Paclitaxel-Coated Balloons for the Treatment of Symptomatic Central Venous Stenosis in Vascular Access: Results From a European, Multicenter, Single-Arm Retrospective Analysis.

INTRODUCTION: This was a European, multicenter, investigator-initiated and run, single-arm retrospective analysis to assess the safety and the clinical benefit of the use of paclitaxel-coated balloon (PCB) for the treatment of symptomatic central venous stenosis (CVS). MATERIALS AND METHODS: Eleven centers from 7 countries across Europe, submitted 86 cases performed during the period between October 2015 and June 2018. Minimum follow-up was 6 months. Patient baseline demographics and procedural details were collected. Mean age was 62.6 years (SD 15.2 years). Median vascular access age was 3.0 years (IQR 1.2-4.8 years). A total of 55 were arteriovenous fistulas (64%) the rest arteriovenous grafts (31/86, 36%). Vessels treated were 43 subclavian veins, 42 brachiocephalic veins and 1 superior vena cava. Median drug-coated balloon diameter was 10 mm (IQR 8-12 mm). Primary outcome measures were clinically assessed intervention-free period (IFP) of the treated segment at 6 months and procedure-related minor and major complications. Secondary outcome measures included access circuit survival, patient survival, and the investigation of independent factors that influence the IFP. RESULTS: IFP was 62.7% at 6 months. Median patient follow-up time was 1.0 year (IQR 0.5-2.2 years). There was 1 minor complication (1/86; 1.2%) and no major complications. Access circuit survival was 87.7% at 6 months. Patient survival was 79.7% at 2 years according to Kaplan-Meier survival analysis. Higher balloon diameters significantly favored IFP [HR 0.71 (0.55-0.92), p=0.006; 5-7 mm group vs 8-12 mm group, p=0.025]. CONCLUSION: In this analysis, use of PCBs for the treatment of symptomatic CVS was safe. Efficacy was comparable to previous trials. Increased balloon size had a significant effect on patency rates.

Multicenter Experience with the Surfacer Inside-Out Access Catheter System in Patients with Thoracic Venous Obstruction: Results from the SAVE Registry.

PURPOSE: To report the device performance and safety for the Surfacer Inside-Out access catheter system in patients with thoracic central venous obstruction (TCVO) requiring central venous access (CVA). MATERIALS AND METHODS: Five sites prospectively enrolled 30 patients requiring a tunneled dialysis catheter between February 2017 and September 2018 in the SAVE (Surfacer System to Facilitate Access in Venous Obstructions) registry. Patient demographics, medical history, and type of TCVO were documented at enrollment. Device performance and adverse events were collected during the procedure and upon hospital discharge. Twenty-nine of the 30 patients enrolled required CVA for hemodialysis. Retrospective classification of TCVOs according to SIR reporting standards showed 9 patients (30%) had Type 4 obstructions, 8 (26.7%) had Type 3, 5 (16.7%) had Type 2, and 8 (26.7%) had Type 1 obstruction. RESULTS: Central venous catheters (CVCs) were successfully placed in 29 of 30 patients (96.7%). The procedure was discontinued in 1 patient due to vascular anatomical tortuosity. All 29 patients with successful CVC placement achieved adequate catheter patency and tip positioning. There were no device-related adverse events, catheter malposition, or intra- or postprocedural complications. Mean time from device insertion to removal for the 29 patients who successfully completed the procedure was 24 ± 14.9 (range, 6-70) minutes. Mean fluoroscopy time was 6.8 ± 4.5 (range, 2.2-25.5) minutes. CONCLUSIONS: The Surfacer Inside-Out procedure provided an alternative option to restore right-sided CVA in patients with TCVO.

Noninnocent behavior of ancillary ligands: apparent trans coupling of a saturated N-heterocyclic carbene unit with an ethyl ligand mediated by nickel.

Oxidative addition of the tridentate N-heterocyclic carbene (NHC) diphosphine ligand precursor ([PCP]H)PF(6) (1) {[PCP] = o-(i)Pr(2)PC(6)H(4)(NC(3)H(4)N)o-C(6)H(4)P(i)Pr(2)} to Ni(COD)(2) results in the formation of the nickel(II) hydride complex ([PCP]NiH)PF(6) (2). This hydride undergoes a rapid reaction with ethylene to generate a nickel(0) complex in which an ethyl group has been transferred to the carbene carbon of the original NHC-diphosphine ligand. If the first intermediate is the anticipated square-planar nickel(II) ethyl species, then the formation of the product would require a process that involves a trans C-C coupling of the NHC carbon and a presumed Ni-ethyl intermediate. Deuterium-labeling studies provide evidence for migratory insertion of the added ethylene into the Ni-H bond rather than into the Ni-carbene linkage; this is based on the observed deuterium scrambling, which requires reversible beta-elimination, alkene rotation, and hydride readdition. However, density functional theory studies suggest that a key intermediate is an agostic ethyl species that has the Ni-C bond cis to the NHC unit. A possible transition state containing two cis-disposed carbon moieties was also identified. Such a process represents a new pathway for catalyst deactivation involving NHC-based metal complexes.

Insertion of organoindium carbenoids into rhodium halide bonds: revisiting a classic type of transition metal-group 13 metal bond formation.

