The risk factors for puncture site bleeding after transfemoral artery puncture intervention:a meta-analysis / 介入放射学杂志

Objective To explore the risk factors for bleeding at the puncture site after femoral artery puncture intervention.Methods A computerized retrieval of observation studies,including cross-sectional studies,case-control studies,and cohort studies,about the risk factors for bleeding at the puncture site after femoral artery puncture intervention from the databases of China National Knowledge Infrastructure(CNKI),Wanfang,VIP,China Biomedical Literature Service(CBM),PubMed,Medline,The Cochrane Library,EMbase and Web of Science was conducted.The retrieval time period was from the establishment of the database to December 31,2022.Newcastle-Ottawa scale(NOS)was used to evaluate the quality of the included studies,and RevMan5.3 software was used to make meta-analysis of the literature data.Results A total of 8 articles with a total sample size of 35 250 patients were included in this analysis.There were 1 410 patients in the postoperative bleeding group and 33 840 patients in the non-bleeding group.The results of the meta-analysis showed that the aged(OR=2.71,95％ CI=2.17-3.38),female(OR=4.26,95％ CI=1.08-16.89),hypertension(OR=2.48,95％CI=1.69-3.63),obesity(OR=2.33,95％ CI=1.59-3.42),use of thrombolytic agents,anticoagulants or platelet antagonists(OR=2.95,95％ CI=2.24-3.89),manual compression(OR=6.78,95％ CI=1.34-34.43)were the risk factors for the bleeding at the puncture site after femoral artery puncture intervention.Conclusion The aged,female,hypertension,obesity,use of thrombolytic agents,anticoagulants or platelet antagonists,and manual compression are the risk factors for the bleeding at the puncture site after femoral artery puncture intervention.(J Intervent Radiol,2024,33:314-320)

Vascular suture, closure and occlusion devices at femoral artery puncture hemostasis after neuro-intervention: a clinical comparative study / 中华放射学杂志

Methods:From February 2018 to January 2022, the clinical data of 1 123 patients who underwent Starclose vascular closure device, Angio-Seal and Exoseal vascular occlusion devices and Perclose ProGlide vascular suture device at femoral artery puncture hemostasis after neuro-intervention, in the Department of Interventional Radiology (Eastern District), The First Affiliated Hospital of Zhengzhou University, were retrospectively analyzed. The patients were divided into three groups based on the intervention method: the closure group (Starclose, n=271), the occlusion group (Angio-Seal, n=327 and Exoseal, n=352) and the suture group (ProGlide, n=173). Next, the hemostatic efficacy and complications associated with the three devices were analyzed and compared. Additionally, regression analysis was conducted to identify any relevant factors that may contribute to complications. Results:Three vascular hemostatic devices demonstrated effective hemostasis and the success rate were 92.6% in the closure group (Starclose), 93.4% in the occlusion group (Angio-Seal 93.0% and Exoseal 93.8%) and 89.6% in the suture group (ProGlide). There was no statistically significant difference( χ2=3.026, P=0.388). Single or multiple complications were observed in 102 patients (9.1%), including local oozing (16 cases in the closure group, 39 cases in the occlusion group, 13 cases in the suture group), local hematoma (14 cases in the closure group, 31 cases in the occlusion group, 11 cases in the suture group), pseudoaneurysm (13 cases in the closure group, 35 cases in the occlusion group, 10 cases in the suture group), local infection (2 cases in the closure group, 3 cases in the occlusion group, 1 case in the suture group). There were no statistically significant differences ( P>0.05). Moreover, serious complications such as femoral artery occlusion, embolus shedding and permanent nerve injury weren′t observed in the three groups. Multivariate logistic regression analysis revealed that overweight ( OR=1.562,95% CI 1.023—2.385, P=0.039), femoral artery with calcified plaque ( OR=1.934,95% CI 1.172-3.189, P=0.010), combined use of multiple antiplatelet drugs ( OR=1.769,95% CI 1.103—2.839, P=0.018), use of an 8F sheath( OR=2.824,95% CI 1.406—5.671, P=0.004) and the operator′s proficiency ( OR=0.508,95% CI 0.328—0.788, P=0.002) were the independent factors influencing complications, of which the first four were identified as risk-promoting factors for complications while the operator′s rich experience and high proficiency were the protective factors. Conclusions:Three hemostatic devices demonstrate effective hemostasis and comparable rates of complications at femoral artery puncture hemostasis after neuro-intervention. Overweight, femoral artery with calcified plaque, combined use of multiple antiplatelet drugs, use of an 8 F sheath and the operator′s proficiency were independent factors influencing complications.Ojective:To investigate the efficacy and complications associated with vascular suture, closure and occlusion devices at femoral artery puncture hemostasis after neuro-intervention.

