Assuntos
Aneurisma , Artéria Axilar , Síndrome de Behçet , Microaneurisma , Humanos , Síndrome de Behçet/complicações , Síndrome de Behçet/diagnóstico , Síndrome de Behçet/tratamento farmacológico , Artéria Axilar/diagnóstico por imagem , Aneurisma/diagnóstico por imagem , Aneurisma/etiologia , Resultado do Tratamento , Masculino , Microaneurisma/etiologia , Microaneurisma/diagnóstico , Adulto , Angiografia por Tomografia Computadorizada , Embolização TerapêuticaRESUMO
Aim: To evaluate the effects of double (axillary and femoral) vs. single (axillary) cannulation on early outcomes of acute type A aortic dissection (ATAAD). Materials & methods: Meta-analysis using PubMed/MEDLINE, Scopus, and Cochrane databases through August 23, 2023. Focused on operative mortality, postoperative stroke, re-exploration for bleeding, spinal cord injury, and renal replacement therapy. Results: Among 5 propensity score-matched studies with 2127 patients, double cannulation showed comparable mortality and higher rates of postoperative stroke (pooled odds ratio: 1.69, 95% confidence interval: 1.19-2.39) and need for renal replacement therapy (pooled odds ratio: 1.35, 95% confidence interval: 1.13-1.60) compared with single cannulation. Conclusion: Double arterial cannulation in ATAAD surgery is associated with increased postoperative stroke and renal replacement therapy than single cannulation.
What is this summary about? We studied the optimal way to maintain blood flow during surgery for acute aortic dissection. We focused on comparing the use of one tube placement site in the axillary artery with two sites, both in the axillary and femoral arteries, in five previous studies.What were the results? Using two sites was associated with a higher risk of stroke and need for dialysis after surgery than using only one site.What do the results mean? Adding a tube in the femoral artery for blood flow may increase the risk of complications. It appears that placing the tube only in the axillary artery may be a safer choice for appropriately selected patients having this surgery.
Assuntos
Dissecção Aórtica , Artéria Axilar , Humanos , Dissecção Aórtica/cirurgia , Doença Aguda , Cateterismo/métodos , Cateterismo Periférico/métodos , Artéria Femoral , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controleRESUMO
BACKGROUND: The axillary artery (AX) access for intra-aortic balloon pump (IABP) as a bridge to heart transplant (HT) allows mobility while awaiting a suitable donor. As end-stage heart failure patients often have an implantable cardioverter defibrillator (ICD) on the left side, the left AX approach may be avoided due to the perception of difficult access and proximity of two devices. We aimed to evaluate the outcomes of patients bridged to HT with a left-sided AX IABP with or without ipsilateral ICDs. METHODS: We retrospectively reviewed HT candidates at our institution supported by left-sided axillary IABP from November 2019 to February 2024, dividing them into two groups based on the presence (Group ICD, n = 48) or absence (Group No-ICD, N = 19) of an ipsilateral left-sided ICD. The exposure time was defined as the time from skin incision to the beginning of anastomoses of a Dacron graft. RESULTS: Technical success was achieved in 100% of the cohort, with median exposure times for AX access similar between groups (ICD, 12 [7.8, 18.2] vs. No ICD, 11 [7, 19] min; p = 0.75). The rate of procedural adverse events, such as significant access site bleeding and ipsilateral limb ischemia, did not significantly differ between both groups. Device malfunction rates were comparable (ICD, 29.2% vs. No ICD, 15.8%; p = 0.35). Posttransplant, in-hospital mortality, severe primary graft dysfunction, and stroke rates were comparable in both groups. CONCLUSION: The presence of an ipsilateral left-sided ICD does not adversely impact the procedural efficacy, complication rates, or posttransplant outcomes of left-sided AX IABP insertion in HT candidates.
