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Objective: To evaluate the comparative effectiveness of two distinct balloon pressure band compression regimens on the treatment outcomes for deep vein thrombosis (DVT) and venous blood flow velocity in the lower limbs of patients undergoing anterograde thrombolysis through the superficial dorsalis pedis vein. Methods: A total of 42 patients diagnosed with DVT were enrolled in the randomized controlled trial. Patients in the control group received balloon pressure band compression positioned 15 cm above the bony landmark of the medial malleolus of the affected limb, with continuous inflation and deflation. On the basis of the control group, a balloon pressure band was also used 15 cm above the bony landmark of the medial malleolus and 10 cm below the midpoint of the patella in the affected limb in experimental group, with rotational inflation at these two sites. The thrombolysis effects and venous blood flow velocity of the lower extremities were compared between the two groups. Results: The differences in limb circumference and Marder scores of patients in the experimental group were significantly lower than those in the control group, while the detumescence rate and venous patency rate of the affected limbs in the experimental group were significantly higher than those in the control group (P < 0.05). After 30 and 60 min of thrombolysis, femoral and popliteal vein blood flow velocities in the experimental group were significantly higher than those in the control group (P < 0.05). After 45 min post-thrombolysis, the femoral vein blood flow velocity in the experimental group remained significantly higher than that in the control group (P < 0.05), though no significant difference was observed in the popliteal vein blood flow velocity (P > 0.05). Conclusion: In this study, alternating balloon pressure band compression applied at 15 cm above the bony marker of the medial malleolus and 10 cm below the patellar midpoint to block superficial venous blood flow was found to enhance thrombolysis efficacy and significantly improve venous blood flow velocity in the lower extremities among patients with DVT. [ABSTRACT FROM AUTHOR]

Background: Catheter ablation of right anterior, anterior–lateral, and anterior–septal accessory pathways is still challenging in children, even after seminal improvements in mapping and catheter design over the last years. The trans-jugular approach was described as an alternative to the femoral vein recently. As a direct comparison between the femoral approach and the superior approach using the axillary vein was lacking, we conducted the present study. Methods: Twenty-two pediatric patients were enrolled in this retrospective study. Patients with prior ablation attempts were excluded. Another 22 consecutive patients with the same AP localizations were selected as a control group and treated with ablation through the femoral vein. Left axillary vein cannulation was performed advancing an 18-gauge needle using fluoroscopic landmarks (the first rib below the inferior border of the clavicle). All mapping and ablations of accessory pathways were performed with a 7 F deflectable radiofrequency ablation catheter. The main outcome of this study was ablation success at 1 year. Recurrences were defined as a relapse of preexcitation on a 12-lead electrocardiogram and/or documented supraventricular tachycardia. Results: There were no significant differences in sex, age, or weight between groups. No complications occurred acutely or during follow-up. There were no significant differences in acute success rates between the two groups (19/22 vs. 22/22; p = 0.56) at 24 h ECG recordings. At the 1-year follow-up the total recurrence rate was 15.9% (7/44 patients); there was a significantly lower recurrence rate among patients in the trans-jugular group (27.2% vs. 4.5%; p = 0.039). Conclusions: The present study suggests that the trans-axillary vein approach is a safe and effective alternative to the classical femoral approach in pediatric patients. [ABSTRACT FROM AUTHOR]

With the alarming rise in cases of arterial hypertension worldwide, there is an urgent need to develop combined therapies to mitigate this scenario. Rose oxide (RO), a monoterpene with anti-inflammatory and hypotensive properties, emerges as an alternative. The present study is the first to evaluate the effect of RO administered chronically and combined with physical exercise (swimming) since both have been reported to have beneficial impacts on hypertension. Male SHR and Wistar rats (aged 12 weeks) received RO for 34 consecutive days (orally; 100 mg/kg). The progression of systolic arterial pressure (SAP) was monitored through tail-cuff plethysmography. Twenty-four hours before the end of the treatment, the animals were anesthetized, and the femoral artery and vein were cannulated to record the pulsatile arterial pressure and to administer drugs, respectively. Hemodynamic and autonomic parameters and baroreflex sensitivity and intrinsic heart rate (IHR) were evaluated. Treatment with RO, administered alone or combined with exercise, reduced SAP and mean arterial pressure in SHR. The swimming protocol did not prevent increases in BP, but when combined with RO, it improved autonomic control, assessed through heart rate variability and parasympathetic tone. IHR was attenuated in SHR, and none of the treatments reversed this response. Therefore, combining RO with physical exercise may enhance their antihypertensive effects, improving autonomic function, reducing oxidative stress and inflammation, providing synergistic cardiovascular benefits, improving metabolic health, promoting a comprehensive lifestyle intervention, and potentially allowing for reduced medication dosages. This multifaceted approach could offer a more effective and sustainable strategy for managing hypertension. [ABSTRACT FROM AUTHOR]

Objective: To explore the preventive effect of different modes of ankle pump exercise on femoral vein PICC catheter-related thrombosis. Method: Convenient sampling method was used to select 172 patients with lung cancer with PICC catheterization through femoral vein admitted to West China Hospital of Sichuan University as the observation group and control group. Comfort angle ankle pump exercise mode and maximum angle ankle pump exercise mode were adopted. We have compared the differences in the incidence of catheter-related thrombosis, unplanned catheter removal, fatigue score, and catheter retention time between two groups of patients. Results: The incidence of catheter-related thrombosis, unplanned catheter removal, fatigue score, and catheter retention time were statistically significant (p <.05) in both groups of patients. Conclusion: The maximum angle ankle pump exercise mode can reduce the incidence of catheter-related thrombosis and unplanned catheter removal in patients with lung cancer with PICC catheterization through femoral vein, increase catheter retention time, but it can easily cause patient fatigue. In clinical practice, patient tolerance should be considered. [ABSTRACT FROM AUTHOR]

To date, lipophilic contrast agents mixed with oil, usually paraffin oil, are the most commonly used contrast agents in post-mortem computed tomography angiography (PMCTA). Iodine-based hydrophilic contrast media in combination with a water-soluble carrier, e.g. polyethylene glycol (PEG), are also common. However, their influence on different tissues and organs is poorly understood. In order to analyse the changes in the cadavers caused by the different carrier substances, we evaluated the effects of PEG 200 and oil on the different tissues and organs. Therefore, during a forensic autopsy, liquid femoral vein blood and samples of different organs and vessels were taken and preserved at room temperature in the two liquids mentioned. The condition of the samples was documented during the autopsy and 24, 48 and 72 h after preservation. Microscopic examination took place after 72 h. After 24 h, the samples placed in PEG 200 already showed a clear solidification of almost all structures. Crumbly blood agglomerates had formed in the previously liquid blood. In contrast, the samples stored in oil showed signs of classic cadaveric decomposition after 24 h, which increased with time. The microscopic and immunohistochemical evaluation of the samples stored in PEG showed a good diagnostic quality. The analysis of tissues stored in oil was much more difficult due to putrefaction. PEG and oil show significantly different effects on human tissues, mainly conservation and dehydration are affected. It is crucial to be aware of these differences in order to choose the most appropriate PMCTA method for each forensic case. [ABSTRACT FROM AUTHOR]

