted using the transfemoral Wagner approach in a cohort of revision hip arthroplasties. METHODS A retrospective review of a single-centre surgical registry was performed. Patients who underwent a revision total hip arthroplasty, in which the uncemented modular fluted tapered stem (REVISION Hip/Anca-Ti6Al4V, LimaCorporate, Udine, Italy) was implanted using the transfemoral Wagner approach, were identified. Patient's demographic data, clinical and radiographic outcomes and post-operative complications were assessed. As a significant subsidence, a 5-mm cut-off was chosen. RESULTS We identified 278 revision hip arthroplasties with a mean follow-up of 35 months. The median of subsidence in the group of 5 mm and less was 2 mm, and 17 mm in the group of subsidence of 5 mm and more. A negative correlation was found between the stem subsidence and the length of good contact between the medial and lateral cortical bone and the stem (medial, - 0.248; P < 0.001, lateral, 0.284; P < 0.001). For 200 mm stems, the percentage of good contact between femoral parts of stem and bone on medial side was 40.5% (81.0 mm) for patients with subsidence of five or less mm, and 30% (60.0 mm) for lateral side. For 140 mm stems, the percentage was 52.86% (74.0 mm) for medial side and 40.36% (56.5 mm) for lateral side. A neck length was shown to correlate significantly with the stem subsidence (P = 0.004). CONCLUSION It is crucial to provide good contact between the bilateral cortical bone and stem, and, if possible, to select implant constructs with shorter femoral necks, in order to reduce subsidence and to ensure longer implant survivorship.
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Ravani M, Koni E, Al Jabri A, Santoro G, Clemente A, Gasbarri T, Palmieri C, Berti S. Transcatheter Tricuspid Valve-in-Valve Replacement in Patients With Large Degenerated Bioprostheses: Two Case Reports Treated With Sapien 3 Device Using The New Ultra Delivery System. Cardiovasc Revasc Med 2020; 21:3-7. [PMID: 32291189 DOI: 10.1016/j.carrev.2020.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 03/01/2020] [Accepted: 03/02/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Marcello Ravani
- Heart Hospital, Fondazione C.N.R. G. Monasterio Ospedale del Cuore, Via Aurelia Sud, 54100 Massa, MS, Italy
| | - Endrin Koni
- Heart Hospital, Fondazione C.N.R. G. Monasterio Ospedale del Cuore, Via Aurelia Sud, 54100 Massa, MS, Italy; Clinical and Interventional Cardiology, Sassari University Hospital, Via Enrico de Nicola, 07100 Sassari, SS, Italy.
| | - Anees Al Jabri
- Heart Hospital, Fondazione C.N.R. G. Monasterio Ospedale del Cuore, Via Aurelia Sud, 54100 Massa, MS, Italy
| | - Giuseppe Santoro
- Heart Hospital, Fondazione C.N.R. G. Monasterio Ospedale del Cuore, Via Aurelia Sud, 54100 Massa, MS, Italy
| | - Alberto Clemente
- Heart Hospital, Fondazione C.N.R. G. Monasterio Ospedale del Cuore, Via Aurelia Sud, 54100 Massa, MS, Italy
| | - Tommaso Gasbarri
- Heart Hospital, Fondazione C.N.R. G. Monasterio Ospedale del Cuore, Via Aurelia Sud, 54100 Massa, MS, Italy
| | - Cataldo Palmieri
- Heart Hospital, Fondazione C.N.R. G. Monasterio Ospedale del Cuore, Via Aurelia Sud, 54100 Massa, MS, Italy
| | - Sergio Berti
- Heart Hospital, Fondazione C.N.R. G. Monasterio Ospedale del Cuore, Via Aurelia Sud, 54100 Massa, MS, Italy
