Utility of a Suture-Mediated Closure System for Large Bore Arterial Access During Challenging Liver Intra-Arterial Catheters Implantation.

PURPOSE: To describe and study the utility of vascular suture-mediated closure systems for large bore arterial access during challenging implantation of liver intra-arterial catheters taking as a reference the conventional procedure involving patients without challenging anatomy. MATERIALS AND METHODS: Between January 2017 and January 2019, 61 consecutive patients underwent 65 intra-arterial catheter IAC implantations for colorectal cancer. Twenty-three procedures (35%) considered by the operators with challenging coeliac trunk angulations were treated using a vascular suture technique where a 6-F introducer was used, the other patients were treated with a conventional 4F access technique. Clinical and radiological characteristics of patients, technical success (implantation of catheters allowing safe infusion of chemotherapy) and complications (Common Terminology Criteria for Adverse Events, CTCAE 5.0) were recorded. RESULTS: Mean coeliac trunk angulations were 36.3° (± 14.3) for the vascular closure group and 49.6° (± 17.1) for the conventional group. Technical success of the procedures was 100% for the vascular closure group and 80% in the conventional group (p < .05). Four patients with technical failure in the conventional group had a successful IAC implantation on the second attempt using the vascular closure technique. The use of a suture-mediated closure system for large bore arterial access allowed more frequent positioning of the distal tip into the gastro duodenal artery (GDA) (p = .01). No major complication occurred. CONCLUSION: The use of a large bore arterial access combined with a suture-mediated closure system may be useful for challenging IAC implantation without major complications.

Tangential cranial ballistic impact: An illustration of the limitations of post-mortem CT scan?

Post-mortem imaging has become more frequently used in forensic procedures, notably in a ballistic context. Despite many advances in this field, the interpretation of computed tomography (CT) can be a very complex matter. Our case illustrates the difficulties of interpretation after quasi-tangential cranial ballistic impact and keyhole wounds. These wounds are difficult to visualize on CT and are among the factors complicating the precise determination of ballistics. These sources of error remind us that CT findings must be interpreted in close comparison with autopsy findings.