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Introduction The distal transradial approach (dTRA) is progressively gaining more clinical use in the fields of cardiology and other vascular interventions, as it offers a number of advantages compared to conventional radial approach (TRA). These include lower rates of vascular occlusion which permits preservation of the proximal radial artery for future procedures in the event of a distal occlusion. Aim To share the experience in the use of dTRA for neurointerventions, showing its advantages, pitfalls as well as sharing our optimized puncture and hemostatic ultrarapid compression protocols to improve the use of this vascular access. Methods A retrospective analysis of our experience of diagnostic and interventional procedures performed via dTRA using an optimized protocol for puncture and postpuncture compression of the dTRA was performed. The rate of complications (hematoma and arterial dissection at puncture site) femoral crossover, and assessment of postprocedural stenosis/occlusion with the ultrarapid compression protocol were also assessed. Results From March 2019 to July 2020 a total of 100 distal radial procedures were carried out and 53 diagnostic angiograms (53%) and 47 interventional procedures (47%) were included in the analysis. We achieved a 96% technical success, with a femoral crossover requirement in 3 cases (3%), and one conventional TRA crossover due to puncture failure. Of the patients 3 presented puncture site hematomas (3%) with no intervention required, 61 patients (61%) underwent the ultrarapid hemostasis protocol in association with a hemostatic pad. Ultrasound follow-up was performed in 20 patients (20%) at 1–2 months with 1 case of occlusion (5%) and 2 of radial stenosis (10%). In all 3 cases proximal radial artery remained patent. Conclusion The dTRA is a safe and feasible access route for angiography and neurointerventions. Using vasodilators prepuncture, we attained a variable increase in the vascular diameter facilitating puncture and reducing the risk of occlusion and vascular spasm. A rapid deflation protocol for postpuncture hemostasis does not significantly increase the hematoma rate.

Estudi retrospectiu per analitzar la incidència, factors de risc i tractament de la hemoglobinuria macroscòpica i oliguria després del tractament de malformacions venoses amb escleroteràpia. Un total de 475 procediments es van realitzar en 131 malalts usant etanol, sulfat tetradecil sòdic o ambdos. Hemoglobinuria temporal es va donar després del 34% de procediments i el 57% d'aquests es van asociar amb oliguria temporal. Aquest risc augmenta amb el increment de dosis. La resolució de la hemoglobinuria i oliguria va ser satisfactòria en tots els malalts. El risc d'hemoglobinuria augmenta a les malformacions que afecten les extremitats inferiors i a les de localitzacions mútiples. This is a retrospective study to asess the incidence, risk factors and treatment for gross hemoglobinuria and oliguria following sclerotherapy for venous malformations. 475 procedures were performed on 131 patients using ethanol, sodium tetradecyl sulfate or both agents. Transient hemoglobinuria occurred after 34 % of sclerotherapy procedures and 57 % of these were associated with transient oliguria with increased risk with higher adjusted doses for both agents. Resolution of the hemoglobinuria and oliguria with hydration, alkalinization and diuretics was successful in all patients. The risk of hemoglobinuria increases with sclerotherapy of venous malformations affecting the lower extremities and multiple locations.

Objetivos Material y método Resultados Conclusiones Bibliografía, Objetivos: En este ensayo pictórico educativo nuestro objetivo es describir mediante imágenes las diferentes complicaciones vasculares después de procedimientos Whipple, y posteriormente exponer el papel y el manejo terapéutico desde la perspectiva de la...

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Purpose Methods and Materials Results Conclusion References Personal Information, Purpose: Review the spectrum of interventional procedures that can be performed on the portal...

Estudi retrospectiu per analitzar la incidència, factors de risc i tractament de la hemoglobinuria macroscòpica i oliguria després del tractament de malformacions venoses amb escleroteràpia. Un total de 475 procediments es van realitzar en 131 malalts usant etanol, sulfat tetradecil sòdic o ambdos. Hemoglobinuria temporal es va donar després del 34% de procediments i el 57% d’aquests es van asociar amb oliguria temporal. Aquest risc augmenta amb el increment de dosis. La resolució de la hemoglobinuria i oliguria va ser satisfactòria en tots els malalts. El risc d’hemoglobinuria augmenta a les malformacions que afecten les extremitats inferiors i a les de localitzacions mútiples. This is a retrospective study to asess the incidence, risk factors and treatment for gross hemoglobinuria and oliguria following sclerotherapy for venous malformations. 475 procedures were performed on 131 patients using ethanol, sodium tetradecyl sulfate or both agents. Transient hemoglobinuria occurred after 34 % of sclerotherapy procedures and 57 % of these were associated with transient oliguria with increased risk with higher adjusted doses for both agents. Resolution of the hemoglobinuria and oliguria with hydration, alkalinization and diuretics was successful in all patients. The risk of hemoglobinuria increases with sclerotherapy of venous malformations affecting the lower extremities and multiple locations.