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Fink B. The transfemoral approach for controlled removal of well-fixed femoral stems in hip revision surgery. J Clin Orthop Trauma 2020; 11:33-37. [PMID: 32001981 PMCID: PMC6985029 DOI: 10.1016/j.jcot.2019.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 11/02/2019] [Accepted: 11/04/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND For the removal of well fixed femoral stems, various standard and extended approaches are possible, all of which have their advantages and disadvantages. They should allow good visualization and avoid uncontrolled damage to the bone (especially devascularization and fractures) and to the musculature (especially the gluteus medius). As an extended approach we prefer the transfemoral approach in a modified Wagner technique. It is indicated for the controlled removal of broken endoprosthetic stems, a significantly thinned bone at risk of fracture, a stable cement mantle, a partially fixed cementless prosthetic stem with a coarse, rough surface, and infected, fixed total hip endoprostheses. In this review article we describe our experience with our technique of the transfemoral approach. MATERIAL AND RESULTS In 68 patients with hip revisions using the modified transfemoral approach, the Harris Hip Score increased continuously from 41.4 points preoperatively to 85.9 points 24 months postoperatively. The bony flap showed bone consolidation in 98.5% of cases. In 76 patients with transfemoral two-stage septic hip revisions, with closure of the flap around the interim prosthesis with cerclage wires and reopening of the flap during second stage revision, the Harris Hip Score was 62.2 ± 12.6 points before the replacement of the spacer and 86.6 ± 15.5 points two years after reimplantation. The healing rate of the bony flap after reimplantation was 98.7%, the absence of infection 93.4%, the rate of stem subsidence 6.6%, and the dislocation rate 6.6%; there was no aseptic loosening of the implants. CONCLUSION The transfemoral approach allows a reliable protection of the gluteus medius and the vastogluteal sling, and enables reproducibly good clinical outcomes.
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Affiliation(s)
- Bernd Fink
- Klinik für Endoprothetik, Allgemeine und Rheumaorthopädie, Orthopädische Klinik Markgröningen GGmbH, Kurt-Lindemann-Weg 10, 71706, Markgröningen, Germany
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Abstract
Objectives To evaluate the feasibility, efficiency, and safety of the transradial approach (TRA) for cerebral angiography versus the transfemoral approach (TFA) in patients. Methods In this trial, 2314 patients underwent cerebral angiography, with 1085 patients undergoing the procedure via radial access and 1229 via transfemoral access. The arterial puncture time, operation success rate, oppression time on puncture points, local vascular complication incidence (including bleeding, hematoma, and pseudoaneurysm), deep venous thrombosis of lower limbs (DVT), and bradycardia/hypotension were observed and compared between the two groups. Results Of the patients who underwent cerebral angiography via radial access, the procedure was successful in 1070 patients; compared with 1219 patients with transfemoral access, there was no significant difference (P > 0.05) in the success rate or the arterial puncture time. Radial access patients were less likely to present with oppression time on puncture points, local vascular complications, DVT, and bradycardia/hypotension compared with femoral access patients. Conclusions For patients undergoing cerebral angiography, radial and femoral approaches are both safe and effective. However, the lower rate of local vascular complications may be a reason to use the radial approach.