Assuntos
Desfibriladores Implantáveis , Insuficiência Cardíaca , Transplante de Coração , Balão Intra-Aórtico , Humanos , Feminino , Masculino , Estudos Retrospectivos , Pessoa de Meia-Idade , Insuficiência Cardíaca/cirurgia , Insuficiência Cardíaca/terapia , Seguimentos , Prognóstico , Artéria AxilarRESUMO
Takayasu arteritis is an inflammatory disease of unknown aetiology affecting large vessels. Medium vessel involvement is also well documented; however, neuropathy as a presenting manifestation is rare. In this case report, a young woman in her 20s presented with an 8-month history of intermittent claudication in the right upper limb progressing to rest pain with allodynia in C5-C8 distribution and painless right axillary mass. On examination, she had absent pulses in the right radial, brachial and subclavian artery with audible bruit in the right subclavian and abdominal aorta. CT angiogram showed features suggestive of Takayasu arteritis with a partially thrombosed aneurysm arising from the right axillary artery leading to compression of the right brachial plexus. This patient received treatment with methotrexate and oral corticosteroids. At 3 months follow-up, there was a reduction in the size of the aneurysm, resolution of compressive symptoms and normalisation of inflammatory markers.
Assuntos
Aneurisma , Artéria Axilar , Neuropatias do Plexo Braquial , Arterite de Takayasu , Humanos , Arterite de Takayasu/complicações , Arterite de Takayasu/diagnóstico , Arterite de Takayasu/tratamento farmacológico , Feminino , Artéria Axilar/diagnóstico por imagem , Aneurisma/etiologia , Aneurisma/diagnóstico por imagem , Aneurisma/complicações , Neuropatias do Plexo Braquial/etiologia , Neuropatias do Plexo Braquial/diagnóstico , Adulto , Angiografia por Tomografia Computadorizada , Metotrexato/uso terapêutico , Metotrexato/administração & dosagemRESUMO
A 66-year-old man with multiple comorbidities including severe peripheral artery disease and heart failure with reduced ejection fraction presented with complex coronary artery disease with an elevated Society of Thoracic Surgeons Predicted Risk of Mortality for coronary artery bypass grafting and a Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery score of 18. With a multidisciplinary heart team approach, the patient successfully underwent percutaneous axillary venoarterial extracorporeal membrane oxygenation (VA-ECMO) supported high-risk percutaneous coronary intervention of a heavily calcified left main bifurcation lesion. Given the patient's peripheral artery disease, alternative arterial access for ECMO cannulation was performed percutaneously via the right axillary artery. Additionally, adequate coronary calcium modification was critical to successful stenting of a heavily calcified left main bifurcation. This case highlights a novel approach to obtaining alternative arterial access for ECMO cannulation and emphasizes the importance of calcium modification to achieve excellent stent results.
Assuntos
Artéria Axilar , Doença da Artéria Coronariana , Oxigenação por Membrana Extracorpórea , Calcificação Vascular , Humanos , Masculino , Idoso , Resultado do Tratamento , Artéria Axilar/diagnóstico por imagem , Doença da Artéria Coronariana/terapia , Doença da Artéria Coronariana/diagnóstico por imagem , Calcificação Vascular/terapia , Calcificação Vascular/diagnóstico por imagem , Calcificação Vascular/fisiopatologia , Intervenção Coronária Percutânea/instrumentação , Intervenção Coronária Percutânea/efeitos adversos , Cateterismo Periférico , Doença Arterial Periférica/terapia , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/fisiopatologia , Stents , Angiografia CoronáriaRESUMO
In the left axilla of a formalin-embalmed adult female cross-breed dog, an unusual course of the axillary artery in relation to the brachial plexus was noted. A part of the axillary artery after the origin of the subscapular artery coursed through the loop formed by the contributions of the caudal pectoral and lateral thoracic nerves and then between the median and ulnar nerves. Thus, the common trunk for the latter two nerves was missing. Instead, in the proximal brachium, they communicated with each other in both directions. A communicating branch between the cranial and caudal pectoral nerves forming a nerve loop, ansa pectoralis lacked the axillary artery and was instead traversed by the subscapular artery. This is a variation in the relationship between the axillary artery and brachial plexus in the domestic dog and has not been reported in the literature yet. The axillary artery entrapped by the contributions of the caudal and lateral thoracic nerves may be considered as a risk factor for the neuroarterial compressions with non-specific signs and should be taken into account both in surgery and imaging.
