Database : MEDLINE
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[PMID]: 29502996
[Au] Autor:Tsilimparis N; Debus SE; Biehl M; Spanos K; Larena-Avellaneda A; Wipper S; Rohlffs F; Kölbel T
[Ad] Address:German Aortic Center Hamburg, University Heart Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany. Electronic address: n.tsilimparis@uke.de.
[Ti] Title:Fenestrated-branched endografts and visceral debranching plus stenting (hybrid) for complex aortic aneurysm repair.
[So] Source:J Vasc Surg;, 2018 Mar 01.
[Is] ISSN:1097-6809
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:OBJECTIVE: The aim of this study was to assess the immediate postoperative and midterm outcome of complex aortic aneurysm treatment necessitating four-vessel revascularization with either a total endovascular approach (fenestrated-branched stent graft [FBSG]) or a hybrid technique of visceral debranching plus stenting. METHODS: The clinical data of consecutively treated patients presenting with a complex aortic aneurysm that necessitated four-vessel revascularization between 2010 and 2015 were retrospectively analyzed. RESULTS: There were 98 patients (65 men [68%]) with a mean age of 70.65 ± 4 years who presented with aortic aneurysm (Crawford type I, 12; type II, 18; type III, 12; type IV, 24; type V, 6; and juxtarenal and suprarenal, 26) and were treated with either FBSG (76/98 [77.5%]) or hybrid repair (22/98 [22.4%]). Twenty-six patients were symptomatic (16, pain; 10, contained rupture). The mean maximum aneurysm diameter was 65 ± 15 mm, and 53% of the patients had a prior aortic intervention. In FBSG-treated patients, 15 off-the-shelf multibranched stent grafts, 3 surgeon-modified fenestrated stent grafts, and 58 custom-made devices tailored to the patient's anatomy were used. Four fenestrations, four branches, and their combination were used in 38 cases, 30 cases, and 8 cases, respectively. A total of 304 target vessels were addressed, with technical success rate of 96% (292/304). In most hybrid cases (18/22 [82%]), a two-stage procedure was undertaken. All target vessels were successfully revascularized with 88 bypasses. The 30-day mortality was 15.3% (15/98), and the early target vessel occlusion was 9.1% (2 in FBSG, 7 in hybrid). After multivariate analysis, type of procedure (hybrid) was independently associated with higher early mortality (odds ratio, 6.3; P = .01). The morbidity was mainly attributed to pulmonary complications (16.3%), lower extremity weakness (16.3%), mesenteric ischemia (6.1%), dialysis on discharge (6.1%), and complete paraplegia (4.3%). Acute renal failure (2.6% vs 18%; P = .03) and mesenteric ischemia (3% vs 23%; P = .001) presented more commonly in the hybrid group. The mean follow-up was 16.4 ± 5 months, and the mortality rate was 19.4% (12% in the FBSG group vs 45% in the hybrid group; P = .05). The graft and stent graft patency rate was 87.8% (three branches and nine bypasses were occluded). CONCLUSIONS: FBSG and hybrid technique seem to be feasible treatment options for complex aortic aneurysms that necessitate four-vessel revascularization. FBSG may be associated with lower mortality and morbidity rates in comparison to the hybrid procedure. FBSG should be the treatment of choice for complex aneurysms in patients with comorbidities, whereas hybrid repair should be considered for acute cases unsuitable for endovascular repair.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180305
[Lr] Last revision date:180305
[St] Status:Publisher

  2 / 4805 MEDLINE  
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[PMID]: 29492602
[Au] Autor:Rombouts SJE; Derksen TC; Nio CY; van Hillegersberg R; van Santvoort HC; Walma MS; Molenaar IQ; van Leeuwen MS
[Ad] Address:Department of Surgery, University Medical Center Utrecht Cancer Center, 3508 GA, Utrecht, PO Box 85500, The Netherlands.
[Ti] Title:Computed tomography findings after radiofrequency ablation in locally advanced pancreatic cancer.
[So] Source:Abdom Radiol (NY);, 2018 Feb 28.