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Affiliation(s)
- Ziliang Wang
- Department of Intervention, Henan Provincial People's Hospital,Henan University, Zhengzhou, Henan, China
| | - Jinchao Xia
- Department of Intervention, Henan Provincial People's Hospital,Henan University, Zhengzhou, Henan, China
| | - Wei Wang
- Henan Provincial Medical Association, Zhengzhou, 450000, Henan, China
| | - Gangqin Xu
- Department of Intervention, Henan Provincial People's Hospital,Henan University, Zhengzhou, Henan, China
| | - Jianjun Gu
- Department of Intervention, Henan Provincial People's Hospital,Henan University, Zhengzhou, Henan, China
| | - Yongfeng Wang
- Department of Intervention, Henan Provincial People's Hospital,Henan University, Zhengzhou, Henan, China
| | - Tianxiao Li
- Department of Intervention, Henan Provincial People's Hospital,Henan University, Zhengzhou, Henan, China
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Buchanan KD, Alraies MC, Weissman G, Ben-Dor I, Satler LF, Waksman R. Bioprosthesis leaflet thrombosis following self-expanding valve-in-valve transcatheter aortic valve replacement in patient taking factor Xa inhibitor and warfarin: A case report. Cardiovasc Revasc Med 2017; 19:29-32. [PMID: 29066342 DOI: 10.1016/j.carrev.2017.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 05/08/2017] [Indexed: 11/26/2022]
Abstract
An 87-year-old female with symptomatic severe aortic stenosis underwent transcatheter valve replacement (TAVR) via the transfemoral approach with a 29mm self-expanding device. Moderate to severe paravalvular regurgitation led to the development of congestive heart failure and hospital readmission 1 month following TAVR. A second 29mm valve was placed to abolish the paravalvular regurgitation. Routine follow-up computed tomography (CT) imaging demonstrated leaflet thickening and decreased leaflet mobility suggesting valve thrombosis, despite adherence to Factor Xa inhibitor. Transthoracic echocardiogram revealed normal transaortic valve gradients. The patient was transitioned to a vitamin K antagonist and repeat imaging 3months later demonstrated progression of thrombosis to an additional leaflet. The case illustrates the potential increased risk of leaflet thrombosis in patients receiving valve-in-valve TAVR procedures, the superiority of multidetector computed tomography to image subclinical leaflet thrombosis, and highlights the need for further investigation in this area.
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Affiliation(s)
- Kyle D Buchanan
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - M Chadi Alraies
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Gaby Weissman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Itsik Ben-Dor
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Lowell F Satler
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
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Meguro K, Ishizaki J, Yanagisawa T, Koitabashi T, Kitamura T, Ako J. Non-occlusive mesenteric ischemia accompanied by aortic regurgitation after transcatheter aortic valve implantation. Cardiovasc Interv Ther 2016; 32:425-429. [PMID: 28028747 DOI: 10.1007/s12928-016-0450-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 12/20/2016] [Indexed: 01/16/2023]
Abstract
An 81-year-old male with severe symptomatic aortic stenosis with ventricular tachycardia was referred for treatment. Balloon aortic valvuloplasty was performed under cardiopulmonary resuscitation. Though transcatheter aortic valve implantation (TAVI) was considered high risk for annulus rupture and aortic regurgitation due to annular calcification, TAVI was performed because of extremely high surgical risk. Moderate-to-severe aortic regurgitation (AR) remained and progression of acidosis could not be managed with continuous hemodiafiltration. His autopsy revealed the development of non-occlusive mesenteric ischemia (NOMI) as the cause of progressive acidosis. AR and hemodynamic instability might contribute to the development and progression of NOMI after TAVI.
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Affiliation(s)
- Kentaro Meguro
- Department of Cardiovascular Medicine, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan.
| | - Junro Ishizaki
- Department of Cardiovascular Medicine, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Tomoyoshi Yanagisawa
- Department of Cardiovascular Medicine, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Toshimi Koitabashi
- Department of Cardiovascular Medicine, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Tadashi Kitamura
- Department of Cardiovascular Medicine, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
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Bazemore TC, Rao SV. Controversies in the Management of ST-Segment Elevation Myocardial Infarction: Transradial Versus Transfemoral Approach. Interv Cardiol Clin 2016; 5:513-522. [PMID: 28581999 DOI: 10.1016/j.iccl.2016.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This article discusses the controversies surrounding the use of transradial versus transfemoral approaches in the management of patients with ST-segment elevation myocardial infarction, beginning with a review of the benefits of transradial percutaneous coronary intervention (PCI) in this population. The unanswered questions about the mechanism underlying the mortality benefit of transradial PCI are discussed, concluding with recommendations for safe and effective strategies for adoption of the transradial approach to optimize outcomes in these high-risk patients.