Analysis of the experience and procedural complications of trans-radial access versus trans-femoral access for hepatic arterial perfusion chemotherapy in patients with advanced hepatic malignancies:a retrospective study / 中华内科杂志

Objective:To analyze the differences between trans-radial access (TRA) and trans-femoral access (TFA) in hepatic arterial perfusion chemotherapy (HAIC) in terms of patient experience, postoperative complications, and patient preferences; explore whether TRA in HAIC is associated with better patient experience and compliance; and determine whether it is safer than TFA.Methods:The study was a retrospective cohort study of patients with advanced hepatocellular carcinoma and liver metastases from colorectal cancer treated with HAIC. We enrolled a total of 91 patients with advanced liver malignancies treated with HAIC from November 2022 to May 2023 in the Department of Interventional Therapy and Hepatobiliary Medicine at Tianjin Medical University Cancer Hospital. The patients were divided into three groups: group TRA ( n=20, receiving TRA HAIC only), group TFA ( n=33, receiving TFA HAIC only), and crossover group [ n=19, receiving TFA HAIC (Cross-TFA group) first, followed by TRA HAIC (Cross-TRA group)]. Meanwhile, to facilitate the expression of partial results, all patients receiving TRA HAIC were defined as the TRA-HAIC group ( n=39, TRA+Cross-TRA group), and all patients receiving TFA HAIC were defined as the TFA-HAIC group ( n=52, TFA+Cross-TFA group). The primary research index was the Quality of Life (QOL) visualization scale score. The secondary research index included approach-related and catheter-related adverse events, duration of surgery, and mean length of patient stay. We used various statistical methods such as Mann-Whitney U test, t-test, Chi-square test, Fisher′s exact test, univariate logistic regression analysis, and multi-factor analysis. Results:TRA patients had significantly lower QOL scores than TFA patients (all P<0.001). The QOL scores of the Cross-TRA group were significantly lower than those of the Cross-TFA group (pain at the puncture site Z=-3.24, P=0.001, others P<0.001). The QOL scores of the Cross-TRA group were compared with those of the TRA group, which showed that the scores of the Cross-TRA group in overall discomfort ( Z=-3.07, P=0.002), postoperative toilet difficulty ( Z=-2.12, P=0.034), and walking difficulty ( Z=-2.58, P=0.010) were significantly lower than those of the TRA group. Satisfaction scores were significantly higher in the Cross-TRA group than in the Cross-TFA group ( Z=-3.78, P<0.001), and patients were more likely to receive TRA HAIC as the next procedure ( χ2=30.42, P<0.001). In terms of mean length of stay, patients receiving TRA HAIC had a significantly lower mean length of stay than those receiving TFA HAIC (50.1±3.2 h vs. 58.4±6.4 h, t=7.98, P<0.001). The incidence of radial artery occlusion (RAO) as an approach-related adverse event was 15.4% (6/39) in the TRA-HAIC group, which was significantly higher than that in the TFA-HAIC group (15.4% vs. 0, χ2=8.56, P=0.005). Notably, multifactorial analysis of RAO-related factors showed that intraoperative enoxaparin use and patency of radial artery flow during pressure were significantly associated with a reduced risk of postoperative RAO ( P=0.037 for enoxaparin use and P=0.049 for pressure). Conclusions:With respect to procedure approach, TRA was significantly better than TFA in terms of patient satisfaction and mean length of stay. Through further process optimization and prevention of adverse reactions, the incidence of adverse reactions can be maintained at a relatively low level, so that patients can benefit from TRA in future operations in terms of cost-effectiveness and medical efficiency.

Bilateral high origin and superficial trajectory of the deep femoral artery: clinical and applied anatomy

ABSTRACT The anatomy of the femoral triangle is explored in various approaches, ranging from pulse verification to invasive catheterization procedures. Within the femoral triangle, the deep femoral artery is one of the vessels reported to present several anatomical variations that must be considered before clinical or surgical interventions. Here, we are reporting a unique bilateral variation of the deep femoral artery for medical education purposes and reflecting on its applied, surgical, and clinical anatomy. During the dissection of the femoral triangle, we observed that the deep femoral artery originated in the vicinity of the inguinal ligament and ran in parallel with the femoral artery in a superficial trajectory on both sides of the donor. On the right side, the DFA continued superficial for 8.8 cm, with an origin of 1.2 cm inferior to the inguinal ligament. On the left side, it presented a similar anatomical arrangement, though with an origin of 1.6cm inferior to the inguinal ligament and a superficial course of 5cm. The position of the lateral circumflex femoral vein posterior to the deep femoral artery played a role in this distinctive, lengthy, and superficial presentation of the deep femoral artery. This anatomical variation directly affects surgical procedures, diagnostics, and endovascular interventions. A deep femoral artery with such a lengthy superficial trajectory can be mistakenly used for catheterization instead of the femoral artery or be injured, disrupting the main blood supply of the thigh muscles.