Assuntos
Artéria Axilar , Plexo Braquial , Cadáver , Animais , Cães , Artéria Axilar/anatomia & histologia , Plexo Braquial/anatomia & histologia , Feminino , Terminologia como AssuntoRESUMO
CASE: A 71-year-old woman presented with post-traumatic arthritis 11 months after open reduction and internal fixation for a left proximal humerus fracture (PHF) dislocation. After revision to reverse total shoulder arthroplasty (rTSA), the patient's left upper extremity was found to be avascular. An emergent thrombectomy was performed with restoration of arterial flow after removal of an acute-on-chronic axillary artery thrombus. CONCLUSION: Although rare, as rTSA becomes more common for management of PHF, incidence of associated vascular injuries is likely to rise. Screening methods and clinical vigilance in diagnosis are advised for patients with anterior PHF dislocations and arterial injury risk factors.
Assuntos
Artroplastia do Ombro , Artéria Axilar , Fraturas do Ombro , Trombose , Humanos , Feminino , Idoso , Artéria Axilar/cirurgia , Artéria Axilar/lesões , Artéria Axilar/diagnóstico por imagem , Fraturas do Ombro/cirurgia , Fraturas do Ombro/diagnóstico por imagem , Artroplastia do Ombro/efeitos adversos , Trombose/etiologia , Trombose/diagnóstico por imagem , Trombose/cirurgia , Fixação Interna de Fraturas/efeitos adversos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/diagnóstico por imagem , Redução Aberta/efeitos adversos , ReoperaçãoRESUMO
BACKGROUND: Arterial catheter placement for hemodynamic monitoring is commonly performed in critically ill patients. The radial and femoral arteries are the two sites most frequently used; there is limited data on the use of the axillary artery for this purpose. The aim of this study was to investigate the rate of complications from ultrasound-guided axillary artery catheter placement in critically ill patients. METHODS: A retrospective study at a tertiary care center of patients admitted to an intensive care unit who had ultrasound-guided axillary artery catheter placement during admission. Primary outcome of interest was catheter related complications, including bleeding, vascular complications, compartment syndrome, stroke or air embolism, catheter malfunction, and need for surgical intervention. RESULTS: This study identified 88 patients who had an ultrasound-guided axillary artery catheter placed during their admission. Of these 88, nine patients required multiple catheters placed, for a total of 99 axillary artery catheter placement events. The median age was 64 [IQR 48, 71], 41 (47%) were female, and median body mass index (BMI) was 26 [IQR 22, 30]. The most common complication was minor bleeding (11%), followed by catheter malfunction (2%), and vascular complications (2%). Univariate analyses did not show any association between demographics and clinical variables, and complications related to axillary arterial catheter. CONCLUSION: The most common complication found with ultrasound-guided axillary artery catheter placement was minor bleeding, followed by catheter malfunction, and vascular complications. Ultrasound-guided axillary arterial catheters are an alternative in patients in whom radial or femoral arterial access is difficult or not possible to achieve.
Assuntos
Artéria Axilar , Cateterismo Periférico , Estado Terminal , Unidades de Terapia Intensiva , Ultrassonografia de Intervenção , Humanos , Feminino , Masculino , Estudos Retrospectivos , Pessoa de Meia-Idade , Idoso , Ultrassonografia de Intervenção/métodos , Cateterismo Periférico/efeitos adversos , Cateterismo Periférico/métodos , Artéria Axilar/diagnóstico por imagem , Hemorragia/etiologiaRESUMO
It has been proposed that formation of abdominal aortic aneurysm (AAA) is part of a systemic arterial dilatative disease. However, arteries in the upper extremities are scarcely studied and it remains unclear whether both muscular and elastic arteries are affected by the proposed systemic arterial dilatation. The aim of this study was to investigate the diameter and stiffness of muscular and elastic arteries in arterial branches originating from the aortic arch. Twenty-six men with AAA (69 ± 4 yr) and 57 men without AAA (70 ± 5 yr) were included in the study. Ultrasound was used to examine the distal and proximal brachial artery, axillary artery, and common carotid artery (CCA), and measurement of diameter and diameter change was performed with wall-tracking software. Blood pressure measurements were used to calculate local arterial wall stiffness indices. The AAA cohort presented larger arterial diameters in the CCA and axillary artery after adjustment for body surface area (P = 0.002, respectively), whereas the brachial artery diameters were unchanged. Indices of increased stiffness in CCA (e.g., lower distensibility, P = 0.003) were seen in subjects with AAA after adjustments for body mass index and mean arterial blood pressure. This study supports the theory of a systemic arterial dilating diathesis in peripheral elastic, but not in muscular, arteries. Peripheral elastic arteries also exhibited increased stiffness, in analogy with findings in the aorta in AAA.NEW & NOTEWORTHY We present data partially supporting the notion of abdominal aortic aneurysm being a systemic vascular disease with focal manifestation in the abdominal aorta, from two well-defined groups recruited from a regional screening program. We show that elastic arteries distal from the aorta exhibit vascular alterations without aneurysmal formation in subjects with AAA compared with controls while muscular arteries seem unaffected.
