Jul 2026· Journal of Vascular Surgery· 0 citations· 12 references
Medicine
TL;DR
MA was routinely performed in elective pEVAR and best practices in radiation safety were rarely achieved with a high rate of direct operator exposure to the beam of radiation, suggesting that best practices in radiation safety are rarely achieved in MA.
Abstract
Objective
Microcatheter angiography (MA) is often performed immediately following access of the common femoral artery using a 4 French micropuncture sheath directly attached to a 10 cubic centimeter (cc) syringe to evaluate the suitability of iliofemoral access. It can also be performed at the end of an operation to assess for access-related complications in procedures requiring large bore (≥12 French) percutaneous access. The operator's hands are particularly vulnerable in MA and we hypothesize that best practices in radiation safety are rarely achieved in MA.
Methods
A retrospective review was performed of all patients who underwent elective percutaneous endovascular aneurysm repair (pEVAR) at a single institution from 2020-2023. Operative reports and digital subtraction angiography (DSA) were reviewed to determine the prevalence of "pre-large bore" and "post-large bore" MA. The primary end-point was the rate of direct operator exposure in MA. Secondary end-points included the rate of intra-operative access complications and radiation dose area product (DAP).
Results
144 patients underwent pEVAR with 282 percutaneous femoral access sites. Of the 282 percutaneous common femoral artery access sites, 9% (N = 25) underwent pre-large bore MA only, 24% (N = 67) underwent post-large bore MA only, and 56% (N = 159) underwent both pre-large bore and post-large bore MA for a total of 410 microcatheter angiograms. The overall rate of direct operator exposure was 56% (N = 231/410) for MA. Individual rates of operator exposure ranged from 51-71% and the three most prevalent performers accumulated cumulative DAP values of 342, 386 and 479 Gy ∙cm2 from MA alone during the study period. Operator exposure was not associated with laterality, C-arm angulation, sheath size, or BMI. There were only 10 intra-operative or peri-operative access complications (6.9% overall; 3.5% per access site) of which only four were specifically recognized by MA.
Conclusion
MA was routinely performed in elective pEVAR and best practices in radiation safety were rarely achieved with a high rate of direct operator exposure to the beam of radiation. The overall rate of access-related complications in elective pEVAR is low and the window for detecting access-related complications with MA is narrow. Because of the high rate of operator exposure, selective MA and the development of guidelines for best practice technique MA should be considered.
Objective. To analyze the results of endovascular removal of intracardiac foreign bodies. Material and methods. We estimated the results of endovascular removal of intracardiac foreign bodies in 9 men aged 35—54 years between 2022 and 2024. Patients were examined according to standard protocol (clinical examination, anamnestic data, electrocardiography, echocardiography, chest X-ray, contrast-enhanced cardiac CT). Endovascular interventions were performed under local anesthesia mainly through femoral and/or jugular access using introducers 6—12 Fr. Results. The technical success rate was 89% (n=8). Three (37%) patients required conversion to open vascular access as soon as foreign body was delivered to the common femoral artery due to technical difficulties in removing large fragments exceeding maximum allowable diameter of endovascular instrument. In one (11%) patient, we preferred removal through sternotomy under cardiopulmonary bypass due to large foreign body and groggy grip by the loop, as well as risk of intraoperative cardioembolic complications. Topographic analysis revealed predominant location of foreign bodies in the right cardiac chambers, in particular, the right ventricle (44%) and right atrium (22%). This corresponds to anatomical features of blood flow and hemodynamics in the right heart, where turbulent flow contributes to fixation of fragments. Less often, foreign bodies were localized in the left heart (33%), and damage to the left ventricle was observed in 22% of cases. This required a special attention when planning access and choosing tools, especially regarding the risk of embolism. There was no in-hospital mortality, and 30-day survival rate was 100%. Conclusion. Endovascular removal of intracardiac foreign bodies is currently perspective in interventional cardiology. This approach demonstrates high efficiency with minimal invasiveness as evidenced by low percentage of intra- and postoperative complications, shorter hospital-stay and rapid rehabilitation.
