Bilateral trans-radial approach in stenting of occluded right axillary artery

With recent advancement in percutaneous endovascular interventions, angioplasty and stenting of axillary artery lesions could become the treatment of choice vs. surgical intervention owing to its lower complication and mortality rates and shorter hospital stay. We report a Caucasian female case with axillary artery chronic total occlusion (CTO) with dual etiology (atherosclerotic and radiation induced), which was successfully managed with stent angioplasty. The strategy used was right radial retrograde approach with contralateral injections from left radial catheter. Two year follow-up revealed widely patent axillary stents. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13019-014-0138-0) contains supplementary material, which is available to authorized users

Distribucija rizičnih čimbenika i dugoročni ishodi u mladih bolesnika podvrgnutih perkutanoj koronarnoj intervenciji u Makedoniji

The aim was to assess coronary artery disease (CAD) risk factor distribution and long-term outcomes in young patients undergoing percutaneous coronary intervention (PCI) in Macedonia. A total of 12,361 PCI patients (from March 2011 to December 2017) were included in the study. Group 1 included 309 young patients aged ≤40 as the main study group, comparing them to 12,052 older PCI patients (group 2) during the study period. We compared CAD risk factor distribution, clinical and procedure characteristics. Additionally, angiographic data, long-term major adverse cardiac and cerebrovascular events (MACCE) and mortality were analyzed in group 1 patients. Median age was 36±4 years in group 1 and 62±11 years in group 2. Male patients predominated in both groups (88% vs.73%). Positive family history for CAD, smoking and obesity was much more common in the young group (p<0.0001). ST segment elevation myocardial infarction (STEMI) primary PCI was also more frequent with 48% of PCI in the young group (p<0.0001). Multivessel CAD and chronic total occlusion interventions were more common in the older group (51% and 28%, respectively; p<0.0001). Procedure duration (31±0.4 vs. 35±22 min) and fluoroscopy time (9±4 vs. 9±12 min) were similar in both groups. There was no difference in access site bleeding (4.8% vs. 4.3%). During the 3.5-year median follow up, MACCE was present in 1.9% of young patients. In conclusion, positive family history for CAD, obesity and smoking were the most common risk factors in the young PCI population. Young PCI patients usually had single vessel CAD with STEMI being more frequent as the cause for primary PCI. Long-term annual survival exceeded 99% in these patients with excellent prognosis after PCI.Cilj istraživanja bio je procijeniti distribuciju rizičnih čimbenika za koronarnu arterijsku bolest (KAB) i dugoročne ishode kod mladih bolesnika podvrgnutih perkutanoj koronarnoj intervenciji (PKI) u Makedoniji. U istraživanje je bilo uključeno ukupno 12.361 bolesnika podvrgnutih PKI (od ožujka 2011. do prosinca 2017. godine). Skupina 1. obuhvatila je 309 mladih bolesnika u dobi od ≤40 godina kao glavna ispitna skupina koja je tijekom istraživanja uspoređena sa skupinom 2. koja je uključivala 12.052 starijih bolesnika. Uspoređivali smo distribuciju rizičnih čimbenika za KAB te kliničke osobine i značajke zahvata. Uz to, u skupini 1. analizirani su angiografski podaci, dugoročni teži štetni srčani i cerebrovaskularni događaji (major adverse cardiac and cerebrovascular events, MACCE) i smrtnost. Medijan dobi bio je 36±4 godine u skupini 1. i 62±11 godine u skupini 2. Pozitivna obiteljska anamneza za KAB, pušenje i pretilost bili su znatno češći u mladoj skupini (p<0,0001). Primarna PKI zbog STEMI bila je također češća s 48% PKI u mladoj skupini (p<0,0001). KAB višestrukih krvnih žila i intervencije zbog kronične potpune okluzije bile su češće u starijoj skupini (51% odnosno 28%; p<0,0001). Trajanje zahvata (31±0,4 prema 35±22 min) i fluoroskopije (9±4 prema 9±12 min) bilo je slično u objema skupinama. Nije bilo razlike u krvarenju na ulaznom mjestu (4,8% prema 4,3%). Tijekom medijana praćenja od 3,5 godine MACCE su zabilježeni u 1,9% mladih bolesnika. U zaključku, najčešći čimbenik rizika u populaciji mladih bolesnika podvrgnutih PKI bila je pozitivna obiteljska anamneza za KAB, pretilost i pušenje. Mladi bolesnici uglavnom su imali KAB jedne krvne žile i podvrgnuti su primarnoj PKI zbog STEMI. Dugoročno godišnje preživljenje bilo je više od 99% u ovih bolesnika s izvrsnom prognozom nakon PKI