[Is] ISSN:2366-0058
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:PURPOSE: The purpose of the study was to provide a systematic evaluation of the computed tomography(CT) findings after radiofrequency ablation (RFA) in locally advanced pancreatic cancer(LAPC). METHODS: Eighteen patients with intra-operative RFA-treated LAPC were included in a prospective case series. All CT-scans performed prior to RFA and 1 week and 3 months of post-RFA, according to standard regimen, were assessed by two radiologists in consensus, using standardized radiological scoring lists. RESULTS: 51 CT-scans were assessed. One week after RFA, the ablation zone was visible in all patients as a (partially) sharply defined (83%), heterogeneous area (94%). At 3 months of follow-up, the ablation zone was completely invaded by tumor in 67% of patients and still present, but decreased in 33%. In two patients (11%), local thrombosis and/or occlusion of the superior mesenteric vein occurred. The occlusions persisted without clinical consequences and the thrombosis disappeared. A peripancreatic fluid collection was visible 1 week after RFA in 3 patients, wherein the ablation zone extended ventrally outside of the pancreas. CONCLUSIONS: Directly after RFA for LAPC, a well-defined ablation zone is visible on CT-imaging. This ablation zone is usually replaced by tumor ingrowth after 3 months. Moreover, the ablation zone regularly included vascular structures, with rare asymptomatic venous occlusion or thrombosis and without adverse effects on arteries.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1803
[Cu] Class update date: 180301
[Lr] Last revision date:180301
[St] Status:Publisher
[do] DOI:10.1007/s00261-018-1519-y

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[PMID]: 29455017
[Au] Autor:Freitas B; Bausback Y; Schuster J; Ulrich M; Bräunlich S; Schmidt A; Scheinert D
[Ad] Address:Department of Interventional Angiology, University Hospital, University of Leipzig, Leipzig, Germany; Division of Surgery, Faculty of Medicine, Federal University of Alagoas, Arapiraca, Brazil; Faculty of Medicine, State University of Health Sciences-UNCISAL, Alagoas, Brazil. Electronic address: bru
[Ti] Title:Thrombectomy Devices in the Treatment of Acute Mesenteric Ischemia: Initial Single Center Experience.
[So] Source:Ann Vasc Surg;, 2018 Feb 15.
[Is] ISSN:1615-5947
[Cp] Country of publication:Netherlands
[La] Language:eng
[Ab] Abstract:INTRODUCTION: To report our preliminary experience with endovascular revascularization of patients with acute mesenteric ischemia (AMI), using thrombectomy devices. MATERIAL AND METHODS: A retrospective analysis of patients admitted to our hospital due to AMI and who were subjected to concomitant or exclusive endovascular treatment, from January 2011 to January 2016. Patients were admitted at the emergency department, underwent imaging investigation and were referred to the endovascular specialist. Endovascular treatment was performed through left brachial artery access and selective catheterization and thrombectomy with a 6F Rotarex Debulking Device (Straub Medical, Wangs, Switzerland). Laparotomy was performed based on clinical and radiologic sings and at the discretion of the surgeon.Demographic, clinical/periprocedural, post-operative, complication and adjunct intervention data were reviewed. Technical success was defined as recanalization of the Riolan's arcade on angiographic control. RESULTS: Twenty patients (mean age 69.8 ± 11.3 years) underwent endovascular revascularization for AMI using thrombectomy devices, during the period of the study. Abdominal pain was the most common complain on admission (65%), with ileus(35%), sepsis(25%) and myocardial infarction as the main clinical referral presentation at admission. Fifteen patients(75%) had suggestive CT signs of AMI on admission. Endovascular revascularization was successfully performed in all patients through the left brachial artery with a mean procedural time of 28±17 minutes. Superior mesenteric artery(SMA) was the main vessel involved in 75% on a solely basis. The majority of the SMA occlusions were in the periosteal(30%) and proximal to Middle Colic Artery offspring(35%). Primary use of thrombectomy devices was performed in all patients, associated with balloon angioplasty(7/20;50%), stent deployment(5/20;25%), intraoperative selective thrombolysis (4/20;20%) and catheter-assisted aspiration in 10%(2/20) of patients. Average time between admission and angio-CT was 1,5±0,5h, between admission and angiographic procedure was 2,5±1h and between admission and surgery was 9±5h. Following recanalization, 14 (70.