M. Chernyavin, Ya.S. Samedov, K. Petrov et al.· Russian Journal of Cardiolog...· 0 citations
BACKGROUND
Retrograde tibial-pedal access is a well-established technique for managing peripheral arterial occlusive disease and its associated ischemic symptoms. While generally considered safe and effective, this method presents notable challenges due to the small caliber and, often, diseased nature of the target vessels, which can complicate entry and cannulation. As a result, multiple access attempts may be necessary, and access-related complications can hinder or even prevent a successful percutaneous intervention.
AIMS
This report aims to describe a single-center experience utilizing a novel access guidewire featuring a small core diameter and an articulating tip to facilitate tibial-pedal access.
METHODS
Patients with peripheral vascular disease in whom tibial-pedal access was attempted between January 2, 2024 and September 15, 2025 were included. Real-time ultrasound guidance was used in all cases. Post-procedural ultrasound was performed after hemostasis was achieved with manual compression to evaluate the accessed vessel patency and rule out complications. Study outcomes were first-attempt and overall guidewire insertion success, post-procedural and 30-day patency of the accessed vessel on ultrasound, and incidence of access site complications.
RESULTS
Records of 167 access procedures attempted in 133 patients were reviewed (left anterior tibial-76, right anterior tibial-71, right posterior tibial-7, left posterior tibial-4, left dorsalis pedis-1). First-attempt success was 98% (154/157 evaluable records) and all-attempt success was achieved in 100% of the cases. There were no access-site complications, such as occlusion, extravasation, or pseudoaneurysm. Patency was confirmed in all accessed vessels immediately following the procedure and maintained in all but one case at the 30-day mark.
CONCLUSIONS
Tibial-pedal access was successfully obtained in all cases, demonstrating an exceptionally high nominal first-attempt success rate and no peri-procedural complications. In conjunction with preserved post-procedural vessel patency, these findings support the articulating-tip guidewire's safety and effectiveness for its intended application.
Ashwani Sastry, Sreejit Nair· Catheterization and cardiova...· 0 citations
The transradial approach (TRA) has become the preferred vascular access for coronary angiography and percutaneous coronary intervention (PCI), offering reductions in bleeding and vascular complications compared with the transfemoral approach, and lower mortality in patients with acute coronary syndromes (ACS). Technical refinements have further enhanced procedural success with TRA. Variations in puncture technique (ultrasound-guidance, through-and-through vs. single-wall technique) and the use of vasodilator “radial cocktails” can improve access success and reduce the risk of radial artery spasm (RAS), while adequate anticoagulation, appropriate sheath sizing, and optimized radial band removal techniques help to reduce radial artery occlusion (RAO). Alternative access strategies such as distal radial (dTRA) and ulnar approaches offer advantages including lower RAO rates and preservation of the proximal radial artery for future conduit use, though these techniques are limited by higher crossover rates, longer cannulation times, and the need for additional operator experience. Optimal intraprocedural anticoagulation in the TRA era remains uncertain, as the bleeding advantage of alternatives to unfractionated heparin may be attenuated given the inherently lower access-site bleeding risk. Procedural complications, including hematoma, RAS, RAO warrant prevention and prompt recognition. Future research should refine anticoagulation strategies, personalize access-site selection, and further evaluate dTRA and ulnar approaches as operator experience matures.
