A new iteration for the single-access large-bore technique during impella supported complex and high-risk coronary intervention: a case report

BACKGROUND Complex and high-risk coronary intervention (CHIP-PCI) and PCI in cardiogenic shock complicating acute coronary syndrome is increasingly performed under mechanical circulatory support—so called protected PCI. Among the available options, Impella CP heart pump (ABIOMED) is percutaneously inserted over the femoral artery and typically requires a second arterial access to perform PCI, which further enhances the risk of vascular and bleeding complications. The single-access technique allows Impella CP placement and PCI performance through the same vascular access. When a 7-french system is desirable, only a long and entirely hydrophilic coated sheath has been previously used, which is not available in Europe. CASE SUMMARY A 85-year-old patient admitted with NSTE-ACS, severely reduced left ventricular function and three-vessel coronary artery disease underwent single access CHIP-PCI under Impella CP support. After a failed attempt to insert a standard 7-french long femoral sheath alongside the Impella catheter, we successfully introduced a 7.5-french sheathless guiding catheter and delivered the planned percutaneous treatment with the benefits conferred by a 7-french—rather than 6 - lumen catheter, without the need for an additional arterial access. DISCUSSION This is, to the best of our knowledge, the first case of CHIP-PCI performed under Impella support utilizing the single-access technique with a 7.5-french sheathless guiding catheter. Beyond advantages of the single-access technique in sparing time and avoiding vascular complications associated with gaining a second arterial access, the lower outer diameter of the sheathless catheter compared with standard 7-french sheaths may allow improved limb perfusion and lower chance of interference with the impella CP catheter.

First experience of laparoscopic kidney cyst resection by a single access method

We describe the first clinical experience of laparoscopic surgery for renal cyst by a single access. Advantages, disadvantages and prospects of this method are analized.

Single access in complex angioplasty using the ventricular support system Impella CP™

The volume of complex coronary interventions has grown in Brazil and worldwide. Since they are performed in patients at increasingly higher risks, new techniques have been developed when interventional cardiologists are faced with uncommon situations, such as no safe arterial access for the procedure. We report a case of a patient with severe peripheral artery disease and occluded right femoral artery, in whom a single access (left femoral artery) was used for positioning the Impella™ and the guidewire for angioplasty.

Comparison of Survival between Single-Access and Conventional Laparoscopic Surgery in Rectal Cancer

Introduction. Innovative laparoscopic surgery for rectal cancer can be classified into 2 types: firstly, new instruments such as robotic surgery and secondly, new technique such as single-access laparoscopic surgery (SALS) and transanal total mesorectal excision (TaTME). Most reports of SALS for rectal cancer have shown pathologic outcomes comparable to those of conventional laparoscopic surgery (CLS); however, SALS is considered to be superior to CLS in terms of lower levels of discomfort and faster recovery rates. This study aimed to compare the survival outcomes of the two approaches. Methods. From 2011 to 2014, 84 cases of adenocarcinoma of the rectum and anal canal were enrolled. The operations were anterior, low anterior, intersphincteric, and abdominoperineal resections. Data collected included postoperative outcomes. The oncological outcomes recorded included 3-year and 5-year survival, local recurrence, and metastasis. Results. SALS was performed on 41 patients, and CLS was utilized in 43 cases. The demographic data of the two groups were similar. Intraoperative volumes of blood loss and conversion rates were similar, but operative time was longer in the SALS group. There were no significant differences in postoperative complications or pathological outcomes. The oncologic results were similar in terms of 3-year survival (100% and 97.7%; p = 1.00), 5-year survival (78.0% and 86.0%; p = 0.401), local recurrence rates (19.5% vs 11.6%, p = 0.376), and metastasis rates (19.5% vs 11.6%; p = 0.376) for SALS and CLS, respectively. Conclusion. SALS and CLS for rectal and anal cancer had comparable pathological and survival results, but SALS showed some superior benefits in the early postoperative period.