The prone position is often used for patients with adult respiratory distress syndrome and specific surgical postures. When performing venous cannulation in this position, it is important to have a structured review to introduce the available major veins and ultrasound-guided procedure. In this review, we discuss the techniques of ultrasound-guided cannulation and provide insights into various aspects, including the anatomical locations of veins, vein sizes, placement techniques, surrounding structures at risk, and reported experiences with catheter placements. Eight major veins can be accessed in the prone position: the internal jugular vein, external jugular vein, brachiocephalic vein, basilic vein, mid-thigh femoral vein, popliteal vein, posterior tibial vein, and small saphenous vein. To minimize the risk of venous thromboembolism, the ratio of catheter diameter to vessel diameter should be less than 0.67. The review also presents the minimal requirement of venous diameter for different catheters in a tabulated form. For larger veins, real-time ultrasound guidance with the long-axis view/in-plane technique is suggested, while for smaller vessels, the short-axis view/out-of-plane technique is recommended. The review includes sonographic illustrations of the two techniques and surrounding arteries and nerves for the eight major veins. The aim of this review is to help clinicians assess the eight major veins and safely insert various types of catheters for patients in the prone position. [ABSTRACT FROM AUTHOR]

The article in CVIR Endovascular discusses the use of direct percutaneous puncture of occluded venous stents as an adjunctive technique to restore patency in patients with chronic venous diseases. The study involved four patients who underwent this procedure after conventional endovascular techniques failed. The technique was successful in all patients, with no adverse events reported, demonstrating its feasibility and usefulness as an escalation technique in recanalizing chronically occluded venous stents. [Extracted from the article]

The article in the CardioVascular & Interventional Radiology journal discusses the successful use of the FlowTriever Aspiration System in removing foreign bodies from the pulmonary arteries of three patients. The patients had embolized foreign bodies including a silicone catheter tip, cyanoacrylate cast, and vertebral augmentation cement. The procedures were effective in removing the foreign bodies without any associated adverse events, showcasing the system's potential in foreign body retrieval techniques. The study was conducted ethically and with appropriate approvals in place. [Extracted from the article]

Combined heart-liver transplantation (CHLT) is a rarely though increasingly performed procedure with evolving indications. Despite CHLT being performed at only a handful of centers, the use of intraoperative mechanical circulatory support to optimize hemodynamics and facilitate dual-organ transplantation varies widely. At our center, we liberally utilize veno-arterial extracorporeal membrane oxygenation (V-A ECMO) when a veno-venous shunt is anticipated to be insufficient in mitigating the hemodynamic perturbations associated with liver reperfusion. In this series, we describe our experience with V-A ECMO in sequential (heart-first) CHLT and demonstrate highly favorable outcomes with this strategy. [ABSTRACT FROM AUTHOR]

The correction notice in Scientific Reports addresses errors in the original article regarding patient age data and the study's date range. The corrected version now accurately reflects the clinical data of 21 hemodialysis patients who underwent percutaneous transluminal angioplasty for reinsertion of tunneled cuffed catheters in the right internal jugular vein from July 2020 to July 2023 at the First and Second Affiliated Hospitals of Bengbu Medical College. The correction ensures the accuracy of the study's findings and methodology. [Extracted from the article]

Background: Postoperative atrial fibrillation (POAF) is the most frequent cardiac arrhythmia following cardiac operations. It has been associated with an increased risk of postoperative cerebrovascular complications, morbidity and mortality. The aim of this study is to evaluate if the type of venous cannulation to institute the cardiopulmonary bypass (CPB) during major cardiac surgery procedures can influence the rate of POAF and late FA onset. Methods: We collected data from 2087 consecutive patients who have been operated at our Institution from January 2016 to December 2018. To obtain two homogenous groups we performed a propensity match analyzes: Group 1 for whom the blood drain of the CPB has been granted via peripheral cannulation (PC) through the right common femoral vein and Group 2 with patients who underwent central cannulation (CC) with insertion of a drainage cannula in the right atrium or in the superior and inferior vein cava. Results: POAF has been observed as statistically similar between the two groups. At 1250‐day follow‐up, While the incidence of POAF was 2.9% and 8.7% in the PC and CC groups, respectively (p =.04). Conclusions: our data seems to show that the two groups do not differ in terms of POAF, while the CC group may have a significantly higher rate of atrial fibrillation in the follow‐up period. [ABSTRACT FROM AUTHOR]

An infant with a corrected gestational age of 38 weeks, weighing 3.1 kg, was referred to our pediatric surgical department because of a fractured peripherally inserted central venous catheter in the left lower limb with the end retracting into the deep venous system. An operation was undertaken to remove the PICC. Because the central venous catheter was, unintentionally, placed in the left small saphenous vein and thus positioned in the left femoral vein, the left great saphenous vein was incised to gain access. Subsequently, the catheter could be removed successfully. Fracturing of a peripherally inserted central venous catheter is a rare occurance. Removal depends on vessel size, location and experertise. [ABSTRACT FROM AUTHOR]

The common femoral artery (CFA) typically gives rise to its superficial and deep branches, with the deep femoral artery (DFA) being the largest and most substantial of these branches. This case study presents a rare variation of the DFA characterized by an unusual branching pattern and its specific relationship with the femoral vein within the subinguinal region. In nutshell, the DFA and the medial femoral circumflex artery shared a common origin from the medial aspect of the CFA. The DFA assumed an unusual course, initially passing anterior to the femoral vein above the saphenofemoral junction, followed by a spiraling trajectory around the medial aspect of the femoral vein before running posteriorly. The embryological origins and clinical implications of this anatomical variation are thoroughly examined. This unusual vascular relationship in the subinguinal region may potentially result in arterial injury during femoral vein cannulation or formation of arteriovenous fistula after the procedure. [ABSTRACT FROM AUTHOR]

Objective: To compare the haemodynamic effects of different ankle movements combined ankle and toe movements on the femoral vein of the lower extremity. Methods: 28 healthy volunteers participated in the study. Doppler ultrasound was used to measure peak systolic velocity and time-averaged mean velocity of the common femoral vein during ankle dorsiflexion, ankle dorsiflexion with simultaneous toe extension, ankle plantarflexion, and ankle plantarflexion with simultaneous toe flexion. Results: In comparison to the resting state, both ankle alone or ankle combined with toe movement showed statistically significant differences (p <.01). However, there were no significant difference in the velocity of the common femoral vein between ankle alone and ankle combined with toe movement (p >.05). It is noteworthy that dorsiflexion of the ankle resulted in the highest peak velocity of blood flow. Conclusion: The impact of ankle movement, with or without toe movement, the velocity of the common femoral vein is not significantly correlated. [ABSTRACT FROM AUTHOR]

