Hydrophilic-coated sheaths increase the success rate of transradial coronary procedures and reduce patient discomfort but do not reduce the occlusion rate: randomized single-blind comparison of coated vs. non-coated sheaths.

OBJECTIVES: To examine the effect of hydrophilic-coated Vs. non-coated sheaths for coronary angiography by transradial access and to determine whether the rate of post-procedural vascular occlusion can be reduced if different sheath diameters are used in accordance with vessel diameters. BACKGROUND: Main complications of the transradial access include spasms, discomfort and occlusion of the radial artery (RA). Coated sheaths have been demonstrated to reduce spasms and discomfort but have not been previously investigated for their potential effect on the occlusion rate. METHODS: A total of 200 consecutive patients were randomized into four groups of 50 patients each. Two study groups were examined with hydrophilic-coated sheaths featuring a caliber of five or six French depending on RA diameters as determined by ultrasound. Two control groups were examined with traditional non-coated sheaths. RA occlusion was the primary endpoint of the study. Secondary endpoints included RA alterations as determined by ultrasound after 4 weeks. Pain intensities during sheath withdrawal were rated on a visual analog scale. RESULTS: Post-procedural occlusion was diagnosed in nine patients of both study groups (9%) and in six patients of both control groups (6%). This difference was not statistically significant (P = 0.42). The same was true of the secondary endpoints (3% Vs. 9%; P = 0.74). However, the pain intensity scores obtained immediately after sheath withdrawal were significantly lower in the patients treated with coated sheaths (1.4 Vs. 2.7; P < 0.0001). CONCLUSIONS: Hydrophilic-coated sheaths for transradial access will reduce patient discomfort but do not involve fewer cases of occlusion than traditional non-coated sheaths.

Mycotic aneurysms affecting both lower legs of a patient with Candida endocarditis--endovascular therapy and open vascular surgery.

The purpose of this study was to report the endovascular and open surgery treatment of Candida-associated mycotic aneurysms in both lower limbs. A 53-year-old patient suffering from Candida endocarditis following aortic valve replacement developed mycotic aneurysms in both lower limbs. The angiography revealed a large aneurysm of the tibioperoneal trunk affecting the right leg. In the left leg, sacculation had developed in section III of the popliteal artery. The right aneurysm was obliterated by embolization with coils. On the left side, the large aneurysm of the popliteal artery was resected; vascular continuity was re-established by interposing a segment of the patient's greater saphenous vein. The postoperative course was uneventful. Mycotic aneurysm is a rare disease. A site in the crural vessels is regarded as exceptionally seldom. To our knowledge, no Candida-associated mycotic aneurysm has been described in this region before. Both endovascular treatment and open surgery proved to be successful.

Transient occlusion of an Angioguard protection system by massive embolization during angioplasty of a degenerated aortocoronary saphenous vein graft.

Distal embolization is the most important complication of balloon dilatation of degenerated saphenous vein grafts. We describe a case of massive embolization associated with transient occlusion in which larger distal embolization and myocardial infarction were avoided despite transient but complete occlusion of a filter protection system (Angioguard).