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retrograde access

Marc Bosiers, Koen Deloose, Joren Callaert
The selection of an optimal vascular access strategy for lower limb endovascular intervention is key for procedural safety and success, and is particularly relevant in diabetic patients, in whom extensive occlusive disease commonly involves the infrapopliteal arteries. Individualizing vascular access requires careful planning, including determining normal and abnormal arterial anatomy; the patient's co-medical conditions, especially renal insufficiency; and review of noninvasive vascular laboratory testing...
June 2018: Seminars in Vascular Surgery
Sakıp Erturhan, Ömer Bayrak, Haluk Şen, Ali Erdem Yılmaz, İlker Seçkiner
OBJECTIVE: To investigate the effects of alpha blocker treatment on the placement of ureteral access sheaths (UAS) during retrograde intrarenal surgery (RIRS). MATERIAL AND METHODS: This study was a retrospective analysis of prospectively collected data. Patients who underwent RIRS due to renal stones between November 2015 and December 2017 were seperated into two groups. Age, gender, body mass index (BMI), stone size, laterality, hydronephrosis degree, and renal stone density were recorded...
January 22, 2019: Turkish Journal of Urology
Christy A Itoga, Yuncai Chen, Cameron Fateri, Paula A Echeverry, Jennifer M Lai, Jasmine Delgado, Shapatur Badhon, Annabel Short, Tallie Z Baram, Xiangmin Xu
Corticotropin-releasing hormone (CRH) is an essential, evolutionarily-conserved stress- neuropeptide. In addition to hypothalamus, CRH is expressed in brain regions including amygdala and hippocampus where it plays crucial roles in modulating the function of circuits underlying emotion and cognition. CRH+ fibers are found in nucleus accumbens (NAc), where CRH modulates reward/motivation behaviors. CRH actions in NAc may vary by the individual's stress history, suggesting roles for CRH in neuroplasticity and adaptation of the reward circuitry...
March 12, 2019: Journal of Comparative Neurology
D A Khelimskii, O V Krestyaninov, A G Badoyan, D N Ponomarev, E A Pokushalov
PURPOSE: to assess results of percutaneous coronary intervention (PCI) with contemporary endovascular techniques of recanalization of chronic total coronary artery occlusions (CTO) in patients with ischemic heart disease (IHD). Occlusion (CTO) he procedural and in-hospital outcomes of consecutive patients undergoing chronic total occlusion percutaneous coronary intervention. MATERIALS AND METHODS: We retrospectively analyzed data from 456 consecutive patients (mean age 59...
March 7, 2019: Kardiologiia
Carlo Fabbri, Alessandro Fugazza, Cecilia Binda, Alessandro Zerbi, Elio Jovine, Vincenzo Cennamo, Alessandro Repici, Andrea Anderloni
We present five cases of pylorus-preserving pancreaticoduodenectomy (PPPD) after endoscopic ultrasonography-guided choledochoduodenostomy (EUS-CD) using a lumen-apposing metal stent (LAMS) as a bridge to surgery in patients with resectable distal malignant biliary obstruction and failed endoscopic retrograde cholangiopancreatography (ERCP). The patients underwent an EUS-CD using EC-LAMS, the bile duct being accessed using the transbulbar approach. The technical success rate of EUS-CD was 100%. No procedure-related adverse events occurred...
March 2019: Journal of Gastrointestinal and Liver Diseases: JGLD
Arian Sultan, Barbara Bellmann, Jakob Lüker, Tobias Plenge, Jan-Hendrik van den Bruck, Karlo Filipovic, Susanne Erlhöfer, Liz Kuffer, Zeynep Arica, Daniel Steven
BACKGROUND: First experiences using a 64-electrode mini-basket catheter (BC) paired with an automatic mapping system (Rhythmia™) for catheter ablation (CA) of ventricular ectopy (VE) and ventricular tachycardia (VT) have been reported. OBJECTIVES: We aimed to evaluate (1) differences in ventricular access for the BC and (2) benefit of this technology in the setting of standard clinical practice. METHODS: Patients (pts) undergoing CA for VE or VT using the Intellamap Orion™ paired with the Rhythmia™ automated-mapping system were included in this study...
March 7, 2019: Journal of Interventional Cardiac Electrophysiology: An International Journal of Arrhythmias and Pacing
Habeeb Salameh, Christopher J DiMaio
"Gallbladder disease is one of the most common gastrointestinal diseases encountered in clinical practice. Surgical removal and percutaneous drainage are both widely available and effective in the management of acute cholecystitis. Several endoscopic approaches exist as an alternative to these interventions. These include transpapillary approaches via endoscopic retrograde cholangiopancreatography (ERCP), transmural drainage and access approaches via endoscopic ultrasound (EUS), and endoscopic surgical approaches using natural orifice transluminal endoscopic surgery (NOTES) techniques...