Assuntos
Aneurisma da Aorta Abdominal , Rigidez Vascular , Humanos , Masculino , Aneurisma da Aorta Abdominal/fisiopatologia , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Idoso , Rigidez Vascular/fisiologia , Pessoa de Meia-Idade , Artéria Braquial/fisiopatologia , Artéria Braquial/diagnóstico por imagem , Elasticidade , Pressão Sanguínea/fisiologia , Ultrassonografia/métodos , Artéria Axilar/fisiopatologia , Artéria Axilar/diagnóstico por imagem , Artéria Carótida Primitiva/diagnóstico por imagem , Artéria Carótida Primitiva/fisiopatologiaRESUMO
We present a case of Takayasu's arteritis in a woman in her 30s, who exhibited visual symptoms and ophthalmic manifestations of the disease, specifically Takayasu's retinopathy stage 4, in both eyes. Despite severe narrowing of all branches of the aortic arch and compromised perfusion in both upper limbs, she had no history of intermittent claudication. Doppler study and CT angiography revealed diffuse circumferential wall thickening of bilateral common carotid, subclavian and axillary arteries. Treatment involved retinal laser photocoagulation and immune suppression. This case underscores that advanced Takayasu's retinopathy can be an initial presentation of Takayasu's arteritis even in a state of severely compromised peripheral limb circulation.
Assuntos
Arterite de Takayasu , Humanos , Arterite de Takayasu/complicações , Arterite de Takayasu/diagnóstico , Feminino , Adulto , Doenças Retinianas/etiologia , Doenças Retinianas/diagnóstico , Artéria Axilar/diagnóstico por imagem , Artéria Subclávia/diagnóstico por imagem , Angiografia por Tomografia Computadorizada , Fotocoagulação a LaserAssuntos
Artéria Axilar , Artéria Femoral , Artéria Mesentérica Superior , Humanos , Artéria Femoral/cirurgia , Artéria Femoral/diagnóstico por imagem , Artéria Mesentérica Superior/cirurgia , Artéria Mesentérica Superior/diagnóstico por imagem , Artéria Axilar/cirurgia , Artéria Axilar/diagnóstico por imagem , Masculino , Resultado do Tratamento , Idoso , Implante de Prótese Vascular/instrumentação , Implante de Prótese Vascular/métodosRESUMO
BACKGROUND: Cannulation strategy in acute type A dissection (ATAD) varies widely without known gold standards. This study compared ATAD outcomes of axillary vs femoral artery cannulation in a large cohort from the International Registry of Acute Aortic Dissection (IRAD). METHODS: The study retrospectively reviewed 2145 patients from the IRAD Interventional Cohort (1996-2021) who underwent ATAD repair with axillary or femoral cannulation (axillary group: n = 1106 [52%]; femoral group: n = 1039 [48%]). End points included the following: early mortality; neurologic, respiratory, and renal complications; malperfusion; and tamponade. All outcomes are presented as axillary with respect to femoral. RESULTS: The proportion of patients younger than 70 years in both groups was similar (n = 1577 [74%]), as were bicuspid aortic valve, Marfan syndrome, and previous dissection. Patients with femoral cannulation had slightly more aortic insufficiency (408 [55%] vs 429 [60%]; P = .058) and coronary involvement (48 [8%] vs 70 [13%]; P = .022]. Patients with axillary cannulation underwent more total aortic arch (156 [15%] vs 106 [11%]; P = .02) and valve-sparing root replacements (220 [22%] vs 112 [12%]; P < .001). More patients with femoral cannulation underwent commissural resuspension (269 [30.9%] vs 324 [35.3%]; P = .05). Valve replacement rates were not different. The mean duration of cardiopulmonary bypass was longer in the femoral group (190 [149-237] minutes vs 196 [159-247] minutes; P = .037). In-hospital mortality was similar between the axillary (n = 165 [15%]) and femoral (n = 149 [14%]) groups (P = .7). Furthermore, there were no differences in stroke, visceral ischemia, tamponade, respiratory insufficiency, coma, or spinal cord ischemia. CONCLUSIONS: Axillary cannulation is associated with a more stable ATAD presentation, but it is a more extensive intervention compared with femoral cannulation. Both procedures have equivalent early mortality, stroke, tamponade, and malperfusion outcomes after statistical adjustment.