Finding the optimal access for proximal upper limb artery (PULA) interventions: Lessons learned from the PULA multicenter registry

Objective The multicenter proximal upper limb artery (PULA) Registry was created to study the optimal puncture sites for the interventions involving the subclavian, axillary, and innominate arteries. Background Little is known about the optimal vascular access for PULA interventions, despite the well-known technical complexity of these procedures. Methods We performed the retrospective analysis of consecutive patients treated for symptomatic steno-occlusive disease of the proximal upper limb arteries between January 2015 and December 2019 in three high-volume centers. Acute thrombotic occlusions were excluded from the study. Results Two hundred and seventy-two patients were treated for significant stenosis and 108 for total occlusion. The baseline patient's characteristics were similar, except for the higher median age of the stenotic patients: 68.5 years (31.1; 90.0) versus 64 years (38.0; 86.0) p = 0.0015. Successful revascularization rate was higher in the stenotic group 93.75% (255/272) versus 86.11% (93/108) p = 0.0230, while the procedure length 27 min (8; 133) versus 46 min (7; 140) p = 0.0001 and fluoroscopy times 439 s (92; 2993) versus 864 s (86; 4176) p = 0.0001 were higher in the occlusion group. The main adverse event rate was similarly low. Dual access was used more often to treat occlusions (60.19% (65/108) vs. 11.40% (31/272) p = 0.0001) without significantly increasing the complication rate. The safest access was ultrasound-guided distal radial artery puncture, significantly better than conventional radial access with 0% (0/31) versus 13.6% (18/131) p = 0.0253 complication. Conclusions The percutaneous revascularization of proximal upper limb arteries is a safe and effective. Dual access can be applied to increase treatment efficacy, without significantly compromising safety

RADIAL ARTERY ANOMALIES IN THE MACEDONIAN POPULATION DURING TRANSRADIAL ANGIOGRAPHY PROCEDURES

Objective: To assess the incidence of arterial anomalies of the radial artery in the Macedonian population registered during transradial access (TRA) angiography procedures in a large series of patients. Background: Transradial angiography (TRA) is now the recommended access for percutaneous coronary intervention, but technically is a more challenging approach for angiography procedures mostly due to the anatomic anomalies on the radial artery, which may influence the success rate of transradial angiographic procedures. Methods: All consecutive 19292 patients from our Center, in the period from March 2011 until December 2014 were examined. Preprocedural radial artery angiography was performed in all patients. Clinical and procedure characteristics, type and incidence of vascular anatomy variants and access site complications were analyzed. Results: Anatomical variants were present in 1625 (8.8%) patients. The most frequent was high-bifurcating radial artery origin from the axillary and brachial arteries in 1017(5.5%) patients, 227 (1.2%) had extreme radial artery tortuosity, 176(0.95%) had a full radial loop, 32(0.17%) with hypoplastic radial artery and 173(0.9%) had tortuous brachial, subclavian and axillary arteries. Radial artery spasm was very common in patients with present radial artery anomalies. Conclusion: Radial artery anomalies are very common in the general population. Knowing the anatomy of the radial artery helps the interventional cardiologist in successfully planning and performing this procedure. Radial artery angiography is strongly encouraged in every patient before the begining of the transradial angiography procedures