Background: Inferior vena cava (IVC) diameter measurement using ultrasound for volume status assessment has shown satisfactory results and is being adopted in Emergency and critical care settings. IVC diameter can vary depending on the cardiac function, respiratory efforts, intraabdominal pressure, and mechanical ventilation. Due to these factors, IVC measurement cannot be considered a stand-alone technique appropriate for every patient. The femoral vein (FV), a more superficial vein than IVC, can be considered an alternative method for assessing fluid responsiveness in patients presenting to the Emergency department. It is easily accessible and can be used in scenarios where IVC cannot be visualized or reliable. Methods: This was a single-center diagnostic study where 85 patients who presented to the ED with chest pain were enrolled prospectively. IVC and femoral vein collapsibility indices, stroke volume, and cardiac output are measured using an ultrasound machine. The measurements were repeated after a passive leg-raising test. These values were compared with each other to assess an intra-class correlation between IVC and femoral vein collapsibility indices. We have also evaluated the relationship between the collapsibility indices of both veins and cardiac output. Discussion & limitations: Our findings show an insufficient correlation between IVC and FV collapsibility indices. However, both vein diameters significantly increased after passive leg raising (PLR), indicating a response to fluid challenge. Post-PLR reduced IVC, and FV collapsibility index (CI) suggests intravascular volume expansion after a fluid challenge, also reflected in the hemodynamic parameters. Our study was conducted only in a subset of relatively stable patients. The applicability of the study in different subsets of patients presenting to ED is still questionable. Conclusion: We conclude that femoral vein indices may not be an accurate alternative for volume assessment in the chosen cohort of patients. IVC and FV metrics do not correlate and may not be accurate for volume responsiveness. We may need to explore the utility of FV and its indices in a larger population in multiple settings for a better understanding of its role in volume assessment and responsiveness. Trial registration: (EC/NEW/INST/2021/1707). Registered 03 January 2023. [ABSTRACT FROM AUTHOR]

Fecal microbiota transplantation (FMT) and probiotics therapies represent key clinical options, yet their complex effects on the host are not fully understood. We evaluated the comprehensive effects of FMT using diarrheal or normal feces, as well as probiotic therapies, on multiple anatomical sites in healthy cynomolgus macaques through colonoscopy and surgery. Our research revealed that FMT led to a partial microbiome transplantation without exhibiting the donor's fecal clinical characteristics. Notably, FMT increased insulin and C-peptide levels in each animal according time series, regardless of fecal conditions. Immunologically, a reduction in neutrophil-to-lymphocyte ratio were exclusively observed in femoral veins of FMT group. In blood chemistry analyses, reductions in aspartate aminotransferase, blood urea nitrogen, and creatinine were observed in the femoral veins, while elevated levels of alanine aminotransferase and calcium were exclusively detected in the portal veins. These changes were not observed in the probiotic group. Also, short chain fatty acids were significantly higher increase in portal veins rather than femoral veins. Transcriptome analysis of liver tissues showed that metabolic pathways were primarily affected by both FMT and probiotics therapies. In summary, FMT therapy significantly influenced metabolic, immunologic and transcriptomic responses in normal macaque models, regardless of fecal conditions. Also, these macaque models, which utilize surgery and colonoscopy, serve as a human-like preclinical platform for evaluating long-term effects and anatomically specific responses to gut-targeted interventions, without the need for animal sacrifice. [ABSTRACT FROM AUTHOR]

The article in CVIR Endovascular discusses the preliminary experiences of using the InThrill Thrombectomy System for treating symptomatic deep vein thrombosis in various locations. The study involved 11 patients with venous occlusive disease who underwent InThrill-mediated mechanical thrombectomy, with a high rate of technical success and clinical improvement. The InThrill Thrombectomy System, designed for small venous thrombectomy in 4-10-mm vessels, showed promise in treating thrombosis in different venous systems, although further research is needed to determine its optimal use in venous anatomy. [Extracted from the article]

Background: Peripherally inserted central catheters (PICCs) are commonly used in neonatal intensive care units for extended intravenous nutrition and therapy. The selection of PICCs insertion sites can significantly influence insertion outcomes and neonatal safety. Aim: This study aimed to determine the most suitable insertion site in the lower extremities for neonatal PICCs. Study Design: A retrospective case note review was conducted on PICCs inserted through lower extremity (LE) sites in a 40‐bed tertiary‐level neonatal intensive care unit at a university teaching hospital. The dates when data were accessed for research purposes were from June 2019 to June 2022. In total, 223 neonates were identified as having had PICCs, with 254 catheters inserted in the lower extremities. The STROBE checklist guided the reporting of this study. Results: Neonates underwent PICC insertion via the LE vein, with an overall complication rate of 13.4% and a one‐attempt success rate of puncture of 86.2%. The rates of complications, catheter occlusion, and catheter‐related infection in the PICC group with insertion through the great saphenous vein were significantly lower than those in the femoral vein group (p <.05). The success rate was significantly higher than that in the femoral vein group (p <.05). Additionally, the incidence of total complications and catheter occlusion complications with PICC insertion via the right LE was significantly lower than that with insertion via the left LE (p <.05). Conclusion: Our study suggested that, when feasible, the saphenous vein in the right LE could be the most suitable insertion site for neonatal PICCs. Relevance to Clinical Practice: These findings provide insights into the complications, indwelling time, and safety of neonatal PICCs in different LE sites, serving as a valuable reference for clinical practice. This study was retrospective in nature, and all staff involved obtained approved access to patient clinical data. Ethical approval was granted by the Ethics Committee of Xiangya Hospital, Central South University (registry number 2022010001). [ABSTRACT FROM AUTHOR]

Background and aims: Methods for femoral venous haemostasis following electrophysiology (EP) procedures include manual compression (MC) and suture‐based techniques such as a figure‐of‐eight suture secured with a hand‐tied knot (Fo8HT) or a modified figure‐of‐eight suture secured with a 3‐way stopcock (Fo8MOD). We hypothesised that short‐term bleeding outcomes using the Fo8MOD approach would be superior to MC. We additionally compared outcomes between Fo8MOD and Fo8HT approaches. Methods: We studied consecutive patients undergoing EP procedures at our institution between March and December 2023. Patients were categorised into three haemostasis groups: MC, Fo8HT and Fo8MOD. Access site complications were classified as major (requiring intervention or blood transfusion, delaying discharge or resulting in death) or minor (bleeding/haematoma requiring additional compression). Results: 1089 patients were included: MC 718 (65.9%); Fo8HT 105 (9.6%); Fo8MOD 266 (24.4%). Procedures were most commonly for atrial fibrillation (52.4%), atrial flutter (10.9%), and atrioventricular nodal re‐entrant tachycardia (10.1%). In patients receiving periprocedural anticoagulation (865, 79.4%), Fo8MOD associated with fewer complications than MC or Fo8HT (major: MC 2.2%, Fo8HT 6.0%, Fo8MOD 0.8%, p =.01; minor: MC 16.5%, Fo8HT 12.0%, Fo8MOD 7.4%, p =.002). In patients not receiving periprocedural anticoagulation, complications did not differ between haemostasis methods (total major and minor complications 5.8%, p =.729 for between groups rates). On multivariable logistic regression, Fo8MOD was associated with a significantly lower risk of access site complications (OR 0.29 [95% CI 0.17–0.48], p <.001), whilst intraprocedural heparinisation (OR 5.25 [2.88–9.69], p <.001) and larger maximal sheath size (OR 1.06 [1.00–1.11], p =.04) were associated with a higher risk of complications. Conclusion: Femoral haemostasis with Fo8MOD associates with fewer access site complications than MC and Fo8HT following EP procedures that need periprocedural anticoagulation. [ABSTRACT FROM AUTHOR]