Pseudoaneurysm due to femoral artery puncture: a review

The femoral artery is the most used percutaneous access site for different endovascular therapeutic options, this being an excellent anatomical site to achieve adequate compression after its puncture, which frequently makes it the site with the highest incidence of complications associated with posterior to arterial puncture. The most frequent complications related to arterial puncture are: hematoma, pseudoaneurysm, retroperitoneal hematoma, and arterial occlusion. The pseudoaneurysm is defined as the interruption in the wall of the artery, product of the lesion of the wall, which causes blood leakage towards the surrounding tissues, remaining contained in a fibrin sac, therefore, the importance of an adequate diagnosis and treatment lies above all in the high risk of rupture or thromboembolism.

Reconstruction of large soft tissue defects in lower limbs with bilateral anteriolateral thigh perforator flaps pedicled with descending branch of lateral circumflex femoral artery in series / 中华显微外科杂志

Objective:To investigate the clinical effect of bilateral anteriolateral thigh perforator flaps (ALTPF) pedicled with descending branch of lateral circumflex femoral artery in series on reconstruction of large soft tissue defects in lower limbs.Methods:A total of 9 patients with large soft tissue defects in lower limbs were selected in the study. The patients were 6 males and 3 females aged between 18 and 57 years old. They were treated in the Department of Hand and Foot Microsurgery, the Affiliated Hospital of Qingdao University from June 2018 to January 2023. Causes of injury: 4 of traffic accident, 2 of crushing, 2 of falling from height and 1 of explosion. Five patients had combined defects in dorsal feet and 4 with tibia fractures and anterior-and-posterior-tibial soft tissue defects. All affected limbs had tissue necroses and infections in various degrees. Deep tissue defects such as tendons, nerves, bones and joints or orthopaedic implants were exposed. The areas of soft tissue defects were 30 cm×14 cm-42 cm×14 cm. All the defects were reconstructed by the bilateral ALTPF pedicled with descending branch of lateral circumflex femoral artery in series. The size of proximal flaps was 25 cm×8 cm-33 cm×13 cm and 20 cm×7 cm-29 cm×13 cm for the distal flaps. Scheduled postoperative follow-ups were conducted to observe the survival of the transferred flaps and functional recovery of calfs and feet. Sensory recovery was assessed against British Medical Research Council (BMRC) criteria. Puno scoring was used to assess the functional recovery and the effectiveness of treatment.Results:All flaps survived and the donor sites healed well. One patient developed vascular compromise within 24 hours after surgery, but it was rectified after timely surgical exploration, however it left with a small area of necrosis at distal end of the flap. The necrosis and wound healed after skin grafting in stage-two surgery. Postoperative follow-up lasted for 8.3 months in average. Two patients underwent flap thinning in stage-two surgery due to bloating appearance, 2 patients had slightly bloated flaps at the calfs, and the rest of 5 patients had satisfactory flap appearance. Two patients received nerve reconstruction by anastomosis of the lateral femoral cutaneous nerves. At the final follow-up, the sensory recovery in 9 patients achieved S 2-S 3+ according to BMRC. The average Puno score achieved 88.36 point±5.36 point, of which 4 patients in excellent, 3 in good and 2 in fair. Conclusion:The use of bilateral ALTPF pedicled with descending branch of lateral circumflex femoral artery in series to reconstruct a large soft tissue defect in lower extremity has a good clinical value, and it has become one of the effective methods.

Paclitaxel drug-coated balloons combined with bare metal stents vs. bare metal stents for the treatment of superficial femoral atherosclerosis obliterans / 中华普通外科杂志

Objective:To compare the efficacy and safety of drug-coated balloons (DCB) combined with bare metal stents (BMS) and BMS only for superficial femoral atherosclerosis obliterans.Methods:The clinical and follow-up data of 80 patients (82 limbs) who received combined treatment or BMS implantation at Cardiovascular Surgery Department of China Japan Friendship Hospital from Jan 2017 to Aug 2022 were retrospectively analyzed.Results:43 patients (43 limbs) were included in combined treatment group. 37 patients (39 limbs) were in BMS only. The average lesion length of combined group was longer than BMS group (19.54±7.04 cm vs. 16.25±6.43 cm, P=0.031). The primary patency rate of combined group at 36 months was not statistically different with BMS only group (56.9% vs. 38.5%, P=0.171). The subgroup analysis of superficial femoral artery TASC C/D (Trans-Atlantic Inter-Society Consensus) and CTO (chronic total occlusion) lesions indicated that efficacy of the combined group was superior to BMS only group. The patency rates of the combined group compared with the BMS group at 36 months were 57.6% vs. 23.8%, P=0.046, 60.2% vs. 31.4%, P=0.028, respectively. There was no significant difference in the FCD-TLR (free from clinical driven target lesion revascularization) between the two groups at 36 months (72.6% vs. 66.5%, P=0.706). There was no significant difference in major adverse events between the two groups ( P>0.05). Conclusion:Paclitaxel drug-coated balloon combined with bare metal stent is a safe and effective treatment for superficial femoral atherosclerosis obliterans, which is superior to bare metal stent, especially in TASC C/D and chronic total occlusive lesions.