Assuntos
Dissecção Aórtica , Artéria Axilar , Artéria Femoral , Humanos , Dissecção Aórtica/cirurgia , Dissecção Aórtica/mortalidade , Feminino , Masculino , Estudos Retrospectivos , Pessoa de Meia-Idade , Idoso , Aneurisma da Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/mortalidade , Cateterismo Periférico/métodos , Doença Aguda , Sistema de Registros , Resultado do TratamentoRESUMO
BACKGROUND: Giant cell arteritis is a critically ischaemic disease with protean manifestations that require urgent diagnosis and treatment. European Alliance of Associations for Rheumatology (EULAR) recommendations advocate ultrasonography as the first investigation for suspected giant cell arteritis. We developed a prediction tool that sequentially combines clinical assessment, as determined by the Southend Giant Cell Arteritis Probability Score (SGCAPS), with results of quantitative ultrasonography. METHODS: This prospective, multicentre, inception cohort study included consecutive patients with suspected new onset giant cell arteritis referred to fast-track clinics (seven centres in Italy, the Netherlands, Spain, and UK). Final clinical diagnosis was established at 6 months. SGCAPS and quantitative ultrasonography of temporal and axillary arteries with three scores (ie, halo count, halo score, and OMERACT GCA Score [OGUS]) were performed at diagnosis. We developed prediction models for diagnosis of giant cell arteritis by multivariable logistic regression analysis with SGCAPS and each of the three ultrasonographic scores as predicting variables. We obtained intraclass correlation coefficient for inter-rater and intra-rater reliability in a separate patient-based reliability exercise with five patients and five observers. FINDINGS: Between Oct 1, 2019, and June 30, 2022, we recruited and followed up 229 patients (150 [66%] women and 79 [34%] men; mean age 71 years [SD 10]), of whom 84 were diagnosed with giant cell arteritis and 145 with giant cell arteritis mimics (controls) at 6 months. SGCAPS and all three ultrasonographic scores discriminated well between patients with and without giant cell arteritis. A reliability exercise showed that the inter-rater and intra-rater reliability was high for all three ultrasonographic scores. The prediction model combining SGCAPS with the halo count, which was termed HAS-GCA score, was the most accurate model, with an optimism-adjusted C statistic of 0·969 (95% CI 0·952 to 0·990). The HAS-GCA score could classify 169 (74%) of 229 patients into either the low or high probability groups, with misclassification observed in two (2%) of 105 patients in the low probability group and two (3%) of 64 of patients in the high probability group. A nomogram for easy application of the score in daily practice was created. INTERPRETATION: A prediction tool for giant cell arteritis (the HAS-GCA score), combining SGCAPS and the halo count, reliably confirms and excludes giant cell arteritis from giant cell arteritis mimics in fast-track clinics. These findings require confirmation in an independent, multicentre study. FUNDING: Royal College of Physicians of Ireland, FOREUM.