Introduction: Extracorporeal membrane oxygenation cannulation strategies vary between adults and children. Femoral approach is common in adults and extremity morbidity is well-documented. Aside from limb ischemia, complications in children are theorized and have yet to be studied. This study aims to comprehensively evaluate implications of pediatric femoral cannulation. Methods: This is a single-center retrospective review of children <21 years, undergoing femoral venoarterial (VA) or venovenous (VV) cannulation between 2015 and 2022. The primary outcome was incidence of lower extremity complications on ECMO (groin hematoma/hemorrhage, vascular thrombosis, North-South syndrome, compartment syndrome, limb loss). Secondary outcome was incidence of post-decannulation extremity complications (pseudoaneurysm, surgical site infection, vascular thrombosis, motor/sensory deficits). Results: 29 children were cannulated via femoral approach. Most required VA support (89%). Common sites were right femoral artery (70.8%) and right femoral vein (56%). 18 patients (75%) had distal reperfusion cannulas (DPC) placed. Short-term lower extremity complication rate was 59%, most frequently groin hematoma/hemorrhage (30%) and North-South syndrome (19%). Compartment syndrome occurred in 3 patients (11%), though none suffered digit/limb loss. There were no significant differences in complications between cannulation approach (open vs percutaneous) or vessel laterality (ipsilateral vs contralateral). Of those decannulated (n = 15), median ECMO duration was 8 days. Following decannulation, 20% suffered pseudoaneurysm. Ten (63%) experienced ipsilateral motor weakness which resolved in 50% of patients at 1-month follow-up; 20% suffered sensory deficits all resolving by discharge. Conclusion: Approximately one third of children who underwent femoral cannulation suffered groin hematoma/hemorrhage and nearly 20% experienced North-South syndrome. Following decannulation, most had extremity weakness while sensory deficits were rarer. This marked risk of extremity morbidity prompts proactive inpatient monitoring and close surveillance after discharge. [ABSTRACT FROM AUTHOR]

Background Interrupted inferior vena cava (IVC) is a rare developmental defect characterized by azygos continuation following failure of fusion of one or more of the component parts of the embryological IVC. It occurs in approximately one in 5000 of the general population. It is usually an isolated finding and is generally asymptomatic. Case summary A 42-year-old patient presented for further clarification of syncope with a 4-day history of persistent exertional dyspnoea. Computed tomography revealed a central pulmonary artery embolism on both sides, with prominent azygos and hemiazygos veins and paravertebral collaterals. For further clarification, a magnetic resonance imaging (MRI) scan was performed, where hypoplasia or stenosis of the inferior suprarenal vena cava was noted. There were collaterals of the azygos and hemiazygos veins. The finding was consistent with the picture of a venous abnormality in the sense of an 'interrupted IVC (suprarenal) with azygos continuation'. Discussion In the case of an isolated interrupted IVC, the patient is usually asymptomatic, and the vascular anomaly itself does not mandate any treatment. This variation should be considered, especially in young patients with deep venous thrombosis (DVT) when no other reason for thromboembolism is evident. To prevent vascular events such as DVT or pulmonary embolism, lifelong anticoagulation therapy is recommended. An interrupted IVC can also cause procedural difficulties during right heart catheterization, electrophysiological studies, cardiopulmonary bypass surgery, femoral vein catheter advancement, IVC filter placement, and temporary pacing through the transfemoral route. [ABSTRACT FROM AUTHOR]

Introduction: Hemostasis following large‐bore femoral vein access remains a challenge. Manual compression has been the standard of care but requires bedside staff, prolonged bed rest, and longer length of stay. The LockeT is an external compression device that attempts to address these issues while achieving venous hemostasis. Objectives: We evaluate postprocedural hemostasis and vascular closure outcomes after using LockeT following cardiac electrophysiologic procedures. Methods: We performed a single‐center, observational study of patients who underwent vascular closure for electrophysiology procedures using LockeT. Postprocedural outcomes were subsequently analyzed. Results: We studied 102 patients (N) for whom LockeT was used to close 182 separate vascular access sites (n). Common procedures were atrial fibrillation ablation (56.9%, N = 58) and left atrial appendage occlusion (28.4%, N = 29). Most often, 8‐Fr [48.3% (n = 126)], 11‐Fr [27.2% (n = 71)], and 8.5‐Fr [16.9% (n = 44)] sheaths were used, with an average procedure time of 82.1 ± 29.4 min. Hemostasis was achieved in 97.8% (n = 187) of all LockeT cases. Time to ambulation and discharge were 3.93 ± 1.10 h and 8.1 ± 4.4 h, respectively. No major complications were noted. Postprocedurally, 52% (N = 53) of patients were discharged on the same day. There were no differences in hemostasis (p =.859) or ambulation times (p =.202) between procedure types. Conclusion: The LockeT can effectively close venous access sites with no major complications. [ABSTRACT FROM AUTHOR]

Aims Vein grafts are used for many indications, including bypass graft surgery and arteriovenous fistula (AVF) formation. However, patency following vein grafting or AVF formation is suboptimal for various reasons, including thrombosis, neointimal hyperplasia, and adverse remodelling. Recently, endothelial-to-mesenchymal transition (EndMT) was found to contribute to neointimal hyperplasia in mouse vein grafts. We aimed to evaluate the clinical potential of inhibiting EndMT and developed the first dedicated preclinical model to study the efficacy of local EndMT inhibition immediately prior to AVF creation. Methods and results We first undertook pilot studies to optimize the creation of a femoral AVF in pigs and verify that EndMT contributes to neointimal formation. We then developed a method to achieve local in vivo SMAD3 knockdown by dwelling a lentiviral construct containing SMAD3 shRNA in the femoral vein prior to AVF creation. Next, in Phase 1, six pigs were randomized to SMAD3 knockdown or control lentivirus to evaluate the effectiveness of SMAD3 knockdown and EndMT inhibition 8 days after AVF creation. In Phase 2, 16 pigs were randomized to SMAD3 knockdown or control lentivirus and were evaluated to assess longer-term effects on AVF diameter, patency, and related measures at 30 days after AVF creation. In Phase 1, compared with controls, SMAD3 knockdown achieved a 75% reduction in the proportion of CD31+ endothelial cells co-expressing SMAD3 (P < 0.001) and also a significant reduction in the extent of EndMT (P < 0.05). In Phase 2, compared with controls, SMAD3 knockdown was associated with an increase in the minimum diameter of the venous limb of the AVF (1.56 ± 1.66 vs. 4.26 ± 1.71 mm, P < 0.01) and a reduced degree of stenosis (P < 0.01). Consistent with this, neointimal thickness was reduced in the SMAD3 knockdown group (0.88 ± 0.51 vs. 0.45 ± 0.19 mm, P < 0.05). Furthermore, endothelial integrity (the proportion of luminal cells expressing endothelial markers) was improved in the SMAD3 knockdown group (P < 0.05). Conclusion EndMT inhibition in a preclinical AVF model by local SMAD3 knockdown using gene therapy led to reduced neointimal hyperplasia, increased endothelialization, and a reduction in the degree of AVF stenosis. This provides important proof of concept to pursue this approach as a clinical strategy to improve the patency of AVFs and other vein grafts. [ABSTRACT FROM AUTHOR]