%) patients underwent open surgery. Laparotomy with intestinal resection (enterectomy, colectomy) and transit deviation was the most common procedure. Complications directly related to the endovascular procedure occurred in two patients, represented by self-limited small perforations. Overall 30-day mortality was 40% (n=8). During the period of this study, no patient died as a result of complications related to the use of Rotational Thrombectomy CONCLUSION: Endovascular treatment of the AMI with the use of thrombectomy devices proved to be technically feasible and reasonably fast procedure. Early diagnosis and adequate treatment remains the cornerstone of the treatment. Early surgical evaluation and close integration between surgical and endovascular specialists are crucial to faster treatment and consequently lower extensive surgical resections and mortality. Further studies are necessary on this field to confirm these findings.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180218
[Lr] Last revision date:180218
[St] Status:Publisher

  4 / 4805 MEDLINE  
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[PMID]: 29455011
[Au] Autor:Rego D; Almeida P; Soares P; Almeida R
[Ad] Address:Angiology and Vascular Surgery Department of Centro Hospitalar do Porto - Hospital de Sto. António. Electronic address: duarterego@hotmail.com.
[Ti] Title:Hybrid Retrograde Celiac Artery Stenting for Acute Mesenteric Ischemia after Gastric Surgery.
[So] Source:Ann Vasc Surg;, 2018 Feb 15.
[Is] ISSN:1615-5947
[Cp] Country of publication:Netherlands
[La] Language:eng
[Ab] Abstract:INTRODUCTION: Celiac artery (CA) occlusions/stenosis are infrequently associated with liver ischemia due to its unique vascularization where portal vein provides about 75% of liver's perfusion. Collateral flow from gastroduodenal artery also provides, in most cases, enough blood supply to prevent ischemic hepatitis. In cases where these collateral pathways are compromised severe liver ischemia can occur. METHODS: We present a case of acute mesenteric ischemia following gastric surgery that was treated with a hybrid retrograde CA stenting. CLINICAL CASE: We report a case of a 72 years old male who underwent gastric surgery for gastric cancer. On 4th post-operative day he presented with acute abdomen and on laparotomy a partial duodenal suture dehiscence was found and suture closed. Due to worsening of patient's clinical condition, with associated ischemic hepatitis, 2 days later an angioCT was performed that showed a superior mesenteric artery (SMA) occlusion at its origin with an associated, severe, ostial stenosis of the CA. On laparotomy, irreversible visceral ischemia was found which led to total colectomy, resection of 50cms of small bowel and splenectomy. Liver ischemia was also confirmed. Femoral access was used to try to cannulate the CA and cross its stenosis, without success. Taking advantadge of the open abdomen we then opted to place a 5F sheath in the splenic artery stump. From this retrograde approach, stenosis traversal was easy and the CA was ballooned and stented with reperfusion of almost all the liver. Despite these efforts patient died, due to multiorganic failure, 8 days later. CONCLUSIONS: Ischemic hepatitis is a rare but serious complication of CA/SMA occlusive disease. Its occurrence is at increased risk after surgeries where collateral flow is compromised. The endovascular treatment is currently the preferred approach to treat visceral arteries occlusive disease, however, antegrade CA cannulation can be tricky and, in an open abdomen scenario, retrograde approach from the splenic artery can be an additional resource. This case demonstrates the flexibility of endovascular techniques and that they can provide useful solutions even during open surgery.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180218
[Lr] Last revision date:180218
[St] Status:Publisher

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[PMID]: 29411014
[Au] Autor:Shen YM; Wolfe H; Barman S
[Ad] Address:Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas.
[Ti] Title:Evaluating Thrombocytopenia During Heparin Therapy.