Insertion of the carbenoid group 13 metal species InCp* (Cp* = pentamethylcyclopentadienyl) and InC(SiMe3)3 into the Rh-Cl bonds of [[RhCp*Cl2]2] yields the new complexes [Cp*Rh(InCp*)3(Cl)2] 1 and [Cp*Rh(mu2-Cl)2(InC(SiMe3)3)3] 2, respectively, exhibiting novel cage-like intermetallic complexes with In-Cl-In bridges.

The clusters [Ma(ECp*)b] (M=Pd, Pt; E=Al, Ga, In): structures, fluxionality, and ligand exchange reactions.

The synthesis and structural characterization of the novel homoleptic cluster complexes [Pd2(GaCp*)2(mu2-GaCp*)3] (1c), [Pd3(GaCp*)4(mu2-GaCp*)4] (2b) and [Pd3(AlCp*)2(mu2-AlCp*)2(mu3-AlCp*)2] (3) (Cp*=C5Me5) are presented. Furthermore, ligand exchange reactions of these cluster complexes are explored. In contrast to the electronically and sterically saturated complexes [M(ECp*)4] (M=Ni, Pd, Pt), the new unsaturated analogues [M(a)(ER)b] (E=Al, Ga, In) react with a variety of typical ligands (Cp*Al, CO, phosphines, isonitriles) to give new di- and tri-substituted compounds like [Pt2(GaCp*)2(mu2-AlCp*)3] (1d), [PdPt(GaCp*)(PPh3)(mu2-GaCp*)3] (4b), or [Pd3(PPh3)3(mu2-InCp*)(mu3-InCp*)2] (8). The trends of the reactivity of [M(a)(ER)b] as well as their fluxional behavior in solution has been elucidated by NMR spectroscopy, resulting in a mechanistic rationale for the ligand exchange reactions as well as the fluxional processes.

Insertion reactions of GaCp*, InCp* and In[C(SiMe3)3] into the Ru-Cl bonds of [(p-cymene)RuIICl2]2 and [Cp*RuIICl]4.

The first carbonyl free ruthenium/low valent Group 13 organyl complexes are presented, obtained by insertion of ER (ER = GaCp*, InCp*, In[C(SiMe(3))(3)]) into the Ru-Cl bonds of [(p-cymene)RuCl2]2, [Cp*RuCl]4 and [Cp*RuCl2]2. The compound [(p-cymene)RuCl2]2 reacts with GaCp*, giving a variety of isolated products depending on the reaction conditions. The Ru-Ru dimers [{(p-cymene)Ru}2(GaCp*)4(mu3-Cl)2] and the intermediate [{(p-cymene)Ru}2(mu-Cl)2] were isolated, as well as monomeric complexes [(p-cymene)Ru(GaCp*)3Cl2], [(p-cymene)Ru(GaCp*)2GaCl3] and [(p-cymene)Ru(GaCp*)2Cl2(DMSO)]. The reaction of [Cp*RuCl]4 with ER gives "piano-stool" complexes of the type [Cp*Ru(ER)3Cl](ER = InCp*, In[C(SiMe3)3], GaCp*. The chloride ligand in complex can be removed by NaBPh4, yielding [Cp*Ru(GaCp*)3]+[BPh4]-. The reaction of [Cp*RuCl2]2 with GaCp* however, does not lead to an insertion product, but to the ionic Ru(II) complex [Cp*Ru(GaCp*)3]+[Cp*GaCl3]-. The ER ligands in complexes 3, 5, 6, 7 and 8 are equivalent on the NMR timescale in solution due to a chloride exchange between the three Group 13 atoms even at low temperatures. The solid state structures, however, exhibit a different structural pattern. The chloride ligands exhibit two coordination modes: either terminal or bridging. The new compounds are fully characterized including single crystal X-ray diffraction. These results point out the different reactivities of the two precursors and the nature of the neutral p-cymene and the anionic Cp* ligand when bonding to a Ru(II) centre.

Novel RhCp*/GaCp* and RhCp*/InCp* cluster complexes.

The reaction of 6 equivalents of GaCp*(Cp*= pentamethylcyclopentadienyl) with [{Cp*RhCl2}2] yields the complex [Cp*Rh(GaCp*)3(Cl)2] (1) exhibting a cage-like intermetallic RhGa3 center with Ga-Cl-Ga bridges. Treatment of this complex with GaCl3 gives the Lewis acid-base adduct [Cp*Rh(GaCp*)2(GaCl3)]. (2) Reaction of [{Cp*RhCl2}2] with understoichiometric amounts of E(I)Cp*(E = Al, Ga, In) leads to a variety of products strongly dependent on the molecular ratio of the reactants. Thus, the reduction of [{Cp*RhCl2}2] with one equivalent of E(I)Cp*(E = Al, Ga, In) gives the RhII dimer [{Cp*RhCl}2]. The insertion of 3 equivalents of InCp* into the Rh-Cl bonds of [{Cp*RhCl2}2] yields the salt [Cp*2Rh]+[Cp*Rh(InCp*){In2Cl4(mu2-Cp*)}]- (3), the anion exhibiting an intermetallic RhIn(3) center with an intramolecularly bridging Cp* ring. The reaction of [{Cp*RhCl}2] with Cp*Ga yields various insertion products. In trace amount the "all hydrocarbon" cluster complex [(RhCp*)2(GaCp*)3] (6) is obtained. The corresponding ethylene containing cluster complex [{RhCp(GaCp*)(C2H4)}2] (7) can be prepared by treatment of [RhCp*(CH3CN)(C2H4)] with GaCp*.