Assuntos
Arterite de Células Gigantes , Ultrassonografia , Arterite de Células Gigantes/diagnóstico por imagem , Humanos , Feminino , Idoso , Masculino , Estudos Prospectivos , Ultrassonografia/métodos , Reprodutibilidade dos Testes , Artérias Temporais/diagnóstico por imagem , Artérias Temporais/patologia , Idoso de 80 Anos ou mais , Artéria Axilar/diagnóstico por imagem , Pessoa de Meia-Idade , Valor Preditivo dos TestesRESUMO
BACKGROUND: Transcatheter Aortic Valve Replacement (TAVR) is the treatment of choice in patients with severe aortic stenosis. Transcarotid (TCa) or Trans-axillary/subclavian (TAx/Sc) are safer and less invasive non-femoral approaches, where transfemoral access is difficult or impossible to obtain. METHODS: This meta-analysis was performed based on PRISMA guidelines after registering in PROSPERO (CRD42023482842). This meta-analysis was performed to compare the safety of the transcarotid and trans-axillary/subclavian approach for TAVR including studies from inception to October 2023. RESULTS: Seven studies with a total of 6227 patients were included in the analysis (TCa: 2566; TAx/Sc: 3661). Transcarotid TAVR approach had a favorable trend for composite of stroke and all-cause mortality (OR 0.79, CI 0.60-1.04), all-cause mortality, stroke, major vascular complication, and new requirement of permanent pacemaker though those were statistically insignificant. On sub-analysis of the results of the studies based on the territory (USA vs French), composite outcome of all cause mortality, stroke and major bleeding (OR 0.54, CI 0.54-0.81), composite of stroke and all cause mortality (OR 0.64, CI 0.50-0.81), and stroke/TIA (OR 0.53, CI 0.39-0.73) showed lower odds of occurrence among patient managed with TCa approach in the American cohort. CONCLUSION: Overall, transcarotid approach had favorable though statistically insignificant odds for composite (stroke and all-cause mortality) and individual outcomes (stroke, all-cause mortality, etc.). There are significant variations in observed outcomes based on study's geographic location. Large prospective randomized clinical trials comparing the two approaches with representative samples are necessary to guide the clinicians in choosing among these approaches.
Assuntos
Estenose da Valva Aórtica , Artéria Axilar , Artéria Subclávia , Substituição da Valva Aórtica Transcateter , Humanos , Substituição da Valva Aórtica Transcateter/métodos , Substituição da Valva Aórtica Transcateter/efeitos adversos , Estenose da Valva Aórtica/cirurgia , Artéria Subclávia/cirurgia , Artérias Carótidas/cirurgia , Resultado do Tratamento , Valva Aórtica/cirurgia , Complicações Pós-Operatórias/epidemiologiaRESUMO
BACKGROUND: Research comparing the effectiveness of central aortic cannulation to axillary artery cannulation in repairing acute type A aortic dissection is limited and controversial. This meta-analysis aimed to compare early outcomes of central aortic cannulation versus axillary artery cannulation for surgery for acute aortic dissection type A. METHODS: A comprehensive systematic search was conducted across PubMed/MEDLINE, Scopus, and the Cochrane Central Register of Controlled Trials up to September 1, 2023. The primary endpoints were operative mortality and incidence of postoperative stroke. Secondary endpoints encompassed cardiopulmonary bypass time, myocardial ischemic time, hypothermic circulatory arrest time, postoperative temporary neurological dysfunction, combination of stroke and temporary neurological dysfunction, as well as the need for reexploration for bleeding, renal replacement therapy, and tracheotomy. A random-effect model was utilized to calculate the pooled effect size. RESULTS: Eleven studies met our eligibility criteria, enrolling a total of 7204 patients (2760 underwent aortic cannulation and 4444 underwent axillary cannulation). The operative mortality and incidence of postoperative stroke did not show statistical differences between the two groups, with a pooled odds ratio of 1.07 (95% confidence interval: 0.73-1.55) and 1.17 (0.95-1.42), respectively. Similarly, none of the secondary endpoints exhibited significant statistical differences between the two groups. CONCLUSIONS: Aortic cannulation can be a viable alternative to axillary artery cannulation for repair of acute aortic dissection type A, as both approaches present similar early clinical outcomes.