[So] Source:JAMA;319(5):497-498, 2018 Feb 06.
[Is] ISSN:1538-3598
[Cp] Country of publication:United States
[La] Language:eng
[Mh] MeSH terms primary: Anticoagulants/adverse effects
Heparin/adverse effects
Intestine, Small/surgery
Thrombocytopenia/chemically induced
Venous Thrombosis/surgery
[Mh] MeSH terms secundary: Anticoagulants/therapeutic use
Humans
Intestine, Small/blood supply
Ischemia/surgery
Male
Mesenteric Artery, Superior
Mesenteric Vascular Occlusion/surgery
Middle Aged
[Pt] Publication type:JOURNAL ARTICLE
[Nm] Name of substance:0 (Anticoagulants); 9005-49-6 (Heparin)
[Em] Entry month:1802
[Cu] Class update date: 180215
[Lr] Last revision date:180215
[Js] Journal subset:AIM; IM
[Da] Date of entry for processing:180208
[St] Status:MEDLINE
[do] DOI:10.1001/jama.2017.21898

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[PMID]: 29446669
[Au] Autor:Naidu SG; Menias CO; Oklu R; Hines RS; Alhalabi K; Makar G; Shamoun FE; Henkin S; McBane RD
[Ad] Address:1 Department of Radiology, Mayo Clinic Hospital, 5777 E Mayo Blvd, Phoenix, AZ 85054.
[Ti] Title:Segmental Arterial Mediolysis: Abdominal Imaging of and Disease Course in 111 Patients.
[So] Source:AJR Am J Roentgenol;:1-7, 2018 Feb 15.
[Is] ISSN:1546-3141
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:OBJECTIVE: The purpose of this study is to identify the imaging characteristics of segmental arterial mediolysis (SAM) at presentation and establish the longitudinal course of disease. MATERIALS AND METHODS: We retrospectively identified patients with SAM at a single institution from 2000 through 2015. Diagnosis was based on published guidelines with multidisciplinary consensus. Imaging studies obtained at initial evaluation were reviewed to evaluate imaging findings and vascular territory distribution. All subsequent follow-up imaging studies were reviewed to assess for progression, stability, or regression. RESULTS: We identified 111 patients (79 men and 32 women; median age, 51 years) who met the diagnostic criteria for SAM. Abdominal pain was the most common presentation (74%), followed by flank pain (21%). SAM most commonly affected the renal arteries (47%), superior mesenteric artery (46%), celiac trunk (46%), hepatic artery (23%), iliac arteries (18%), and splenic artery (14%). The most common imaging findings were dissection (86%), aneurysm (57%), beading or webs (28%), occlusion (19%), and a rind or wall thickening (15%). The 247 available follow-up imaging studies for 97 patients (median follow-up, 12 months) showed progression in 19 patients (20%), with either stability or regression observed in the remaining patients. CONCLUSION: SAM most commonly affects the renal arteries, superior mesenteric artery, and celiac artery. Dissections and aneurysms are the most common imaging findings. Follow-up imaging studies show stability or regression in most patients.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180215
[Lr] Last revision date:180215
[St] Status:Publisher
[do] DOI:10.2214/AJR.17.18309

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[PMID]: 29433829
[Au] Autor:Copin P; Zins M; Nuzzo A; Purcell Y; Beranger-Gibert S; Maggiori L; Corcos O; Vilgrain V; Ronot M
[Ad] Address:Department of Radiology, University Hospitals Paris Nord Val-de-Seine, Beaujon, 92110 Clichy, Hauts-de-Seine, France; University Paris Diderot, Sorbonne Paris Cité, 75018 Paris, France.
[Ti] Title:Acute mesenteric ischemia: A critical role for the radiologist.
[So] Source:Diagn Interv Imaging;, 2018 Feb 09.
