Access via the femoral vein

Central venous access via the femoral vein (FV) is safe, relatively easy and very usual in infants and children undergoing cardiac surgery for congenital heart disease. It has a low insertion-related complication rate. It is therefore a good choice for short-term central venous lines and a preferred insertion site for less experienced staff. The maintenance-related complications of thrombus formation and infections are higher compared to the internal jugular and the subclavian venous access. Some of these complications are reduced by the use of heparin bonded catheters, routine use of antibiotics, and timely removal of these lines in patients with persistent signs of infection but without another focus being defined.peer-reviewe

Radial versus femoral access for rotational atherectomy: A UK observational study of 8622 patients

Background—Rotational atherectomy (RA) is an important interventional tool for heavily calcified coronary lesions. We compared the early clinical outcomes in patients undergoing RA using radial or femoral access. Methods and Results—We identified all patients in England and Wales who underwent RA between January 1, 2005, and March 31, 2014. Eight thousand six hundred twenty-two RA cases (3069 radial and 5553 femoral) were included in the analysis. The study primary outcome was 30-day mortality. Propensity scores were calculated to determine the factors associated with treatment assignment to radial or femoral access. Multivariable logistic regression analysis, using the calculated propensity scores, was performed. Thirty-day mortality was 2.2% in the radial and 2.3% in the femoral group (P=0.76). Radial access was associated with equivalent 30-day mortality (adjusted odds ratio [OR], 1.06; 95% confidence interval [CI], 0.77–1.46; P=0.71), procedural success (OR, 1.04; 95% CI, 0.84–1.29; P=0.73), major adverse cardiac and cerebrovascular events (OR, 1.05; 95% CI, 0.80–1.38; P=0.72), and net adverse clinical events (OR, 0.90; 95% CI, 0.71–1.15; P=0.41), but lower rates of in-hospital major bleeding (OR, 0.62; 95% CI, 0.40–0.98; P=0.04) and major access site complications (OR, 0.05; 95% CI, 0.01–0.38; P=0.004), compared with femoral access. Conclusions—In this large real-world study of patients undergoing RA, radial access was associated with equivalent 30-day mortality and procedural success, but reduced major bleeding and access site complications, compared with femoral access

Access via the internal jugular vein

Central venous access via the internal jugular vein (IJV) is safe, relatively easy and very commonly used in infants and children undergoing cardiac surgery for congenital heart disease. Because of the wide range of anatomical variations an ultrasound-guided technique is advantageous in many cases, in particular in patients who have had previous punctures or those in whom difficulties are anticipated for various reasons. The right internal jugular vein is the preferred vein for central venous access as it offers straight access to the superior vena cava. The rate of complications - insertion-related as well as long term - are lower compared to the femoral and the subclavian access.peer-reviewe

Antegrade common femoral artery closure device use is associated with decreased complications.

ObjectiveAntegrade femoral artery access is often used for ipsilateral infrainguinal peripheral vascular intervention. However, the use of closure devices (CD) for antegrade access (AA) is still considered outside the instructions for use for most devices. We hypothesized that CD use for antegrade femoral access would not be associated with an increased odds of access site complications.MethodsThe Vascular Quality Initiative was queried from 2010 to 2019 for infrainguinal peripheral vascular interventions performed via femoral AA. Patients who had a cutdown or multiple access sites were excluded. Cases were then stratified into whether a CD was used or not. Hierarchical multivariable logistic regressions controlling for hospital-level variation were used to examine the independent association between CD use and access site complications. A sensitivity analysis using coarsened exact matching was performed using factors different between treatment groups to reduce imbalance between the groups.ResultsOverall, 11,562 cases were identified and 5693 (49.2%) used a CD. Patients treated with a CD were less likely to be white (74.1% vs 75.2%), have coronary artery disease (29.7% vs 33.4%), use aspirin (68.7% vs 72.4%), and have heparin reversal with protamine (15.5% vs 25.6%; all P < .05). CD patients were more likely to be obese (31.6% vs 27.0%), have an elective operation (82.6% vs 80.1%), ultrasound-guided access (75.5% vs 60.6%), and a larger access sheath (6.0 ± 1.0 F vs 5.5 ± 1.0 F; P < .05 for all). CD cases were less likely to develop any access site hematoma (2.55% vs 3.53%; P < .01) or a hematoma requiring reintervention (0.63% vs 1.26%; P < .01) and had no difference in access site stenosis or occlusion (0.30% vs 0.22%; P = .47) compared with no CD. On multivariable analysis, CD cases had significantly decreased odds of developing any access site hematoma (odds ratio, 0.75; 95% confidence interval, 0.59-0.95) and a hematoma requiring intervention (odds ratio, 0.56; 95% confidence interval, 0.38-0.81). A sensitivity analysis after coarsened exact matching confirmed these findings.ConclusionsIn this nationally representative sample, CD use for AA was associated with a lower odds of hematoma in selected patients. Extending the instructions for use indications for CDs to include femoral AA may decrease the incidence of access site complications, patient exposure to reintervention, and costs to the health care system

Short-Term Radiographic Evaluation of a Tri-Tapered Femoral Stem in Direct Anterior Total Hip Arthroplasty