Assuntos
Aneurisma Aórtico , Dissecção Aórtica , Artéria Axilar , Cateterismo Periférico , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença Aguda , Aorta/cirurgia , Aneurisma Aórtico/cirurgia , Aneurisma Aórtico/mortalidade , Aneurisma Aórtico/diagnóstico por imagem , Dissecção Aórtica/cirurgia , Dissecção Aórtica/mortalidade , Dissecção Aórtica/diagnóstico por imagem , Artéria Axilar/cirurgia , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/mortalidade , Cateterismo Periférico/efeitos adversos , Cateterismo Periférico/mortalidade , Medição de Risco , Fatores de Risco , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/mortalidade , Fatores de Tempo , Resultado do TratamentoRESUMO
Temporary mechanical circulatory support is a treatment of choice for patients in severe cardiogenic shock. Combining veno-arterial extracorporeal life support (ECLS) with devices that enable left ventricular unloading emerges as a promising strategy to diminish detrimental effect of elevated left ventricular afterload and to improve survival. However, the need to establish multiple arterial access sites remains a major drawback of this approach due to a significant rate of vascular complications. We describe herein a case of a single arterial access for ECLS and intra-aortic balloon pump using axillary artery that may provide a simple, modular and flexible approach for escalation or de-escalation of mechanical circulatory support.
Assuntos
Oxigenação por Membrana Extracorpórea , Coração Auxiliar , Humanos , Choque Cardiogênico/cirurgia , Choque Cardiogênico/etiologia , Oxigenação por Membrana Extracorpórea/métodos , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Artéria Axilar , Balão Intra-Aórtico/efeitos adversos , Coração Auxiliar/efeitos adversosRESUMO
BACKGROUND: Use of alternate access for complex neonatal interventions has gained acceptance with carotid and axillary artery access being used for ductal and aortic interventions. METHODS: This study was a retrospective, single-center study at Cincinnati Children's Hospital Medical Center. The study included infants, aged ≤90 days, who underwent cardiac catheterization with either carotid or axillary artery access between 2013 and 2022. Data encompassing demographics, clinical information, catheterization data, and the incidence of pseudoaneurysm as a procedural complication were collected. RESULTS: Among 29 young infants (20 males, 69%), 4 out of 15 patients (27%) who underwent the carotid approach developed pseudoaneurysms, while 1 out of 14 patients (7.1%) who underwent the axillary approach developed one. Two patients required transcatheter intervention due to enlargement of pseudoaneurysms, involving the placement of transarterial flow-diverting stent and occlusion of left common carotid artery. Longer sheath in-to-out time (135 vs. 77 min, p = 0.001), and higher closing activated clotting times (ACT) (268 vs. 197 s, p = 0.021) were observed among patients with pseudoaneurysms compared to those without. CONCLUSIONS: Young infants with alternative access via the carotid and axillary arteries may be at risk of pseudoaneurysm formation during longer procedures and with higher ACTs for closure. Ultrasound-guided compression can be employed to prevent the progression and in resolution of these lesions.
Assuntos
Falso Aneurisma , Masculino , Recém-Nascido , Lactente , Criança , Humanos , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/epidemiologia , Falso Aneurisma/etiologia , Artéria Axilar/diagnóstico por imagem , Estudos Retrospectivos , Incidência , Resultado do Tratamento , Cateterismo Cardíaco/efeitos adversos , Cateterismo Cardíaco/métodos , Fatores de Risco , Artéria FemoralRESUMO
OBJECTIVE: Traumatic axillary and subclavian artery injuries are uncommon. Limited data are available regarding patient and injury characteristics, as well as management strategies and outcomes. METHODS: Retrospective chart review was performed on patients presenting to University of Louisville Hospital, an urban Level One Trauma Center, with traumatic axillary and subclavian artery injuries from 2015-2021. Patients were identified using University of Louisville trauma, radiology, and billing database searches based on ICD9/10 codes for axillary and subclavian artery injuries. Descriptive statistics are expressed as frequencies and percentages. Comparisons were performed using Fisher's Exact and Chi-squared tests. RESULTS: Forty-four patients with traumatic axillary-subclavian arterial injuries were identified for analysis. Blunt and penetrating trauma were equally represented (n = 22 for both). A variety of injury types were seen, including