[Is] ISSN:2211-5684
[Cp] Country of publication:France
[La] Language:eng
[Ab] Abstract:Acute mesenteric ischemia is defined as an inadequate blood supply to the gastrointestinal tract resulting in ischemic and inflammatory injury that may progress to necrosis of the bowel wall. Prognosis is poor with a mortality rate greater than 95% without treatment, dropping to around 70% when surgical treatment is performed. Contrast-enhanced computed tomography (CT) has become the cornerstone of the diagnosis by showing features of vascular disorders (occlusion and/or insufficient blood supply) and features of intestinal ischemic injury. CT should be performed as rapidly as possible. Imaging-based patient management is required, and multimodal and multidisciplinary management should be introduced. The treatment involves multidisciplinary management by gastroenterologists, vascular and digestive surgeons, cardiologists, intensivists, and diagnostic and interventional radiologists. Based on our experience at a dedicated mesenteric stroke center, this article gives an overview of the diagnosis of acute mesenteric ischemia. The goal of this review is to improve the understanding of the imaging-based diagnosis to further improve the management of this life-threatening condition.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180213
[Lr] Last revision date:180213
[St] Status:Publisher

  8 / 4805 MEDLINE  
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[PMID]: 29433410
[Au] Autor:Ertugay S; Daylan A; Bozkaya H; Oguz E; Apaydin A; Parildar M; Posacioglu H
[Ad] Address:1 Department of Cardiovascular Surgery, Ege University School of Medicine, Izmir, Turkey.
[Ti] Title:Snorkel Technique for Inferior Mesenteric Artery During Endovascular Repair of Abdominal Aortic Aneurysm.
[So] Source:Vasc Endovascular Surg;:1538574418758597, 2018 Jan 01.
[Is] ISSN:1938-9116
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:PURPOSE: The snorkel technique is commonly used to preserve renal arteries in juxta renal aneurysm during endovascular repair. Herein, we present a patient who underwent bifurcated endograft implantation with snorkel technique for inferior mesenteric artery (IMA) in order to preserve the major source of bowel circulation. CASE REPORT: A 69-year-old male patient was diagnosed with abdominal aortic aneurysm. His history revealed that he had bowel resection due to a car accident 30 years ago. In addition, he was given relaparotomy 4 times due to intestinal complications. Computed tomography showed fusiform aneurysm with a maximal diameter of 60 mm and chronical occlusion of the superior mesenteric artery. Inferior mesenteric artery was found to be hypertrophic. During EVAR, 6 mm × 10 cm covered VIABAHN Endoprosthesis (Gore Medical) was implanted to the IMA over a 0.018 guidewire via puncture of the left axillary artery. Initially, the main body of the aortic stent-graft (Gore C3, size 23-14-16) was implanted to the infra renal segment of the aorta (below the renal arteries and the orifice using VIABAHN) via the right femoral artery. Next, the contralateral leg (Gore, 14-12-00) was implanted. Computed tomography was examined at 1- and 32-month postoperatively, and no endoleak or patency of IMA stent was detected. CONCLUSION: In this case of IMA-dependent circulation of the intestinal system, the protection of IMA via snorkel technique was successful.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180213
[Lr] Last revision date:180213
[St] Status:Publisher
[do] DOI:10.1177/1538574418758597

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[PMID]: 29382004
[Au] Autor:Lim KH; Jang J; Yoon HY; Park J
[Ad] Address:Department of Surgery, Trauma Center, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, South Korea.
[Ti] Title:Acute superior mesenteric vein thrombosis associated with abdominal trauma: A rare case report and literature review.
[So] Source:Medicine (Baltimore);96(47):e8863, 2017 Nov.