April 2019: Gastrointestinal Endoscopy Clinics of North America
Jeremy S Nussbaum, Nikhil A Kumta
Endoscopic retrograde cholangiopancreatography is the preferred procedure for biliary drainage in benign and malignant obstructions. Endoscopic ultrasound-guided biliary drainage is an emerging technique for when endoscopic retrograde cholangiopancreatography fails. It is a highly versatile procedure with several options of access point, stent direction, and drainage route. Based on the current literature, the cumulative success rate is 88% to 93%, with an overall complication rate of 13% to 20%. Endoscopic ultrasound-guided biliary drainage seems to be an effective and valuable alternative technique after failed endoscopic retrograde cholangiopancreatography when performed by highly skilled endoscopists...
April 2019: Gastrointestinal Endoscopy Clinics of North America
Prashant Kedia, Paul R Tarnasky
Choledocholithiasis is a common disorder that is managed universally by endoscopic retrograde cholangiopancreatography (ERCP). For difficult or complex stones, ERCP with conventional techniques may fail to achieve biliary clearance in 10% to 15% of cases. This review summarizes the literature regarding the current available endoscopic techniques for complex stone disease, including mechanical lithotripsy, endoscopic papillary large balloon dilation, cholangioscopy-guided lithotripsy, and endoscopic ultrasound-guided biliary access...
April 2019: Gastrointestinal Endoscopy Clinics of North America
Miguel Podesta, Miguel Podesta
Background: Management of partial or complete traumatic urethral disruptions of the posterior urethra in children and adolescents, secondary to pelvic fracture poses a challenge. Controversy exists as to the correct acute treatment of posterior urethral injuries and delayed management of PFPUDDs. We reviewed the urological literature related to the treatment of traumatic posterior urethral injuries and delayed repair of these distraction defects in children and adolescents. Material and Methods: There are few long-term outcomes studies of patients who underwent PFPUDDs repairs in childhood; most reports included few cases with short follow up...
2019: Frontiers in Pediatrics
Soshi Tanabe, Shiori Uezono, Hitomi Tsuge, Maki Fujiwara, Miki Miwa, Shigeki Kato, Katsuki Nakamura, Kazuto Kobayashi, Ken-Ichi Inoue, Masahiko Takada
Pseudotyped lentiviral vectors give access to pathway-selective gene manipulation via retrograde transfer. Two types of such lentiviral vectors have been developed. One is the so-called NeuRet vector pseudotyped with fusion glycoprotein type E, which preferentially transduces neurons. The other is the so-called HiRet vector pseudotyped with fusion glycoprotein type B2, which permits gene transfer into both neurons and glial cells at the injection site. Although these vectors have been applied in many studies investigating neural network functions, it remains unclear which vector is more appropriate for retrograde gene delivery in the brain...
March 5, 2019: Scientific Reports
Musa Ekici, Berat Cem Ozgur, Aykut Bugra Senturk, Arzu Akdagli Ekici, Cemil Aydin, Mehmet Murat Baykam
OBJECTIVE: To evaluate the safety and effectiveness of fluoroscopy-free RIRS (Retrograde intrarenal surgery) method in urolithiasis. STUDY DESIGN: An observational study. PLACE AND DURATION OF STUDY: Department of Urology, Hitit University Corum Training and Research Hospital, Corum, Turkey, from October 2014 and October 2017. METHODOLOGY: Preoperative and postoperative data of 62 cases of renal calculi that underwent fluoroscopy-free RIRS procedure by a single surgeon were prospectively evaluated...
March 2019: Journal of the College of Physicians and Surgeons—Pakistan: JCPSP
Thomas J Wang, Christopher C Thompson, Marvin Ryou
BACKGROUND: Performing endoscopic retrograde cholangiopancreatography (ERCP) in patients with Roux-en-Y gastric bypass (RYGB) anatomy is technically challenging. Device-assisted enteroscopy and laparoscopic-assisted methods suffer from high failure rates and/or post-procedural complications. A novel endoscopic technique termed EUS-Directed Transgastric ERCP (EDGE) or Gastric Access Temporary for Endoscopy (GATE) has recently emerged, demonstrating excellent technical and therapeutic success...
February 25, 2019: Surgical Endoscopy
James B Naidich, Amanda Weiss, Ernesto P Molmenti, Jason J Naidich, John S Pellerito
OBJECTIVES: Retrograde vertebral artery flow, the steal phenomenon, is most frequently caused by a flow-limiting stenosis of the proximal subclavian artery. The reversal of flow can be incomplete, resulting in bidirectional flow: retrograde in systole and antegrade in diastole. Less often, retrograde vertebral artery flow is the consequence of increased subclavian flow, as might occur with a well-functioning dialysis access fistula. Our objective was to evaluate bidirectional vertebral artery flow associated with dialysis access fistulas...
