Background: Peripherally inserted central catheters (PICC) are intravenous devices inserted through a superficial or deep vein of an upper or lower extremity and advanced to the distal third of the superior vena cava or proximal third of the inferior vena cava. They offer the advantages of greater safety for infusion of vesicant/irritant and hyperosmolar solutions and enable administration of antibiotics, prolonged parenteral nutrition (PPN), and chemotherapy agents. They also involve reduced risk of infection compared to other vascular catheters and are more cost-effective than centrally inserted venous catheters (CICVC). Objectives: To present the results of our team' s experience with US-guided and fluoroscopy-positioned PICC placement at the Hospital and Maternidade São Luiz (HMSL) Itaim, Rede D' or, Brazil. Methods: This was a prospective, non-randomized study, conducted from February 2015 to November 2016. The institution' s preestablished protocol was followed when vascular access was requested. Indications, prevalent diseases, type of catheter implanted, technical success, and complications related to the catheters were analyzed and inclusion and exclusion criteria are described. Results: A total of 256 vascular accesses were requested, and 236 PICCs (92.1%) and 20 CICVCs (7.9%) were implanted. The main indications were as follows: prolonged antibiotic therapy (52%), PPN (19.3%), and difficult venous access (16%). Technical successes was achieved in 246 catheter placements (96.1%). The right basilic vein was the most common vein punctured for access, in 192 patients (75%), followed by the right brachial vein, in 28 patients (10.9%). Conclusions: Ultrasound-guided and fluoroscopy-positioned PICC placement had a low incidence of complications, reduced infection rates, and proved safe and effective in cases of difficult vascular access. PICCs can be considered the devices of choice for central vascular access.
Objectives: To compare the early outcomes between the custom-made four-branched endografts (4bEVARs) and the new off-the-shelf 4bEVAR (t-branch) for the endovascular repair of thoracoabdominal aortic aneurysms (TAAAs).Methods: Between January 2010 and December 2013, 42 consecutive patients with TAAAs underwent endovascular aortic repair with 4bEVARs. Twenty-two patients (group A, 53%) received a custom-made (Crawford classification type I: 2 [9%], type II: 4 [18%], type III: 9 [41%], type IV: 7 [32%]) and 20 patients (group B, 47%) a t-branch device (type II: 8 [40%], type III: 12 [60%]). Main outcome measure was the technical success, defined as successful target revascularization without occlusion of the bridging endografts at the completion angiography. Secondary end points were mortality, reintervention, and paraplegia or paraparesis.Results: Technical success was 100% in both groups. Thirty-day mortality was 9% in group A (n ¼ 2) and 0% in group B (P ¼ .51). Survival rates at 6 months were 77% in group A (mean follow-up, 14 6 12 months) and 95% in group
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.