Background: In electrophysiological procedures, multiple punctures on the femoral vein can be necessary depending on the number of catheters required. The femoral vein is typically located indirectly by using its anatomical relationship to the artery as a reference. However, this conventional approach can lead to significant complications, including bleeding, peri-interventional transfusion, pseudoaneurysms, or arteriovenous fistulas. Despite these risks, there is limited evidence comparing the safety of ultrasound-guided venipuncture versus the conventional technique in electrophysiological procedures. Objective: This study aimed to evaluate the impact of ultrasound-guided venipuncture on vascular access complications in electrophysiological procedures and to identify associated risk factors. Methods: In this single-center trial, patients scheduled for electrophysiological procedures at Ulm University Heart Center, Germany, were enrolled between November 2021 and October 2023. Venipuncture in the groin was performed using either the conventional or an ultrasound-guided approach. The primary composite endpoint was defined as peri-interventional major vascular access complications (Bleeding Academic Research Consortium (BARC) ≥2 bleeding, pseudoaneurysms, arteriovenous fistulas, and peri-interventional transfusion) and minor complications (BARC 1). Results: A total of 1370 patients were included: 749 in the conventional group and 621 in the ultrasound group. The primary endpoint was achieved in 19.2% of the conventional group and 12.1% of the ultrasound group (p < 0.001). An increased sheath diameter and a higher number of venous accesses were identified as risk factors for the primary endpoint. Conclusions: Ultrasound guidance for venous groin puncture in electrophysiological procedures reduces access-related complications, supporting its use with careful attention to sheath size and number. [ABSTRACT FROM AUTHOR]

Introduction: Deep vein thrombosis (DVT) is a type of venous thromboembolism, which is a global problem that affects not only adults but also children. Many risk factors are known; inherited or acquired ones caused by sepsis, malignancy, total parenteral nutrition, smoking, medications, or central venous line. Case presentation: The case report presents a complicated medical history of a patient with long-term secondary DVT, finally treated with stent implantation at the age of 16. At the age of 2, he congested a caustic substance, and the treatment resulted in catheter-related thrombosis. Primarily, pharmacological treatment was ineffective. Only after 14 years, subsequently, many treatment attempts, balloon angioplasty, and stent implantation in the left external iliac vein and left common iliac vein were performed successfully via puncture of the right common jugular vein and common femoral veins. The patient was asymptomatic and regularly attended follow-up visits and also control computed tomography venography was performed two times. Conclusions: This case report shows the successful management of DVT in a pediatric patient. In addition, the importance of a holistic approach and observation due to still unknown long-term complications should be emphasized. [ABSTRACT FROM AUTHOR]

Background: B-type natriuretic peptides (BNP) and cardiac enzymes are both recognized biomarkers of heart health. Many studies have reported that using these indicators can assess cardiac condition and predict prognosis of patients undergoing surgery. Currently little is known on the effect of increased cardiac input after venous recanalization on cardiac physiology in patients with chronic venous obstruction (CVO). Objectives: The aim of this study was to explore the effect of iliocaval recanalization and stenting on cardiac biomarkers in patients with CVO. Methods: This was a prospective study involving 60 patients in a single unit. Blood tests were collected 1 day before and 1 day after venous intervention. Three groups as group 1: patients with iliofemoral post-thrombotic syndrome (PTS) but without involvement of inferior vena cava (IVC) (n = 33); group 2: patients with iliofemoral PTS and involvement of IVC (n = 19) and group 3: patients with non-thrombotic vein lesion (NIVL) (n = 8) were compared based on cardiac biomarker levels. Results: Median concentration of post-operative BNP (259.60 pg/mL) was greater than preoperative levels (49.80 pg/mL) [interquartile range (IQR), 147.15/414.68 versus 29.85/82.88; p < 0.001]. The levels of CK-MB [preop: 3 U/l (IQR, 1.40/11.00) versus postop: 14 U/l (IQR, 12/17), p < 0.001] and troponin T [preop: 3.00 pg/mL (IQR, 3.00/5.25) versus postop: level of 6 pg/mL (IQR, 3.00/9.50), p < 0.001]. Post-procedure increases in cardiac enzymes showed significant differences in BNP (p = 0.023) and troponin T (p = 0.007) across the three groups, while CK-MB levels were not significantly different (p > 0.05). Intergroup comparisons of postoperative BNP: group 1 versus group 2 (p = 0.013), group 2 versus group 3 (p = 0.029), group 1 versus group 3 (p = 0.834); and postoperative troponin T: group 1 versus group 2 (p = 0.018), group 2 versus group 3 (p = 0.002), group 1 versus group 3 (p = 0.282). According to multiple linear regression analysis, length of stenting and level of preoperative BNP were independent determinants of postoperative BNP levels (p < 0.05), and preoperative troponin T affected postoperative troponin T independently (p < 0.05). Conclusions: Troponin T, CK-MB and BNP seem to increase after venous recanalization and stent implantation, the elevation being more prominent for longer lesions. [ABSTRACT FROM AUTHOR]

Aims Conduction system pacing (CSP) and atrioventricular junction ablation (AVJA) improve outcomes in patients with symptomatic, refractory atrial fibrillation (AF). Superior approach (SA) from the pocket, via the axillary or subclavian vein, has been recently proposed as an alternative to the conventional femoral access (FA) to perform AVJA. In this study, we compare the impact of these alternative approaches on nurse workload (NWL) and patient satisfaction. Methods and results This was a prospective, observational study enrolling consecutive patients undergoing simultaneous CSP and AVJA. Electrophysiology laboratory (EP Lab) NWL was calculated by using a self-developed model. Ward NWL was calculated using the MIDENF® validated scale. Patient satisfaction was collected using the Hospital Consumer Assessment of Healthcare Provider Systems questionnaire. A total of 119 patients were enrolled: in 50, AVJA was primarily attempted with SA, and in 69 with FA. Compared with FA, SA was associated with a lower EP Lab NWL (169.8 ± 26.7 vs. 202.7 ± 38.9 min; P < 0.001) and a lower Ward NWL (474.5 ± 184.8 vs. 808.6 ± 289.9 min; P < 0.001). Multivariate analysis identified SA as an independent predictor of lower EP Lab NWL [hazard ratio (HR) 4.60; P = 0.001] and of lower Ward NWL (HR 45.13; P < 0.001). Compared with FA, SA was associated with a higher patient-reported rating regarding their experience during hospital stay (P = 0.035) and the overall hospital evaluation (P = 0.026). Conclusion In patients undergoing simultaneous CSP and AVJA, the use of an SA for ablation is a valid alternative to conventional FA. Compared with FA, this approach significantly reduces NWL and is associated with greater patient satisfaction. Registration ClinicalTrials.gov : NCT03612635 [ABSTRACT FROM AUTHOR]

In case of venous route abnormality during a leadless pacemaker (LP) implantation, it can be challenging if we still performed via the predesigned femoral vein. We report a patient with normal preoperative laboratory and image results, but azygos continuation of the inferior vena cava (IVC) was suspected during the procedure. Then, we decided to change the implantation strategy, the LP implantation was successfully performed via right jugular vein instead of the classical IVC route. Finally, venous computed tomography (CT) angiography was conducted to testify such venous developmental abnormality. Clinical trial number: Not applicable [ABSTRACT FROM AUTHOR]