Vascular pressurisation and super-reflux techniques applied in free anterolateral thigh flap / 中华显微外科杂志

Objective:To investigate the clinical effect of vascular pressurisation and super reflux on free anterolateral thigh flap (ALTF).Methods:From January 2017 to September 2021, the Department of Hand and Foot Microsurgery, the Second Affiliated Hospital of Hainan Medical College had treated 31 cases of soft tissue defects of the limbs. The patients were 23 males and 8 females, aged 4-76 years old at 40 years old in average. All the patients received transfer of free ALTFs carrying 2 groups of blood vessels of the descending and oblique branches of lateral circumflex femoral artery (LCFA). The vascular pressurisation and super-reflux techniques were applied in wound repair. Soft tissue defect area 7 cm × 5 cm-22 cm × 10 cm. The sizes of flaps were 8 cm×6 cm-23 cm×11 cm. All the donor sites were sutured directly. Fifteen patients had inner flap pressurisation (or super-reflux) and the rest of 16 patients had external flap pressurisation (or super-reflux). After surgery, scheduled follow-ups were conducted through outpatient clinic, telephone and WeChat reviews or home visits to evaluate the efficacy of wound repair.Results:All the 31 flaps survived, except 2 flaps that had mild infection after surgery. The wounds of donor and recipient sites healed completely. The time of follow-up was 3-55 months. The skin of flaps achieved good texture, colour, lustre and appearance. TPD of the flaps ranged 7-12 mm.Conclusion:Vascular pressurisation and super reflux technique are stable and reliable in the clinical application of free ALTF to repair soft tissue defects of limbs.

Clinical efficacy analysis of different interventional approaches for patent ductus arteriosus in children (≤7 years) / 中国胸心血管外科临床杂志

@#Objective    To explore the safety and effectiveness of different interventional approaches for the treatment of patent ductus arteriosus (PDA) in children. Methods    The children (≤7 years) who underwent interventional treatment for PDA from 2019 to 2020 in our hospital were retrospectively included. The patients were divided into 3 groups according to the procedures: a conventional arteriovenous approach group, a simple venous approach group, and a retrograde femoral artery approach group. The clinical efficacy of the patients was compared. Results     A total of 220 patients were included. There were 78 males and 142 females, with an average age of 3.21±1.73 years, weight of 14.99±5.35 kg, and height of 96.19±15.77 cm. The average diameter of the PDA was 3.35±1.34 mm. A total of 85 patients received a conventional arteriovenous approach, 104 patients received a simple venous approach, and 31 patients received a retrograde femoral artery approach. The diameter of PDA in the retrograde femoral artery group was smaller than that in the other two groups (3.44±1.43 mm vs. 1.99±0.55 mm; 3.69±1.17 mm vs. 1.99±0.55 mm, P<0.001); the contrast medium usage [40 (30, 50) mL vs. 20 (20, 30) mL; 35 (25, 50) mL vs. 20 (20, 30) mL, P≤0.001] and operation time [32 (26, 44) min vs. 25 (23, 30) min; 29 (25, 38) min vs. 25 (23, 30) min, P<0.05] in the simple venous approach group were significantly less or shorter than those in the other two groups; the length of hospital stay of the conventional arteriovenous group was longer than that in the other two groups [3 (3, 5) d vs. 4 (3, 6) d; 4 (3, 5) d vs. 4 (3, 6) d, P<0.05]. There was no significant difference in postoperative complications. Conclusion    It is safe and effective to close PDA through simple venous approach. The retrograde femoral artery approach has the advantage of simplifying the surgical procedure for PDA with small diameters.

Comparison of pain levels of traditional radial, distal radial, and transfemoral coronary catheterization

SUMMARY OBJECTIVE: The aim of our study was to compare the traditional radial artery, distal radial artery, and transfemoral artery, which are vascular access sites for coronary angiography, in terms of pain level using the visual analog scale. METHODS: Between April 2021 and May 2022, consecutive patients from three centers were included in our study. A total of 540 patients, 180 from each of the traditional radial artery, distal radial artery , and transfemoral artery groups, were included. The visual analog scale was applied to the patients as soon as they were taken to bed. RESULTS: When the visual analog scale was compared between the groups, it was found to be significantly different (transfemoral artery: 2.7±1.6, traditional radial artery: 3.9±1.9, and distal radial artery: 4.9±2.1, respectively, p<0.001). When the patients were classified as mild, moderate, and severe based on the visual analog scale score, a significant difference was found between the groups in terms of body mass index, process time, access time, and number of punctures (p<0.001). Based on the receiver operating characteristic analysis, body mass index>29.8 kg/m2 predicted severe pain with 72.5% sensitivity and 73.2% specificity [(area under the curve: 0.770, 95%CI: 0.724-0.815, p<0.0001)]. CONCLUSION: In our study, we found that the femoral approach caused less access site pain and a high body mass index predicts severe pain.

