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• Training is required for all doctors new to REBOA regardless of existing vascular access skills and simpler catheter systems. • Doctors skilled in vascular access benefit from an initial inter-procedural transfer of skills effect when first learning REBOA. • However, novice doctors perform equally well after a focussed simulation-based training, indicating that either group can learn the technical aspects of inserting REBOA. • A time-fixed simulation-based training program does not ensure technical proficiency of doctors learning REBOA, despite vast experience. • Individual skills assessment should be used to ensure proficiency following training for all doctors regardless of previous experience. Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an emerging and potentially life-saving procedure, necessitating qualified operators in an increasing number of centres. The procedure shares technical elements with other vascular access procedures using the Seldinger technique, which is mastered by doctors not only in endovascular specialties but also in trauma surgery, emergency medicine, and anaesthesiology. We hypothesised that doctors mastering the Seldinger technique (experienced anaesthesiologist) would learn the technical aspects of REBOA with limited training and remain technically superior to doctors unfamiliar with the Seldinger technique (novice residents) given similar training. This was a prospective trial of an educational intervention. Three groups of doctors were enroled: novice residents, experienced anaesthesiologists, and endovascular experts. The novices and the anaesthesiologists completed 2.5 h of simulation-based REBOA training. Their skills were tested before and 8–12 weeks after training using a standardised simulated scenario. The endovascular experts, constituting a reference group, were equivalently tested. All performances were video recorded and rated by three blinded experts using a validated assessment tool for REBOA (REBOA-RATE). Performances were compared between groups and with a previously published pass/fail cutoff. Sixteen novices, 13 board-certified specialists in anaesthesiology, and 13 endovascular experts participated. Before training, the anaesthesiologists outperformed the novices by 30 percentage points of the maximum REBOA-RATE score (56% (SD 14.0) vs 26% (SD 17%), p <0.01). After training, there was no difference in skills between the two groups (78% (SD 11%) vs 78 (SD 14%), p = 0.93). Neither group reached the endovascular experts' skill level (89% (SD 7%), p <0.05). For doctors mastering the Seldinger technique, there was an initial inter-procedural transfer of skills advantage when performing REBOA. However, after identical simulation-based training, novices performed equally well to anaesthesiologists, indicating that vascular access experience is not a prerequisite to learning the technical aspects of REBOA. Both groups would need more training to reach technical proficiency. [ABSTRACT FROM AUTHOR]

Background Preoperative embolization is based on the preoperative digital subtraction angiography (DSA) tumor blush, and as such is considered the "gold standard" for determining tumor vascularity. However, to our knowledge reliability studies evaluating vascularity ratings of DSA tumor blush in spinal metastases have not been published previously. Purpose To evaluate inter- and intra-rater agreement in the assessment of the vascularity of spinal metastases using DSA tumor blush. Material and Methods This reliability study included 46 patients with symptomatic metastatic spinal cord compression requiring surgery. DSA data stored in the hospital picture archiving and communication system (PACS) from the participants of a randomized controlled trial were used. Inter- and intra-rater agreement on vascularity assessment using DSA tumor blush according to a three-step ordinal scale was evaluated: no hypervascularity; moderate hypervascularity; and pronounced hypervascularity. The statistical analysis was based on the linear weighted kappa's for multiple raters that extend Cohen's κ. Three raters and κ = 0.2 in the null hypothesis implied that the power of the study was 0.96. Results Inter- and intra-rater agreements were moderate in rating the vascularity of spinal metastases and the agreements were significantly higher than the κ = 0.20 in the null hypothesis ( P = 0.0002 and P = 0.0001). The κ value for inter-rater agreement was 0.57 (95% confidence interval [CI], 0.41-0.72) and for intra-rater agreement 0.55 (95% CI, 0.38-0.71). Conclusion There is moderate inter-rater and intra-rater agreement in classifying the vascularity of spinal metastases on a three-step ordinal scale for DSA tumor blush. [ABSTRACT FROM AUTHOR]

Background Vascular access complications after coronary angiography (CAG) and percutaneous coronary intervention (PCI) are known to increase morbidity, prolong hospitalization and raise hospital costs. Therefore, risk factor identification and improvement of safety strategies for vascular management are important. We aimed to assess the incidence of major vascular complications related to femoral access, and to identify potential risk factors. Methods Over a period of six years, 23,870 index procedures (CAG) were performed in two centres, prospectively entered in the database and retrospectively analysed. Data was obtained from the Eastern Danish Heart Registry and cross-matched with data from the Danish Vascular Registry. Index procedures were defined as the first trans-femoral procedure. Demographic, procedural and mortality data, as well as information on access complications requiring surgery within 30 days were collected. Mortality data were collected for minimum 12 months. Results We identified 130 (0.54%) access complications requiring surgery; 65 pseudoaneurysms (0.28%), 46 arterial occlusions (0.19%), 15 hematomas (nine groin and six retroperitoneal hematomas) (0.06%), and 4 arterial dissections (0.02%). Risk factors for complications were left sided femoral access (OR 4.11 [2.29–7.37] p < 0.001), peripheral arterial disease (PAD) (OR 2.42 [1.48–3.94] p < 0.0001) and female sex (OR 2.22 [1.51–3.24] p < 0.0001). Conclusion Vascular complications related to femoral access in coronary diagnostic and interventional procedures are low (0.54%). Risk factors were left sided access, PAD, and female sex. [ABSTRACT FROM AUTHOR]

Vascular access complications (VACs) remain one of the biggest challenges when performing transcatheter aortic valve implantation (TAVI). This study aimed to investigate the short- and medium-term safety and efficacy of the Viabahn endoprosthesis (Gore, Flagstaff, AZ) when used to treat TAVI-induced vascular injury. Over a 40-month period, 354 patients underwent true percutaneous transfemoral (TF)-TAVI using a CoreValve and Prostar-XL closure system; this was our study population. A VAC leading to acute intervention occurred in 72 patients (20.3%) - of these, 18 were managed by balloon angioplasty, 48 were treated by Viabahn stenting (technical success rate 98%), and 6 needed surgical intervention. Overall, this approach resulted in a major VAC rate of 3.1% (n = 11) in our study cohort. Length of hospitalization and 30-day mortality rates were comparable in patients with a VAC treated by Viabahn stenting versus patients without vascular complications. Two patients (4.5%) presented with new-onset claudication; one of them had the stent implanted covering the deep femoral artery (DFA). At medium-term follow-up (median 372 days; range 55 to 978 days) duplex ultrasound showed 100% patency of the Viabahn endoprostheses with no signs of stent fracture or in-stent stenosis/occlusion. In conclusion, the use of self-expanding covered stents is safe and effective in case of TF-TAVI–induced vascular injury, with good short- and medium-term outcomes. Importantly, coverage of the DFA should be avoided. If confirmed by long-term (>5 years) follow-up studies, this strategy for treating TAVI-induced VAC may be used routinely in high-risk patients. [ABSTRACT FROM AUTHOR]