Deep Vein Thrombosis (DVT), a subtype of Venous Thromboembolism (VT) is more likely to occur in areas such as the lower leg, thigh or pelvis when vessel wall damage, blood flow stasis and hypercoagulability are present. Untreated DVT in the lower extremities can enlarge and result in further complications such as Post Thrombotic Syndrome (PTS) and an elevated risk of pulmonary thromboembolism. Prothrombotic anomalies may arise as a result of a variety of circumstances including the degree and type of infection, inflammation, bed rest, the use of mechanical ventilators and venous catheterisation. The rise in DVT cases in recent years along with thrombus complications in various patient populations calls for customised DVT care and intervention. This research was carried out on a young man without any notable medical history and no history of addictions who arrived complaining of severe swelling that had developed over the course of a day, affecting his left lower limb. A bilateral lower limb doppler ultrasound suggested thrombosis in the popliteal vein, great saphenous vein, deep femoral vein and common femoral vein in the left lower limb. Low molecular weight heparin injection was used to treat the patient. However, as the patient had not shown any significant signs of clinical improvement, an Inferior Vena Cava (IVC) filter was inserted to prevent pulmonary thromboembolism, and catheter-based thrombolysis was performed to break down clots and restore blood flow, thereby reducing the risk of long-term complications like PTS. Following recovery, the patient was discharged on oral anticoagulants and is currently on regular follow-up. [ABSTRACT FROM AUTHOR]

The article discusses a case of Takotsubo cardiomyopathy in a Caucasian woman, which later mimicked apical hypertrophic cardiomyopathy due to myocardial edema during recovery.

Introduction: Femoral vein transposition is one of the final resorts for vascular access in patients with exhaustion of upper limb venous patrimony and central venous occlusive disease. Its major pitfalls include hemodialysis access‐induced distal ischemia and infection. Surgical procedures may be warranted to preserve vascular access if ischemia develops. Several techniques are reported in the literature for femoral vein transposition. Case Report: We expose an endoscopic femoral vein harvesting as an alternative to the single thigh incision in order to avoid its associated complications. In the setting of ischemia, proximalization of arterial inflow was used to manage femoral vein transposition associated limb ischemia. Conclusion: This case report aims to expose the aforementioned unreported surgical techniques for lower limb arteriovenous fistula, its advantages, and pitfalls, as well as considerations on its future use. [ABSTRACT FROM AUTHOR]

Superior vena cava syndrome (SVCS) is caused by obstruction to the blood flow through this vein. Indwelling central venous devices, such as cardiac pacemakers and haemodialysis catheters have emerged as the most common benign aetiology of SVCS. SVCS is particularly severe in patients with end‐stage renal disease who require continuous renal replacement therapy plus infusion therapy. The presence of SVCS results in a reduction of available venous access for affected patients. Therefore, venous access plays a crucial role in the management of these patients. The importance of dealing with vascular access (VA) in critical patients with these conditions cannot be overstated. This case describes an 81‐year‐old man with respiratory failure who had end‐stage renal disease complicated with SVCS. Using ultrasound‐guided puncture, we inserted a peripherally inserted central catheter (PICC) into the superficial femoral vein to meet his infusion requirements in intensive care. After successful placement, the catheter tip position was adjusted using imaging to position the tip relative to the haemodialysis catheter. Whenever patients with severe renal dysfunction are treated, central veins should be preserved. Safe PICC access is possible via the superficial femoral vein to protect the last central VA for rational use. This meets urgent needs for infusion and deserves promotion. [ABSTRACT FROM AUTHOR]

Background: Thin lateral femoral wall has been investigated as a sign of instability in trochanteric hip fractures, necessitating lateral wall reconstruction or the use of a cephalomedullary nail (CMN). Various cut-off values have been proposed to guide implant choice. This review aims to determine the clinical significance of the lateral femoral wall thickness (LWT) in trochanteric hip fractures and identify an optimal cut-off value for increased risk of lateral wall (LW) fracture when using Dynamic Hip Screw (DHS). Methods: A comprehensive search was conducted in databases including Medline, Embase, and the Cochrane library up to July 2023. A predefined strategy was employed, with 5 eligible studies critically appraised using the methodological index for non-randomized studies (MINORS) criteria. Outcomes assessed encompassed the standardised mean difference (SMD) of LWT between the LW fracture and non LW fracture groups, aggregate LWT mean in LW fracture group, and the relation between AO/OTA fracture type with LW fracture utilising the chi-square test. Results: Among 481 patients from 5 studies, 112 experienced LW fractures, while 369 did not postoperatively. Analysis indicated a significantly lower LWT in the LW fracture group (SMD −1.13, I² = 41.3%, p = 0.146). The mean LWT in the LW fracture group was 18.2 mm, with a 95% confidence interval of 17.29–19.10 mm. Conclusions: A preoperative thin lateral femoral wall is a critical predictor of fixation failure and suboptimal functional outcomes when using a DHS. Thorough evaluation of pre- and intraoperative x-rays is essential. CMN is recommended over DHS in cases with LWT measurements <19 mm. [ABSTRACT FROM AUTHOR]

Background Intracardiac masses are historically treated with surgery. As percutaneous technologies continue to evolve, non-surgical techniques for mass removal may become options. We present a case of a woman with a large right atrial mass that was percutaneously removed en bloc without surgery. Case summary A 77-year-old woman presents with a 40 mm right atrial mass. The mass was increasing in size, and she preferred to avoid surgical removal. The tumour was removed percutaneously from the femoral vein using a large suction cannula in combination with transection of the stalk using an electrified snare. The case was complicated by a haemopericardium that was treated successfully by injecting a haemostatic matrix into the pericardial space. The pathology returned papillary fibroelastoma. Discussion The TEXAS technique used to remove the right atrial mass in this case is a modification of a previously described technique (SEATTLE procedure). Using this method, we were able to remove a 40 mm tumour from the right atrium without surgery. This is the largest reported intracardiac tumour that has been removed en bloc percutaneously. Percutaneous removal of right atrial tumours appears feasible, although this may be limited to smaller tumours based on the results of our case. [ABSTRACT FROM AUTHOR]

Introduction: In pulmonary embolism (PE), when used for catheter‐directed thrombolysis (CDT), low‐dose alteplase is associated with good outcomes. Tenecteplase has been only used as intravenous for this indication. In the context of our national economic crisis where alteplase was unavailable, we describe our experience with tenecteplase CDT. Case: A 73‐year‐old male, hypertensive and smoker with COPD, presented to the ED with intermediate high‐risk PE.(ED) with intermediate high‐risk PE. Heparin infusion was initiated. A few hours later, the patient developed atrial fibrillation (AF) for which amiodarone infusion was started. Also, a left femoral and popliteal vein thrombosis was also confirmed by the lower extremity duplex. As the patient remained dyspneic with unstable vital signs, the decision was to perform a CDT. In the absence of alteplase, tenecteplase was used at 0.5 mg/h over 30 h, for a total of 15 mg. Result: Twenty‐four hours after tenecteplase initiation, dyspnea and vital signs had significantly improved. Oxygen support was gradually dropping to finally stop. Being on concomitant heparin infusion, the patient had a mild blood oozing at the femoral vein site of entry; however, this did not require any transfusion or discontinuation of heparin. The patient regained his baseline physical and mental functions and was discharged on enoxaparin and amiodarone tablet. Discussion: This is the first experience describing the use of tenecteplase as part of CDT in a patient with acute intermediate high‐risk PE. The combination to therapeutic heparin infusion, already described in different clinical scenarios with intravenous tenecteplase, was safe and well tolerated Conclusion: CDT with tenecteplase was, for the first time, safely and effectively used in an intermediate high‐risk PE patient. However, more studies are needed to confirm and establish these findings. [ABSTRACT FROM AUTHOR]

