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The profunda femoral artery is an uncommon location for a pseudoaneurysm and is technically challenging to resolve with traditional techniques, such as ultrasound-guided compression or thrombin injection, owing to its deep anatomical location. Balloonassisted thrombin injection (BATI) is a technique that has been shown to be effective using contralateral access for technically difficult pseudoaneurysms in high-risk surgical patients. We report a case of BATI using radial access in a patient with a profunda femoral artery pseudoaneurysm. [ABSTRACT FROM AUTHOR]

Introduction: The use of concomitant Impella in cardiogenic shock patients treated with veno-arterial extra-corporeal membrane oxygenation (VA-ECMO) has demonstrated contrasting results. Hypothesis: To evaluate the short-term mortality in patients with cardiogenic shock treated with VA-ECMO and a concomitant Impella in comparison to patients being treated only with VA-ECMO. Methods: A comprehensive search of existing databases from 2000 to 2017 was performed. Studies reporting short-term mortality in patients with cardiogenic shock treated with VA-ECMO were included. Studies designed as case reports/series, systematic or narrative reviews, pediatric or animal studies were excluded. A Mantel-Haenszel model was used to calculate pooled risk ratios (RR) and 95% confidence intervals (CI) using random-effects model. A p-value of <0.05 with CI range not including unity was considered significant. Results: Of the 382 titles identified, five studies representing 425 patients were included. VA-ECMO was used in 312 (73.4%) and both VA-ECMO and Impella were used in 113 (26.6%) patients. Heterogeneity between studies was moderate between studies (I2 = 66%). Median age across studies varied between 51-63 years with 59-88% patients being male. In the pooled analysis, short-term mortality was not significantly different in cardiogenic shock patients on VA-ECMO with and without concomitant Impella support - 54% vs. 55.1%; RR 1.13 (95% CI 0.71-1.78); p =0.50. Conclusions: In this meta-analysis of 425 patients with cardiogenic shock requiring VA-ECMO support, the use of an Impella did not influence short-term mortality in the total cohort. [ABSTRACT FROM AUTHOR]