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Affiliation(s)
- Taylor C Bazemore
- Department of Internal Medicine, Duke University Medical Center, Box 3182, Durham, NC 27710, USA.
| | - Sunil V Rao
- Division of Cardiology, Department of Internal Medicine, Duke University Medical Center, 2100 Erwin Road, Durham, NC 27705, USA; Department of Cardiology, Durham VA Medical Center, 508 Fulton Street, 111A, Durham, NC 27705, USA
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Hahalis G, Deftereos S, Bertrand OF. Ulnar artery: The Ulysses ultimate resort for coronary procedures. Hellenic J Cardiol 2016; 57:S1109-9666(16)30146-4. [PMID: 27712911 DOI: 10.1016/j.hjc.2016.07.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 07/06/2016] [Indexed: 11/22/2022] Open
Abstract
Despite the increasing worldwide adoption of the transradial access site, the ulnar artery (UA) only very infrequently serves as a primary option for coronary procedures. In contrast to the uncertainty surrounding previous reports regarding the feasibility and safety, recent data from larger registries and randomized trials provide more conclusive evidence that the transulnar route may be safely selected as an alternative arterial access approach. However, a default transulnar strategy appears time-consuming and is associated with higher crossover rates compared with the radial artery (RA). Once arterial access is obtained, the likelihood of a successful coronary procedure is high and similar between the two forearm arteries. The UA has similar flow-mediating vasodilating properties with and seems at least as vulnerable as the RA with regard to incident occlusion, with UA occlusion (UAO) rates being probably higher than previously anticipated. A learning curve effect may not be apparent for crossover rates among experienced radialists, but increasing experience is associated with reduction in the fluoroscopy time, contrast volume and frequency of large hematoma formation. The UA may represents an important alternative access site for coronary procedures, and experienced radial operators should obtain additional skills to perform the transulnar approach. Nevertheless, in view of this method's lower feasibility compared to the RA, an initial ulnar access strategy should be reserved for carefully selected patients to ensure satisfactory cannulation rates.
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Lee DG, Lee DH, Shim JH, Suh DC. Feasibility of the Transradial or the Transbrachial Approach in Various Neurointerventional Procedures. Neurointervention 2015; 10:74-81. [PMID: 26389010 PMCID: PMC4571557 DOI: 10.5469/neuroint.2015.10.2.74] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 07/06/2015] [Indexed: 11/26/2022] Open
Abstract
Purpose The generally preferred vascular access for neurointerventional procedures is the transfemoral approach (TFA). In complicated cases such as patients with aortic diseases or tortuous vessels, transradial or transbrachial approaches (TRA or TBA) could be good alternatives. The purpose of this study is to review a single medical center experience using the alternative accesses. Materials and Methods We reviewed the medical records of 30 TRA and 10 TBA cases among 2,073 cases treated between January 2010 and July 2013. We reviewed and analyzed the frequency of TRA and TBA, the reason the operator had chosen the TRA or TBA, the category of the procedure, caliber of the sheath, the success rate, and the complications rates. Results The most common reason the non-TFA route was chosen was due to the patient's tortuous vascular system (n=24, 60%). The most common category of intervention was balloon angioplasty and/or stent placement (n=18, 45%). The largest caliber of the introducing sheath was 6 Fr in TRA and 7 Fr in TBA. Procedural success was achieved in 37 cases (success rate: 92.5%), and in three cases it failed. Six patients with complications were reported. Among them, four cases of minor complications (10%) occurred. There was no serious complication directly related to the access problem. Conclusion Both TRA and TBA can be good alternative access routes when TFA is not appropriate in various neurointervential procedures.