minimal/intimal injury, laceration, pseudoaneurysm, transection, occlusion, and arteriovenous fistula. Management strategies were also variable, including non-operative, endovascular, planned hybrid, open, and endovascular converted to open. In operative patients, revascularization technical success was high (n = 31, 97%) with low likelihood of thrombosis (n = 2, 6%) and no infections. Among all patients, amputation rate was 5% (n = 2) and mortality rate was 9% (n = 3). Regarding arterial involvement, blunt injury was more likely to affect the subclavian (n = 18) than the axillary artery (n = 6) (P = .04). No significant difference was seen in brachial plexus injury based on artery involved (subclavian = 9 vs axillary = 11, P = .14) or mechanism (blunt = 6 vs penetrating = 11, P = .22). Non-operative management was more likely with subclavian artery injury (n = 11) vs axillary artery injury (n = 1) (P = .008). There was no significant difference between decision for non-operative (blunt = 9, penetrating = 3) vs operative (blunt = 13, penetrating = 19) management based on mechanism (P = .09). Transection injury was associated with an open repair strategy (endovascular/hybrid = 1, open/endovascular to open conversion = 11, P = .0003). Of the three patients requiring endovascular to open conversion, two required amputation, which were the only two patients in the study undergoing amputation. CONCLUSIONS: Both open and endovascular/hybrid strategies are useful when treating traumatic axillary and subclavian artery injuries and are associated with high likelihood of revascularization technical success, with low rates of thrombosis or infection, when treated promptly at a trauma center with vascular specialists available. Transection injuries were most often treated with open revascularization. Patients undergoing amputation had blunt transection injuries to the subclavian artery and underwent endovascular to open conversion after failed attempts at endovascular revascularization.
Assuntos
Amputação Cirúrgica , Artéria Axilar , Procedimentos Endovasculares , Artéria Subclávia , Centros de Traumatologia , Lesões do Sistema Vascular , Ferimentos não Penetrantes , Ferimentos Penetrantes , Humanos , Artéria Subclávia/lesões , Artéria Subclávia/cirurgia , Artéria Subclávia/diagnóstico por imagem , Lesões do Sistema Vascular/cirurgia , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/mortalidade , Lesões do Sistema Vascular/terapia , Lesões do Sistema Vascular/epidemiologia , Estudos Retrospectivos , Masculino , Artéria Axilar/lesões , Artéria Axilar/cirurgia , Artéria Axilar/diagnóstico por imagem , Feminino , Adulto , Pessoa de Meia-Idade , Resultado do Tratamento , Ferimentos Penetrantes/cirurgia , Ferimentos Penetrantes/mortalidade , Ferimentos Penetrantes/terapia , Procedimentos Endovasculares/efeitos adversos , Ferimentos não Penetrantes/cirurgia , Ferimentos não Penetrantes/terapia , Ferimentos não Penetrantes/diagnóstico por imagem , Ferimentos não Penetrantes/mortalidade , Adulto Jovem , Fatores de Risco , Salvamento de Membro , Hospitais Urbanos , Fatores de Tempo , Idoso , Adolescente , Bases de Dados FactuaisRESUMO
Percutaneous transaxillary approach (PTAX) through the first segment of the axillary artery is not widely recognized as a safe method. Furthermore, PTAX has never been directly compared between Impella-supported percutaneous coronary interventions (Impella-PCI) and transcatheter aortic valve replacement (TAVR). This study evaluated the feasibility and safety of PTAX through the first axillary segment in Impella-PCI versus TAVR. In cases where standard imaging guidance was insufficient, a technique involving puncturing the axillary artery "on-the-balloon" was employed. The endpoints were bleeding and vascular complications, as defined by BARC and VARC-3 criteria. PTAX was successfully performed in all 46 attempted cases: 23 for Impella-PCI and 23 for TAVR. Strict adherence to BARC and VARC-3 criteria led to the frequent identification of major bleeding (57%) and a moderately frequent diagnosis of vascular complications (17%). These incidences were primarily based on post-procedural hemoglobin reduction (> 3 g/dl) but not overt bleeding. The Impella group exhibited a higher rate of BARC 3b bleeding due to a greater hemoglobin decline resulting from the prolonged implant duration and PCI itself. Left axillary access was linked to smaller blood loss. Bleeding and vascular complications, as per BARC and VARC-3 definitions, did not affect short-term prognosis, with only 3 Impella patients succumbing to heart failure unrelated to the procedures during one-month follow-up period.