We aimed to compare duration of uterine artery embolization, radiation exposure, safety and quality of life associated with the procedure in patients undergoing uterine artery embolization using transradial and transfemoral access. METHODSThis randomized controlled trial was conducted from February 2013 to March 2017 in three hospitals. Transradial access was used in 78 patients and transfemoral access in 75 patients. Clinical characteristics of the patients were comparable between the two groups. Patients were evaluated for the success and duration of the procedure, radiation exposure, major and minor complications. Quality of life associated with the procedure was assessed among patients with uterine fibroids. RESULTSEmbolization procedures were successfully performed in all patients in both groups. The duration of uterine artery embolization (32.27±7.99 vs. 39.24±9.72 minutes, p < 0.001), uterine artery catheterization time (12.36±5.73 vs. 19.08±6.06 minutes, p < 0.001) and radiation exposure (0.28±0.14 vs. 0.5±0.21 mZv, p < 0.001) were significantly lower in the transradial access group. The rate of major (0% vs. 2.7%, p = 0.37) and minor (11.53% vs. 17.3%, p = 0.42) complications was comparable between the two groups. Transradial access was associated with a statistically significant improvement in the quality of life associated with the procedure among patients with uterine fibroids. CONCLUSIONTransradial access in uterine artery embolization has the same efficacy and safety compared to transfemoral access. This access reduces radiation exposure and duration of the procedure.
Background Factor VII activating protease (FSAP) is of interest as a marker for vascular inflammation and plaque destabilization. The aim of this study was to analyze the expression profile of FSAP in endarterectomy specimens that were taken from patients with asymptomatic and symptomatic carotid atherosclerotic plaques and to compare them with circulating FSAP levels. Methods and Results Plasma FSAP concentration, activity, and mRNA expression were measured in endarterectomy specimens and in monocytes and platelets. Plaque and plasma FSAP levels were higher in symptomatic patients (n=10) than in asymptomatic patients (n=14). Stronger FSAP immunostaining was observed in advanced symptomatic lesions, in intraplaque hemorrhage‐related structures, and in lipid‐rich areas within the necrotic core. FSAP was also colocalized with monocytes and macrophages (CD11b/CD68‐positive cells) and platelets (CD41‐positive cells) of the plaques. Moreover, human platelets expressed FSAP in vitro, at both the mRNA and protein levels. Expression is stimulated by thrombin receptor‐activating peptide and ADP and reduced by acetylsalicylic acid. Conclusions Plasma FSAP levels were significantly increased in patients with symptomatic carotid stenosis and thus may be involved in plaque development This plaque‐associated FSAP may be produced by platelets or macrophages or may be taken up from the circulation. To establish FSAP’s utility as a circulating or plaque biomarker in patients with symptomatic carotid atherosclerotic plaques, further studies are needed.
Treatment of benign prostatic hyperplasia is an important and challenging problem of modern medicine. One of the most modern methods of the treatment of this disease is prostatic artery embolization. This procedure is most often done through transfemoral approach. Transradial vascular access has many advantages over the transfemoral access. Our study presents a comparative analysis of the use of transradial and transfemoral approach in this type of interventions. Transradial access was used in 13 patients, and transfemoral access - in 12 patients. The success of the procedure was 100% in both groups. The total duration of the procedure, the time needed for catheterization of internal iliac and prostatic arteries and the radiation exposure were significantly lower in the transradial approach group. There were no significant differences in the incidence of complications between two groups. The use of the transradial access was associated with a significant reduction of the frequency and severity of the discomfort associated with the procedure. Transradial approach has numerous advantages over the transfemoral approach and may have great clinical significance.
BACKGROUND: Pancreatic cancer is one of the most aggressive malignant neoplasms, and the results of treatment of which remain extremely unsatisfactory. One of the methods to increase the effectiveness of surgical treatment of pancreatic cancer is selective oil chemoembolization of the pancreatic arteries. Transfemoral access is typically used as a vascular access during this type of intervention, in which complications from the vascular access are often observed. AIM: This study aimed to analyze the results of the use of transradial and transfemoral approaches for chemoembolization of pancreatic cancer. MATERIALS AND METHODS: We analyzed the results of chemoembolization of pancreatic arteries in 32 patients with pancreatic cancer. Transfemoral access was used in 16 (50%) patients and transradial access in 16 (50%) patients. According to the main clinical and anamnestic data, both groups were comparable. The endpoints of the study were technical success and complication rate of chemoembolization, total duration of the procedure, time needed for catheterization of the target artery, radiation exposure, and degree of discomfort for the patient. RESULTS: Chemoembolization of pancreatic arteries was successfully performed in 100% of patients in both groups. Major vascular complications were observed in three (18.8%) patients in the transfemoral access group and in one (6.3%) in the transradial access group (p=0.6). The total duration of the procedure and the time needed for catheterization of the target artery were 54.546.61 and 51.306.46 min (p=0.17) and 12.7 and 13.25 min (p=0.72), respectively. Radiation exposure was 0.680.10 mSv in the transfemoral access group and 0.650.10 mSv in the transradial access group (р=0.4). Transradial access was associated with a statistically significant reduction in all parameters of procedural discomfort. CONCLUSION: In terms of efficiency and safety of use, the transradial approach is not inferior to the traditional transfemoral approach, and in terms of patient comfort, it can be recommended as a priority for chemoembolization of the pancreatic arteries.
.,5 ель исследования. Провести сравнительный анализ эффективности и без-опасности использования трансрадиального (ТРД) и трансфеморального (ТФД) доступа при эмболизации бронхиальных артерий (ЭБА). Материалы и методы. В исследование вошло 29 пациентов (15 в группу ТРД и 14 в группу ТФД) с массивным или рецидивирующим легочным кровотечением. Ос-новные клинические характеристики пациентов были сопоставимы в обеих группах. Проводилась оценка успеха процедуры, частоты развития осложнений, общей продол-жительности ЭБА, лучевой нагрузки, дискомфорта, связанного с процедурой.Результаты. Успех процедуры составил 100% в обеих группах. Общая продол-жительность процедуры, лучевая нагрузка, частота больших и малых осложнений были сопоставимы между исследуемыми группами. Использование ТРД сопровождалось до-стоверным снижением частоты развития и выраженности дискомфорта, связанного с ЭБА.Выводы. ТРД при проведении ЭБА не уступает в эффективности и безопасно-сти ТФД. Длительность процедуры и лучевая нагрузка сопоставимы при использовании обоих доступов. К преимуществам ТРД относится повышение комфорта пациента по-сле вмешательства.Ключевые слова: легочное кровотечение, эмболизация бронхиальной артерии, трансрадиальный доступ, трансфеморальный доступ.Контактный автор: Хайрутдинов Е.Р.,
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