A Modified Ascending Aortic Cannulation Technique in Minimally Invasive Totally Thoracoscopic Cardiac Surgery

ABSTRACT Cannulation through the femoral artery is the preferred method of establishing peripheral cardiopulmonary bypass in minimally invasive totally thoracoscopic cardiac surgery. However, faced with the contraindication of femoral artery cannulation, modified ascending aortic cannulation is an alternative approach to minimally invasive totally thoracoscopic cardiac surgery.

Minimal Invasive Thoracoscopic Mitral Valve Surgery

ABSTRACT Introduction: The totally thoracoscopic approach for mitral valve (MV) disease is a minimally invasive method. We investigated the procedure's feasibility, safety and effectiveness when it was performed by an experienced operator. Methods: We retrospectively analysed 96 consecutive patients with MV disease treated between March 2016 and November 2019 by minimally invasive procedures. The procedures were performed on a femoral artery-vein bypass through two ports, including a main operation port and a thoracoscopic port. The clinical data of patients were collected, including preoperative cardiac function, operative data, postoperative complications, and follow-up. Results: A total of 96 patients (57 male patients; average age, 49.7±14.5 years; left ventricular ejection fraction, 65.6±7.7%) were enrolled in this study. No intraoperative conversion incision or death occurred. The cardiopulmonary bypass and aortic cross-clamp times were 163.8±50.6 minutes and 119.7±38.9 minutes, respectively. Postoperative chest tube drainage in the first 24 hours was 232.8±108.1 ml. The ventilation time and length of intensive care unit stay were 13.2±6.2 hours and 2.9±2.2 days, respectively. One patient died of disseminated intravascular coagulation and prosthesis thrombosis 3 days after the operation, fearing anticoagulant-related hemorrhage. The overall success rate of valve repair during 1-year follow-up was 97.9%. Conclusion: The totally thoracoscopic procedure on mitral valves by an experienced surgeon is technically feasible, safe, effective and worthy of widespread adoption in clinical practice.

Aneurisma verdadero aislado en arteria femoral superficial asociado a síndrome del dedo azul / True isolated aneurysm in superficial femoral artery associated with blue finger syndrome

Los aneurismas femorales son raros y más aún en la arteria femoral superficial. Estos representan solo el 3 por ciento de todos los aneurismas periféricos. El objetivo de este trabajo fue presentar el caso de un aneurisma verdadero aislado en arteria femoral superficial asociado a síndrome del dedo azul. Se reporta un paciente masculino de 75 años, fumador, con antecedentes patológicos personales de hipertensión arterial, que llega remitido con urgencia desde su área de salud por presentar cambios de coloración (cianosis), frialdad y dolor en la planta y los dedos del pie derecho (microembolias distales). En la tomografía computarizada contrastada se observó aneurisma aislado en la arteria femoral superficial de 4,5 cm de diámetro transversal. Se decidió operar al paciente y se realizó aneurismectomía con interposición de injerto protésico con politetrafluoroetileno, con una configuración de anastomosis término-terminal. Tuvo una evolución clínica posoperatoria inmediata y tardía satisfactoria. Entre los aneurismas femorales, los que afectan a la arteria femoral superficial están menos descritos y pueden complicarse con trombosis, embolización distal o rotura. Existe un alto consenso para su reparación, al eliminar la fuente embólica, prevenir la trombosis, tratar la rotura, eliminar cualquier efecto de masa y restaurar la perfusión de la extremidad distal. Dado que el síndrome del dedo azul puede ser la primera manifestación de esta enfermedad, su rápido reconocimiento, diagnóstico precoz de la fuente embolígena y tratamiento médico-quirúrgico pueden evitar la amputación mayor o la muerte del paciente(AU)

Femoral aneurysms are rare and even more so in the superficial femoral artery. These account for only 3 percent of all peripheral aneurysms. The objective of this study was to present the case of an true isolated aneurysm in the superficial femoral artery associated with blue finger syndrome. A 75-year-old male patient, smoker, with a personal pathological history of arterial hypertension, is reported to be urgently referred from his health area for presenting changes in coloration (cyanosis), coldness and pain in the sole and toes of the right foot (distal microembolisms). The contrasted computed tomography showed an isolated aneurysm in the superficial femoral artery of 4.5 cm transverse diameter. It was decided to operate on the patient and aneurysmectomy was performed with interposition of prosthetic graft with polytetrafluoroethylene, with a configuration of termino-terminal anastomosis. He had a satisfactory immediate and late postoperative clinical evolution. Among femoral aneurysms, those affecting the superficial femoral artery are less described and can be complicated by thrombosis, distal embolization, or rupture. There is a high consensus for their repair by removing the embolic source, preventing thrombosis, treating rupture, eliminating any mass effects and restoring perfusion of the distal limb. Since blue finger syndrome may be the first manifestation of this pathology, its rapid recognition, early diagnosis of the emboligenic source and medical-surgical treatment can prevent major amputation or death of the patient(AU)

