Direct puncture versus contralateral femoral artery approach for catheter-directed thrombolysis of occluded infra-inguinal arterial bypass grafts.

AIM: To compare the safety, effectiveness, and clinical outcome of percutaneous direct puncture approach versus contralateral femoral native vessel approach for catheter-directed thrombolysis of occluded infra-inguinal bypass grafts. MATERIALS AND METHODS: A retrospective analysis was performed comprising a cohort of patients who underwent catheter-directed thrombolysis procedures of occluded infra-inguinal bypass grafts between January 2013 and January 2022, with a follow-up period until June 2022. This included 55 procedures via the native vessel approach and 18 procedures via the direct puncture approach. Primary outcomes were technical success and procedural safety; secondary outcomes included re-intervention rate, limb salvage, and mortality as assessed by log-rank testing and Kaplan-Meier curves. RESULTS: There were no differences between the two groups with regard to patient demographics, except for the number of previous vascular procedures (n=6.83 ± 3.07 direct approach versus n=4.96 ± 2.79 native vessel approach, p=0.025). Thrombolysis was comparably successful in both groups (n=13/18; 72% direct approach versus n=42/55; 76%, p=0.723). There were no differences in the duration of thrombolysis administration. The rate of adverse events was slightly lower in the direct approach group, but without significance (p=0.092). There were no adverse events related to the puncture site in the direct approach group. No differences were found between the time-to-event values for re-occlusion, re-intervention, amputation, or mortality respectively (p=0.662; p=0.520; p=0.816; p=0.462). CONCLUSION: The direct puncture approach seems to be a safe and efficient approach for catheter-directed thrombolysis procedures in infra-inguinal occluded bypass grafts, with clinical outcomes comparable to the native vessel approach.

On the optimisation of the bed porosity and the particle shape of ordered chromatographic separation media.

We report on a theoretical study wherein we considered a large number of ordered two-dimensional porous pillar arrays with different pillar shapes and widely varying external porosity and calculated the flow resistance and the band broadening (under retentive conditions) over the complete range of practical velocities using a commercial computational fluid dynamics software package. It is found that the performance of the small porosity systems is very sensitive to the exact pillar shape, whereas this difference gradually disappears with increasing porosity. The obtained separation impedances are very small in comparison to packed bed and monolithic columns and decrease with increasing porosity. If accounting for the current micromachining limitations, a proper selection of the exact shape and porosity even becomes more critical, and different design rules are obtained depending on whether porous or non-porous pillars are considered.

Influence of the pillar shape on the band broadening and the separation impedance of perfectly ordered 2-D porous chromatographic media.

We report on a computational study assessing the effect of the pillar shape in perfectly ordered porous chromatographic media. Using computational fluid dynamics to compare the band broadening and flow resistance characteristics of a large number of different pillar shapes, it is found that the most axially elongated shapes yield the best chromatographic performance and that diamonds are to be preferred over ellipsoids. The former pack into a more uniform pore space and display a smaller C(s) value, whereas the latter pack into a locally constricted pore space and therefore generate a considerably larger flow resistance. For the presently considered case of a densely packed array (epsilon = 0.4), changing the pillar shape from a cylinder to a more elongated diamond, for example, reduces the minimal plate heights from h(min) = 0.84 to h(min) = 0.72, the C factor from C = 0.062 to C = 0.050, and the separation impedance from E(min) = 330 to E(min) = 220, without affecting the number of interchannel coupling points.

Computational study of the band broadening in two-dimensional etched packed bed columns for on-chip high-performance liquid chromatography.

The chromatographic performance of several straightforward two-dimensional etched packed bed column lay-outs (equilaterally staggered arrays of, respectively, circular, hexagonal, and diamond-like pillars) has been compared using commercial computational fluid dynamics software. In all cases, the bed porosity was kept at epsilon = 0.4 and a retained component with zone capacity ratio k" = 2 was considered. Exploring the use of six different possible characteristic dimensions to bring the Van Deemter plots of the three different considered particle shapes into agreement, none of them yielded a perfect agreement. Using the pillar volume-based equivalent cylinder diameter (deq) as the characteristic dimension, the diamond-like pillars yielded a significantly smaller h(min) value than the cylinders and the hexagons (h(min) approximately equal to 0.74 for the former versus h(min) approximately equal to 0.83 for the two latter). Including the flow resistance into the analysis, it was found that the "hydrodynamic" shape of the particles has an important influence on the separation impedance E. The more axially elongated diamond pillars yielded an Emin number as small Emin = 180 (for a retained component with k" = 2), i.e. about 40% smaller than the cylinders and the hexagons (Emin = 300-330). The obtained h(min) and Emin values are also significantly smaller than the values often cited for the best possible packed bed HPLC columns. We believe this is a consequence of the assumed perfect homogeneity of the etched structures, and hence hints at the potential benefits of perfectly ordered chromatographic columns, as was already inferred by Knox [J. Chromatogr. A 831 (1999) 3; 960 (2002) 7] and He et al. [Anal. Chem. 70 (1998) 3790].