[Is] ISSN:1536-5964
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:RATIONALE: Acute mesenteric vein thrombosis (MVT) is defined as new-onset thrombosis of the mesenteric vein without evidence of collateralization, finally resulting in extensive intestinal infarction. MVT may be idiopathic or be caused by conditions responsible for thrombophilia and acquired risk factors. To date, there have been few reports of MVT after trauma. Herein we describe our experiences treating three patients with MVT. PATIENT CONCERNS: Case 1 was a 44-year-old man with transverse colon mesenteric hematoma after blunt abdominal trauma. Case 2 was a 55-year-old man with jejunal transection after a traffic accident. Case 3 was a 26-year-old man presented with multiple abdominal stab bowel injury. DIAGNOSES: A 1-week follow-up abdominal computed tomography scan showed superior mesenteric vein thrombosis in all of three patients. INTERVENTIONS: All patients were treated with anticoagulant for 3 or 6 months. OUTCOMES: MVTs were completely resolved without any complications. LESSONS: If early diagnosis and treatment could be available, anticoagulation alone might be adequate for the treatment of SMVT associated with trauma. Early anticoagulation in patients with acute SMVT may avoid the grave prognosis observed in patients with arterial thrombosis.
[Mh] MeSH terms primary: Abdominal Injuries/complications
Mesenteric Vascular Occlusion/etiology
Venous Thrombosis/etiology
Wounds, Nonpenetrating/complications
[Mh] MeSH terms secundary: Acute Disease
Adult
Humans
Male
Mesenteric Vascular Occlusion/drug therapy
Mesenteric Veins
Middle Aged
Venous Thrombosis/drug therapy
[Pt] Publication type:CASE REPORTS; JOURNAL ARTICLE; REVIEW
[Em] Entry month:1802
[Cu] Class update date: 180209
[Lr] Last revision date:180209
[Js] Journal subset:AIM; IM
[Da] Date of entry for processing:180201
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000008863

  10 / 4805 MEDLINE  
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[PMID]: 29398309
[Au] Autor:Harris E; Warner CJ; Hnath JC; Sternbach Y; Darling RC
[Ad] Address:Albany Medical College, and Albany Medical Center Hospital, Albany, NY; The Vascular Group, Albany, NY.
[Ti] Title:Percutaneous axillary artery access for endovascular interventions.
[So] Source:J Vasc Surg;, 2018 Feb 02.
[Is] ISSN:1097-6809
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND: As endovascular therapy becomes increasingly complex, adjunct techniques such as upper extremity arterial access facilitate visceral branch interventions. The purpose of this study was to assess the viability of axillary artery percutaneous access in endovascular repair. METHODS: Records of all patients undergoing axillary artery percutaneous access as part of an endovascular intervention from December 2015 to December 2016 were examined. Demographics of the patients (age, sex, medical comorbidities, smoking status, and anticoagulation) were documented. Each case was examined for technical success and perioperative complications, including hematoma, brachial plexus injury, and return to the operating room. Early functional outcomes were assessed using clinic follow-up documentation. RESULTS: During the study interval, 25 axillary artery punctures in a total of 19 patients were performed for endovascular intervention. The mean age was 72 years; most patients were male (68%), and the cohort had a typical vascular comorbidity profile (hypertension in 84%, hyperlipidemia in 90%, diabetes in 21%, coronary artery disease in 58%, and chronic obstructive pulmonary disease in 47%; 90% were active or former smokers). Axillary access was obtained as part of complex endovascular aneurysm repair in 13 patients, mesenteric vessel intervention in 3 patients, and iliac intervention in 3 patients. Sheath size was most frequently 6F (6 punctures) or 7F (15 punctures). Closure devices included Perclose (Abbott Vascular, Santa Clara, Calif) in 36% and Angio-Seal (Terumo Interventional Systems, Somerset, NJ) in 64%. There were two perioperative deaths and one instance of return to the operating room for hematoma. There was no perioperative stroke, axillary occlusion, or severe brachial plexus injury. One patient had transient ipsilateral postoperative thumb numbness, and one patient had residual bleeding after closure requiring manual pressure. CONCLUSIONS: Percutaneous axillary artery access is a viable strategy to facilitate complex endovascular interventions. This technique avoids the need for brachial or axillary artery exposure and allows larger sheath sizes because of the caliber of the axillary artery. There were no major neurologic or ischemic complications. This technique is a relatively safe and practical alternative to approaches involving exclusively femoral and brachial access.
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1802
[Cu] Class update date: 180209
[Lr] Last revision date:180209
[St] Status:Publisher


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