Experimental Evaluation of Chitosan Membrane and Collagen Sponge (TachoSil®) as Sealants in Cardiovascular Surgery

ABSTRACT Introduction: The objectives of this study are to experimentally evaluate the haemostatic effects of two organic substances, a membrane of chitosan and a collagen sponge coated with thrombin and human fibrinogen (TachoSil®), in sealing 7-0 needle stitches holes on the femoral arteries of rats as well as to evaluate local histological reactions. Methods: Twenty-four rats were included, and four holes were made in each common femoral artery. In the control group, haemostasis was achieved only by compression with gauze sponge; and in the two other groups, haemostasis was achieved with application of one of these two substances. Results: Membrane of chitosan and TachoSil® showed a power to reduce the time to achieve haemostasis compared with the control group (P=0.001), and the haemostatic effects of these two substances were comparable. There was lower blood loss in the groups where these two substances were used when compared with the control group, but no difference was found comparing the two substances. Conclusion: The use of these sealants did not promote more adhesion or local histological reactions when compared to the control group. Since chitosan is easy to find in nature, has a positive effect to promote haemostasis, and did not bring considerable local reactions, it might be used as a sealant in cardiovascular surgery.

Anatomical Variations of ProfundaFemoris Artery in Indian Population

Background: Aim: To assess anatomical variations of profundafemoris artery in Indian population.Methods:45 embalmed lower extremities adult human cadavers age range of 30� years were recruited for the study. The femoral triangles were dissected with proper care to identify the profundafemoris and circumflex femoral arteries. Their source of origin, position, and distance were noted with the mid-inguinal point (MIP) as a reference point.Results:Side of profundafemoris artery (PFA) was postero- lateral in 60%, posterior in 30%, lateral in 5% and absent in 5%. Medial circumflex femoral artery (MCFA) had 65%, 15%, 12% and 8% and lateral circumflex femoral artery (LCFA) had 80%, 15%, 5% and 0% respectively. Origin of profundafemoris artery (PFA) was FA in 90% and common trunk with medial circumflex femoral artery in 10%. Origin of Medial circumflex femoral artery (MCFA) was FA in 55%, PFA in 40% and FA with common trunk with MCFA in 5%. Origin of lateral circumflex femoral artery (LCFA) was femoral artery in 70%, PFA in 20% and FA with common trunk with PFA in 10%. A significant difference was observed (P< 0.05).Conclusions:A thorough knowledge of variation of profunda femoral artery is of great importance and to avoid complications.

Eventos clínicos adversos relacionados con el uso del método femoral y método radial en pacientes sometidos a procedimientos de cardiología intervencionista en el Hospital Nacional Hipólito Unanue / Clinical adverse events related to the use of femoral and radial artery access in patients who underwent interventional cardiology procedures in the Hospital Nacional Hipólito Unanue

RESUMEN Objetivo: Determinar cuáles fueron los eventos clínicos adversos relacionados con el uso del método femoral y método radial en pacientes que fueron sometidos a procedimientos de cardiología intervencionista en el Hospital Nacional Hipólito Unanue, durante el periodo 2015-2017. Materiales y métodos: La metodología fue comparativa, retrospectiva, con diseño observacional y analítico. Se trabajó con un total de 151 historias clínicas de pacientes que presentaron eventos clínicos adversos. Se empleó la revisión documental como técnica de recolección de datos, y una ficha de recolección de datos como instrumento, la cual fue diseñada por el investigador. Para realizar el análisis se utilizó el programa R. Resultados: De 151 cateterismos cardiacos, el 51,66 % se realizó por el método femoral y 48,34 %, por el método radial. Con respecto a la edad de los pacientes, el promedio fue 59,6 ±11,3 años; el 39,73 % de ellos estuvo entre el rango de 60 a 70 años; y el 73,50 % fueron pacientes del sexo masculino. En cuanto a las comorbilidades, la hipertensión arterial y la diabetes mellitus fueron las enfermedades más recurrentes entre los pacientes. Se presentaron eventos clínicos adversos relacionados con el uso de ambos métodos de acceso vascular, aunque no se consideraron graves; sin embargo, su incidencia es alta. Para la muestra del método femoral, en 50 % de los casos, se presentó hematoma (25,60 %), hemorragia (9 %), isquemia (1,30 %), reacción vagal (1,30 %), pseudoaneurisma (1,30 %), un caso raro tipo quemadura (1,30 %) y dolor (10,20 %); mientras que, en el método radial, en 19,14 % de los casos, se presentó hematoma (8,21 %), hemorragia (2,73 %), espasmo radial (1,40 %) y dolor (6,80 %). Conclusiones: Después de que se determinó cuáles eran los eventos clínicos adversos, se llegó a la conclusión de que es mejor usar el método radial en vez del método femoral para procedimientos de cardiología intervencionista.