Introduction: Access site complications remain common following atrial fibrillation (AF) catheter ablation. Femoral vascular closure devices (VCDs) reduce time to hemostasis compared with manual compression, although large‐scale data comparing clinical outcomes between the two approaches are lacking. Methods: Two cohorts of patients undergoing AF ablation were identified from 36 healthcare organizations using a global federated research network (TriNetX): those receiving a VCD for femoral hemostasis, and those not receiving a VCD. A 1:1 propensity score matching (PSM) model based on baseline characteristics was used to create two comparable cohorts. The primary outcome was a composite of all‐cause mortality, vascular complications, bleeding events, and need for blood transfusion. Outcomes were assessed during early (within 7 days of ablation) and extended follow‐up (within 8–30 days of ablation). Results: After PSM, 28 872 patients were included (14 436 in each cohort). The primary composite outcome occurred less frequently in the VCD cohort during early (1.97% vs. 2.60%, odds ratio (OR) 0.76, 95% confidence interval (CI) 0.65–0.88; p <.001) and extended follow‐up (1.15% vs. 1.43%, OR 0.80, 95% CI 0.65–0.98; p =.032). This was driven by a lower rate of vascular complications during early follow‐up in the VCD cohort (0.83% vs. 1.26%, OR 0.66, 95% CI 0.52–0.83; p <.001), and fewer bleeding events during early (0.90% vs. 1.23%, OR 0.73, 95% CI 0.58–0.92; p =.007) and extended follow‐up (0.36% vs. 0.59%, OR 0.61, 95% CI 0.43–0.86; p =.005). Conclusion: Following AF ablation, femoral venous hemostasis with a VCD was associated with reduced complications compared with hemostasis without a VCD. [ABSTRACT FROM AUTHOR]

Introduction: Transvenous lead extractions (TLEs) for cardiac implantable electronic device complications often encounter difficulties with strong adhesions to the myocardium or vessels. In this report, we introduce a novel "Four‐Stage Rocket" technique for effective TLE in cases where conventional methods fail. Methods and Results: Two challenging cases where conventional TLE methods failed were treated using a combination of four devices: Needle's Eye Snare, Agilis NxT Steerable Introducer, GlideLight Laser sheath, and GORE® DrySeal Flex Introducer sheath, employed via the inferior vena cava. The "Four‐Stage Rocket" technique successfully detached firmly adhered leads near the tricuspid valve annulus, where the traditional superior vena cava approach was inadequate. Conclusion: The "Four‐Stage Rocket" technique offers a potential alternative in complex TLE cases, aligning the laser direction with the adhesion detachment and reducing the tissue damage risk. [ABSTRACT FROM AUTHOR]

Hemorheological factors may show arterio-venous differences. Alterations in acid-base and metabolic parameters may also influence these factors. However, little is known about changes in micro-rheological parameters during abdominal surgery, influencing splanchnic circulation. In anesthetized pigs, the external jugular vein, femoral artery and vein were cannulated unilaterally, and paramedian laparotomy was performed. In the anastomosis group, after resecting a bowel segment, end-to-end jejuno-jejunostomy was completed. Blood samples (from cannulas and by puncturing the portal vein) were taken before and after the intervention. Hematological, acid-base and blood gas parameters, metabolites, red blood cell (RBC) deformability and aggregation were determined. The highest hematocrit was found in portal blood, increasing further by the end of operation. A significant pH decrease was seen, and portal blood showed the highest lactate and creatinine concentration. The highest RBC aggregation values were found in arterial, the lowest in renal venous blood. The RBC aggregation increased with higher lactate concentration and lower pH. Osmotic gradient deformability declined, with the lowest values in portal and renal venous samples. In conclusion, micro-rheological parameters showed arterio-venous and porto-renal venous differences, influenced by oxygenation level, pH and lactate concentration. The intestinal anastomosis operation caused an immediate micro-rheological deterioration with portal venous dominancy in this experiment. [ABSTRACT FROM AUTHOR]

Introduction: Diagnosing deep venous thromboses and venous thromboemboli (DVT/VTE) in pregnant patients presents a unique challenge for emergency physicians. The risk of DVT/VTE increases during pregnancy, and the potential consequences of misdiagnoses are severe. Point-of-care ultrasonography (POCUS) is frequently a first-line diagnostic imaging modality. However, recent studies have shown a high incidence of thromboses proximal to the common femoral vein during pregnancy, and these would not be visualized using compressive ultrasonography, which traditionally can only visualize thromboses distal to the femoral vein. Case Report: A 38-year-old female, 25-weeks primiparous, presented to the emergency department with a three-day history of left lower extremity swelling. Point-of-care three-point compression testing was used to evaluate for a DVT; however, no thrombus was visualized. Given high clinical suspicion, color and spectral Doppler testing were performed and demonstrated turbulent flow and reduced respiratory variation in the common femoral vein. This prompted further additional testing for a proximal DVT using magnetic resonance venography, which revealed an occlusive left external iliac thrombus. The patient was subsequently started on daily subcutaneous enoxaparin and discharged home with close follow-up. Conclusion: Emergency physicians play a critical role in evaluations for the presence of DVT/VTE, particularly in pregnant patients. We endorse the use of POCUS with three-point compression testing, as well as color and spectral Doppler imaging, to help identify proximal DVTs in this patient population. This case report can aid physicians in the diagnosis of this pathological condition that if left untreated can have severe consequences. [ABSTRACT FROM AUTHOR]

A 15‐year‐old male patient presented with a 3‐year history of recurrent dizziness and headaches and was initially diagnosed with patent foramen ovale. A transcatheter closure procedure was planned and conducted under general anesthesia, utilizing ultrasound guidance through the femoral vein. Preadmission echocardiography confirmed the presence of a patent foramen ovale. However, further investigation with transesophageal echocardiography (TEE) performed under general anesthesia, revealed that the observed atrial septal anomaly was not a patent foramen ovale. Instead, real‐time TEE identified it as the left atrial opening of the coronary vein. Subsequent detailed TEE tracking confirmed a rare case of coronary sinus ostium atresia with left atrial reflux of the coronary vein, leading to a significant revision of the initial diagnosis and planned treatment. [ABSTRACT FROM AUTHOR]

Background: During transcatheter aortic valve implantation (TAVI), secondary access is required for angiographic guidance and temporary pacing. The most commonly used secondary access sites are the femoral artery (angiographic guidance) and the femoral vein (temporary pacing). An upper extremity approach using the radial artery and an upper arm vein instead of the lower extremity approach using the femoral artery and femoral vein may reduce clinically relevant secondary access site-related bleeding complications, but robust evidence is lacking. Trial design: The TAVI XS trial is a multicentre, randomised, open-label clinical trial with blinded evaluation of endpoints. A total of 238 patients undergoing transfemoral TAVI will be included. The primary endpoint is the incidence of clinically relevant bleeding (i.e. Bleeding Academic Research Consortium (BARC) type 2, 3 or 5 bleeding) of the randomised secondary access site (either diagnostic or pacemaker access, or both) within 30 days after TAVI. Secondary endpoints include time to mobilisation after TAVI, duration of hospitalisation, any BARC type 2, 3 or 5 bleeding, and early safety at 30 days according to Valve Academic Research Consortium‑3 criteria. Conclusion: The TAVI XS trial is the first randomised trial comparing an upper extremity approach to a lower extremity approach with regard to clinically relevant secondary access site-related bleeding complications. The results of this trial will provide important insights into the safety and efficacy of an upper extremity approach in patients undergoing transfemoral TAVI. [ABSTRACT FROM AUTHOR]