Tanawat Attachaipanich, M. Khawaja, H. H. Virk et al.· Frontiers in Cardiovascular...· 0 citations
Background Postprocedural iliofemoral angiography is commonly used to detect access-site complications after transfemoral transcatheter aortic valve implantation (TF-TAVI). However, the clinical value of routine angiographic surveillance remains uncertain. Aims To compare vascular and access-site-related complications according to Vascular Academic Research Consortium-3 (VARC-3) criteria associated with routine and selective postprocedural iliofemoral angiography after TF-TAVI. Methods We retrospectively analyzed 1,147 TF-TAVI procedures at 2 sites of a single center with different institutional strategies for postprocedural angiographic assessment. One site routinely performed iliofemoral angiography after TAVI (n = 674), whereas the other applied a selective strategy based on procedural suspicion (n = 473). Results Vascular and access-site complications (VARC-3) were similar between strategies (selective 6.6% vs routine 8.0%; OR: 0.76; 95% CI: 0.48-1.19). Routine angiography detected more access-site bleedings (13.9% vs 5.2%; P < 0.001), without differences in hemoglobin drop, transfusion due to access-site bleeding, or bleeding-related death. Overall vascular reinterventions were comparable (4.2% vs 6.5%; P = 0.095), with more catheter-based interventions in the routine strategy and more surgical/thrombin-based interventions in the selective strategy. In adjusted and inverse probability of treatment weights–weighted analyses, bleeding complications remained lower with the selective strategy, whereas overall VARC-3 complications did not differ. After adjustment using the inverse probability of treatment weights model, the angiography strategy was not associated with acute kidney injury despite higher total contrast in the routine group. Conclusion Routine angiography increases detection of minor vascular abnormalities, while selective angiography guided by clinical suspicion may provide comparable clinical outcomes. Routine postprocedural angiography may be unnecessary in many patients. Prospective randomized studies are needed to determine the optimal surveillance strategy.
A. von Ehr, Jonathan Rilinger, Derek Y. Hazard et al.· JACC: Advances· 0 citations
Transcaval access was first described in animals in 2013 and in humans in 2014. It was initially developed for patients with peripheral artery disease who were undergoing transcatheter aortic valve replacement (TAVR), a procedure that requires large-bore access. Since then, transcaval access has been increasingly adopted worldwide and has emerged as a safe and viable alternative to conventional femoral access for TAVR. With more evidence supporting the safety of transcaval access and an increasing number of procedures requiring large-bore arterial access, the application of transcaval access has been expanded for mechanical circulatory support devices and aortic procedures. Transcaval access has also been adopted by the 2024 Society for Cardiovascular Angiography and Interventions expert consensus statement as a superior alternative over transaxillary access for TAVR. This article aims to provide a step-by-step guide for transcaval access (with and without CT planning), emphasising preoperative planning, transcaval crossing and closure and troubleshooting.
M. Chiang, A. Ko, B. Chow et al.· Journal of Asian Pacific Soc...· 0 citations
PURPOSE
Repeated interventions for arteriovenous (AV) access dysfunction in hemodialysis patients are costly, burdensome, and detrimental to quality of life. The FLEX Vessel Preparation (VP) system utilizes a technique termed kinetic endovascular micro-incision creation (KEMIC) to improve vessel compliance and durability prior to angioplasty. This study compares real-world procedural and specifically the economic outcomes from matched U.S. and European cohorts.
MATERIALS AND METHODS
This is a retrospective, quality-improvement (QI)-exempt comparative study from two high-volume centers. Twelve FLEX patients managed by a single U.S. vascular surgeon were compared to 60 matched PTA controls via propensity matching. The European cohort included 74 patients treated with FLEX at a single center and compared to 80 matched PTA controls in Germany. FLEX-VP was performed using three to eight passes with a balloon-free, microblade catheter, typically via a 6 F sheath and followed by low-pressure angioplasty and/or drug-coated balloon.
RESULTS
U.S. FLEX patients underwent 1.5 fewer interventions per patient-year than PTA controls (0.7 vs 2.2, p < 0.01). In Germany, FLEX reduced reinterventions by 0.4 per patient-year compared to PTA (0.6 vs 1.0, p < 0.001). Depending on local procedure costs, these reductions translate to estimated per-patient annual savings of $1451-$2902 in the U.S. and €426-€767 in Germany. Kaplan-Meier analyses demonstrated superior reintervention-free survival at 12 months in both cohorts (U.S.: 70.7% vs 46.1%; Germany: 67.4% vs 44.3%).
CONCLUSIONS
KEMIC is a reproducible, low-risk, stent-sparing approach that improves access durability while potentially delivering substantial savings to payers and systems.
R. Shahverdyan, Daniel G Clair, Jordan Knepper· Journal of Vascular Access· 0 citations
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