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Affiliation(s)
- Dong Geun Lee
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. ; Department of Neurology, Sejong General Hospital, Bucheon, Korea
| | - Deok Hee Lee
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Ho Shim
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. ; Department of Radiology, Ulsan Hospital, Ulsan, Korea
| | - Dae Chul Suh
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Abstract
Despite advances in antithrombotic and antiplatelet therapy, bleeding complications remain an important cause of morbidity and mortality in patients with acute ST segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). Many bleeding events are related to the access site. Transradial access (TRA) PPCI is associated with significant reduction in bleeding and vascular complications and reduced cardiac mortality compared with the transfemoral approach (TFA). High-risk patients might particularly benefit from TRA. Radial skills providing procedural times and success rates comparable with those of the TFA are strongly recommended before using this technique in the STEMI PPCI setting.
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Affiliation(s)
- Sasko Kedev
- Medical Faculty, University Clinic of Cardiology, University of St. Cyril & Methodius, Vodnjanska 17, Skopje 1000, Macedonia.
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Zemedkun M, LaBounty TM, Bergman G, Wong SC, Lin FY, Reynolds D, Gomez M, Dunning AM, Leipsic J, Min JK. Effectiveness of a low contrast load CT angiography protocol in octogenarians and nonagenarians being evaluated for transcatheter aortic valve replacement. Clin Imaging 2014; 39:815-9. [PMID: 25982494 DOI: 10.1016/j.clinimag.2014.08.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Revised: 07/29/2014] [Accepted: 08/08/2014] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Transcatheter aortic valve replacement (TAVR) typically requires computed tomographic angiography (CTA) for aortoiliofemoral assessment to determine feasibility of a transfemoral approach, although many candidates being considered for TAVR are at increased risk of contrast-induced nephropathy (CIN). OBJECTIVE To determine the feasibility and safety of a load contrast load CTA protocol in octogenarians and nonagenarians at risk of CIN. APPROACH We evaluated 54 consecutive octogenarians and nonagenarians considered for TAVR who underwent CTA using a standard contrast protocol (n=21) versus a protocol incorporating low-dose contrast in patients at risk of CIN (n=33). We compared clinical characteristics, CTA image quality (score 1-4) and interpretability, and clinical outcomes, including CIN and vascular complications. RESULTS The mean age was 88.5±4.0 years, 37% were male, and chronic renal insufficiency was common in both the standard and low-dose contrast cohorts (57% vs. 70%, P=.39). The low-dose contrast protocol was associated with a significantly less contrast volume compared to standard contrast protocol (127±18 ml vs 76±55 ml, P<.001). Individuals imaged using low-dose (n=16) versus standard (n=17) contrast protocols received 80% less contrast volume (23±10 vs. 125±23 ml, P<.001). There was similar graded image quality (3.8±0.4 vs. 3.9±0.3, P=.76) and interpretability (100% for each, P=1.0) between standard and low-dose contrast protocol groups. There was no significant difference in rates of CIN after CTA between standard and low-dose contrast protocol groups (10% vs. 3%, P=.55), with no CIN events in those imaged by low-dose CTA. There were no major vascular injuries associated with TAVR or pigtail insertion, no major bleeding for CTA, and no noninterpretable studies in all patients. CONCLUSION In this proof-of-principle study, a low-dose contrast protocol appears feasible and safe in octogenarians and nonagenarians undergoing screening for TAVR, and results in significant reduction in contrast load as compared to a standard contrast protocol without observed differences in image quality or safety.
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Affiliation(s)
- Micheas Zemedkun
- Department of Medicine, NewYork-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, USA
| | - Troy M LaBounty
- Departments of Imaging, Medicine, and Biomedical Sciences, Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Geoffrey Bergman
- Department of Medicine, NewYork-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, USA
| | - Shing-Chiu Wong
- Department of Medicine, NewYork-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, USA
| | - Fay Y Lin
- Department of Medicine, NewYork-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, USA
| | - Dolores Reynolds
- Department of Medicine, NewYork-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, USA
| | - Millie Gomez
- Department of Radiology, NewYork-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, USA
| | - Allison M Dunning
- Department of Medicine, NewYork-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, USA
| | - Jonathon Leipsic
- Department of Medical Imaging and Division of Cardiology, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - James K Min
- Department of Radiology, NewYork-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, USA.
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