Transseptal Coronary Angioplasty in Patients with Severe Peripheral Vascular Disease

How to perform a percutaneous coronary intervention, when no conventional arterial access site is available: A case report

“…An ante-grade approach via trans-atrial septum had been tried for PCI, however, it has the limitation of selective coronary cannulation and poor backup support to exchange various balloon catheters. 15…”

“…An ante-grade approach via trans-atrial septum had been tried for PCI, however, it has the limitation of selective coronary cannulation and poor backup support to exchange various balloon catheters. 15 Surgical revascularization for both CAD and type D aortoiliac disease was not feasible in the setting of an acute coronary syndrome when coronary angiography was not performed and there were limitations to placing an internal mammary graft during coronary bypass surgery, 16 as both subclavian arteries were blocked. In conclusion, we hereby describe a case with concomitant CAD and PAD, who had the absence of conventional arterial access sites to perform cardiac catheterization.…”

Therapeutic Heart Catheter through an ECMO Arterial Line: Non-conventional way Made Possible

“…It will be may be less suitable for small children where the French scale size of the angiography catheter is around half of the French scale size of the ECMO cannula, and the flow may be severely restricted [3]. For the group of patients like our case with peripheral vascular insufficiency, the access alternatives are a direct arterial access via ECMO by insertion of a hemostatically valved Y connector near to the femoral arterial cannula [3], which was not available in our institution, an anterograde access through transseptal route [4] and a transcaval access through femoral vein via a crossing system [5], which was performed on over 200 patients in the USA. These alternatives are more useful in elective patients with enough time to plan an angiography, furthermore this was not possible in an emergent case because the lake of necessary equipment and time.…”