Introduction. Direct anterior approach (DAA) total hip arthroplasty (THA) has become increasingly popular, largely due to utilization of a true internervous and intermuscular plane. However, recent literature has demonstrated an increased rate of femoral implant subsidence with this approach. Hence, different femoral implants, such as the tri-tapered femoral stem, have been developed to facilitate proper component insertion and positioning to prevent this femoral subsidence. The purpose of this study was to evaluate the subsidence rate of a tri-tapered femoral stem implanted utilizing a DAA, and to determine if the proximal femoral bone quality affects the rate of subsidence. Methods. A retrospective analysis of 155 consecutive primary THAs performed by a single surgeon was conducted. Age, gender, primary diagnosis, and radiographic measurements of each subject were recorded. Radiological evaluations, such as bone quality, femoral canal fill, and implant subsidence, were measured on standardized anteroposterior (AP) and frog-leg lateral radiographs of the hip at 6-week and 6-month postoperative follow-up evaluations. Results. The average subsidence of femoral stems was 1.18 ± 0.8 mm. There was no statistical difference in the amount of subsidence based on diagnosis or proximal femora quality. The tri-tapered stem design consistently filled the proximal canal with an average of 91.9 ± 4.9% fill. Subsidence was not significantly associated with age, canal flare index (CFI), or experience of the surgeon. Conclusion. THA utilizing the DAA with a tri-tapered femoral stem can achieve consistent and reliable fit regardless of proximal femoral bone quality

Early tumor response to intraarterial or intravenous administration of carboplatin to treat naturally occurring lower urinary tract carcinoma in dogs.

BackgroundSurvival times and tumor responses associated with malignant neoplasia of the lower urinary tract are poor despite the vast array of current treatments. Therefore, the evaluation of alternative treatments, such as intraarterial administration of chemotherapy (IAC) should be considered.ObjectiveTo describe a technique for superselective catheterization for IAC and to evaluate initial tumor response by ultrasonography after both IAC and intravenous administration of chemotherapy (IVC).AnimalsClient-owned dogs with lower urinary tract neoplasia treated with either IVC (n = 15) or IAC (n = 11).MethodsRetrospective study. An arterial approach via the carotid or femoral artery was utilized to obtain superselective access and administer chemotherapy in the IAC cases. Medical record review was performed, data were recorded, and recorded variables were evaluated statistically.ResultsIntraarterial chemotherapy was successfully administered in all cases. There was a significantly greater decrease in longest unidimensional measurement in the IAC group as compared to the IVC group (P = .013). The IAC group was also significantly more likely to have a tumor response as assessed by modified RECIST guidelines (P = .049). Dogs in the IAC group were significantly less likely to develop anemia (P = .001), lethargy (P = .010) and anorexia (P = .024).Conclusion and clinical importanceThis study demonstrated the feasibility and efficacy of performing IAC for lower urinary tract neoplasia. Further investigation is necessary as the follow-up time was short and the impact on long-term outcome and survival was not determined

Preliminary Implementation of the Next Generation Cannulation Simulator

© 2019 IEEE. Personal use of this material is permitted. Permission from IEEE must be obtained for all other uses, in any current or future media, including reprinting/republishing this material for advertising or promotional purposes, creating new collective works, for resale or redistribution to servers or lists, or reuse of any copyrighted component of this work in other works.Extracorporeal Membrane Oxygenation (ECMO) is a highly complex/critical lifesaving procedure known to support patients with cardiac and respiratory issues. Patients on ECMO are monitored 24/7 by a team of highly trained ECMO team comprising nurses, physicians, respiratory therapists, and perfusionists promptly intervening to any potential emergency situation. Simulation-Based Training (SBT) allows clinicians to experience and practice realistic hands-on procedures and scenarios without any risk. In ECMO, cannulation is a critical procedure performed to externally reroute the blood flow so it can be re-oxygenated by the ECMO machine before being recirculated through the patient's body. In a close collaboration with Hamad Medical Corporation (HMC), this project aims to develop a cost effective, realistic, and user-friendly ECMO simulator focusing on the venous and arterial cannulation procedure, The main features of this simulator include cannulation emergencies caused by low pressure flow, excessive force, recirculation, or mispositioned wire/cannula. Therefore, the ECMO cannulation simulator will not only greatly contribute to the initial and ongoing local training of HMC ECMO clinicians but also contribute to improving patient care by lowering the risks associated with the cannulation process

Reanalysis of Agelietti Procedure (A Method of Corrective Supracondylar Femoral Osteotomy)

Objective: Supracondylar femoral osteotomy is the time tested method, used for correcting the angular (varus & valgus) deformities at the knee. Traditionally, Coventry type of osteotomy where a medial or lateral based wedge of bone is removed or an open wedge osteotomy is made & the space filled with bone graft, is done to achieve the desired correction. This osteotomy is subsequently stabilized with Kirschner wires or plates & screws. Later the limb is externally supported in brace or plaster cast. Here we present a case series of 10 cases, where we have analyzed the efficacy of Aglietti procedure, as a method of femoral supracondylar osteotomy for correcting the valgus deformity at the knee. Methods: Ten valgus adolescent knees were operated in 7 patients by following the Aglietti procedure for correcting the angular deformity at the knee. The results were analyzed taking into consideration the operating time, blood loss during surgery estimated by the number of surgical mops used, stability of the osteotomy in the post-operative period & ultimate range of motion (ROM) obtained at the end of 6 months after the surgery. Results: The average age of patients dealt with was 12.6 years (n=7) with females predominating (n=5) against 2 males. The average time was 47.5 minutes. The average size of the surgical mops used was 15x20 cms. Surgical mops used per patient were 1.6. The average range of flexion achieved at the end of 6 months after surgery was 131.45 degrees ( Rounded average to a measurable value being 131 degrees). Conclusion: In our case series we found Aglietti procedure as an effective method to correct the valgus deformity in adolescent knees. Supracondylar femoral osteotomies are not only for varus an valgus corrections; this osteotomy is used as well for rotation correction and flexion and extension correction, mainly in CP patients. But we used the Agelietti procedure for the correction of angular deformities(varus/valgus) in patients of nutritional rickets. However more number of cases need to be done to make a final conclusion of establishing the superiority of this method over other methods