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Safety and Efficacy of Transbrachial Access for Coronary Procedures: Case Report and Review of Literature | Iris publishers
Authored by Mehssani Z*
Introduction
Trans radial approach (TRA) has gained popularity over the trans femoral access (TFA) and has become the default option for coronary procedures around the world, as it has less bleeding access site complications and it is associated with a lower degree of adverse clinical events rate. However, in some situations, the trans radial arterial access could be unsuccessful. We present a case of a 66 years old man with history of aortobifemoral bypass surgery admitted in our department for an ACS and neither TFA nor TRA access were possible.
Case Report
We describe a case of a 66 years old male, with an aortoiliac occlusive disease who was admitted to the vascular surgery unit for aortobifemoral bypass surgery. He had a significant medical history of hypertension, diabetes and an extensive smoking. Pre-operative CAD screening including stress test was normal. The day following the vascular surgery, the patient suffered from severe angina with EKG abnormalities and troponin elevation. He was diagnosed with a non-ST-segment elevation myocardial infarction (NSTEMI). He was forthwith referred to our department for an angiogram to assess for coronary artery disease that may require revascularisation therapy. In the Cath Lab, the radial artery pulse was non palpable due to the thick arterial wall and a low flow state, puncture and cannulation on both radial arterial sides were challenging. In addition, the transfemoral access was not feasible knowing that the patient has just undergone an artobifemoral graft surgery one day ago (Figures 1&2).
To overcome this technical problem, the right brachial artery as an alternative vascular access has been attempted. 1 ml of lidocaine was injected into the subcutaneous tissues overlying the right brachial artery (Figure 3).
A Terumo needle dedicated to radial access was used and a 6F sheath (Terumo interventional system) was pushed easily over an hydrophilic wire and inserted for diagnostic purpose and ad-hoc intervention depending on needs, the intra-arterial nitroglycerine usually used in TRA access to prevent spasm was not administered, and 3000 UI of unfractionned heparin was injected into the sheath sidearm. Judkin’s left and right catheters were successfully advanced into the ascending aorta enabling left main and right coronary engagement and angiography without any difficulties in catheter manipulation during the procedure.
Severe CAD was diagnosed with left main disease, mid LAD stenosis , severe obtuse marginal stenosis and a severe calcified lesion of the RCA ostium. CABG was proposed in order to perform complete revascularisation. After the procedure, the sheath was removed and hemostasis was done by digital compression for 15 min. The puncture site was bandaged and a hard support has been placed under the arm to limit movements of the elbow, with very close monitoring during the first 6 hours.
Discussion
Trans radial arterial approach (TRA) coronary angiogram reduces vascular complications compared with trans femoral approach (TFA). However, the mechanism and predictors of TRA failure access have not been well characterized (Congenital radial artery atrophy/hypoplasia, tortuous configurations, radioulnar loop and abnormal origin of the radial artery; damage to the radial artery and loss of pulse). Many interventional cardiologists considered that switching to the TBA is outdated and risky access. It has been demonstrated significantly higher rate of vascular and neurological complications than other access in previous studies [1]. Nevertheless, with additional care by using smaller sized catheters, an adequate anticoagulation regimen proper methods for achievement of haemostasis as well as a close and careful observation afterward, Newcomers are trying to overcome this mindset and make the TBA approach possible when the TRA fails [2].
Sabbah et al [3] studied 4955 cases undergoing coronary revascularization. Respectively, 22 %, 57 % and 21 % cases were divided into TBA, TRA, and TFA groups. Results showed that forearm artery access in TBA and TRA groups was associated with higher procedural success compared with TFA group . Compared with TRA group, TFA group had higher rate of MACE and inhospital cardiac death, and also higher incidence of major access site hematoma. TBA and TFA groups had higher rate of access site pseudoaneurysm. Gan et al [1] studied 5110 cases undergoing coronary procedures. Of these, 180 and 121 cases were enrolled to TBA and TFA groups, respectively.
Results showed TBA group had a slighter lower incidence of major complications compared with TFA group without significant difference even in minor complications. There was no incidence of brachial artery thrombosis and no puncture-related neurological dysfunction in TBA group.