ABSTRACT Objective: To determine the clinical adverse events related to the use of femoral and radial artery access in patients who underwent interventional cardiology procedures in the Hospital Nacional Hipólito Unanue from 2015 to 2017. Materials and methods: A comparative, retrospective, observational and analytical study was conducted with a total of 151 medical records of patients who had clinical adverse events. Medical record review was used as data collection technique, and a data collection sheet designed by the researcher was used as instrument. The R software was used for the analysis. Results: Out of 151 cardiac catheterizations, 51.66 % were performed by a femoral artery access and 48.34 % by a radial artery access. The average age of the patients was 59.6 ± 11.3 years, out of which 39.73 % ranged between 60 and 70 years, and 73.50 % of the patients were males. The most frequent comorbidities were arterial hypertension and diabetes mellitus. Non-serious clinical adverse events occurred as a result of both vascular access procedures; however, their incidence was high. Fifty percent (50%) of the patients who underwent a femoral artery access procedure showed the following adverse events: hematoma (25.60 %), bleeding (9 %), ischemia (1.30 %), vagal response (1.30 %), pseudoaneurysm (1.30 %), a rare skin rash that looked like a burn (1.30 %) and pain (10.20 %). In contrast, 19.14 % of the patients who underwent a radial artery access procedure presented hematoma (8.21 %), bleeding (2.73 %), radial artery spasm (1.40 %) and pain (6.80 %). Conclusions: After determining the clinical adverse events, it was concluded that radial artery access is better than femoral artery access for interventional cardiology procedures.

Repair of multiple defects of foot and ankle with lobulated chimeric perforator flap pedicled with descending branch of lateral femoral circumflex artery: Report of 6 cases / 中华显微外科杂志

Objective:To investigate the clinical effect of lobulated chimeric perforator flap pedicled with descending branch of lateral circumflex femoral artery (d-LCFA) in repair of multiple composite tissue defects of the foot and ankle.Methods:From February 2017 to March 2021, a total of 6 patients with foot and ankle multiple site deficiency injuries were treated in the Department of Hand Surgery, Shenzhen Hospital of Integrated Traditional Chinese and Western Medicine. The area of the soft tissue defect was 14.0 cm×9.0 cm~28.0 cm×9.0 cm. The size of the flap were 15.0 cm×10.0 cm-29.0 cm×10.0 cm. In all the cases, the wounds were complicated with bone defects and different degrees of infection. After primary debridement, VSD was used for continuous lavage and drainage. In the second stage, the defect was repaired with a lobulated chimeric perforator flap of d-LCFA. The colour, texture and sensory recovery of flap were observed in the scheduled postoperative follow-up.Results:All flaps survived smoothly without vascular crisis. After 10-12 months of follow-up, no recurrence of infection was found. The flaps had no pigmentation, soft in texture, with non-bloated appearance, good wear resistance, and recovered part of sensation. According to the British Medical Research Council (BMRC) hand sensory function evaluation standard, the sensation recovered to S 1-S 2. Conclusion:The lobulated chimeric perforator flap pedicled with d-LCFA only requires microanastomosis with 1 vascular pedicle. It simultaneously covers wounds in different depths at multiple sites and is also anti-infective. It is an ideal flap for repairing multi-site composite tissue defects of foot and ankle.

Degradable high purity magnesium screw in fixing the greater trochanter bone flap pedicled with transverse branch of lateral circumflex femoral artery: Treatment of avascular necrosis of femoral head in 12 young and middle-aged patients / 中华显微外科杂志

Objective:To investigate the effect of a degradable high-purity magnesium screw in fixing the greater trochanter bone flap of a lateral circumflex femoral artery transverse branch in the treatment of ischemic necrosis of femoral head in young and middle-aged adults.Methods:From February 2017 to February 2019, 12 cases (15 hips) of young and middle-aged patients with avascular necrosis of femoral head were treated in the Department of Orthopaedic of Affiliated Zhongshan Hospital of Dalian University. The age of patients was 30-53 years old. According to Association Research Circulation Osseous (ARCO), 2 hips were graded in stage II b, 4 in ARCO II c, 1 in ARCO III a, 5 in ARCO III b, 2 in ARCO III c and 1 in ARCO IV. The greater trochanter bone flap with a lateral circumferential vascular branch was used to fill the necrotic area, and fixed by a biodegradable high purity magnesium screw in the bone flap transfer. At 3, 6 and 12 months postoperation, the patient came to the hospital outpatient clinic for follow-up, and then were reviewed once a year. Imaging efficacy was evaluated by comparing preoperative and postoperative imaging. The Harris score and Visual Anoalogue Scale (VAS) score were tested at 12 and 24 months after surgery. The Harris score and VAS score before and after surgery were compared by Friedman test, and P<0.05 was considered statistically significant. Results:All 12 patients (15 hips) were entered in the 24-36 months of follow-up. At 12 and 24 months after surgery, Harris score was found at 87 (86, 92) and 90 (87, 92) respertively, which were both higher than that before surgery [59 (52, 74)] with a significant statistical difference ( Z=-3.743, Z=-4.473, P<0.05). However, there was no significant difference in Harris scores between 12 and 24 months after the surgery ( Z=-0.730, P>0.05). At the 12 and 24 months after surgery, VAS score was found at 3 (2, 3) and 2 (1, 3) respertively, which were both lower than that before surgery [6 (5, 6) ] with a significant statistical difference ( Z=-3.560, Z=-4.656, P<0.05). There was no statistical difference in VAS scores between 12 and 24 months after surgery ( Z=-1.095, P>0.05). X-ray and CT scan showed that the bone flaps healed well and the areas of osteonecrosis were repaired. Thirteen femoral heads were in good shape, and 2 femoral heads had further collapse of hips. No patients underwent joint replacement surgery at the time of last follow-up. Conclusion:Fixation of the greater trochanter flap of lateral circumflex femoral artery transverse branch with a degradable high-purity magnesium screw can ensure the healing of the flap at the implantation site and avoid the displacement and shedding of the flap. It is a new therapeutic option to treat the avascular necrosis of femoral head of young and middle-aged people.