February 25, 2019: Journal of Ultrasound in Medicine: Official Journal of the American Institute of Ultrasound in Medicine
Thomas C Hall, Said Habib
Introduction: Vascular closure devices are commonly used to achieve rapid haemostasis and early ambulation following arterial puncture for endovascular procedures. Although device failure rates are low, the consequences of arterial occlusion include severe limb ischaemia. We describe a novel endovascular technique for the treatment of Angio-Seal arterial closure device (Terumo, Europe NV) failure causing femoral artery occlusion. Materials and methods: We describe 2 cases of lower limb angioplasty performed for critical limb ischaemia where the access site was closed using an Angio-Seal according to the manufacturer instructions for use (IFU)...
2019: Clinical Medicine Insights. Case Reports
A Meining
Endoscopic interventions in the biliary system are defined by the elimination of an outflow obstruction such as in choledocholithiasis or the optimization of bile flow by means of stent drainage. Exclusive use of diagnostic endoscopic retrograde cholangiography (ERC) is now obsolete, but due to its minimally invasive approach, therapeutic ERC is the method of choice for intervention in appropriate indications. If access to the biliary system via the papilla is not possible, approaches as guided by endoscopic ultrasound appear to be a valid option for the experienced endoscopist...
February 21, 2019: Der Radiologe
Peter Tajti, Khaldoon Alaswad, Dimitri Karmpaliotis, Farouc A Jaffer, Robert W Yeh, Mitul Patel, Ehtisham Mahmud, James W Choi, M Nicholas Burke, Anthony H Doing, Phil Dattilo, Catalin Toma, A J Conrad Smith, Barry F Uretsky, Elizabeth Holper, Srinivasa Potluri, R Michael Wyman, David E Kandzari, Santiago Garcia, Oleg Krestyaninov, Dmitrii Khelimskii, Michalis Koutouzis, Ioannis Tsiafoutis, Jaikirshan J Khatri, Wissam Jaber, Habib Samady, Brian Jefferson, Taral Patel, Shuaib Abdullah, Jeffrey W Moses, Nicholas J Lembo, Manish Parikh, Ajay J Kirtane, Ziad A Ali, Darshan Doshi, Iosif Xenogiannis, Larissa I Stanberry, Bavana V Rangan, Imre Ungi, Subhash Banerjee, Emmanouil S Brilakis
OBJECTIVES: This study examined the frequency and outcomes of radial access for chronic total occlusion (CTO) percutaneous coronary intervention (PCI). BACKGROUND: Radial access improves the safety of PCI, but its role in CTO PCI remains controversial. METHODS: We compared the clinical, angiographic, and procedural characteristics of 3,790 CTO interventions performed between 2012 and 2018 via radial-only access (RA) (n = 747) radial-femoral access (RFA) (n = 844) and femoral-only access (n = 2,199) access at 23 centers in the United States, Europe, and Russia...
February 25, 2019: JACC. Cardiovascular Interventions
David C Bloom, Zachary L Watson, Donna M Neumann
Adeno-associated Virus (AAV) vectors are useful vehicles for delivering transgenes to a number of different tissues and organs in vivo. To date, most of these applications deliver the vectors to their target by either infusion into the bloodstream or direct injection into the target tissue. Recently there has been progress in delivering AAV vectors to neurons of the peripheral nervous system (PNS) following application of vectors to the peripheral epithelium, such as the skin or eye. This delivery only requires treatment of the epithelium to access the underlying nerve termini, and following treatment the vectors are transported retrogradely to the cell bodies of these neurons in the ganglia, such as dorsal root ganglia (DRG) or trigeminal ganglia (TG)...
2019: Methods in Molecular Biology
Samuel H Lai, Jordan Fenlon, Benjamin B Roush, John Munn, Mark Rummel, Daniel Johnston, Chris Longton, Krishna M Jain
OBJECTIVE: The objective of this study was to evaluate the safety and efficacy of a retrograde tibial approach in revascularization of lower extremities for treatment of ischemia in anatomically challenging patients. METHODS: This is a retrospective study of 57 procedures performed between 2012 and 2016 using the retrograde approach to treat patients with flush occlusion, inability to cross the lesion, failed bypass, or hostile groin. Demographic data, Rutherford classes, vessels treated, and approach were noted...
February 15, 2019: Journal of Vascular Surgery
Lorenzo Masieri, Simone Sforza, Andrea Mari, Simone Morselli, Riccardo Tellini, Fabrizio Di Maida, Graziano Vignolini, Sergio Serni, Marco Carini, Andrea Minervini
BACKGROUND: The aim of the study was to describe the surgical outcomes of a series of consecutive patients treated with robot-assisted pyeloplasty (RAP) for ureteropelvic junction obstruction in a single tertiary referral centre. METHODS: We prospectively collected and retrospectively analysed data of 292 patients submitted to RAP performed from September 2011 to December 2016 by four experienced surgeons. The stenotic ureteropelvic junction was resected according to the Anderson-Hynes technique...
February 14, 2019: Minerva Urologica e Nefrologica, the Italian Journal of Urology and Nephrology
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