Conclusion
Our case alongside cited studies above provides evidence that the brachial approach has to be considered as an efficient alternative to the femoral approach for coronary angiogram and interventional procedures when radial access is unsuccessful.
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Pancreatic Cancer: Overview of Recommendations from the 2018 National Institute of Clinical Excellence (NICE) Guidelines on Providing pain relief to Patients with Endoscopic Therapies
Authored by AI Koulouris*
Stereotactic Body Radiation Therapy (SBRT) also known as stereotactic ablative Radiotherapy (SABR) is a newer modality of delivering radiation therapy for many primary and secondary tumors, with good results. Multiple beams are focused to deliver high dose to single target so that tumour receive very high dose and normal tissue receive very limited dose.
Read More...Full Text For More Articles in Advances in Cancer Research & Clinical Imaging please click on https://www.irispublishers.com/acrci/ For More Open Access Journals in Iris Publishers please click on https://irispublishers.com/journals.php
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ISSN 2689-4246 (Online) | Current trends in clinical & medical sciences
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Iris Publishers | Publons
The main aim of Iris Publishers is to exploit the scientific information throughout the globe with easily accessible data in most convenient electronic formats. As an Open access publisher we offer a great podium for every researcher to share their knowledge with a wider audience of the scientific community. Here we are providing our services in diversified academic disciplines with a mission to publish innovative research in the fields of science, medicine and technology.
Read More.....Please click on https://publons.com/publisher/6970/iris-publishers
#IrisPublsihers#Iris Publishers#irispublishers Reviews#irispublishers blogspot#irispublishers publons
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IRIS Publishers (@IrisPublishers) | Twitter
To accelerate the growth of scientific learning through research gathered from all over the world. We want to be the catalysts for new discoveries in medicine, neurosurgery and other fields of science that will help cure diseases and find new ways of sustainable living.
Read More, Please click on Iris Publishers
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iris publishers | Universidad Nacional Autónoma de México ..
To accelerate the growth of scientific learning through research gathered from all over the world. We want to be the catalysts for new discoveries in medicine, neurosurgery and other fields of science that will help cure diseases and find new ways of sustainable living.
Read More…https://unam.academia.edu/irispublishers
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Report the Effective of Integrated Palliative Care using for Advanced Cancer as Second-Line or Later Treatment by Herbal Extractive Medicine-Iris Publishers
Authored by Pu Rong*
Background: The on-going treatments of unresectable pancreatic, hepatocellular and late-stage lung cancer (PC\HCC\LC) are less effectiveness as second-line or later treatment. However, the palliaitve care is alternative option. Here, we reported the patients who received palliative care by herbal extractive medicines (CHM).
Methods: 13 pancreatic, 31 hepatocellular and 168 lung cancer patients were enrolled. CHM (Senghuang, SH; Xianhe Baijiang, XB), which approved by the China Food and Drug Administration (CFDA), hyperthermia and arginine were initiated. Survival time, quality of life (QOL) and toxicity were evaluated.
Result: The average ECOG score improved and no severe hematology and digestion side-effects were observed. In PC group, the median and the average survival time were 5.1 and 6.5 months; The 3-, 6-, and 10-month survival rates were 92.3%, 46.2%, and 30.8%, respectively. The longest survival time was 16.7 months and patient still alive. In HCC group, the average and median survival time were 12.48 and 5.03 months; The 3-, 6-, and 12-month survival time rates were 77.42%, 38.71%, and 29.03%, respectively. The longest survival time was 84.2 months. In LC group, the 6 months, 1-, 2- and 5-year survival time rates were 33.93%, 19.05%, 14.29% and 4.17%, respectively. Meanwhile, in lung cancer group, once the survival time was over 6 months, the average and median survival time were 29.98 and 14.80 months; and the 1-, 2- and 5-year survival time rates were up to 56.14%, 42.11% and 12.28%, respectively.
Conclusion: CHM can be considered as complementary and alternative medicine that provide moderate effective and low toxicity for advanced cancer.