Cardiac output (Q̇C) and leg blood flow (Q̇LEG) can be measured simultaneously with high accuracy using transpulmonary and femoral vein thermodilution with a single‐bolus injection. The invasive measure has offered important insight into leg hemodynamics and blood flow distribution during exercise. Despite being the natural modality of exercise in humans, there has been no direct measure of Q̇LEG while running in humans. We sought to determine the feasibility of the thermodilution technique for measuring Q̇LEG and conductance during high‐intensity running, in an exploratory case study. A trained runner (30 years male) completed two maximal incremental tests on a cycle ergometer and motorized treadmill. Q̇LEG and Q̇C were determined using the single‐bolus thermodilution technique. Arterial and venous blood were sampled throughout exercise, with continuous monitoring of metabolism, intra‐arterial and venous pressure, and temperature. The participant reached a greater peak oxygen uptake (V̇O2peak) during running relative to cycling (74 vs. 68 mL/kg/min) with comparable Q̇LEG (19.0 vs. 19.5 L/min) and Q̇C (27.4 vs. 26.2 L/min). Leg vascular conductance was greater during high‐intensity running relative to cycling (82 vs. 70 mL/min/mmHg @ ~80% V̇O2peak). The "beat phenomenon" was apparent in femoral flow while running, producing large gradients in conductance (62–90 mL/min/mmHg @ 70% V̇O2peak). In summary, we present the first direct measure of Q̇LEG and conductance in a running human. Our findings corroborate several assumptions about Q̇LEG during running compared with cycling. Importantly, we demonstrate that using thermodilution in running exercise can be completed effectively and safely. [ABSTRACT FROM AUTHOR]

Introduction: Successful implantations of the Aveir VR, have been effectively demonstrated in adults; however, there remain limited reports supporting safe and feasible implantation of the Aveir VR in the young population. Methods: Retrospective, observational study of Aveir VR implantation of young patients (≦21 years old) at UC Davis Medical Center from November 2022 to January 2024 via the internal jugular or femoral vein implantation approaches. Indications for pacing, patient demographics, pacing thresholds and longevity were reported at the time of implantation and last follow‐up. Results: A total of 10 patients received the Aveir VR with a median age of years (IQR 12.5–17) and median weight of 50.8 kg (IQR 44.6–60.9) kg. The majority were male (80%). Aveir VR leadless pacemaker occurred via internal jugular venous (90%) or femoral venous (10%) approaches. Indications for placement were intermittent complete heart block (60%) and sinus pauses (40%). Adequate impedance, sensing and thresholds were maintained from implantation to a median follow‐up of 9 months. Predicted pacemaker longevity at follow‐up median was 23.8 years. There were no complications in any of the 10 patients. Conclusion: Aveir VR implantation via the internal jugular and femoral veins is feasible in the young patient population with stable pacing parameters at follow‐up. [ABSTRACT FROM AUTHOR]

Femoral vein is increasingly used for venous cannulation procedures. Its anomalies in the femoral triangle could complicate these procedures. We report an extremely rare type of femoral venous ladder observed during routine cadaveric dissections. The variation was found in the left lower limb of an adult male cadaver aged 70 years. The femoral vein was a single vein in initial 3 cm and terminal 4 cm of its course. The middle part of the vein showed a duplication and a complex ladder pattern and encircled the femoral artery in the femoral triangle. This anomaly could predispose the vein for deep vein thrombosis. Knowledge of this anomaly could be useful during radiological procedures, femoral hernia repair and femoral triangle abscess and lymph node clearance. [ABSTRACT FROM AUTHOR]

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Ventriculoatrial shunts are the alternative treatments when it is impossible to use ventriculoperitoneal shunts. Limited indication for ventriculoatrial shunt is due to the possibility of very serious complications inherent with this procedure. We present a case report of a young patient who suffered from disconnection of an atrial catheter from the valve after an accidental blow to his neck. The atrial catheter was dislocated to the heart and pulmonary artery and it was extracted through the femoral vein in the groin area using an endovascular technique. The procedure went without complications. A new atrial catheter was introduced under ultrasonic guidance during surgical revision. [ABSTRACT FROM AUTHOR]

Objectives: We recently reported the first controlled Doppler ultrasonography (US) study demonstrating increased common femoral vein (CFV) thickness in Behçet's Disease (BD). Standard lower extremity venous Doppler US is performed in erect position. In order to confirm accuracy and applicability of method, we measured CFV thickness in both supine and standing positions in this study. Method: We included sex and age-matched 42 BD patients and 41 healthy controls (HCs). After routine visits, bilateral CFV thickness was measured with Doppler US both in supine and standing positions. Results: Bilateral CFV thickness was significantly higher in BD than in HC. There were no statistically significant differences in measurements of CFV wall thickness between standing and supine positions in both groups. Conclusions: CFV measurement by Doppler US is a new and non-invasive diagnostic tool for the diagnosis of BD. Our study confirmed that patient position does not affect CFV wall thickness measurement for diagnosis of BD. [ABSTRACT FROM AUTHOR]

Purpose: To compare femoral endovenectomy with the creation of an arteriovenous fistula (FE + AVF), versus iliofemoral endovenous stenting with the concurrent extended femoral vein (FV-S) stenting in patients with chronic iliofemoral venous obstruction (IFVO). Materials and Methods: In a randomized prospective single-center study, 48 received (FV-S), while the other 54 had (FE + AVF). Results: There were no statistically significant differences in the primary outcomes between the two groups (FV-S) and (FE + AVF) (59% vs 56.8%, 75% vs 79.1%, respectively). At a median of 13 months after the treatment. However, the FV-S group's patients experienced fewer postoperative problems (p = .012), shorter procedures (p = .001), and shorter stays in the hospital (p = .025). Conclusion: There is no difference between the efficacy and symptomatic resolution of the FV-S group and the FE + AVF group at the same time, FV-S has lower postoperative complications and a shorter procedure duration and hospital stay. [ABSTRACT FROM AUTHOR]

This study evaluates the pain experienced by patients undergoing endovenous laser ablation (EVLA) of the great saphenous vein (GSV) when combined with an ultrasound-guided femoral nerve block (FNB). The aim was to assess the effectiveness of FNB in reducing pain during the procedure and its impact on patient comfort, procedure duration, and recovery time. A total of 50 patients diagnosed with varicose veins were enrolled. The results indicated that ultrasound-guided FNB significantly reduced intra-procedural pain levels compared to the control group, improving patient outcomes. [ABSTRACT FROM AUTHOR]

The article discusses a case of a 50-year-old female with a fractured port-a-catheter successfully removed using the Inari ClotTriever device. The patient had a history of breast cancer and experienced complications with the catheter, leading to the need for removal. The innovative technique presented in the article offers a less invasive alternative to open surgery for challenging foreign body removal cases, highlighting the importance of patient preference and psychological impact in medical decision-making. [Extracted from the article]