Computer assisted design of lobulated perforator flap based on descending branch of lateral circumflex femoral artery in reconstruction of heel defects / 中华显微外科杂志

Objective:To investigate the feasibility and clinical effect of the computer assisted design of the lobulated perforator flap based on the descending branch of lateral circumflex femoral artery(d-LCFA) to reconstruct the soft tissue defects of heel.Methods:From October 2014 to November 2016, a computer assisted virtual technology was used to simulate the process of pre-operative design, isolation, and harvest of d-LCFA perforating flaps. This method was used to guide the design and harvest of the flap of d-LCFA in the repair of large-area soft tissue defects of the heel in all of the 5 patients. One patient received a combine flap of the d-LCFA flap and the perforating branch of the inferior abdominal artery flap(DIEPF). Heel appearance and function were reconstructed in phase I together with the repair of the defect. Donor site was directly sutured. The recovery effect was followed-up in the clinic.Results:The 3D visualised model of the vessels in the donor area for quadriceps artery was successfully established in all 5 patients, and the design and removal of the perforating flap were successfully guided. All the 10 flaps survived successfully in 5 patients, except 1 patient had a backflow disorder at the distal end of the inferior epigastric artery perforator flap, with partial necrosis and II grafting. After 6 to 12 months of follow-up(mean, 8.7 months), the flap showed good in colour and texture, with satisfactory heel appearance. The donor site was left with a linear scar.Conclusion:Computer assisted design technology can effectively help in the design of the polyfoliate perforator flap pedicled with d-LCFA, using this technique to assist the design and repair of large area soft tissue defect of heel could reconstruct the shape of heel in phase I and restore the function of the heel to the maximum extent.

Analysis of risk factors and construction of prediction a risk score scale of hemorrhagic complications at the puncture site after cerebrovascular intervention with femoral artery access / 中国实用护理杂志

Objective:To analyze the risk factors associated with hemorrhagic complications at the puncture site after femoral artery access cerebrovascular interventions and construct a bleeding risk scale.Methods:Two hundred and fifteen patients who underwent femoral artery puncture interventions in the neurointerventional department ward of the First Affiliated Hospital of Zhengzhou University from April to October 2020 were selected for the study, including 60 cases in the complication group and 155 cases in the control group. The patients′ general data, interventional procedure-related data and laboratory tests were analyzed univariately and then incorporated into a binary multi-factor logistic regression analysis to determine independent risk factors, and a bleeding risk scale was constructed according to the regression model.Results:Compared with the control group, there was a statistically significant increase in the incidence of women, diabetes mellitus, use of glucose-lowering drugs, proportion of (anticoagulant/antiplatelet drugs) use and irritability in the complication group ( χ2 values were 4.94-15.81, all P<0.05); age, BMI, HbA1c, prothrombin time activity, and sheath size and operative time were higher than those of the control group, and prothrombin time and creatinine values were lower than those of the control group, with statistically significant differences ( t values of -6.25 to 2.80, respectively, all P<0.05). Multifactorial logistic regression analysis showed that gender ( OR=0.09, 95% CI 0.025-0.302), BMI ( OR=1.736, 95% CI 1.462-2.115), HbA1c ( OR=1.775, 95% CI 1.107-2.845), and use of anticoagulant/antiplatelet drugs ( OR= 0.082, 95% CI 0.015- 0.448) and time to surgery ( OR=1.031, 95% CI 1.012-1.052) were independent risk factors for bleeding complications. In the risk scale: the total score was -3 to 13, and risk existed for a score ≥5. The sensitivity of this scale was 83.3%, the specificity was 92.3%, and the area under the ROC curve was 0.878 ( P<0.001, 95% CI 0.818 to 0.938). Conclusions:Female, high BMI, high HbA1c, anticoagulant/antiplatelet drug use, and long procedure time can increase the risk of bleeding complications at the femoral artery puncture. The predictive model has good predictive performance and can be extended for use.