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For More Articles in Advances in Cancer Research & Clinical Imaging please click on https://www.irispublishers.com/acrci/
For More Open Access Journals in Iris Publishers please click on https://irispublishers.com/journals.php
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Nanoparticulate Carriers of Anticancer Drugs and Therapeutics-Iris Publsihers
Authored by Ignác Capek*
Nanoscale drug delivery platforms have been developed over the past four decades that have shown promising clinical results in several types of cancer and inflammatory disorders. Nanoparticles have special characteristics of high surface to volume ratio, size controllability, and can be easily functionalized during synthesis [1]. Biodegradable polymer nanoparticles have been used as carriers for drugs, peptides, proteins, vaccines, and nucleotides [2]. Nanoparticles (NPs) can protect drug moieties from degradation and provide sustained drug release. NPs are sometimes effective in facilitating intracellular delivery of bioactive materials. Polylactideco- glycolic acid (PLGA) NPs have been used for various applications in vaccination, cancer therapy, and the treatment of cerebral disorders.
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For More Articles in Advances in Cancer Research & Clinical Imaging please click on https://www.irispublishers.com/acrci/
For More Open Access Journals in Iris Publishers please click on https://irispublishers.com/journals.php
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ISSN 2641-6379 (Online) | World journal of agriculture and soil science
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ISSN 2644-2957 (Online) | Online journal of complementary & alternative medicine
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ISSN 2689-4246 (Online) | Current trends in clinical & medical sciences
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Iris Publishers | Scilit
Welcome to IRIS Publishers. Here you can read from our vast archive of scientific knowledge that we’ve collected from all over the world.
We are keen on building a community where new and updated information can be shared between scholars, doctors, medical researchers and professors, while aiding the growth of learners and building new possibilities and opportunities for the prosperity of science.
What’s more? All content published here is open access, which means you have the power of scientific wisdom at your disposal 24/7, anytime and from anywhere for free!
Our curated content is original and rigorously peer-reviewed, so be assured of the premium quality information, checked and approved by highly acclaimed academic editors and subject matter experts.
Excited? Here’s how you can contribute;
For those of you, who like to explore, we invite you to share your thoughts with the world on our platform that reaches a huge international audience. Or you could read our carefully selected and published articles to quench your thirst for scientific enlightenment. Share a text document of your research with us and we’ll review it and post is on the website for the world to know More About : https://www.scilit.net/publisher/11297
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Iris Publishers - Academia.edu | Depression from Sadness to Melancolia - Journal of Neurology & Neuroscience- Iris Publishers
Depression from Sadness to Melancolia - Journal of Neurology & Neuroscience- Iris Publishers
Sometimes we have felt so sad and so disappointed for afew hours or days, situation that leads us to sleep badly, haveawakenings consists before, decreased appetite, easy crying,tiredness, attention deicit, grumpy, even wanting to “swallow theEarth” which is a small thought to “want to die”; These situations are normIn the mood swings we experience throughout the L day or ina few weeks, and that is recovering with the passage of time, thanksto the adjustment in your brain neurotransmitters experience, wehave already commented that they are chemicals in the brain thatallow to carry out the different phases of thought.
This series of symptoms or sensations We come from a series of external stimuli or characteristic experiences that all, absolutelyeveryone must go through once in our lives, as are the heartbreaks,both marital separation and the various breakups of courtship,The loss of A loved one, an economic bankruptcy, A robbery, ajob dismissal, anyway. The big problem lies in The Times, that is to say, when this series of situations are presented to the passageof a month, and that they become incapacitated for their work, fortheir family, for the life in general, this is when it goes from beinga moment of sadness to the moment of using the word sounding Depression.
And it is that depression does not respect age, sex, religion,social position or other variant of the human being; It has different presentations because in children we can see it with attention deicit, irritability, unsocial personality or avoids meetings, orkicker or let them hit in school; In adolescents with dificulties sleeping, either with lack or excess, sadness, easy crying, loss of daily habits; Or in elderly people with severe forgetfulness thatsimulates Alzheimer’s disease
Read More About This Article :
https://www.academia.edu/38512713/Depression_from_Sadness_to_Melancolia_-_Journal_of_Neurology_and_Neuroscience-_Iris_Publishers
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ISSN 2641-6379 (Online) | World journal of agriculture and soil science
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